Search tips
Search criteria 


Logo of bmjLink to Publisher's site
BMJ. 1992 March 14; 304(6828): 675–680.
PMCID: PMC1881503

Adjuvant psychological therapy for patients with cancer: a prospective randomised trial.


OBJECTIVE--To determine the effect of adjuvant psychological therapy on the quality of life of patients with cancer. DESIGN--Prospective randomised controlled trial comparing the quality of life of patients receiving psychological therapy with that of patients receiving no therapy, measured before therapy, at eight weeks, and at four months of follow up. SETTING--CRC Psychological Medicine Group of Royal Marsden Hospital. PATIENTS--174 patients aged 18-74 attending hospital with a confirmed diagnosis of malignant disease, a life expectancy of at least 12 months, or scores on various measures of psychological morbidity above previously defined cut off points. INTERVENTION--Adjuvant psychological therapy, a brief, problem focused, cognitive-behavioural treatment programme specifically designed for the needs of individual cancer patients. MAIN OUTCOME MEASURES--Hospital anxiety and depression scale, mental adjustment to cancer scale, Rotterdam symptom checklist, psychosocial adjustment to illness scale. RESULTS--156 (90%) patients completed the eight week trial; follow up data at four months were obtained for 137 patients (79%). At eight weeks, patients receiving therapy had significantly higher scores than control patients on fighting spirit and significantly lower scores on helplessness, anxious preoccupation, and fatalism; anxiety; psychological symptoms; and on orientation towards health care. These differences indicated improvement in each case. At four months, patients receiving therapy had significantly lower scores than controls on anxiety; psychological symptoms; and psychological distress. Clinically, the proportion of severely anxious patients dropped from 46% at baseline to 20% at eight weeks and 20% at four months in the therapy group and from 48% to 41% and to 43% respectively among controls. The proportion of patients with depression was 40% at baseline, 13% at eight weeks, and 18% at four months in the therapy group and 30%, 29%, and 23% respectively in controls. CONCLUSIONS--Adjuvant psychological therapy produces significant improvement in various measures of psychological distress among cancer patients. The effect of therapy observed at eight weeks persists in some but not all measures at four month follow up.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Hughes JE. Psychological and social consequences of cancer. Cancer Surv. 1987;6(3):455–475. [PubMed]
  • Maguire P, Tait A, Brooke M, Thomas C, Sellwood R. Effect of counselling on the psychiatric morbidity associated with mastectomy. Br Med J. 1980 Nov 29;281(6253):1454–1456. [PMC free article] [PubMed]
  • Spiegel D, Bloom JR, Yalom I. Group support for patients with metastatic cancer. A randomized outcome study. Arch Gen Psychiatry. 1981 May;38(5):527–533. [PubMed]
  • Linn MW, Linn BS, Harris R. Effects of counseling for late stage cancer patients. Cancer. 1982 Mar 1;49(5):1048–1055. [PubMed]
  • Telch CF, Telch MJ. Group coping skills instruction and supportive group therapy for cancer patients: a comparison of strategies. J Consult Clin Psychol. 1986 Dec;54(6):802–808. [PubMed]
  • Cain EN, Kohorn EI, Quinlan DM, Latimer K, Schwartz PE. Psychosocial benefits of a cancer support group. Cancer. 1986 Jan 1;57(1):183–189. [PubMed]
  • Bridge LR, Benson P, Pietroni PC, Priest RG. Relaxation and imagery in the treatment of breast cancer. BMJ. 1988 Nov 5;297(6657):1169–1172. [PMC free article] [PubMed]
  • Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. [PubMed]
  • Greer S, Watson M. Mental adjustment to cancer: its measurement and prognostic importance. Cancer Surv. 1987;6(3):439–453. [PubMed]
  • Watson M, Greer S, Young J, Inayat Q, Burgess C, Robertson B. Development of a questionnaire measure of adjustment to cancer: the MAC scale. Psychol Med. 1988 Feb;18(1):203–209. [PubMed]
  • de Haes JC, van Knippenberg FC, Neijt JP. Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist. Br J Cancer. 1990 Dec;62(6):1034–1038. [PMC free article] [PubMed]
  • Greer S, Moorey S, Baruch J. Evaluation of adjuvant psychological therapy for clinically referred cancer patients. Br J Cancer. 1991 Feb;63(2):257–260. [PMC free article] [PubMed]
  • Ford MF, Jones M, Scannell T, Powell A, Coombes RC, Evans C. Is group psychotherapy feasible for oncology outpatients attenders selected on the basis of psychological morbidity? Br J Cancer. 1990 Oct;62(4):624–626. [PMC free article] [PubMed]
  • Baider L, Amikam JC, De-Nour AK. Time-limited thematic group with post-mastectomy patients. J Psychosom Res. 1984;28(4):323–330. [PubMed]
  • Bridge LR, Benson P, Pietroni PC, Priest RG. Relaxation and imagery in the treatment of breast cancer. BMJ. 1988 Nov 5;297(6657):1169–1172. [PMC free article] [PubMed]
  • Sensky T, Dennehy M, Gilbert A, Begent R, Newlands E, Rustin G, Thompson C. Physicians' perceptions of anxiety and depression among their outpatients: relationships with patients and doctors' satisfaction with their interviews. J R Coll Physicians Lond. 1989 Jan;23(1):33–38. [PubMed]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Group