Clinical trials have shown that cognitive behavioral interventions are an effective means of reducing nausea and vomiting in cancer chemotherapy patients. These findings are consistent with a biobehavioral model of cancer stress and raise the possibility that other aspects of quality of life could be improved during chemotherapy through psychological intervention. The proposed research will investigate this issue by examining the effectiveness of a cognitive behavioral program of stress management training conducted before the start of chemotherapy on subsequent quality of life. Improving patients' abilities to manage stress is expected to reduce common aversive symptoms (nausea, vomiting, fatigue, and pain), decrease psychological distress, and improve physical and psychosocial functioning (e.g., sleep and family interactions) during the course of repeated infusions. The proposed research will also explore whether the amount of professional time and resources required to provide stress management training can be reduced by means of a patient self administered intervention. Patients will be randomly assigned before the start of chemotherapy to one of two methods of delivering stress management training (self administered or clinician administered) or to a control condition (usual psychosocial care). Medical, psychosocial, and health economic data will be used to evaluate outcome and will be collected before the start of chemotherapy and at regular intervals during treatment.
The specific aims are: 1) To determine the impact of a cognitive behavioral intervention conducted before the start of chemotherapy on subsequent quality of life. The addition of a cognitive behavioral intervention (self administered or clinician administered stress management training) to usual psychological care is expected to: reduce common aversive symptoms (nausea, vomiting, pain, and fatigue), reduce psychological distress (symptom related, anticipatory, and global), and improve physical and psychosocial functioning. 2) To evaluate the clinical effectiveness of two methods of delivering a cognitive behavioral intervention to chemotherapy patients. Self administered and clinician administered forms of stress management training are each expected to result in improved quality of life relative to usual psychosocial care. 3) To examine the relative cost effectiveness of two methods of delivering a cognitive behavioral intervention to chemotherapy patients. Self administered stress management training is expected to yield a more favorable ratio of costs to clinical effectiveness than clinician administered stress management training while adding relatively little to the cost of usual psychosocial care.
| Stein, Kevin D; Jacobsen, Paul B; Blanchard, Chris M et al. (2004) Further validation of the multidimensional fatigue symptom inventory-short form. J Pain Symptom Manage 27:14-23 |
| Jacobsen, Paul B; Meade, Cathy D; Stein, Kevin D et al. (2002) Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. J Clin Oncol 20:2851-62 |
