Lindemalm, C., Mozaffari, F., Choudhury, A., Granstam-Björneklett, H., Lekander, M., Nilsson, B., . . . Mellstedt, H. (2008). Immune response, depression and fatigue in relation to support intervention in mammary cancer patients. Supportive Care in Cancer, 16(1), 57-65.

To examine the effect of a support intervention on immune function and levels of depression, anxiety, and fatigue in breast cancer patients after completion of surgery and adjuvant treatment  

Authors chose 41 women from an ongoing prospective randomized study. The first patients in each stratum of treatment were chosen for the current study. Of the 41 women, 21 received adjuvant combined radiochemotherapy (CT-RT) and 20 women received radiotherapy (RT). Eleven women (CT-RT) were randomized to the support group, and 10 women (RT) were randomized to the support group. Ten CT-RT and 10 RT patients served as controls. The support intervention consisted of educational lectures about cancer etiology risk factors, treatment, psychological and physical effects, and coping. Exercise, relaxation training, qigong, and art therapy were also included. The intervention was provided for one week and, two months later, for another four days. Study measures were obtained at baseline, 2 months, 6 months, and 12 months.

• The sample was composed of 41 participants.
• The range of mean patient age was 56–69 years.
• Males: 0 %; females: 100%.
• Participants were patients with breast cancer.
• Most patients were receiving chemotherapy and radiation therapy.
   

• Single site
• Outpatient
• Vasteras Hospital, Sweden
   

Phase of care: transition phase after initial treatment

Randomized controlled trial

• Hospital Anxiety and Depression Scale    
• Norwegian Fatigue Questionnaire
• Immune analysis
   

• Results revealed no significant immune effect from support intervention.
• More patients in the support group had higher anxiety scores at the start of the intervention than did patients in the nonsupport group.
• The mean value of anxiety in the support group was higher than that in the nonsupport group, and the value improved significantly over time.
• Patients in both groups had low levels of depression, with no significant difference in depression scores.
• Patients in both groups had no significant difference in fatigue. The measure of fatigue decreased over time for all patients.
• No significant differences in study measures existed between groups.
   

The support intervention had no effect on depression or immune parameters. The intervention did not appear to cause any difference in improvement of anxiety and fatigue over time.

• The  study had a small sample size, with fewer than 100 participants.
• Participants had low depression scores at baseline.
• Authors did not specify how the intervention was provided—individually, in groups, in the home, or in some other setting. 
• The study had a risk of bias due to no blinding.

Findings do not support effectiveness of the intervention tested here. Results show that levels of depression, anxiety, and fatigue reduced significantly over time.