Yun, Y.H., Kim, Y.A., Lee, M.K., Sim, J.A., Nam, B.H., Kim, S., . . . Park, S. (2017). A randomized controlled trial of physical activity, dietary habit, and distress management with the Leadership and Coaching for Health (LEACH) program for disease-free cancer survivors. BMC Cancer, 17, 298-017-3290-9.
To assess if cancer survivors’ physical activity, dietary habits, and distress management would benefit from a Leadership and Coaching for Health (LEACH) program
Participants were randomly assigned to the LEACH Program (LP) intervention group or the usual care (UC) control group.
LP group received a one-hour health education workshop (topics covered included physical activity, dietary habits, and distress management), a three-hour leadership workshop, and individual telephone coaching for 24 weeks. A total of 16 tele-coaching sessions were held: 30 minutes per week for 12 sessions, 30 minutes per 2 weeks for 2 sessions, and 30 minutes per month for 2 sessions.
The UC group was asked to continue their usual care and received a health education booklet on dietary habits, physical activity, and distress management, as well as a four-hour lecture on physical activity, dietary habits, distress management, and a screening for a second cancer.
Patient evaluations took place at baseline, 3 months, 6 months, and 12 months.
PHASE OF CARE: Survivorship
12 month randomized control trial, patients evaluated at 0, 3, 6, and 12 months.
Cancer registry from 10 South Korean teaching hospitals; questionnaire based on the “Rules for National Cancer Prevention: Dietary Practice Guideline” and the Korean National Health and Nutrition Examination Survey data; METs (kcal/kg per week) for physical activity; Post-Traumatic Growth Inventory; Seven Habit Profile; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; Diener’s Satisfaction With Life Scale; Hospital Anxiety and Depression Scale; Impact of Events Scale-Revised; Medical Outcomes Study Social Support Survey; Ten Rules for Highly Effective Health Behavior
There was no significant difference between the two groups; UC and LP for primary or secondary outcomes.
For primary outcome, UC and LP groups did not significantly differ in intake of fruit and vegetable intake, and physical activity, but differed at 12 months in post-traumatic positive growth (p = 0.065).
For secondary outcomes, from baseline to 3 months, the LP group showed a greater decrease in the anxiety score (p = 0.025), a greater increase in social functioning score (p = 0.018), and a greater decrease in appetite loss (p = 0.048) and financial difficulties (p = 0.036).
From baseline to 12 months, the LP group showed a decrease in fatigue (p = 0.065) and an increase in number of 10 Rules for Highly Effective Health Behavior adhered to by patients. Patient subjective cancer-induced stress in response to specific traumatic events, scored between UC and LP groups, were marginally significant from baseline to 12 months (p = 0.068).
Participants’ primary behaviors of physical activity and dietary habits did not change due to this program. Participants’ management of their anxiety, social functioning, and symptoms did somewhat improve.
Long-term cancer survivors partnering with healthcare professionals may be helpful in reducing distress and anxiety in cancer survivors who recently completed cancer treatment. Increased education and training is needed for the long-term cancer survivors to coach.
Sun, F.K., Hung, C.M., Yao, Y., Lu, C.Y., & Chiang, C.Y. (2017). The effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in breast cancer patients receiving chemotherapy. Cancer Nursing, 40, E39-E48.
To measure the effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in patients with breast cancer receiving chemotherapy
Two interventions. (a) muscle relaxation techniques using CD at least two times daily for 12 weeks, three visits in the hospital by the researcher who trained them in the practice of the MRT, and understood the techniques. (b) Therapeutic walking with a pedometer provided to patients. Walking technique and pedometer use taught by researcher. Asked to walk 90-120 minutes per week or three times per week for at least 30 minutes per session. Record steps, walking time, strength for 12 weeks. Control group: no intervention.
Randomized control study
The results showed no significant difference in any outcome variable in the pretest. The results of the post-test indicated that the two groups scored significantly differently only on the Center for Epidemiological Studies Depression Scale (U = 638, p < 0.05). The patients with breast cancer who participated in the three-month muscle relaxation and therapeutic walking interventions had a lower level of depression (RE = 37) than those who did not (RC = 51.16).
No difference in groups on pretesting (initially). After intervention, the group with the intervention scored significantly differently only on the depression scale.
Nursing staff could teach and encourage the use of muscle relaxation techniques, as well as therapeutic walking to reduce depressive symptoms for patients undergoing chemotherapy.
Cheng, K.K.F., Lim, Y.T.E., Koh, Z.M., & Tam, W.W.S. (2017). Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database of Systematic Reviews, 8, CD011152.
PHASE OF CARE: Survivorship
HBMS programs in breast cancer survivors were found to provide beneficial short-term improvement of breast cancer-specific quality of life and global quality of life. Also, immediately after the intervention, a reduction in anxiety, fatigue, and insomnia was assessed.
Group-based intervention was shown to be the most effective mode of delivery toward improving physical, emotional, and functional quality of life
Kozik, T.M., Hickman, M.C., Schmidt, S., Connolly, T.F., Paustenbach, K., Vosti, P., & Bhattacharyya, M. (2018). An exercise program to improve depression and sleep disorders in oncology patients: The SAD study. European Journal of Oncology Nursing, 37, 19–22.
To evaluate the effect of a structured supervised outpatient exercise program on insomnia and depression in patients with cancer.
Patients were referred by their oncologist office to the program. Participants were consented, administered two instruments before and after, and then participated in a 90-minute structured, supervised exercise program two days per week. The exercise consisted of a warm-up, cardiovascular circuit training, strength training, and cool down. The program was for 10 weeks.
PHASE OF CARE: Active anti-tumor treatment
75 patients were enrolled and 40 completed the 10-week program. The study demonstrated a significant improvement in insomnia. Baseline scores (mean = 9.5; SD = 3.7) compared to final scores (mean = 6.3; SD = 3.5) showed (t = 4.468; p = 0.01). The significance level of 0.05 is over the 90%. The depression scores were also seen as significantly different from baseline (mean = 37.4; SD = 9.7) and final scores (mean = 33; SD = 9.7) (t = 2.427; p = 0.01). The significance of 0.05 is about 80%. The study team also evaluated those who did not complete the program and there was no difference. Depression scores at baseline were higher for those who did not complete the program.
This study showed improvement in depression and insomnia in patients with cancer who participated in a structured, supervised exercise program.
Nurses should assess patients for insomnia and depression and provide appropriate referrals to structured exercise programs. The cost is low and many cancer centers have existing exercise programs for fatigue which could be combined with the mental health benefits. Nurses could encourage and participate in development of these programs with their healthcare and community fitness centers where none currently exist.
Fuller, J.T., Hartland, M.C., Maloney, L.T., & Davison, K. (2018). Therapeutic effects of aerobic and resistance exercises for cancer survivors: A systematic review of meta-analyses of clinical trials. British Journal of Sports Medicine, 52, 1311.
PHASE OF CARE: Not specified or not applicable
The effects of exercises on thousands of patients in 140 meta-analyses are reviewed. The beneficial effect is statistically significant in 75% of the meta-analyses. The effect for cardiovascular fitness and muscle strength are classified as moderate, and the effect on fatigue, quality of life, and depression are classified as small. The incidence of exercise-related adverse event is very low (3.5%). The large majority of the studied cancer population are patients with breast cancer.
The study shows how exercises have an important role in the well-being of patients and survivors. It would be interesting to have another meta-analyses on different cancer populations and at different stages of the disease/treatment. It would also be interesting to have the results by gender.
Nurses should encourage patients to have a physical activity. Cardiovascular markers and muscular fitness is improved with exercises as well as depression, fatigue, and quality of life to a lesser extent. In addition, it is relatively easy to find information on how to exercise.
Fisher, H.M., Jacobs, J.M., Taub, C.J., Lechner, S.C., Lewis, J.E., Carver, C.S., . . . Antoni, M.H. (2017). How changes in physical activity relate to fatigue interference, mood, and quality of life during treatment for non-metastatic breast cancer. General Hospital Psychiatry, 49, 37-43.
To determine the effectiveness of physical activity following surgery for breast cancer in improving depression and quality of life
Participants were randomized between a CBSM (cognitive behavioral stress management) intervention group (which corresponds to a 2 hours per week meeting for 10 consecutive weeks) and a single-day psychoeducational control group. The CBMS intervention consist in a structured intervention with relaxation and cognitive behavioral therapy, coping effectiveness training, assertiveness, and anger management.
PHASE OF CARE: Active anti-tumor treatment
Randomized control trial
7-item Perceived Interference Subscale of the 12-item Fatigue Symptom Inventory, IBS for depression, 7-Item Functional Well-Being Subscale of the Functional Assessment of Cancer Therapy (FACT-B)
Both the control and the intervention arm saw significant changes in clinician-rated depression and depressed mood (control: standardized B = 0.15; B = 0.29, p = 0.049; p < 0.001) (intervention: standardized B = 0.14; B = 0.29, p < 0.001;p < 0.001) with regard to FRDI; however, there were no significant changes in functional QOL with either arms with regard to FRDI.
The study shows that a moderate physical activity improves fatigue, depression, and quality of life for patients with breast cancer , and nurses should make a point of encouraging this. Future replications are needed, the sample chosen may already have the awareness of the health benefits of physical activity before the study was enacted.
Nurses should encourage physical activity in patients with breast cancer.
Lundt, A., & Jentschke, E. (2019). Long-term changes of symptoms of anxiety, depression, and fatigue in cancer patients 6 months after the end of yoga therapy. Integrative Cancer Therapies, 18, 1534735418822096.
To examine the long-term changes of anxiety, depression, and fatigue in patients with cancer six months after a yoga intervention
Gentle hatha yoga provided to the participants in small groups under supervision and guidance. 60 minutes once a week for 8 weeks total. Participants also received a CD and a printed manual to motivate training at home.
PHASE OF CARE: Active anti-tumor treatment
Prospective observational one group pre-/post-test design
Self-reported Generalized Anxiety Disorder Scale (GAD-7) to measure anxiety, Patient Health Questionnaire (PHQ-2) to measure depression, European Organization for Research and Treatment of Cancer QOL (EORTC) Questionnaire-Fatigue scale to measure fatigue
There was a statistically significant reduction in the anxiety, depression, and fatigue levels after six months from the baseline. A small time effect on anxiety (SES = 0.22, CI [-0.3, 0.47]) and fatigue (SES = 0.27, CI [-0.11, 0.13]) indicating slight nonsignificant increase of symptoms. No time effect found in terms of depression (SES = 0.01, CI = [-0.11, 0.13]).
Although the study shows reduction in outcomes, studies with larger sample sizes with better study designs (i.e., RCT) are needed to confirm the findings.
Yoga appears to have some benefit in reducing the symptoms of anxiety, depression, and fatigue, and the benefits may be lasting. Additional research with randomized studies will be important to confirm these results.
Griffiths, R.R., Johnson, M.W., Carducci, M.A., Umbricht, A., Richards, W.A., Richards, B.D., . . . Klinedinst, M.A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30, 1181–1197.
To examine the effect of two psilocybin doses on symptoms of anxiety and depression among patients with advanced cancer
Participants were assigned to two groups: one received low-dose psyilocybin in the first session and high-dose psyilocybin in a second session. The other group received psilocybin doses in reverse order. The first session was done about one month after study entry, and the second session was five weeks later. Study measures were obtained at baseline, during, and at the end of each session, and approximately six months later. Session monitors met with patients prior to sessions to establish rapport and prepare the patient for the sessions. Drug session were done in a living room-like environment with two monitors present.
Crossover, double blind, randomized study
There were no serious adverse effects of the intervention. There were transient moderate increases in blood pressure after psilocybin. Transient psychological distress was seen in some patients with high-dose psilocybin. All measures of depression, anxiety, and total mood disturbance showed significant improvement with high dose (p < 0.001). Death acceptance and optimism also were increased with high-dose intervention (p < 0.01). These changes were maintained at 6 months.
High-dose psilocybin under supportive conditions was shown to decrease symptoms of depression and anxiety, and improve mood, optimism, acceptance of death and spirituality. These effects were generally maintained for months after drug use.
Administration of psilocybin under controlled supportive conditions was shown to have multiple benefits for patients with terminal cancers. Further confirmatory research is warranted, and research comparing outcomes with psilocybin to other appropriate interventions would be helpful.
Gregoire, C., Bragard, I., Jerusalem, G., Etienne, A.M., Coucke, P., Dupuis, G., . . . Faymonville, M.E. (2017). Group interventions to reduce emotional distress and fatigue in breast cancer patients: A 9-month follow-up pragmatic trial. British Journal of Cancer, 117, 1442–1449.
To determine the long-term (nine months) effectiveness of three different group interventions compared to usual care for patients with breast cancer
Participants were allowed to select one of three groups to receive either cognitive behavioral therapy, yoga, and self-hypnosis. People who declined to participate were in a control group. Measurements were taken T0 through T3 to include before and after the short-term interventions, at month 3, and at month 9 follow-up.
PHASE OF CARE: Multiple phases of care
Three group intervention self-selection; testing at T0, T1, T2 (month 3), T3 (month 9)
Demographics; medical history; Hospital Anxiety Depression Scale (anxiety and depression emotional distress); Quality of Life 30-item questionnaire (fatigue); Insomnia Severity Index (sleep quality)
Only results from baseline (T0) and the month 9 follow-up (T3) were reported using MANOVA with repeated analysis and post-hoc analysis.
Post-hoc comparisons of time T0-T1: hypnosis group showed significant decreases in anxiety (p = 0.000), depression (p = 0.004), and fatigue (p = 0.045). Yoga group showed significant decrease in anxiety (p = 0.01).
Post-hoc comparisons of time at T3: hypnosis group showed decreases in anxiety (p = 0.000), depression (p = 0.000), and fatigue (p = 0.002); yoga group showed decrease in anxiety (p = 0.024).
Self-hypnosis led to improvements in anxiety, depression, and fatigue. Anxiety improved in the yoga group. There were no improvements in the CBT or control groups.
Two of the three interventions may be helpful in reducing anxiety, depression, or fatigue when measured at nine months. Self-hypnosis may help patients improve emotional distress such as depression and anxiety, and may also reduce fatigue; yoga may also help improve anxiety. Larger samples and longer follow-up studies are needed.