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Usual counseling adequate during early breast cancer

Monday March 12, 2012
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Women with early-stage breast cancer who receive the usual care available in medical centers experience physical, emotional and social adjustment over time without additional interventions of standardized educational and supportive videotapes or individualized telephone counseling offered during each of the breast cancer stages, according to a study led by by nurse researchers.

Deborah Witt Sherman, RN, PhD, CRNP, ANP-BC, ACHPN, FAAN, professor at the University of Maryland School of Nursing, led a study to evaluate the effectiveness of educational and supportive videotapes and/or telephone counseling compared to usual care on the adjustment of women with early-stage breast cancer during the stages of diagnosis, post-surgery, adjuvant therapy and ongoing recovery.

Patients in all groups showed improvement over time in overall health, psychological well-being and social adjustment. There were no significant differences in physical adjustment as measured by side effect incidence or severity, or overall health.

However, there was poorer emotional adjustment over time in the control group compared to the intervention groups on the measure of side effect distress.

For the telephone counseling group, in contrast to expectations going into the study, the researchers found a marked decline in psychological well-being from the adjuvant therapy phase 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. "Maybe ongoing conversations about negative experiences keep opening the wound rather than letting it heal," Sherman said in a news release from the University of Maryland.

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.

Those findings have significant implications regarding the process of breast cancer survivorship, Sherman said. 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 said: "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, Sherman said, 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.

Methodology

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.

One group of women also received standardized educational and 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 received both the educational videotapes and telephone counseling.

The videotapes included interviews with women and their family members, and 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.

Individualized telephone counseling sessions helped women normalize their experiences and offered guidance and counseling to address their specific needs. Sherman said 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.

The study was conducted by researchers at the University of Maryland School of Nursing, the College of Nursing at New York University, NYU Hospital Centers, Biomedical Statistical Consulting at NYU, the NYU University Cancer Center and Novartis Pharmaceuticals.

It appeared in the February issue of Applied Nursing Research. To read it, visit http://bit.ly/w0Uqhc.


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