To evaluate the feasibility of a patient-controlled cognitive-behavioral intervention for pain, fatigue, and sleep disturbance during treatment for advanced cancer, and to assess initial efficacy of the intervention in controlling symptoms.
One-group pretest-posttest design.
Outpatient oncology clinics at a Comprehensive Cancer Center in the Midwestern United States.
30 adults with advanced (recurrent or metastatic) colorectal, lung, prostate, or GYN cancer receiving chemotherapy or radiotherapy.
Participants completed baseline measures (demographics, symptom inventory) and received education and training to use an MP3 player loaded with 12 cognitive-behavioral strategies (e.g., relaxation exercises, guided imagery, nature sound recordings). Participants used the strategies as needed for symptom management over the following 2-weeks, keeping a log of symptom ratings with each use. Following the two-week intervention, participants completed a second symptom inventory and an evaluation of the intervention.
Main Research Variables
Feasibility, patient-controlled cognitive-behavioral intervention, pain, fatigue, sleep disturbance.
73% of the 43 eligible patients agreed to participate (N=30) and of these, 90% (n=27) completed the study. The majority of participants reported that they enjoyed the intervention, had learned useful skills, and perceived improvement in their symptoms. Symptom scores at 2-weeks did not differ significantly from baseline, however significant reductions in pain, fatigue, and sleep disturbance severity were found in ratings made immediately before and after use of a cognitive-behavioral strategy.
The patient-controlled cognitive-behavioral intervention appears feasible for further study and could reduce day-to-day severity of co-occurring pain, fatigue, and sleep disturbance.
Implications for Nursing
A randomized controlled trial is necessary to test efficacy of the intervention for co-occurring pain, fatigue, and sleep disturbance. In the mean time, based on previous efficacy studies, cognitive-behavioral strategies can be recommended for certain individual symptoms.