Women with early-stage breast cancer who receive the usual care available in medical centers experience physical, emotional, and social adjustment over time without the additional interventions of standardized educational/supportive videotapes or individualized telephone counseling offered during each of the breast cancer stages.
Deborah Witt Sherman, PhD, CRNP,, a professor at the University of Maryland School of Nursing, led an intervention study that appears in the current issue of the journal Applied Nursing Research, to evaluate the effectiveness of educational and supportive videotapes and/or telephone counseling compared to usual (standard care) on the adjustment of women with early-stage breast cancer during the stages of diagnosis, post-surgery, adjuvant therapy, and ongoing recovery.
The researchers enrolled 249 patients with early stage breast cancer from three major medical centers and one community hospital in New York City. They randomly assigned the patients into four groups. All four received usual care consisting of inpatient care and office visits provided by the medical team, including their physician, and nursing staff.
In addition to the usual care group, another group of women received the standardized educational supportive videotapes specific to the stage of breast cancer they were experiencing. A third group received individualized telephone counseling specific to each stage. A fourth group received both the educational videotapes and telephone counseling.
The videotapes included interviews with women and their family members, as well as interviews with breast surgeons, oncologists, and nurse experts. Consistent with crisis and stress-coping theories that guided the study, the educational videotapes were created to provide information about what the patients can expect physically, emotionally, and socially during each stage of the breast cancer experience.
As the telephone counseling was individualized, each session helped women normalize their experience and offered guidance and counseling to address their specific needs. Sherman says the counseling sessions explored whether breast cancer was viewed as a threat or as a challenge by the patient, as well as what types of support were valued by women.
Some specific findings of the study include:
* Patients in all groups showed improvement over time in overall health, psychological well-being, and social adjustment.
* There were no significant group differences in physical adjustment, as measured by side effect incidence, severity, or overall health.
* There was poorer emotional adjustment over time in the usual care (control) group as compared to the intervention groups on the measure of side effect distress.
For the telephone counseling group, there was a marked decline in psychological well-being from the adjuvant therapy phase through the ongoing recovery phase.
As an exception, Sherman reported that women receiving usual care reported greater side effect distress when receiving chemotherapy or radiation than did women who received educational or telephone support. In contrast to expectations, women receiving telephone counseling alone had a marked decline in psychological well-being during the adjuvant therapy through the ongoing recovery phase.
The researchers proposed that although personal discussion regarding the cancer experience may provide an outlet for women to discuss their concerns, it may not allow the opportunity to move health-related concerns into the background. Sherman suggests, "Maybe ongoing conversations about negative experiences keeps opening the wound rather than letting it heal."
The researchers learned that adjustment issues continue for women during the ongoing recovery phase when all medical treatments have been completed. A small group of women in the study did not adjust well whether receiving usual care or extra interventions.
The findings have significant implications regarding the process of breast cancer survivorship, says Sherman. More research is needed to understand the long-term physical, emotional, and social issues experienced by women as they enter the phase termed "survivorship" and the ongoing process of healing and adjustment, she says.
"Clearly, adjustment to breast cancer does not end with the completion of medical treatment, as some women continue to live with physical and emotional symptoms and experience uncertainty about their future.The good news is that the comprehensive support offered today as the standard of care, and most likely the opportunity for women to obtain support through the Internet and various support groups, is enough to promote breast cancer adjustment with or without additional interventions," Sherman says.
The study was conducted by researchers at the University of Maryland School of Nursing, the College of Nursing at New York University (NYU), NYU Hospital Centers, Biomedical Statistical Consulting at NYU, the NYU University Cancer Center, and Novartis Pharmaceuticals.