Gaston-Johansson, F., Fall-Dickson, J. M., Nanda, J., Ohly, K. V., Stillman, S., Krumm, S., . . . Kennedy, M. J. (2000). The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. Cancer Nursing, 23, 277–285.

The comprehensive coping strategy program (CCSP) provided patients with information emphasizing the use of pain control to decrease psychological distress and physical symptoms, such as fatigue. Patients were provided with handouts that explained ways to reduce pain, the use of cognitive restructuring information on distorted thinking, and positive coping self-statements. Patients were taught how to perform a brief muscle relaxation, which included a guided imagery component. Handouts were provided that described relaxation therapy and its benefits. A handheld recorder was given to patients to guide them through the relaxation exercise. Patients were instructed to use a five-minute audiotape recording at least every day and before stressful events. Patients were instructed to record their use of audiotapes and handouts in a diary. Outcomes were assessed at baseline, two days before allogeneic bone marrow transplant (ABMT), and seven days after ABMT. 

• In total, 128 women with breast cancer scheduled for ABMT were included.
• Most patients were aged between 41 and 50 years.
• Of the patients in the CCSP group, 90% were married, which was significantly higher than the control group (57% married; p < 0.001), and 40% had practiced some earlier coping method, which was significantly higher compared to 21% of the those in the control group (p < 0.05).

National Cancer Institute (NCI)–designated comprehensive cancer center located in the eastern United States

Patients were undergoing the active treatment phase of care.

This was a randomized, controlled, prospective clinical trial that included

• Patients scheduled for ABMT who received the CCSP
• Patients scheduled for ABMT who received standard medical care.

Visual analog scale (VAS)

Fatigue was experienced by 91% of the participants. The peak fatigue level was observed days before ABMT for both groups; the CCSP group experienced a 10.80-point increase, and the control group experienced a 20.33-point increase. The CCSP group experienced a statistically significant improvement in fatigue seven days after ABMT in comparison to the control group (p < 0.05); however, this difference disappeared after controlling for demographic variables and fatigue two days prior to ABMT. An index of nausea and fatigue was created for day seven after ABMT, and there was a statistically significant difference between the groups, with demographic variables controlled, with the control group reporting more nausea and fatigue than the intervention group (p < 0.05).

The generalizability of the results was limited to the sample, which consisted primarily of highly educated, married, Caucasian women with high incomes.