Kwekkeboom, K.L., Abbott-Anderson, K., Cherwin, C., Roiland, R., Serlin, R.C., & Ward, S.E. (2012). Pilot randomized controlled trial of a patient-controlled cognitive-behavioral intervention for the pain, fatigue, and sleep disturbance symptom cluster in cancer. Journal of Pain and Symptom Management, 44, 810–822.
To assess the efficacy of a cognitive-behavioral (CB) intervention for the pain, fatigue, and sleep disturbance symptom cluster
Patients were randomized to the CB group or a waitlist control group. The intervention was a single one-on-one training session with a research nurse providing information about causes of pain, fatigue, and sleep disturbance; rational about how CB strategies could affect symptoms; overview of 12 strategies; and recommendations for patients to practice. CB strategies were relaxation and imagery approaches. Patients were provided scripted recordings to use on an MP3 player and written instructions. Patients were followed for two weeks and completed study assessments at baseline and at two weeks. The control group had usual care. Patients in the intervention group were to keep a log recording each use of CB strategies, and all patients in both groups were taught to complete a daily symptom diary. Follow-up phone calls were made to both groups on the second study day, the seventh study day, and at the end of the two-week study period. Post-intervention measures of symptom severity were mailed to participants to complete and provide to clinic staff.
CB strategies were used an average of 13.65 times (SD = 6.98) during the two weeks. Patients in the control group were significantly more depressed at baseline (p = .003). Total cluster scores post-intervention were lower in the intervention group (eta2 0.052, p = .032). Examination of individual symptoms showed differences between groups in pain (P = .006) and fatigue, but not in sleep.
Use of various patient self-controlled relaxation and imagery recordings appeared to have a beneficial effect in reducing pain and fatigue compared to controls. No clear effect was seen on sleep disruption.
Findings suggest that patient use of relaxation and imagery instructions and recordings may improve management of pain and fatigue during cancer treatment.