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Support Group Intervention in Primary Breast Cancer: Health-Related Quality of Life, with Special Reference to Anxiety, Depression and Fatigue
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to investigate in a (RCT) the effect of support group intervention in women with primary breast cancer in the short term, and with a long-term follow-up. Women with primary breast cancer were randomized between April 2002 and November 2007 and stratified according to adjuvant treatment with chemotherapy. Of 382 eligible patients, 191+191 patients were randomized to intervention and control groups respectively. Control patients were subjected to standard follow-up procedures. Patients in the intervention group received support intervention at the Foundation of Lustgården Mälardalen during one week followed by four days of follow-up two months later. Patients in intervention and control groups filled in questionnaires at baseline, after 2, 6 and 12 months and in the long-term follow-up after a mean of 6.5 years. In paper I, we studied the effect of the intervention on anxiety and depression measured by the HAD scale and we could show that a significantly lower proportion of women in the intervention group had high anxiety scores compared with women in the control group after 12 months; however, the proportion of women with high depression scores were unaffected. In paper II, we studied the effect of the intervention on fatigue and health-related quality of life (HRQoL) measured by the Norwegian version of the fatigue questionnaire (FQ) and EORTC-QLQ 30 and BR 23.We could not demonstrate any significant effect of the intervention. In paper III, we studied the effect of the intervention on sick-leave, healthcare utilization and the effect of the intervention in economic terms. We used a specially formulated questionnaire. There was a trend towards longer sick leave and more health-care utilization in the intervention group. The difference in total costs was statistically significantly higher in the intervention group after 12 months (p= 0.0036). In paper IV, we studied the long-term effects of the support intervention on anxiety, depression, fatigue and HRQoL. We could show a significant effect of the intervention on cognitive function, body image, future perspective and fatigue, the largest effect was seen among women who received chemotherapy; however, no effects on anxiety and depression were demonstrated.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , 77 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 819
Keyword [en]
Support group intervention, breast cancer, anxiety, depression, fatigue, health-related quality of life, sick-leave, health-care utilization
National Category
Clinical Medicine
Research subject
Oncology
Identifiers
URN: urn:nbn:se:uu:diva-182083ISBN: 978-91-554-8485-9 (print)OAI: oai:DiVA.org:uu-182083DiVA: diva2:558449
Public defence
2012-11-17, Aulan, Ingång 21, Västmanlands sjukhus Västerås, Västerås, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-10-26 Created: 2012-10-03 Last updated: 2013-01-23Bibliographically approved
List of papers
1. A randomised controlled trial of support group intervention after breast cancer treatment: Results on anxiety and depression
Open this publication in new window or tab >>A randomised controlled trial of support group intervention after breast cancer treatment: Results on anxiety and depression
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2012 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 51, no 2, 198-207 p.Article in journal (Refereed) Published
Abstract [en]

Background

Previous studies have demonstrated that between 20 and 30% of women treated for breast cancer have measurable signs of anxiety and depression compared with 6% in a population of healthy women. Depression has been proposed as a predictive factor for recurrence and survival. The aim of the present study was to evaluate if psychosocial support intervention could influence anxiety and depression during the first year after diagnosis.

Material and methods

Newly diagnosed breast cancer patients were randomised between April 2002 and November 2007 and stratified by adjuvant chemotherapy. Of 382 eligible patients, 191 + 191 patients were randomised to intervention group or control group, respectively. Control patients were subjected to standard follow-up routines. The Intervention group had support intervention at the Foundation Lustgarden Malardalen. The rehabilitation lasted one week on a residential basis followed by four days of follow-up two months later. We used the Swedish version of the HAD scale with a cut-off value greater than 10 for clinical symptoms of depression and anxiety.

Results

Support group intervention lowered anxiety over time (p < 0.001) but depression was unaffected (p = 0.610).

Conclusion

This prospective randomised trial of support group intervention in a large homogenous group of breast cancer women showed a statistically significant effect on lowering anxiety over time. No statistically significant effect of intervention could be seen on depression.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-169093 (URN)10.3109/0284186X.2011.610352 (DOI)000299385600007 ()
Available from: 2012-02-27 Created: 2012-02-23 Last updated: 2017-12-07Bibliographically approved
2. A randomized controlled trial of a support group intervention on the quality of life and fatigue in women after primary treatment for early breast cancer
Open this publication in new window or tab >>A randomized controlled trial of a support group intervention on the quality of life and fatigue in women after primary treatment for early breast cancer
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2012 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 20, no 12, 3325-3334 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

When diagnosed with breast cancer, most women's lives change as well as their perspectives on and appreciation of life. The aim of the present study was to evaluate whether psychosocial support intervention could influence health-related quality of life (HRQOL) and fatigue during the first year after diagnosis.

MATERIAL AND METHODS:

Of 382 patients with newly diagnosed breast cancer, 191 patients were randomized to an intervention group and 191 patients were randomized to a routine control group. The intervention group received support intervention that lasted 1 week on a residential basis, followed by 4 days of follow-up 2 months later. The support intervention included informative educational parts, relaxation training, mental visualization, and nonverbal communication. HRQOL was measured using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23 questionnaires and fatigue with the Norwegian version of the fatigue scale at baseline and at 2, 6, and 12 months after intervention.

RESULT:

There was a time-dependent improvement in both functional and symptom scales between baseline and 12 months as measured by the EORTC QLQ-C30 and BR23 questionnaires and there was a decrease in fatigue between baseline and after 2 months with further improvement up to 12 months in both groups, but there were no differences between the intervention and control groups at any point in time.

CONCLUSION:

HRQOL improves and symptoms of fatigue decrease over time, but we could not see any additional effect from the rehabilitation program in this setting.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-181545 (URN)10.1007/s00520-012-1480-1 (DOI)000310232500038 ()22576981 (PubMedID)
Available from: 2012-09-25 Created: 2012-09-25 Last updated: 2017-12-07Bibliographically approved
3. A randomized controlled trial of support group intervention after breast cancer treatment: Results on sick leave, health care utilization and health economy
Open this publication in new window or tab >>A randomized controlled trial of support group intervention after breast cancer treatment: Results on sick leave, health care utilization and health economy
Show others...
2013 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 52, no 1, 38-47 p.Article in journal (Refereed) Published
Abstract [en]

Background

More than 50% of breast cancer patients are diagnosed before the age of 65.  Returning to work after treatment is, therefore, of interest for both the individual and society. The aim was to study the effect of support group intervention on sick leave and health care utilization in economic terms.

Material and Methods

Of 382 patients with newly diagnosed breast cancer, 191 + 191 patients were randomized to an intervention group or to a routine control group respectively. The intervention group received support intervention on a residential basis for one week, followed by four days of follow-up two months later. The support intervention included informative-educational sections, relaxation training, mental visualization and non-verbal communication. Patients answered a questionnaire at baseline, 2, 6 and 12 months about sick leave and health care utilization.

Result

There was a trend towards longer sick leave and more health care utilization in the intervention group. The difference in total costs was statistically significantly higher in the intervention group after 12 months (p= 0.0036).

Conclusion

Costs to society were not reduced with intervention in its present form.

Keyword
Support intervention, breast cancer, return to work, sick leave, health care utilization, health economy
National Category
Medical and Health Sciences
Research subject
Oncology
Identifiers
urn:nbn:se:uu:diva-182056 (URN)10.3109/0284186X.2012.734921 (DOI)000312505900006 ()
Available from: 2012-10-02 Created: 2012-10-02 Last updated: 2017-12-07Bibliographically approved
4. Long-term follow-up of a randomized study of support group intervention in women with primary breast cancer
Open this publication in new window or tab >>Long-term follow-up of a randomized study of support group intervention in women with primary breast cancer
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2013 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 74, no 4, 346-353 p.Article in journal (Refereed) Published
Abstract [en]

Background:

Despite a fairly good prognosis, many breast-cancer patients suffer from symptoms such as anxiety, depression and fatigue, which may affect health-related quality of life and may persist for several years. The aim of the present study was to perform a long-term follow-up of a randomized study of support group intervention in women after primary breast cancer treatment.

Materials and methods:

Three hundred and eighty two women with primary breast cancer were randomized to support group intervention or control group, 181 in each group. Women in the intervention group participated in 1 week of intervention followed by 4 days of follow-up 2 months later. This is a long-term follow-up undertaken, in average, 6.5. years after randomization. Patients answered the questionnaires the European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire (EORTC QLQ-C30) and the Breast Cancer Module questionnaire (BR23), the Hospital Anxiety and Depression Scale (HAD) and the Norwegian version of the fatigue scale (FQ).

Results:

After adjusting for treatment with chemotherapy, age, marriage, education and children at home, there was a significant improvement in physical, mental and total fatigue (FQ), cognitive function, body image and future perspective (EORTC QLQ C30 and BR23) in the intervention group compared with controls. The proportion of women affected by high anxiety and depression scores were not significantly different between the groups.

Conclusion:

Support intervention significantly improved cognitive function, body image, future perspective and fatigue, compared with to the findings in the control group.

Keyword
long-term follow-up, support group intervention, breast cancer, anxiety, depression, fatigue, health related quality of life
National Category
Medical and Health Sciences
Research subject
Oncology
Identifiers
urn:nbn:se:uu:diva-182057 (URN)10.1016/j.jpsychores.2012.11.005 (DOI)000316586600013 ()
Available from: 2012-10-02 Created: 2012-10-02 Last updated: 2017-12-07Bibliographically approved

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