Chan, C.W., Richardson, A., & Richardson, J. (2011). Managing symptoms in patients with advanced lung cancer during radiotherapy: Results of a psychoeducational randomized controlled trial. Journal of Pain and Symptom Management, 41, 347–357.

To examine the effectiveness of a psychoeducational intervention (PEI) on the symptom cluster of anxiety, breathlessness, and fatigue compared with usual care

A 40-minute educational intervention consisted of preparatory information; discussion of symptom experience; exploration of means of, and goals associated with, symptoms; advice on self-care strategies; and training and practice in progressive muscle relaxation. The educational package consisted of an audiotape and leaflets as well as discussion on the selected symptoms and their self-care management.

• The study reported on a sample of 140 patients.
• No data on patient age were provided, but inclusion criteria stipulated that participants be age 16 or older.
• The sample was 83% male and 17% female.
• Patients were diagnosed with stage 3 or 4 lung cancer and were scheduled to receive palliative radiation therapy.
• Mean duration of cancer illness was 4.4 months.
• Chest and mediastinum were the major sites of radiation therapy.
• Of the sample, 87% were married and 54% were retired.

• Single site
• Hong Kong

Patients were undergoing the active treatment phase of care.

A pre/post-test randomized controlled trial design was used.

• Visual analog scale to measure intensity of breathlessness
• Piper Fatigue Scale: 23-item intensity subscale (Chinese version)
• State-Trait Anxiety Inventory: 20-item A-state scale (Chinese version)
• Short Form-34 Health Survey functional ability subscale (Chinese version)

Univariate tests on anxiety showed a significant difference (p = 0.001) in the pattern of change over the course of time, with a very small effect size (partial eta² = 0.051).

Findings suggest that interventions such as those tested in the current study, including progressive muscle relaxation, education, and counseling, have significant effects on patterns of symptom change over time.

• Between-group differences were not analyzed or reported.
• The study yielded very small effect sizes.
• The study had no attentional control.
• The control group had more advanced stage of cancer (p < 0.05) compared to the intervention group and therefore had much higher attrition rates (42% versus 11%).
• Results reported gave information about pattern changes over time, but data provided did not give clear information regarding the direction of change associated with the intervention.

Progressive muscle relaxation and education may be helpful in managing anxiety, fatigue, and breathlessness in patients with cancer, but effects may be small.