Patients receiving treatment for advanced cancer often experience co-occurring pain, fatigue, and sleep disturbance that are not relieved with medications. Brief cognitive- behavioral coping strategies such as relaxation or imagery have been shown to be useful for these symptoms individually and may be effective for the cluster of co-occurring pain, fatigue, and sleep disturbance. Because single cognitive-behavioral strategies don't work equally well for all persons, providing training in multiple cognitive-behavioral strategies is necessary. However, oncology nurses report having insufficient time and are often not available to deliver the interventions exactly when patients experience symptom exacerbation. This application proposes a patient-controlled cognitive- behavioral (PC-CB) intervention, using an MP3 player to deliver recorded cognitive- behavioral strategies. The PC-CB intervention would allow patients to select from a variety of cognitive-behavioral strategies based on their personal preferences, and facilitate self-administration of those strategies at whatever time and place the symptoms occur, without increasing burden on nursing staff. Primary aims are (1) to explore acceptability and patterns of use of the recorded cognitive-behavioral strategies and (2) to pilot test efficacy of the PC-CB intervention compared to a waitlist control. Subjects will be 104 adult patients with advanced lung, colon, prostate or GYN cancers who are experiencing pain, fatigue, and sleep disturbance during treatment (chemotherapy or radiation therapy). Patients will be randomly assigned to receive the PC-CB intervention or a waitlist control condition. Person in the PC-CB intervention group will receive a training session about the cognitive-behavioral strategies and an individualized plan for practice during 2-weeks of cancer treatment. All participants, including the waitlist control group, will keep a diary of their symptoms for the same period. Measures of symptom intensity (pain, fatigue, and sleep disturbance) and symptom interference with daily activities will be completed by all subjects before and after the 2-week intervention. If the PC-CB intervention is acceptable and appears effective, data from this pilot will be used in preparing an R01 application. This line of work has the potential to advance knowledge of brief cognitive-behavioral interventions from effects on a single symptom to effects on a cluster of co-occurring symptoms and could reduce symptom intensity, distress, and suffering among patients with cancer.
This application proposes to test a 2-week patient-controlled cognitive-behavioral intervention for co-occurring pain, fatigue, and sleep disturbance during cancer treatment. An MP3 player will be used to allow patients to self-select and administer a variety of cognitive-behavioral strategies at whatever time and place their symptoms occur. This line of work has the potential to advance knowledge of brief cognitive-behavioral interventions from effects on a single symptom to effects on a cluster of co-occurring symptoms and could reduce symptom intensity, distress, and suffering among patients with cancer.
|Kwekkeboom, Kristine L; Abbott-Anderson, Kristen; Cherwin, Catherine et al. (2012) Pilot randomized controlled trial of a patient-controlled cognitive-behavioral intervention for the pain, fatigue, and sleep disturbance symptom cluster in cancer. J Pain Symptom Manage 44:810-22|