Hirai, K., Motooka, H., Ito, N., Wada, N., Yoshizaki, A., Shiozaki, M., . . . Akechi, T. (2012). Problem-solving therapy for psychological distress in Japanese early-stage breast cancer patients. Japanese Journal of Clinical Oncology, 42, 1168–1174.

To examine the feasibility and effectiveness of problem-solving therapy for psychological distress among patients with early-stage breast cancer

The problem-solving therapy involved five weekly sessions aimed at assessing problems, setting goals, generating solutions, choosing a solution, and implementing the solution and evaluating results. The therapy included a manual and worksheet for patients to use. Authors collected self-report data prior to the intervention, after the final sessions, and three months after the final sessions.

• Mean patient age was 50.21 years (SD = 11.09 years).
• The sample was 100% female.
• The majority of participants had stage II disease. All had had prior surgery; 89% were on hormone therapy.
• Of all participants, 43% were employed full- or part-time, 79% were married, and 21% had a college education.

• Single site
• Outpatient setting
• Japan

Patients were undergoing active antitumor treatment.

A pre/post-test design was used.

• Two-item 11-point Likert-type distress scale
• Hospital Anxiety and Depression Scale (HADS), Japanese version
• Scale that measured self-efficacy of patients with advanced cancer
• Brief Cancer-Related Worry Inventory
• European Organization for Research and Treatment Cancer Core Quality-of-Life Questionnaire (QLC-C30), Japanese version

Four patients dropped out of the study after starting treatment. Analysis showed a significant effect of time on anxiety and depression scores (p < 0.01).  Over time scores for global health status, physical functioning, emotional functioning, and role functioning improved significantly.

The study shows that symptoms of anxiety and depression and some aspects of quality of life improved over time. The effect of the intervention cannot be evaluated from these study results. Though authors state that the intervention was feasible, the fact that 17% of the initial sample did not complete the study suggests that the intervention was not of interest to a substantial proportion of the patients.

• The study had a small sample size, with fewer than 30 participants.
• The study had risks of bias due to the lack of a control group, blinding, and random assignment.

Study results are insufficient to allow evaluation of the acceptability and efficacy of the problem-solving intervention.