Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Effects of counseling for late stage cancer patients A specialized home care intervention improves survival among older post-surgical cancer patients. Stressful life experiences and risk of relapse of breast cancer: observational cohort study Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial.
OBJECTIVES We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier , shortly after their diagnosis and initial surgical treatment . We also explored the role of several factors as possible predictors of outcome . DESIGN This was a r and omized controlled experimental study . The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates ( age , sex , Breslow depth , tumor site , baseline Profile of Mood States Total Mood Disturbance , baseline active-behavioral coping , baseline natural killer cell activity , and treatment [ ie , group intervention ] ) . The stepwise procedure was used for covariate selection . RESULTS For control patients , there was a trend for recurrence ( 13/34 ) and a statistically significant greater rate of death ( 10/34 ) than for experimental patients ( 7/34 and 3/34 , respectively ) . We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival . Analysis of multiple covariates found that only Breslow depth and treatment ( ie , group intervention ) were significant . Adjusting for Breslow depth , treatment effect remained significant . Finally , baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival . Surprisingly , higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death . CONCLUSION Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease . However , the exact nature of this relationship warrants further investigation Much has been written about working with the dying . Few , if any , controlled studies have examined the application of principles set forth . The authors evaluate the effectiveness of working with dying cancer patients by assessing changes in quality of life , physical functioning , and survival .  One‐hundred twenty men with end‐stage cancer were r and omly assigned to experimental or control groups ; the 62 experimental group patients  were seen regularly by a counselor . Patients were assessed before r and om assignment and at one , three , six , nine , and 12 months on quality of life and functional status . Experimental group patients improved significantly more than the control group on quality of life within three months . Functional status and survival did not differ between groups . A sub sample of lung cancer patients provided cross‐validation of findings . Although survival was not expected to differ , it was predicted that functioning would be enhanced if quality of life improved . One interpretation is that little can be done to alter physical function and survival when intervention occurs late in the progression of a fatal disease . This in no way reduces the value of improving overall quality of life , since enhancing the quality of survival for end‐stage cancer patients is a high priority medical goal CONTEXT Changes in the healthcare system have result ed in shortened hospital stays , moving the focus of care from the hospital to the home . Patients are discharged post-operatively with ongoing needs , and whether they receive nursing care post-hospitalization can influence their recovery and survival . Little information is available about the factors that influence outcomes , including the survival of older cancer patients after cancer surgery . OBJECTIVE To compare the length of survival of older post-surgical cancer patients who received a specialized home care intervention provided by advanced practice nurses ( APNs ) with that of patients who received usual follow-up care in an ambulatory setting .  We also assessed potential predictors of survival in terms of depressive symptoms , symptom distress , functional status , comorbidities , length of hospital stay , age of patient , and stage of disease . DESIGN A r and omized controlled intervention study . SETTING Discharged older cancer patients after surgery at a Comprehensive Cancer Center in southeastern Pennsylvania . PATIENTS Three hundred seventy-five patients aged 60 to 92 , newly diagnosed with solid cancers , were treated surgically between February 1993 and December 1995 . One hundred ninety patients were r and omized to the intervention groups and 185 to the usual care group .  INTERVENTION The intervention was a st and ardized protocol that consisted of st and ard assessment and management post-surgical guidelines , doses of instructional content , and schedules of contacts . The intervention lasted 4 weeks and consisted of three home visits and five telephone contacts provided by APNs . Both the patients and their family caregivers received comprehensive clinical assessment s , monitoring , and teaching , including skills training . MAIN OUTCOME MEASURE Time from enrollment of patients into the study until death or last date known alive at the end of November 1996 . RESULTS During the 44-month follow-up period , 93 ( 24.8 % ) of 375 patients died . Forty-one ( 22 % ) of those who died were patients in the specialized home care intervention group , compared with 52 ( 28 % ) in the usual care group . Stage of disease at diagnosis differed between the two groups at baseline ( 38 % late stage patients in the intervention group compared with 26 % in the control group , P = .01 ) , so stratified analysis was performed . Overall , the specialized home care intervention group was found to have increased survival ( P = .002 using stratified log-rank test ) . Among early stage patients only , there was no difference in survival between the intervention and control groups . Among late stage patients , there was improved survival in the intervention group . For example , 2-year survival among late stage intervention group cases was 67 % compared with 40 % among control cases . When Cox 's proportional hazard model was used to adjust for significant baseline covariates , the relative hazard of death in the usual care group was 2.04 ( CI : 1.33 to 3.12 ; P = .001 ) after adjusting for stage of disease and surgical hospitalization length of stay . CONCLUSIONS This is the first empirical study of post-surgical cancer patients to link a specialized home care intervention by advanced practice nurses with improved survival . Additional research is needed to test home care interventions aim ed at maintaining quality of life outcomes and their effects on survival of post-surgical cancer patients Abstract Objective : To confirm , using an observational cohort design , the relation between severely stressful life experiences and relapse of breast cancer found in a previous case-control study . Design : Prospect i ve follow up for five years of a cohort of women newly diagnosed as having breast cancer , collecting data on stressful life experiences , depression , and biological prognostic factors . Setting : NHS breast clinic , London ; 1991 - 9 . Participants : A consecutive series of women aged under 60 newly diagnosed as having a primary operable breast tumour . 202/222 ( 91 % ) eligible women participated in the first life experiences interview .  170 ( 77 % ) provided complete interview data either up to 5 years after diagnosis or to recurrence . Main outcome measure : Recurrence of disease . Results : We controlled for biological prognostic factors ( lymph node infiltration and tumour histology ) , and found no increased risk of recurrence in women who had had one or more severely stressful life experiences in the year before diagnosis compared with women who did not ( hazard ratio 1.01 , 95 % confidence interval 0.58 to 1.74 , P=0.99 ) . Women who had had one or more severely stressful life experiences in the 5 years after diagnosis had a lower risk of recurrence ( 0.52 , 0.29 to 0.95 , P=0.03 ) than those who did not . Conclusion : These data do not confirm an earlier finding from a case-control study that severely stressful life experiences increase the risk of recurrence of breast cancer . Differences in case control and prospect i ve methods may explain the contradictory results . We took the prospect i ve study as the more robust , and the results suggest that women with breast cancer need not fear that stressful experiences will precipitate the return of their disease BACKGROUND / AIMS The impact of psychotherapeutic support on survival time in patients with gastrointestinal cancer undergoing surgery was studied . METHODOLOGY A r and omized controlled trial was conducted in cooperation with the Departments of General Surgery and Medical Psychology , University Hospital of Hamburg , Germany . Two hundred and seventy-one consenting patients with a preliminary diagnosis of cancer of the esophagus , stomach , liver/gallbladder , pancreas or colon/rectum were stratified by gender and r and omly assigned to a control group that received st and ard care , as provided on the surgical wards , or to an experimental group that received formal psychotherapeutic support in addition to routine care during the hospital stay . Patients in both groups completed the EORTC- Quality of Life question naire pre-operatively , post-operatively , and at 3 , 6 , 12 , and 24 months following surgery . Date of death , if applicable , was also recorded . Unadjusted and adjusted survival analyses were performed . RESULTS Kaplan-Meier survival curves demonstrated better survival for the experimental group than for the control group . The unadjusted significance level for group differences was p = 0.002 for survival up to 2 years . Cox regression models that took TNM Staging or the Residual Tumor Classification into account also found significant differences at the 2-year follow-up . Secondary analyses found that most of the differences in favor of the experimental group occurred in females and in patients with stomach , pancreatic , primary liver or colorectal cancer . CONCLUSIONS The results of this study indicate that patients with gastrointestinal cancer , particularly those who are female and those who undergo surgery for stomach , pancreatic , primary liver or colorectal cancer , benefit from a formal program of psychotherapeutic support in terms of survival
Background : There is growing evidence that positive psychosocial intervention improves the wellbeing of cancer patients .
Two meta-analyses conducted to date confirmed a significant small-to-moderate effect on quality of life .
Previous randomized trials reported that psychosocial intervention also improved survival .
However , more recent trials failed to detect a difference in survival .
A systematic review of r and omized trials that have examined the effectiveness of psychosocial intervention in cancer patients in terms of survival prolongation was conducted .