Arafa, M.E.A., & Hassan, M. (2013). Psychoeducational program for breast cancer survivors, effect on cancer-related fatigue and quality of life. Egyptian Journal of Psychiatry, 34, 25–33. 

DOI Link

Study Purpose

To evaluate the efficacy of the psychoeducational program in alleviating cancer-related fatigue and mood symptoms, and improving quality of life among breast cancer survivors

Intervention Characteristics/Basic Study Process

The intervention components included (a) to acquire a broader definition of fatigue; (b) to develop relaxation skills; (c) to gain knowledge of effective coping strategies to deal with physical factors associated with fatigue (e.g., circadian cycle and sleep hygiene); (d) to determine the links between thoughts, emotions, and fatigue; (e) to articulate ways to increase self-regulation techniques (e.g., self-recording, goal setting) and apply them to individualized walking programs; and (f) to inform on how to further decrease passive coping strategies (e.g., behavioral and social disengagement, naps).
 
Delivery Mode/Duration/Times: The program included four weekly group meetings (4–8 patients) of one hour, including (a) motivation of daily walking training and physical exercise, and instructions of the previous sessions; and (b) the psychoeducative, fatigue management sessions with cognitive behavioral content. 
 
The program also included home-based assignments. Participants were invited to practice relaxation and complete self-rating records of it.

Sample Characteristics

  • N = 40 for the intervention group, 40 for the control group (waiting control)   
  • AGE = 42.1 years (9.7) for the intervention, 41.8 years (10.3) for the control group
  • FEMALES: 100%
  • CURRENT TREATMENT: Radiation 
  • KEY DISEASE CHARACTERISTICS: Breast cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Nonmetastatic breast cancer, stages 1 and 2, Karnofsky Performance Scale (KPS) scores of 70 and more

Setting

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: At the outpatient clinic in the Department of Clinical Oncology in the Faculty of Medicine, Cairo University, Egypt

Phase of Care and Clinical Applications

  • PHASE OF CARE: Transition phase after active treatment
  • APPLICATIONS: Palliative care 

Study Design

Case control study

Measurement Instruments/Methods

  • Multidimensional Fatigue Inventory SF-36 (MFI SF-36) 
  • Hospital Anxiety and Depression Scale (HADS)

Results

A significant difference existed between the mean scores of fatigue in group A patients (intervention) before the intervention and after one month (p < 0.05). A significant difference existed between mean scores of fatigue in group A patients and group B patients (control) after one month (p < 0.05). A significant difference existed between the mean of SF-36 (physical component score and mental component score) in group A patients before the intervention and after one month (p < 0.05). Also, a significant difference existed between mean scores of SF-36 in the patients in group A patients and group B patients after one month (p < 0.05).

Conclusions

The four-week psychoeducational program improved fatigue and quality of life after radiation therapy in patients with breast cancer.

Limitations

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Risk of bias (no appropriate attentional control condition)
  • Selective outcomes reporting
  • Intervention expensive, impractical, or training needs
  • Questionable protocol fidelity
 

 

Nursing Implications

The intervention may be taught by trained nurses and can be part of a routine supportive care at very low additional costs for healthcare systems.