Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial.

BACKGROUND: Research has shown that self-directed stress management training improves mental well-being in patients undergoing chemotherapy. The present study extends this work by evaluating separate and combined effects of stress management training and home-based exercise. METHOD: Following assessment of mental and physical well-being, depression, anxiety, exercise, and stress reduction activity before chemotherapy started, patients were randomized to stress management training (SM), exercise (EX), combined stress management and exercise (SMEX), or usual care only (UCO). Outcomes were reassessed 6 and 12 weeks after chemotherapy started. Significance testing of group-by-time interactions in 286 patients who completed all assessments was used to evaluate intervention efficacy. RESULTS: Interaction effects for mental and physical well-being scores were not significant. Depression scores yielded a linear interaction comparing UCO and SMEX (p = 0.019), with decreases in SMEX but not UCO. Anxiety scores yielded a quadratic interaction comparing UCO and SMEX (p = 0.049), with trends for changes in SMEX but not UCO. Additional analyses yielded quadratic interactions for exercise activity comparing UCO and SMEX (p = 0.022), with positive changes in SMEX but not UCO, and for stress management activity comparing UCO and SM (p < 0.001) and UCO and SMEX (p = 0.013), with positive changes in SM and SMEX but not UCO. CONCLUSION: Only the combined intervention yielded effects on quality of life outcomes, and these were limited to anxiety and depression. These findings are consistent with evidence that only the combined intervention yielded increases in both exercise and stress management activity. Future research should investigate ways to augment this intervention to enhance its benefits.

Pilot study of a self-administered stress management and exercise intervention during chemotherapy for cancer.

GOALS OF WORK: This pilot project explored the feasibility, safety, and effectiveness of a self-administered exercise and stress management intervention for cancer patients receiving chemotherapy. PATIENTS AND METHODS: Thirty-nine of 56 eligible patients (acceptance =69%) with a variety of solid tumors volunteered for the study. Participants were advised to exercise 20-40 min at 50-75% estimated heart rate reserve 3-5 times per week. In addition, patients were provided with instruction and written materials regarding stress management techniques. Follow-up data were collected during regularly scheduled outpatient visits at the start of the second, third, and fourth chemotherapy cycles using diary entries and the same questionnaires previously administered at baseline. MAIN RESULTS: Twenty-four of 39 patients (62%) completed all study requirements. These participants completed 438 of the 678 exercise sessions assigned (adherence =62%). Of the stress management techniques, positive thinking most practiced most frequently (48%), followed by deep breathing (38%) and active relaxation (37%). Paired t tests, comparing baseline values with final recorded values, indicated a significant improvement over time in bodily pain (p<0.03) and mental health (p<0.04) subscale scores. Participants' evaluations of the combined intervention were favorable: 90% felt it was helpful to them and 100% would recommend it to another patient. CONCLUSIONS: A self-administered intervention combining aerobic exercise and stress management was acceptable and safe for cancer patients receiving chemotherapy. Preliminary data demonstrating intervention efficacy should be confirmed in subsequent randomized clinical trials.

Comparison of 2 quality-of-life questionnaires in women treated for breast cancer: the RAND 36-Item Health Survey and the Functional Living Index-Cancer.

BACKGROUND AND PURPOSE: A variety of health status questionnaires have been used in physical rehabilitation studies involving women with breast cancer, but the usefulness of these questionnaires as measures of physical, mental, and social well-being has not been firmly established in this population. This study was conducted to assess the convergent and discriminative properties of the RAND 36-Item Health Survey and the Functional Living Index-Cancer (FLIC). SUBJECTS: Both questionnaires were administered concurrently to 110 outpatients treated surgically for breast cancer at a National Cancer Institute-designated Comprehensive Cancer Center. METHODS: Bivariate correlations and a multi-trait-multi-method matrix were used to evaluate convergent validity between summary and subscale scores from both questionnaires. Discriminative validity was assessed by testing for expected differences between women who were treated for breast cancer with and without secondary lymphedema. RESULTS: Correlations between overall quality-of-life scores produced by both questionnaires were modest, indicating that the instruments focus on somewhat different aspects of health-related quality of life. Global quality-of-life and physical well-being scores were lower among women with lymphedema secondary to breast cancer. The FLIC demonstrated greater sensitivity to group differences in emotional well-being. DISCUSSION AND CONCLUSION: The results suggest that neither questionnaire can be replaced by the other in studies of women treated for breast cancer. Both questionnaires were able to distinguish physical functioning deficits in women with lymphedema secondary to breast cancer, but symptom- or treatment-specific measures may be required to assess more subtle difficulties related to the emotional aspects of health and functioning in this population.