Moving Beyond Cancer-NCI

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Moving Beyond Cancer

Living with a diagnosis of cancer is recognised as challenge at the physical, psychological, economic, family, society and spiritual levels. This recognition of the needs has resulted in a number of programmes to support the survivors.
An effort by the National Cancer Institute is noteworthy for the exploration of the different methods of intervention and their evaluation.
National Cancer Institute (NCI) reported its results(JOURNAL OF CLINICAL ONCOLOGY, SEPTEMBER 2005)on psychosocial interventions for breast cancer survivors.

The central the message to the cancer survivors is

“when treatment ends, you may expect life to return to the way it was beforeyou were diagnosed with cancer. But it can take time to recover”.

The brief intervention to help the survivors is to be adaptive for the long-term survivorship.

The Moving Beyond Cancer trial had three arms involving a control group, peer-modelling videotape and two educational sessions.

Breast cancer patients were registered within 6 weeks after surgery. After medical treatment,they completed baseline measures and were randomly assigned to standard National Cancer Institute print material (CTL); standard print material and peer-modeling videotape (VID); or standard print material, videotape, two sessions with a trained cancer educator, and informational workbook (EDU). Two primary end points were examined: energy/fatigue and cancerspecific
distress. Secondary end points were depressive symptoms and post-traumatic growth. Perceived preparedness for re-entry was analyzed as a moderator of effects.

Of 558 women randomly assigned to treatment, 418 completed the 6-month assessment and 399 completed the 12-month assessment.

The control group received an email document on ‘Facing Forward – Life After Cancer Treatment’ published by NCI. This book was developed based on the experience of survivors on the practical ways of dealing with the problems and guidelines to managing their physical, social and emotional health. The manual was on suggestions for medical follow-up care, managing fatigue, memory, pain, menopausal symptoms, sexual issues, weight gain, lymphedema, neuropathy and coping emotional challenges.

The second group of women assigned to the videotape intervention received ‘Facing Forward – Life After Cancer Treatment’, as well as an author-developed and professionally filmed videotape entitled,Moving Beyond Cancer. This film addressed re-entry challenges in four life domains:

• physical health,
• emotional well-being,
• interpersonal relations, and
• life perspectives.
The film observes four breast cancer survivors as they describe their experience in each of the four domains, as well as active coping skills they used to meet associated challenges. The film also depicts an African American breast cancer support group in which the members discuss the experiences of re-entry and model active coping. It includes commentary by an oncologist expert in breast cancer (Susan Love,MD) on the re-entry experience and on active methods for approaching problems during re-entry.

The third group received counselling session conducted by trained cancer educators. Women reviewed their cancer-related concerns in the four life domains described previously, identified a primary concern and their associated goals, developed an approach-oriented action plan to address that concern (e.g., getting more information, seeking social support), and addressed barriers to their plan. At this session, they also were given the Moving Beyond Cancer videotape and an author-constructed manual. Conducted two weeks later by the same educator for individual participants and lasting approximately 30 minutes, the second telephone-delivered session was designed to focus on reactions to and questions on the videotape and manual, evaluate progress on and revise the action plan, and address a generalization of strategies to other re-entry challenges.

The result of the trial, the videotape intervention(Second group) had a significant effect over six months of intervention especially with regard to improvement in energy/fatigue. The benefit was particularly seen among women who felt least prepared for re-entry.

The value of these findings is highlighted by evidence that fatigue is the most common adverse effect of cancer treatment and causes significant impairment in emotional, social, and occupational function;facilitating recovery of energy is an important outcome for women who have completed treatment and are ready to resume their lives. This effect was achieved with a relatively minimal intervention that is easily delivered.

Being receptive to the new “normal” as a survivor, includes change of eating, doing things, using sources of support and medical care.However, there were no differences between the groups at the end of 12 months.

The study concludes:

‘A peer-modeling videotape can accelerate the recovery of energy during the re-entry phase in women treated for breast cancer, particularly among those who feel less prepared for re-entry’.

The Video can be accessed at:

http://www.cancer.gov/types/breast/moving-beyond-breast-cancer-video

The section on YOUR FEELING from Pages 36-48 covers the following topics:
Worrying About Your Health
Feeling Stress
Coping With Depression and Anxiety
Feeling Angry
Feeling Alone
Joining a Support Group
Finding Meaning After Cancer Treatment.
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Prepared by :
Ms.Annie Alexander,
St. John’s Medical College and Hospital,
Bangalore.

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