A self-administered stress management training program did a better job of helping patients cope with the adverse effects of chemotherapy than a one-hour program in which training was given by mental health professionals, according to a study published in the Journal of Clinical Oncology on June 15, 2002 (see the journal abstract).
Other studies have shown that cancer patients undergoing chemotherapy can benefit from stress management training that helps them cope with pain, fatigue, anxiety and depression. Typically, stress management training is provided in one-on-one sessions between a mental health professional and a patient. However, because such one-on-one sessions are costly and because relatively few mental health professionals work in cancer treatment settings, stress management training is not widely available to cancer patients.
The results of the new study suggest that most cancer patients do not need one-on-one stress management training sessions with a mental health professional, said Michael Stefanek, Ph.D., chief of the Basic Behavioral Research Branch at the National Cancer Institute: "A self-administered stress management program, with some guidance from a mental health professional, works well for many patients who have moderate levels of depression and anxiety."
Although the study findings need to be replicated, they may ultimately help to make stress management training available to more cancer patients by making it less costly to provide, Stefanek added.
The study, whose lead author is Paul B. Jacobsen, Ph.D., involved 411 patients with several types of cancer who were being treated at the H. Lee Moffitt Cancer Center in Tampa, Florida. Before they received chemotherapy for the first time, the patients were randomly assigned to one of three treatment groups.
One group received "usual care," consisting of an evaluation by an oncology social worker. Patients who showed signs of depression or a substance abuse problem were referred to a specialist for treatment. The social worker also provided patients with information about support groups and other resources at the cancer center and in the community.
A second group, in addition to usual care, received one hour of training in stress management techniques from a psychologist. The third group, in addition to usual care, had a 10-minute meeting with a psychologist who gave them a self-study package consisting of a videotape, a booklet, and an audiotape that provided instruction in the same stress management techniques.
At entry to the study and after each of four rounds of chemotherapy, the patients filled out questionnaires in which they rated their general physical and mental health, vitality, pain, nausea, anxiety, depression, and perceptions of role limitations due to emotional problems.
Compared with patients who got usual care, patients who received the self-study package reported better physical functioning, greater vitality, fewer role limitations, and better mental health. Patients who received an hour of stress management training from a psychologist fared about the same as those who got usual care. The self-administered training package cost about two-thirds less than the average cost of professionally delivered stress management training for patients starting chemotherapy.
The better results seen with the self-administered training package might be explained in part by the inclusion of testimonials from other cancer patients about the benefits they got from using the stress management techniques, Stefanek said. "Many cancer patients actively look for information from other patients about what chemotherapy is like and what coping strategies have helped them," he said. "These testimonials may have been a powerful component of the self-administered program that was missing in the professionally led program." MFT Continuing EducationThe hour of training received by patients in the professionally led program may also have been insufficient to enable patients to apply the techniques effectively, Stefanek said. Most professionally taught stress management programs involve multiple sessions. By contrast, patients in the self-administered program could replay the audiotape and videotape and reread the booklet as desired to reinforce their mastery of the stress management techniques.
Even the usual care provided in this study was better than that offered at most cancer centers, Stefanek said. "Most centers would not typically provide an evaluation of each patient by a social worker, who identifies and refers those patients who may have more severe emotional problems."
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