Although patients undergoing chemotherapy experience fewer side effects than in the past, nausea and fatigue can be debilitating in many patients, as can the emotional distress that accompanies coping with cancer . A number of studies have shown that psychosocial interventions incorporating stress-management techniques can relieve emotional distress and nausea both prior to and following chemotherapy. The Moffitt study, comparing how such techniques are learned, concluded that a self-guided approach produces the best results.
In this study, reported in the Journal of Clinical Oncology, 382 patients diagnosed with cancer but not yet undergoing chemotherapy were evaluated by an oncology social worker. The social worker determined the patient's need for psychosocial services, evaluated how well the patient understood their medical condition, screened for the presence of possible mental health disorders, and gave the patient information about support services present at the cancer center and in the community—all the usual care normally offered to a newly-diagnosed patient. In addition, some patients also received intensive individual training with a clinician in stress management techniques shown to be effective in improving mental and physical well-being in patients undergoing chemotherapy. These stress management techniques included progressive muscle relaxation training with guided imagery, systematic desensitization, and biofeedback. An audiotape was made of the training session for patients to use when practicing these techniques on their own.
Still another group of patients, after receiving the initial evaluation with the oncology social worker, underwent brief instruction in stress management techniques with a clinician, but were also given a 12-page instruction booklet entitled "Coping with Chemotherapy," and an accompanying videotape for use at home. The instructional materials were developed at Moffitt in conjunction with Cathy Meade, PhD, RN, who collaborated with Jacobsen in this study. The booklet and instructional video covered the same topics described by the clinician in the group of patients receiving intensive professional training in stress management techniques.
Jacobsen found that of the three groups, the self-guided patients using the instructional booklet and video showed the most improvement in their quality of life, even though they did not receive formal training by a clinician. In contrast, those who did undergo intensive training with a clinician faired no better than those receiving standard care. Both sets of patients using stress-management techniques—those receiving professionally-administered training and self-guided patients using the booklet and tape-- had similar expectations regarding the success of therapy and used the techniques with the same frequency.
According to Jacobsen, the patients receiving the booklet and tape may have felt more empowered because they could review and utilize the techniques at their own pace. Alternatively, patients who received professionally-administered training may have felt less comfortable with the techniques, and were less skilled when employing them.
Jacobsen also points out that it cost two-thirds less to implement stress-management training in the self-guided patients, despite the cost of the booklet and videotape. Jacobsen hopes that Moffitt will make these materials available to all patients, and eventually offering them to other cancer centers around the country.
This study was funded by research grants from the American Cancer Society and the National Cancer Institute.
Journal
Journal of Clinical Oncology