Rissanen, R., Arving, C., Ahlgren, J., & Nordin, K. (2014). Group versus individual stress management intervention in breast cancer patients for fatigue and emotional reactivity: A randomised intervention study. Acta Oncologica, 53, 1221–1229. 

To evaluate if stress management delivered in group or individual settings improved fatigue and emotional reactivity among newly diagnosed patients with breast cancer

Group stress management (GSM) consisted of 10 two-hour sessions over three months. Homework was assigned between sessions and discussed in the group. Sessions were cognitive behavioral (CBT) therapy-based with specific subjects: introduction to stress and stress response, negative thoughts and stress behavior, irritability and anger, quality of life, expectations of life, reactions to a cancer diagnosis, sexuality, and recapturing. Individual stress management (ISM) consisted of four to eight one-hour sessions over four and a half months using the same subjects from thee GSM group. Subjects were offered additional sessions as needed. Subjects also were given homework assignments between sessions. Both groups were led by a nurse trained in the intervention, which was also manual-based.

• N = 155 included in analysis  
• MEAN AGE = 57 (GSM), 58 (ISM)
• FEMALES = 100%
• KEY DISEASE CHARACTERISTICS: Stages I–III patients with breast cancer who received surgery and were about to receive chemotherapy, radiation, or hormonal therapy. In the GSM group, 54 patients received resection and 21 received a mastectomy. In the ISM group, 45 patients received resection and 32 received a mastectomy. For adjuvant treatment in the GSM group, 49 patients were to receive chemotherapy, 59 were to receive radiation, and 39 were to receive hormonal therapy. For adjuvant treatment in the ISM group, 40 patients were to receive chemotherapy, 55 were to receive radiation, and 45 to receive hormonal therapy.

• SITE: Multi-site    
• SETTING TYPE: Multiple settings    
• LOCATION: Falun, Gavle, and Uppsala hospitals

• PHASE OF CARE: Active antitumor treatment

Nonblinded, randomized, controlled trial that was randomized at three-month timepoints after enrollment if cutoff scores on the Hospital Anxiety and Depression Scale or the Impact of Events Scale were met or were higher

• Multidimensional Fatigue Inventory (MFI-20)
• Everyday Life Stress Scale (ELSS)  
• Demographics and medical information also collected

At the three-month evaluation, 304 women met eligibility requirements for randomization and 149 declined. Forty-two of 77 (52%) women who were randomized to the GSM group attended group sessions and completed an average nine of 10 sessions. Seventy-one of 78 women who were randomized to the ISM group completed an average of five of eight sessions. Those who declined participation in both groups reported significantly less activity. Results were compared at 12 months to three months. There were no significant changes over time and no significant changes between the GSM and ISM groups on fatigue or emotional reactivity. There was no significant difference over time in MFI-20 or ELSS scores. Thirty-one percent of participants who refused participation cited a lack of distress as the reason.

This study demonstrated no significant improvement in fatigue for patients breast cancer who participated in a CBT-based group or an individual intervention.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Subject withdrawals ≥ 10%

The willingness of patients to participate in group interventions should be considered when developing such programs.