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Distress, Emotional reactivity and Fatigue following Breast Cancer: A Theoretical Approach and a Randomised Intervention Study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: Overall aims were to evaluate a stress management intervention with a stepped care approach among women with breast cancer and to explore distress, emotional reactivity and fatigue, both using a theoretical approach and self-reported assessment.

Methods: A total of 821 women were approached, 372 women rejected participation, 23 women failed to return the questionnaire and one died, hence, 425 patients (52%) accepted participation. Study I evaluated the cognitive processing model with the aid of an untreated patient group, including 189 women according to the main study protocol. Sixty-six of these women were ineligible for the intervention, as they did not report clinical levels of distress. The remaining 123 women were eligible but they declined participation. Study II explored the validation of the ELSS and emotional reactivity among women with breast cancer. The population comprised of all 425 women (breast cancer sample) and 176 women randomly selected from the PAR register (random women sample). Studies III and IV evaluated the intervention and included all 425 women.

Main findings: Study I: avoidance does not mediate the relationship between intrusion and later psychological distress in an early stage breast cancer population. Study II: the ELSS has acceptable validity and reliability. The factor structure of the ELSS was similar in both samples and correlated well with the STAQ (gold standard). Younger age was the only variable associated with emotional reactivity at the start of curative treatment. Studies III and IV: a stepped care approach did not reduce the number of women who require a more extensive treatment at three-months post-diagnosis. Both intervention groups (group/individual) reduced their levels of distress, but there were no significant differences between them. Only about half of the women who were randomised in the second step of the intervention accepted participation.

Conclusions: The present thesis provides information regarding distress, emotional reactivity and fatigue among women with breast cancer. A majority of women with early stage breast cancer seem to process the trauma of a cancer diagnosis in a satisfactory way but may experience some emotional reactivity, and younger women may experience more emotional distress. The results also highlight the need for validated measures and carefully planned psychosocial interventions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 67 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1012
Keyword [en]
Breast cancer, randomised intervention study, Group vs. individual therapy, Oncological rehabilitation, cognitive processing, validation
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-229042ISBN: 978-91-554-8982-3 (print)OAI: oai:DiVA.org:uu-229042DiVA: diva2:735440
Public defence
2014-09-10, Universitetshuset, Sal IX, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-08-20 Created: 2014-07-28 Last updated: 2014-09-08
List of papers
1. How can health care help female breast cancer patients reduce their stress symptoms?: A randomized intervention study with stepped-care
Open this publication in new window or tab >>How can health care help female breast cancer patients reduce their stress symptoms?: A randomized intervention study with stepped-care
Show others...
2012 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 12, 167- p.Article in journal (Refereed) Published
Abstract [en]

Background: A life threatening illness such as breast cancer can lead to a secondary diagnosis of PTSD (post traumatic stress disorder) with intrusive thoughts and avoidance as major symptoms. In a former study by the research group, 80% of the patients with breast cancer reported a high level of stress symptoms close to the diagnosis, such as intrusive thoughts and avoidance behavior. These symptoms remained high throughout the study. The present paper presents the design of a randomized study evaluating the effectiveness and cost-effectiveness of a stress management intervention using a stepped-care design.

Method: Female patients over the age of 18, with a recent diagnosis of breast cancer and scheduled for adjuvant treatment in the form of chemotherapy, radiation therapy and/or hormonal therapy are eligible and will consecutively be included in the study. The study is a prospective longitudinal intervention study with a stepped-care approach, where patients will be randomised to one of two interventions in the final stage of treatment. The first step is a low intensity stress-management intervention that is given to all patients. Patients who do not respond to this level are thereafter given more intensive treatment at later steps in the program and will be randomized to more intensive stress-management intervention in a group setting or individually. The primary out-come is subjective distress (intrusion and avoidance) assessed by the Impact of Event Scale (IES). According to the power-analyses, 300 patients are planned to be included in the study and will be followed for one year. Other outcomes are anxiety, depression, quality of life, fatigue, stress in daily living and utilization of hospital services. This will be assessed with well-known psychometric tested questionnaires. Also, the cost-effectiveness of the intervention given in group or individually will be evaluated.

Discussion: This randomized clinical trial will provide additional empirical evidence regarding the effectiveness of a stress-management program given in group or individually during adjuvant therapy in terms of decreased stress, minimizing fatigue, and maintaining or enhancing patients' quality of life and psychological well-being.

Keyword
Breast cancer, Randomized multicenter interventions study with stepped-care approach, Stress management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-181950 (URN)10.1186/1471-2407-12-167 (DOI)000307557300001 ()
Available from: 2012-10-02 Created: 2012-10-02 Last updated: 2017-12-07Bibliographically approved
2. Cognitive processing in relation to psychological distress in women with breast cancer: a theoretical approach
Open this publication in new window or tab >>Cognitive processing in relation to psychological distress in women with breast cancer: a theoretical approach
Show others...
2014 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 23, no 2, 222-228 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To evaluable a cognitive procession model developed by Creamer and colleagues, this study examined the longitudinal relationship between intrusion and psychological distress, via avoidance, in women with breast cancer.

METHODS:

Participants included 189 patients who were newly diagnosed with breast cancer. The longitudinal association between intrusion, avoidance and psychological distress and the mediating role of avoidance between intrusion and psychological distress were examined. Intrusion was measured at inclusion (T1), avoidance at 3 months post-inclusion (T2) and psychological distress at 12 months post-inclusion (T3).

RESULTS:

Results suggested that avoidance at T2 did not mediate the relationship between intrusions at T1 and psychological distress at T3.

CONCLUSION:

The results did not provide support for Creamer's model in an early-stage breast cancer population, which suggests that early-stage breast cancer patient's process trauma differently from late-stage cancer patients. Therefore, it might be suggested that early-stage and late-stage cancer patients require different types of support and treatment for the distress experienced.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-209605 (URN)10.1002/pon.3392 (DOI)000329746800013 ()24105774 (PubMedID)
Available from: 2013-10-22 Created: 2013-10-22 Last updated: 2017-12-06Bibliographically approved
3. Emotional reactivity among female breast cancer patients at the start of postoperative adjuvant treatment: An observational study and validation of the ELSS scale
Open this publication in new window or tab >>Emotional reactivity among female breast cancer patients at the start of postoperative adjuvant treatment: An observational study and validation of the ELSS scale
(English)Article in journal (Other academic) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-225484 (URN)
Available from: 2014-06-04 Created: 2014-06-04 Last updated: 2014-09-08Bibliographically approved
4. A stepped care stress management intervention on cancer-related traumatic stress symptoms among breast cancer patients: A randomized study in group vs. individual setting
Open this publication in new window or tab >>A stepped care stress management intervention on cancer-related traumatic stress symptoms among breast cancer patients: A randomized study in group vs. individual setting
2015 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 24, no 9, 1028-1035 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To evaluate the mode of delivery of a stress management intervention, in a group or individual setting, on self-reported cancer-related traumatic stress symptoms. A secondary aim was to evaluate a stepped care approach.

Methods

All study participants (n  = 425), who were female, newly diagnosed with breast cancer and receiving standard oncological care were offered Step I of the stepped care approach, a stress management education (SME). Thereafter, they were screened for cancer-related traumatic stress symptoms, and, if present (n = 304), were invited to join Step II, a more intense intervention, derived from cognitive behavioral therapy, to which they were randomized to either a group (n = 77) or individual (n  = 78) setting. To assess cancer-related traumatic stress symptoms, participants completed the Impact of Event Scale and the Hospital Anxiety and Depression Scale at the time of inclusion, three-months post-inclusion and approximately 12-months post-inclusion.

Results

The SME did not significantly decrease any of the cancer-related traumatic stress symptoms. No statistically significant differences were found between the group and the individual setting interventions. However, only 54% of the participants attended the group setting compared to 91% for the individual setting.

Conclusion

The mode of delivery had no effect on the cancer-related traumatic stress symptoms; however, the individual setting was preferred. In future studies, a preference-based RCT design will be recommended for evaluating the different treatment effects.

Keyword
Screening, Impact of Event Scale, Hospital Anxiety and Depression Scale, Group vs. individual therapy, Breast cancer, Oncological rehabilitation
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-229041 (URN)10.1002/pon.3763 (DOI)000360992900006 ()25631707 (PubMedID)
Funder
Swedish Cancer Society, 96 2577
Available from: 2014-07-28 Created: 2014-07-28 Last updated: 2017-12-05Bibliographically approved
5. Group versus individual stress management intervention in breast cancer patients for fatigue and emotional reactivity:: A randomised intervention study
Open this publication in new window or tab >>Group versus individual stress management intervention in breast cancer patients for fatigue and emotional reactivity:: A randomised intervention study
2014 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, no 9, 1221-1229 p.Article in journal (Refereed) Published
Abstract [en]

Background. Fatigue and emotional reactivity are common among women suffering from breast cancer and might detrimentally affect these women's quality of life. This study evaluates if the stress management delivered either in a group or individual setting would improve fatigue and emotional reactivity among women with a newly diagnosed breast cancer.

Material and methods. Participants (n = 304) who reported elevated levels of distress at three-month post-inclusion were randomised between stress management in a group (GSM) (n = 77) or individual (ISM) (n = 78) setting. Participation was declined by 149 women. Participants completed the Multidimensional Fatigue Inventory (MFI-20) and the Everyday Life Stress Scale (ELSS) at the time of inclusion, 3- and 12-month post-inclusion. Analyses were made according to intention to treat and per-protocol principles. Mann-Whitney tests were used to examine differences between the two intervention groups.

Results. No significant differences were detected between the GSM and ISM groups on fatigue or emotional reactivity. In addition, there were no changes over time for these outcomes.

Conclusions. There were no differences between the two intervention arms with reference to fatigue or emotional reactivity; however, a clinically interesting finding was the low number of women who were interested in participating in a psychosocial intervention. This finding may have clinical implications when psychosocial support is offered to women with a newly diagnosed breast cancer and also in the planning of future studies.

National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-225485 (URN)10.3109/0284186X.2014.923935 (DOI)000342282100012 ()25007225 (PubMedID)
Funder
Swedish Cancer Society, 96 2577Swedish Research Council, 521-2009-3129
Available from: 2014-06-04 Created: 2014-06-04 Last updated: 2017-12-05Bibliographically approved

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