Gregoire, C., Bragard, I., Jerusalem, G., Etienne, A.M., Coucke, P., Dupuis, G., . . . Faymonville, M.E. (2017). Group interventions to reduce emotional distress and fatigue in breast cancer patients: A 9-month follow-up pragmatic trial. British Journal of Cancer, 117, 1442–1449.

To determine the long-term (nine months) effectiveness of three different group interventions compared to usual care for patients with breast cancer 

Participants were allowed to select one of three groups to receive either cognitive behavioral therapy, yoga, and self-hypnosis. People who declined to participate were in a control group. Measurements were taken T0 through T3 to include before and after the short-term interventions, at month 3, and at month 9 follow-up.

• N =123 total; 21 yoga, 67 self-hypnosis (after dropouts and one who died), 10 CBT, 24 control group 
• AGE: 27-73 across all groups 
• FEMALES: 100%
• CURRENT TREATMENT: Not applicable; mixed numbers of patients who had surgery, chemotherapy, radiation therapy, and hormonal therapy
• KEY DISEASE CHARACTERISTICS: Non-metastatic breast cancer; 18 months postdiagnosis 
• OTHER KEY SAMPLE CHARACTERISTICS: Inclusion criteria were at least 18 years old and can read, speak, and write French

• SITE: Not stated/unknown   
• SETTING TYPE: Not specified    
• LOCATION: Belgium

PHASE OF CARE: Multiple phases of care

Three group intervention self-selection; testing at T0, T1, T2 (month 3), T3 (month 9)

Demographics; medical history; Hospital Anxiety Depression Scale (anxiety and depression emotional distress); Quality of Life 30-item questionnaire (fatigue); Insomnia Severity Index (sleep quality)

Only results from baseline (T0) and the month 9 follow-up (T3) were reported using MANOVA with repeated analysis and post-hoc analysis. 

Post-hoc comparisons of time T0-T1: hypnosis group showed significant decreases in anxiety (p = 0.000), depression (p = 0.004), and fatigue (p = 0.045). Yoga group showed significant decrease in anxiety (p = 0.01). 

Post-hoc comparisons of time at T3: hypnosis group showed decreases in anxiety (p = 0.000), depression (p = 0.000), and fatigue (p = 0.002); yoga group showed decrease in anxiety (p = 0.024).

Self-hypnosis led to improvements in anxiety, depression, and fatigue. Anxiety improved in the yoga group. There were no improvements in the CBT or control groups.

• Small sample (< 100)
• Risk of bias (no random assignment)
• Other limitations/explanation: Control group included some of the non-consenters

Two of the three interventions may be helpful in reducing anxiety, depression, or fatigue when measured at nine months. Self-hypnosis may help patients improve emotional distress such as depression and anxiety, and may also reduce fatigue; yoga may also help improve anxiety. Larger samples and longer follow-up studies are needed.