Supportive care provided by physicians and nurses to women with breast cancer Effects of two types of social support and education on adaptation to early-stage breast cancer. Treatment of depression in cancer patients The effect of counselling on physical disability and social recovery after mastectomy. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness Effects of a nursing intervention on subjective distress, side effects and quality of life of breast cancer patients receiving curative radiation therapy--a randomized study. A problem‐solving approach to stress reduction among younger women with breast carcinoma Nurse-led follow-up on demand or by a physician after breast cancer surgery: a randomised study. Education and peer discussion group interventions and adjustment to breast cancer. The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy. The efficacy of a mind-body-spirit group for women with breast cancer: a randomized controlled trial. The effect of education in managing side effects in women receiving chemotherapy for treatment of breast cancer. Effect of nurse case management on the treatment of older women with breast cancer. An evidence-based specialist breast nurse role in practice: a multicentre implementation study. Short-term effects of telephone therapy for breast cancer patients. Development of an intervention to restore attention in cancer patients Effect of counselling on the psychiatric morbidity associated with mastectomy. Effects of dialogue and therapeutic touch on preoperative and postoperative experiences of breast cancer surgery: an exploratory study. Recruitment and Retention of Families in Clinical Trials with Longitudinal Designs An Intervention to Increase Quality of Life and Self-Care Self-Efficacy and Decrease Symptoms in Breast Cancer Patients Telephone therapy for patients with breast cancer. Efficacy of an in-home nursing intervention following short-stay breast cancer surgery. Coping with radiation therapy: effects of a nursing intervention on coping ability for women with breast cancer. Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Information needs of elderly postsurgical cancer patients during the transition from hospital to home. Psychological support for patients undergoing breast cancer surgery: a randomised study Patient initiated follow up of breast cancer. Specialist nurse counsellor interventions at the time of diagnosis of breast cancer: comparing 'advocacy' with a conventional approach. The Impact of Event Scale: validation of an Italian version. Computerized information and support for patients with breast cancer or HIV infection. Satisfaction, utilisation and perceived benefit of individual psychosocial support for breast cancer patients--a randomised study of nurse versus psychologist interventions.
Abstract . Breast cancer patients ' utilisation of supportive care has been understudied . In this paper , results from a population -based survey are used to assess the role of physicians and nurses in providing supportive care to women . Participants for this study were women with histologically confirmed invasive breast cancer diagnosed 23–36 months prior to contact about the study , who were r and omly selected from the Ontario Cancer Registry . Patients for whom a physician approved contact were sent a survey question naire . There were two follow-up mailings . The survey included items related to patients ' perceptions of supportive care involvement of oncologists , surgeons , family physicians and nurses .  Among 1,119 eligible patients , 65 % returned completed question naires . A total of 72 % of these women reported having talked with an oncologist about one or more supportive care issues ; 78 % with a surgeon ; 73 % with a family physician ; and 45 % with a nurse . Factors linked to seeking supportive care from physicians and /or nurses included : younger age , working status , higher education , additional health insurance beyond that provided by government , higher household income , and receiving chemotherapy . Results indicate that physicians and nurses were providing important supportive care to most women with breast cancer . In a health care context where specialised supportive care services ( e.g. help from dietitians , psychologists , social workers ) are often unavailable or difficult to access , supportive care remains largely a responsibility of medical and nursing professionals . Even brief interventions may make an important difference to how patients deal with their illness over time A Roy adaptation model-based support and education intervention for women with early-stage breast cancer was tested in a three-group , three-phase r and omized clinical trial of a sample of 125 women . The experimental group received 13 months of combined individual telephone and in-person group support and education , Control Group 1 received 13 months of telephone-only individual support and education , and Control Group 2 received one-time mailed educational information . The experimental group and Control Group 1 reported less mood disturbance at the end of all three phases , less loneliness at the end of Phases II and III , and a higher- quality relationship with a significant other at the end of Phase II than did Control Group 2 . No group differences were found for cancer-related worry or well-being . The findings suggest that individual telephone support may provide an effective alternative to in-person support groups . Further study of telephone interventions is recommended using ethnically and economically heterogeneous sample One hundred and fifty‐two women undergoing mastectomy were r and omly assigned to routine care or routine care plus monitoring by a specialist nurse . The nurse detected and referred 76 % of her patients for psychiatric help . Only 15 % of the routine care subjects that warranted help were referred . Twelve to eighteen months after surgery , morbid anxiety and depression were less common in the monitored ( 5 % and 5 % ) than in the control ( 30 % and 50 % ) group . This difference appeared to be due primarily to psychiatric treatment which included antidepressant medication , anxiolytic drugs , and supportive psychotherapy . Few affective disorders remitted without such treatment . In a further study , the effects of  antidepressant medication plus cognitive therapy and cognitive therapy  alone were compared . Both treatments alleviated depression in the short term but the improvement was sustained in the long term only in those given combined treatment A controlled trial was conducted to determine if a specialist nurse improved the physical and social recovery of patients after mastectomy and helped them adapt to the breast loss . Seventy five patients were counselled by the nurse who also monitored their progress after discharge while 77 patients received the care normally given by the surgical unit . Twelve to eighteen months after surgery those helped by the nurse showed a greater social recovery , return to work , adaptation to breast loss and satisfaction with their breast prostheses . Eleven percent remained distressed by the mastectomy but most responded well to breast reconstruction . The nurse had little impact on physical disability . The morbidity found in the control group highlights the need to find ways of reducing it . While the appointment of a specialist nurse can achieve this the morbidity would probably also be much reduced if the breast was conserved when possible , reliable staging methods other than axillary clearance were developed and the adverse effects of cytotoxic drugs and radiotherapy were reduced PURPOSE S/ OBJECTIVES To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidence d by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate . DESIGN Experimental , two-group pretest , post-test . SETTING Two university teaching hospital outpatient radiation therapy departments . SAMPLE 46 women beginning a six-week program of radiation therapy for early stage breast cancer . METHODS Following r and om assignment , subjects in the exercise group maintained an individualized , self-paced , home-based walking exercise program throughout treatment . The control group received usual care . Dependent variables were measured prior to and at the end of radiation therapy . In addition , symptoms were assessed at the end of three weeks of treatment . MAIN RESEARCH VARIABLES Participation in the walking exercise program , physical functioning fatigue , emotional distress , and difficulty sleeping . FINDINGS Hypothesis testing by multivariate analysis of covariance , with pretest scores as covariates , indicated significant differences between groups on outcome measures ( p < 0.001 ) . The exercise group scored significantly higher than the usual care group on physical functioning ( p = 0.003 ) and symptom intensity , particularly fatigue , anxiety , and difficulty sleeping . Fatigue was the most frequent and intense subjective symptom reported . CONCLUSIONS A self-paced , home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy . IMPLICATION S FOR NURSING PRACTICE Nurse-prescribed and -monitored exercise is an effective , convenient , and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment National guidance and clinical guidelines recommended multidisciplinary teams ( MDTs ) for cancer services in order to bring specialists in relevant disciplines together , ensure clinical decisions are fully informed , and to coordinate care effectively . However , the effectiveness of cancer teams was not previously evaluated systematic ally . A r and om sample of 72 breast cancer teams in Engl and was studied ( 548 members in six core disciplines ) , stratified by region and caseload . Information about team constitution , processes , effectiveness , clinical performance , and members ' mental well-being was gathered using appropriate instruments . Two input variables , team workload ( P=0.009 ) and the proportion of breast care nurses ( P=0.003 ) , positively predicted overall clinical performance in multivariate analysis using a two-stage regression model . There were significant correlations between individual team inputs , team composition variables , and clinical performance . Some disciplines consistently perceived their team 's effectiveness differently from the mean . Teams with shared leadership of their clinical decision-making were most effective . The mental well-being of team members appeared significantly better than in previous studies of cancer clinicians , the NHS , and the general population . This study established that team composition , working methods , and workloads are related to measures of effectiveness , including the quality of clinical care The purpose of this r and omized study was to investigate whether a nursing intervention using Orem 's self-care theory as a framework would affect subjective distress , side effects and quality of life as perceived by breast cancer patients receiving curative radiation therapy .  The intervention consisted of five 30-min sessions once a week during the treatment period and two follow-up sessions after completion of treatment . The experimental group consisted of 67 patients , as did the control group .  Measurements were collected five times : at baseline before commencement of treatment , at weeks 3 and 5 ( completion of treatment ) and follow-up periods of 2 weeks and 3 months . No measurable effect of the nursing intervention was found for side effects or quality of life but nursing intervention proved to have a positive effect in minimizing stress reactions ( p = < 0.05 ) . It is suggested that a nursing intervention should be implemented for breast cancer patients receiving curative radiation therapy Previous research indicates that younger women ( i.e. , ≤ 50 ) with breast carcinoma experience greater emotional distress than older women ( i.e. , > 50 ) and that coping style is significantly related to the psychosocial adjustment of women with this disease . The purpose of this study was to evaluate through a r and omized controlled trial the effectiveness of a problem‐solving training intervention design ed to empower women with breast carcinoma to cope with a range of difficulties when diagnosed in mid‐life The value of routine follow-up with frequent visits to a breast cancer specialist-both in terms of detection of recurrence and patient satisfaction-has been question ed . The aim of this study was to compare nurse-led follow-up on dem and versus physician follow-up after breast cancer treatment with regards to patients ' well-being , satisfaction , access to medical care and medical safety .  Two hundred and sixty-four consecutively selected women with newly diagnosed breast cancer , classified as UICC stage I or stage II , were r and omised to follow-up at two hospitals in Sweden , either by routine medical follow-up , the physician group ( PG , n=131 ) , or on dem and by a specialist nurse , the nurse group ( NG , n=133 ) . Measures were done at baseline and twice a year over a period of 5 years by means of a question naire containing the Hospital Anxiety and Depression Scale ( HAD ) , and the Satisfaction and Accessibility ( SaaC ) scale . Number of contacts with the health care services , number of diagnostic procedures , and time to recurrence or death were monitored . The ratings of HAD and SaaC did not show any statistically significant differences between the groups . The levels of anxiety and depression were generally low and levels of patient satisfaction high . There were no differences between the groups concerning time to recurrence or death . This study indicates that women with breast cancer in stages I to II can be followed up by a specialist nurse with high patient satisfaction and good medical safety BACKGROUND We report a clinical trial comparing the effectiveness of education-based and peer discussion -based group interventions on adjustment to breast cancer . METHODS Women with stage I , II , or III breast cancer ( n = 312 ) were r and omly assigned to 1 of 4 group conditions : control , education , peer discussion , or education plus peer discussion ( combination ) . Seven groups ( each comprising 8 - 12 women ) were conducted in each of the 4 conditions ( 28 groups total ) . Adjustment was measured before the intervention , immediately after the intervention , and 6 months after the intervention . RESULTS Consistently positive effects on adjustment were seen in the education groups both immediately following and 6 months after the intervention . There were no benefits of participation in peer discussion groups , and some indications of adverse effects on adjustment at both follow-up examinations . The effects could be explained by changes in self-esteem , body image , and intrusive thoughts about the illness . CONCLUSIONS Education-based group interventions facilitated the initial adjustment of women diagnosed with early stage breast cancer . There was no evidence of benefits from peer discussion group interventions PURPOSE / OBJECTIVES To measure the effectiveness of customized guided imagery for increasing comfort in women with early stage breast cancer . DESIGN Experimental longitudinal , r and om assignment to groups . SETTING Two urban radiation oncology departments . SAMPLE 53 women ( 26 in the experimental group , 27 in the control group ) aged 37 - 81 ; 80 % European and 10 % African American with stage I or II breast cancer about to begin radiation therapy . METHODS The experimental group was to listen to a guided imagery audiotape once a day for the duration of the study . The  Radiation Therapy Comfort Question naire was self-administered at three time points : prior to the introduction of intervention and the beginning of radiation therapy ( Time 1 ) , three weeks later ( Time 2 ) , and three weeks after completing radiation therapy ( Time 3 ) . The  State Anxiety Inventory  was administered at Time 1 only . MAIN RESEARCH VARIABLES The effect of use of guided imagery on comfort with anxiety as a control variable . FINDINGS Pooled data indicated a significant overall increase in differences in comfort between the treatment and control group , with the treatment group having higher comfort over time . The data also revealed a significant linear trend in differences between groups . No significant interaction of group and time existed . CONCLUSIONS Guided imagery is an effective intervention for enhancing comfort of women undergoing radiation therapy for early stage breast cancer . The intervention was especially salient in the first three weeks of therapy . IMPLICATION S FOR NURSING PRACTICE Guided imagery audiotapes specifically design ed for this population were re source effective in terms of cost , personnel , and time Increasing numbers of women with breast cancer are seeking alternatives to st and ard group support in coping with their illness . This study examines outcomes for 181 women with breast cancer r and omized to either a 12-week st and ard group support or a 12-week complementary and alternative medicine ( CAM ) support intervention .  Participants in the CAM group were taught the use of meditation , affirmation , imagery and ritual . The st and ard group combined cognitive-behavioral approaches with group sharing and support . Both interventions were found to be associated with improved quality of life ( CAM , P=0.008 ; St and ard , P=0.006 ) , decreased depression ( CAM , P=0.004 ; St and ard , P=0.02 ) , decreased anxiety ( CAM , P=0.0003 ; St and ard , P=0.02 ) and increased " spiritual well-being " ( CAM , P=002 ; St and ard , P=0.003 ) . Only the CAM group showed increases in measures of Spiritual Integration ( P=0.001 ) which were also significant between groups ( P=0.003 ) . The St and ard group was associated with decreased confusion ( P=0.01 ) and decreased helplessness/hopelessness ( P=0.01 ) , while the CAM group was associated with decreased avoidance ( P=0.01 ) . None of these latter changes were significant between groups . At baseline , very high correlations were noted between measures of quality of life , mood , and spiritual integration . At the end of the intervention , the CAM group showed higher satisfaction ( P=0.006 ) and fewer dropouts ( P=0.006 ) compared to the st and ard group . Better outcomes in quality of life in the CAM group were associated with lower initial fighting spirit ( r=-.39 , P=0.001 ) . No baseline factors predicted better outcomes in the St and ard group . In summary , the study found equivalence on most psychosocial outcomes between the two interventions PURPOSE / OBJECTIVES To determine the effectiveness of informational audiotapes on self-care behaviors , state anxiety , and use of self-care behaviors ; to describe the occurrence and intensity of common side effects in patients with breast cancer . DESIGN R and omized clinical trial . SETTING Outpatient chemotherapy clinics operated by a university center in a rural area . SAMPLE 70 women receiving their first treatment of chemotherapy .  METHODS Subjects completed demographic data and the Spielberger State-Trait Anxiety instrument ( stai ) . The experimental group received two audiotapes . At one and three months , subjects completed the modified nail self-care diary  and  stai via telephone . MAIN RESEARCH VARIABLES State anxiety , side-effect severity , and use and efficacy of self-care behaviors . FINDINGS The most frequent side effects were fatigue , nausea and vomiting , and taste change . The experimental group reported symptom improvements that were not found in the control group . The experimental group increased the use of recommended self-care behaviors , whereas the control group continued to use the same self-care behaviors without effectiveness . State anxiety for both groups diminished over time ; however , anxiety in the control group was consistently higher . CONCLUSIONS Audiotapes are effective teaching tools . Self-care behaviors can be taught and can be effective in managing side effects . Anxiety was high in both groups , but the symptom decreased in the women who received audiotapes and telephone calls . IMPLICATION S FOR NURSING Constraints on nurses decrease the length of teaching time available , but audiotapes provide effective teaching and reinforcement of education . Anxiety in clinical environments interferes with patient learning . Teaching effective self-care behaviors enhances patients ' independence , comfort , control , and quality of life OBJECTIVES To evaluate the effect of nurse case management on the treatment of older women with breast cancer . DESIGN R and omized prospect i ve trial . SETTING Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas . PARTICIPANTS Three hundred thirty-five women ( 166 control and 169 intervention ) aged 65 and older newly diagnosed with breast cancer . INTERVENTION Women seeing surgeons r and omized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer . MEASUREMENTS The primary outcome was the type and use of cancer-specific therapies received in the first 6 months after diagnosis . Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis . RESULTS More women in the intervention group received  breast-conserving surgery  ( 28.6 % vs 18.7 % ; P=.031 ) and  radiation therapy  ( 36.0 % vs 19.0 % ; P=.003 ) . Of women undergoing breast-conserving surgery , greater percentages in the case management group received  adjuvant radiation  ( 78.3 % vs 44.8 % ; P=.001 ) and axillary dissection ( 71.4 % vs 44.8 % ; P=.057 ) . Women in the case management group were also more likely to receive more breast reconstruction surgery ( 9.3 % vs 2.6 % , P=.054 ) , and women in the case management group with advanced cancer were more likely to receive chemotherapy ( 72.7 % vs 30.0 % , P=.057 ) . Two months after surgery , higher percentages of women in the case manager group had normal arm function ( 93 % vs 84 % ; P=.037 ) and were more likely to state that they had a real choice in their treatment ( 82.2 % vs 69.9 % , P=.020 ) . Women with indicators of poor social support were more likely to benefit from nurse case management .  CONCLUSION Nurse case management results in more appropriate management of older women with breast cancer The objective of this study was to examine the feasibility , implementation , acceptability and impact of an evidence -based specialist breast care nurse ( SBN ) model of care in Australia . Primary data were collected from four diverse Australian breast cancer treatment centres over a 12-month period . The design was a multicentre demonstration project . Information about the provision of care and patient needs was collected through prospect i ve logs . Structured interviews were conducted with women who received the SBN intervention ( N = 167 ) and with a  control group of women treated prior to the intervention period ( N = 133 ) . Health professionals ( N = 47 ) were interviewed about their experience of the SBN . Almost all women had contact with an SBN at five scheduled consultations and 67 % of women in the intervention group requested at least one additional consultation with the SBN . Women in the intervention group were more likely to receive hospital fact sheets and to be told about and participate in clinical trials . Ninety-eight per cent of women reported that the availability of an SBN  would affect their choice of hospital , with 48 % indicating that they would recommend only a hospital with a SBN available . Health professionals reported that SBNs improved continuity of care , information and support for the women , and result ed in more appropriate referrals and use of the time of other members of the team . In conclusion , the SBN model is feasible and acceptable within diverse Australian treatment centres ; there is evidence that some aspects of care were improved by the SBN The authors report the short-term effects of a clinical trial testing 2 telephone therapies for breast cancer patients . Women ( N = 222 ) with breast cancer were recruited and r and omly assigned to cancer education , emotional expression , or st and ard care . Oncology nurses conducted 6 individual 30-min-therapy phone sessions . Women in the cancer education condition reported greater perceived control than women in the st and ard care condition . No treatment effects were obtained for mood or quality of life . These are the 1st data from a large-scale study testing telephone therapy , and they suggest that such therapies may be ineffective . Explanations for the results include therapy type and delivery , participant characteristics , short- versus long-term results , therapy conent , and whether therapy is necessary for breast cancer patients Developing interventions to maintain or restore attentional capacity during dem and ing phases of illness will help promote effective functioning in people with cancer . This study tested the effects of an experimental intervention aim ed at maintaining or restoring attentional capacity in 32 women during the 3 months after surgery for localized ( Stage I or II ) breast cancer . The intervention was design ed to minimize or prevent attentional fatigue through regular participation in activities that engage fascination and have other restorative properties . Attentional capacity was assessed using objective and subjective measures at four time points , ∼3 , 18 , 60 , and 90 days after breast cancer surgery . After the first observation , subjects were r and omly assigned to receive the intervention ( n = 16 ) or not to receive intervention ( n = 16 ) . Repeated measures ANOVA showed a significant interaction of experimental intervention and time on attentional capacity . Specifically , subjects in the intervention group showed significant improvement in attentional capacity over the four time points , while the nonintervention group showed a pattern of inconsistent performance over time . Findings suggest that nurses can intervene to maintain or restore attentional capacity in women after surgery for localized breast cancer . The theoretical basis for further development of attention-restoring interventions in patients with cancer is discussed A controlled trial was conducted to determine whether counselling by a specialist nurse prevented the psychiatric morbidity associated with mastectomy and breast cancer . Seventy-five patients were counselled by the nurse and monitored during follow-up , while 77 patients received only the care normally given by the surgical unit . Counselling failed to prevent morbidity , but the nurse 's regular monitoring of the women 's progress led her to recognise and refer 76 % of those who needed psychiatric help . Only 15 % of the control group whose condition warranted help were recognised and referred . Consequently , 12 to 18 months after mastectomy there was much less psychiatric morbidity in the counselled group ( 12 % ) than in the control group ( 39 % ) . These findings highlight the high degree of psychiatric morbidity in patients who have undergone mastectomy and indicate the need to find ways of reducing this morbidity PURPOSE / OBJECTIVES To obtain preliminary data and determine the feasibility of a large-scale experimental study to test the efficacy of the Rogerian Science of Unitary Human Beings-based intervention of dialogue and therapeutic touch ( TT ) on pre- and postoperative anxiety and mood and postoperative pain from breast cancer surgery . DESIGN Experimental . SETTING Mid-Atlantic region ; ambulatory . SAMPLE 29 Caucasian and 2 African American English-speaking women with positive breast cancer biopsy ( experimental , n = 14 ; control , n = 17 ) , ranging in age from 31 - 84 years old ( F = 55.6 ) . METHODS Treatments administered in subjects ' homes within seven days prior to surgery and 24 hours after hospital discharge . Experimental treatment consisted of 10 minutes of TT and 20 minutes of dialogue . Control treatment consisted of 10 minutes of quiet time and 20 minutes of dialogue . Data ( Spielberger State-Trait Anxiety Inventory . Affects Balance Scale , and Visual Analog Scale-Pain ) were collected at the conclusion of each home visit . MAIN RESEARCH VARIABLES Anxiety , mood , and pain . FINDINGS The experimental group had lower preoperative state anxiety than the control groups ( p = 0.008 ) . No difference was found for preoperative mood . No differences were found for any postoperative measure . CONCLUSIONS A large-scale study of dialogue and TT would require changes in design and recruitment strategies . IMPLICATION S FOR NURSING PRACTICE Nurses may provide more comprehensive care by incorporating dialogue and TT or quiet time into their pre- and postoperative care . Additional research , however , is recommended to determine the differential effects of dialogue , TT , and quiet time on women 's experiences with breast cancer prior to incorporating these noninvasive modalities into clinical practice The Family Home Visitation Program : Nurse as Coach was a 3-year , National Cancer Institute-funded , multisite , r and omized trial of a nursing intervention . It tested the effectiveness of an in-home coaching intervention design ed to enhance long-term adjustment of breast cancer 's effect on familyfunctioning . We summarize our recruitment and retention experiences , review accrual and retention issues identified from our experiences and those of other research ers , and suggest 24 specific strategies to maximize sample size in future clinical trial studies . Our target sample consisted of 200 women with early stage breast cancer and their male partners and children . We obtained 313 eligible referrals from 91 sites : 217 participants ( 69.3 % ) were accrued , 96families ( 30.7 % ) refused , 181 participants ( 83.4 % ) were retained , 11 ( 5.1 % ) were dropped because of changes in eligibility status or because of scheduling error , and another 25 ( 11.5 % ) elected to withdraw This study tested effects of a nurse-administered self-efficacy intervention given on five monthly occasions and design ed to enhance  patients ’ self-care self-efficacy . The hypotheses were that at four months and eight months after beginning chemotherapy the efficacy-enhancing experimental group would have significantly higher scores on quality of life and self-care self-efficacy than the control group and significantly less symptom distress .  Fifty-six women receiving chemotherapy for breast cancer were r and omized to the experimental and control groups . Outcome variables were quality of life , measured by the Functional Assessment of Cancer Treatment-Breast ( FACT-B ) , symptom distress , measured by the Symptom Distress Scale ( SDS ) , and factors of self-care self-efficacy  , measured by  Strategies Used by Patients to Promote Health ( SUPPH ) . The interaction effects for the FACT-B ranged from small for functional concerns ( eta square = .03 ) to large for social concerns ( eta square = .110 ) ; effects for the SDS were large ( eta square = .140 ) , and for factors on the SUPPH effect sizes ranged from small ( eta square = .01 ) for Enjoying Life and Stress Reduction to medium ( eta square = .089 ) for Coping , and large ( eta square = .141 ) for Making Decisions . Interventions to promote self-efficacy may increase quality of life and decrease symptom distress for women diagnosed with breast cancer PURPOSE / OBJECTIVES To test the value of telephone-administered cognitive-behavioral therapy in a study of patients with breast cancer . DESIGN Women were assigned r and omly to a therapy group or an assessment -only control group . SETTING A tertiary cancer treatment center serving rural areas of North Dakota and Minnesota . SAMPLE Women were recruited within three to four months of stage I ( n = 27 ) or stage II ( n = 26 ) breast cancer diagnosis . Age ranged from 30 - 82 ( mean = 51.5 years ) . Most participants ( n = 35 ) underwent a modified radical mastectomy ; 17 underwent a lumpectomy .  METHODS Therapy involved 10 30-minute ( or less ) telephone sessions . Data that were collected from mailed question naires included psychological distress ( Profile of Mood States ) , perceived stress , coping ( Coping Response Indices-Revised ) , quality of life ( Medical Outcome Scale ) , and satisfaction with therapy . Measures were completed at baseline and at 4- and 10-month follow-up intervals . MAIN RESEARCH VARIABLES Telephone therapy , stress , coping , and quality of life . FINDINGS With time , women in the therapy and control groups reported reduced stress and improved quality of life . However , significant reductions in some kinds of distress ( anxiety , anger , depression , and confusion ) were not observed . Most therapy participants liked the telephone treatment sessions but showed only modest improvement ( less anxiety and confusion ) compared with women in the control group . CONCLUSIONS Most patients reported being comfortable with the telephone therapy and said that they felt better as a result of it . However , the outcome data showed that telephone therapy -- as carried out in this study --produced only modest benefits . Research ers need to consider who is best for delivering such therapy . IMPLICATION S FOR NURSING PRACTICE Providing telephone therapy to patients with breast cancer has potential benefits , and nurses may be the appropriate professionals to administer the therapy This r and omized controlled trial ( n = 240 ) was design ed to test the efficacy of a sub-acute home nursing intervention  following short-stay surgery for breast cancer . Intervention participants received the in-home nursing protocol , whereas non-intervention participants received agency nursing care or no nursing care . Data , collected via question naire , telephone interview , and chart audit , included surgical recovery/self-care knowledge , functional status , anxiety , quality of life ( QOL ) , and health service utilization . There were no significant group differences on postoperative functional status , anxiety , QOL , further surgeries , or complications . Intervention participants were more likely to receive instruction on surgical self-care ( p < or=.001 ) and report improved social/family QOL ( p < or=.05 ) , with fewer home visits ( p < or=.001 ) . These findings suggest that a targeted nursing protocol may , at reasonable cost , improve QOL and enhance health-related knowledge A r and omized study was carried out to investigate whether a nursing intervention , using Orem 's self-care theory as a framework , would affect the coping ability of women with breast cancer during and following radiation therapy .  The intervention consisted of promoting of behaviours to support the patient to restore , maintain or increase their abilities to interact with the situation and adapt to the dem and s of radiation treatment . The control and experimental groups both consisted of 67 patients . The Wheel Question naire was used to evaluate the effect of the intervention . Our results showed that the intervention provided patients older than 59 years the ability to cope with the treatment ( df = 2 , F = 3.463 , P = > 0.05 ) . The present study supports the idea that individual interventions aim ed at improving well-being helps patients . It also highlights the fact that individual approaches to improving well-being are needed . Such interventions should be directed to patients at risk for poor adjustment , such as those older than 50 years of age PURPOSE / OBJECTIVES To evaluate quality of life ( QOL ) and cost outcomes of advanced practice nurses ' ( APNs ' ) interventions with women diagnosed with breast cancer . DESIGN R and omized clinical trial . SETTING Integrated healthcare system in a midwestern suburban community . SAMPLE 210 women with newly diagnosed breast cancer with an age range of 30 - 85 years . METHODS The control group ( n = 104 ) received st and ard medical care . The intervention group ( n = 106 ) received st and ard care plus APN interventions based on Brooten 's cost- quality model and the Oncology Nursing Society 's st and ards of advanced practice in oncology nursing QOL was measured using the Functional Assessment of Cancer Therapy , Mishel Uncertainty in Illness Scale and Profile of Mood States at seven intervals over two years . Information about costs ( charges and reimbursement ) was collected through billing systems . MAIN RESEARCH VARIABLES Uncertainty , mood states , well-being , charges , and reimbursement . FINDINGS Uncertainty decreased significantly more from baseline in the intervention versus control group at one , three , and six months after diagnosis ( p = 0.001 , 0.026 , and 0.011 , respectively ) , with the strongest effect on subscales of complexity , inconsistency , and unpredictability . Unmarried women and women with no family history of breast cancer benefited from nurse interventions in mood states and well-being . No significant cost differences were found . CONCLUSIONS APN interventions improved some QOL indicators but did not raise or lower costs . IMPLICATION S FOR NURSING PRACTICE The first six months after breast cancer diagnosis is a critical time during which APN interventions can improve QOL outcomes . More research is necessary to define cost-effective interventions PURPOSE To describe information needs of elderly postsurgical cancer patients . Few reports have described learning needs of postsurgical cancer patients during the initial weeks after hospitalization . Responding to information needs during the transition to home is important for helping patients and families to appropriately manage illness . DESIGN Descriptive , using records kept for patients assigned to the experimental group in a larger study completed in 1996 . The sample was 148 American patients surgically treated for a new diagnosis of prostate , breast , gastrointestinal , lung , or head and neck cancer . Information needs were identified from topics addressed by advanced practice nurses during 4-week episodes of home care . METHODS Content analysis of 3,280 statements of teaching interventions . FINDINGS Teaching themes were instructing on postoperative self-care , advising on symptom management , clarifying the illness experience , discussing psychological responses , and preparing patients and families to coordinate follow-up care . Topics included describing the expected course of illness , informing about community re sources , identifying events that require physician notification , and advising on pain management . Topic emphasis varied by site of cancer . CONCLUSIONS Information needs of elderly postsurgical cancer patients during transition from hospital to home are extensive . Teaching interventions ranged from giving concrete instructions about care of a surgical wound to interpreting complex information about options for cancer treatment . Elderly postsurgical cancer patients need informational support during the transition from hospital to home Abstract Objective : To evaluate the effect of support from a nurse specialising in breast care and a voluntary support organisation on prevalence of psychological morbidity  after surgery for breast cancer . Design : Prospect i ve r and omised study . Setting : Three teaching hospitals in Glasgow with established breast clinics . Subjects : 272 women aged less than 70 years undergoing surgery for breast cancer . Interventions : Patients were r and omly allocated to receive routine care from ward staff , routine care plus support from breast care nurse , routine care plus support from voluntary organisation , or routine care plus support from nurse and organisation . Main outcome measures : Prevalence of psychological morbidity as assessed by self rating scales : 28 item general health question naire and its subscales , and hospital anxiety and depression scale . Measurements were made at first postoperative clinic visit and at three , six , and 12 months after surgery . Results : On each self rating scale , psychological morbidity tended to fall over the 12 month period . For each scale , scores were consistently lower in patients offered support from breast care nurse alone compared with the other groups , which were similar to each other . Differences were significant or nearly so : P values were 0.015 ( 28 item general health question naire ) , 0.027 ( anxiety and insomnia ) , 0.072 ( severe depression ) , 0.053 ( somatic symptoms ) , 0.031 ( social dysfunction ) , 0.093 ( hospital anxiety ) , and 0.003 ( hospital depression ) . Conclusion : Support from breast care nurse can significantly reduce psychological morbidity , as measured by self rating scales , in women undergoing breast cancer surgery . Key messages Key messages The value of different forms of psychological support for breast cancer patients is uncertain We compared effect of four different types of support for patients undergoing surgery for breast cancer : routine care from ward staff , routine care plus support from specialist breast care nurse , routine care plus support from voluntary organisation , or routine care plus support from nurse and organisation Scores of psychological morbidity were consistently lower in patients offered support from breast care nurse alone compared with the other groups , which were similar to each other Psychological support from an experienced breast care nurse can reduce psychological morbidity in patients undergoing surgery for breast This paper reports on a r and omised controlled trial assessing two types of outpatient follow up for women previously treated for stage 1 breast cancer now in remission . These were  st and ard clinic follow up ( n = 31 , age range : 48 - 83 years ) and patient initiated follow up ( n = 30 , age range 53 - 87 years ) . The latter method involved giving the women written information on the signs and symptoms of recurrence and instructing them to telephone the Breast Care Nurse if they encountered any problems . The groups were compared in terms of cancer and breast cancer-specific quality of life , and psychological morbidity at recruitment , 6 months and 1 year . Satisfaction with follow up was assessed at 6 months and 1 year . Details regarding contact with healthcare professionals were collected at 1 year . There were no major differences in quality of life and psychological morbidity between the groups although more women in the st and ard clinic group reported reassurance and being checked as advantages whereas more women in the patient initiated follow up group reported convenience as an advantage . Patient initiated follow up is a potential alternative to st and ard clinic follow up for this group of women and appears to have no adverse effects . This could enable a cost saving to be made Over recent years , specialist breast care nurses have become increasingly recognized as core members of any breast care team within the UK . Part of the role is to support patients at the highly stressful stage of receiving a diagnosis . This paper describes an ' advocacy ' style of nurse counsellor intervention which aims to improve patients ' preparation for , and involvement in , the diagnostic consultation and provides a framework for future counselling support . One hundred and three women undergoing surgery following diagnosis of breast cancer or a benign breast lump were supported using either this advocacy intervention or a more conventional model of care . The aim was to identify the most effective and appropriate method of intervening at this important stage . Assessment took place before surgery , with 2-week and 6-month follow-ups , and included the Hospital Anxiety and Depression Scale , Rotterdam Symptom Check List and semi-structured interviews addressing perceived quality of care , involvement in decision-making and psycho-social functioning . Whilst the results of many measures were similar for women in the two intervention groups , qualitative data support the implementation of the advocacy method by the breast care nurse OBJECTIVE To vali date an Italian version of the Impact of Event Scale ( IES ) in patients addressing the emotional impact of a recent road accident . METHODS Seventy-nine subjects were examined within 1 - 34 weeks after an accident by means of ( 1 ) . an Italian version of the IES , ( 2 ) . a free description of the accident , and ( 3 ) . a question naire assessing subjects ' behaviour and feelings . RESULTS IES data were analysed by means of the principal component analysis ( PCA ) method , followed by a quartimax rotation , obtaining a two-factor solution interpreted as intrusion ( Factor 1 ) and avoidance ( Factor 2 ) . Furthermore , the scores to the two subscales were considered in order to assess their predictive value on some variables linked to the traumatic event . Intrusion significantly discriminated the emotional intensity and fear level of subjects as a consequence of the accident . CONCLUSIONS The IES is a two-dimensional test capable of evaluating posttraumatic stress . The intrusion and avoidance factors explained 40 % of the total variance . The two-factor solution has a psychological counterpart and is similar to the findings of earlier studies conducted on a larger number of subjects in other countries Abstract In a r and omized trial , a computer program was made available to patients with breast cancer or HIV infection . This article focuses on patient concerns over time and their use of the computer program OBJECTIVE In a prospect i ve , r and omised study , individual psychosocial support performed by : ( 1 )  specially trained oncology nurses ( INS ) or ( 2 ) psychologists ( IPS ) were compared with respect to utilisation , satisfaction and perceived benefit . METHODS Between December 1997 and December 1999 , consecutive breast cancer patients ( n=120 ) were included at start of adjuvant therapy ( chemo- , endocrine and /or loco-regional radiotherapy ) .  Data were collected by an extended version of the ' IPS-patient satisfaction question naire ' within 1 week after termination of the support intervention . Question naires were also mailed to all patients 6 , 12 and 18 - 24 months after inclusion . Levels of distress were collected with the Hospital Anxiety and Depression Scale ( HADS ) and Impact of Event Scale ( IES ) question naires . RESULTS The patients were highly satisfied with the  individual psychosocial support intervention  they received , irrespective of which profession provided the support . However , the patients in the INS group reported higher levels of benefit regarding disease-related problems , regardless if the patients at baseline reported low or high levels of distress . CONCLUSIONS Patients were highly satisfied with an individual psychosocial support intervention . In areas dealing with somatic aspects , the group intervened by nurses were more satisfied than the one by psychologists . PRACTICE IMPLICATION S Individual psychosocial support by specially trained nurses is a realistic alternative in routine cancer care
BACKGROUND Breast Care Nurses ( BCNs ) are now established internationally , predominantly in well re source d healthcare systems .
The role of BCNs has exp and ed to reflect the diversity of the population in which they work , and the improvements in survival of women with breast cancer .
Interventions by BCNs aim to support women and help them cope with the impact of the disease on their quality of life .
OBJECTIVES To assess the effectiveness of individual interventions carried out by BCN 's on quality of life outcomes for women with breast cancer .