Early rehabilitation of cancer patients – an individual randomized stepped-care stress-management intervention
Mené en Norvège sur 291 patients atteints de cancer et souffrant de réactions de stress face à la maladie (intrusions, évitement à l'effraction traumatique), d'une détresse psychologique (anxiété, dépression) ou d'une réactivité émotionnelle (impatience, hostilité), cet essai randomisé évalue l'efficacité d'une intervention individuelle de prise en charge du stress en deux étapes, et utilisant les techniques d'une psychothérapie comportementale
Objective : To evaluate the effects of an individual stepped-care stress-management intervention for cancer patients on cancer-related stress reactions (intrusion/avoidance), and secondarily on psychological distress (anxiety/depression) and emotional reactivity (impatience/hostility). Methods : Consecutively 291 cancer patients were included in a randomized controlled intervention study. Patients randomized to the intervention who did not report clinically significant stress levels (n=72) after the first counselling session participated in only one counselling session and a follow-up (Step 1). The remaining patients (n=66) received an additional 3-8 sessions, depending on individual needs (Step 2). The intervention used techniques derived from cognitive behavioral therapy (CBT) such as daily registration of events and behaviors as well as scheduled behavioral and physical activity, along with short relaxation exercises. The intervention was completed within 26 weeks of inclusion. The Impact of Event Scale, Hospital Anxiety and Depression Scale, and Everyday Life Stress Scale were used to evaluate effects for two years. Results : The linear mixed effects model analysis showed a difference between the randomization groups in favor of the intervention for avoidance and intrusion after the first six weeks (p=0.001 and p=0.003) and for emotional reactivity after 17 weeks (p=0.007). There were no differences in psychological distress. Decreases in cancer-related stress reactions and depression were noted for the Step 2 intervention. Conclusions : An individual stepped-care stress-management intervention for cancer patients, performed by specially educated health professionals using techniques derived from CBT, seems beneficial for cancer patients and may therefore be a realistic complement to routine cancer care.
Psycho-Oncology 2018