Does Helping Patients with Cancer Manage Their Symptoms at Home Improve Their Quality of Life? [Internet]

Excerpt

Background: Cancer patients endure an average of 7 to 14 physical and emotional symptoms that can lead to depression, anxiety, and reduced quality of life (QOL). Improving their ability to self-manage symptoms can diminish suffering, improve QOL, and decrease emergency department visits.

Objective: This randomized clinical trial tested the efficacy of the COPE (Creativity, Optimism, Planning, Expert guidance) intervention with patients who reported moderate to severe symptoms while receiving cancer treatment.

Method: We randomized 534 outpatients in active treatment for any stage of cancer into 3 groups: (1) a control group that received usual care, (2) a supportive care control group that received 3 supportive nursing visits with the interventionists, and (3) a COPE intervention group that received 3 individual intervention sessions. During the first intervention visit, we taught the patients in the COPE group the COPE intervention focusing on each of their self-identified most bothersome symptoms. We used 2 subsequent visits and 2 telephone calls to reinforce the principles of COPE and help patients apply this approach to managing other symptoms. We collected patient self-reported data about symptoms (intensity, frequency, interference, appraisal of distress), self-efficacy, and barriers to self-management weekly for 10 weeks.

Patient Outcomes: We assessed the primary outcomes of QOL, anxiety, and depression at baseline and weeks 4, 8, and 10, and we assessed health services utilization at baseline and week 13. We predicted that the COPE group would show significant improvement in depression, anxiety, and QOL as well as utilization of health care resources during the past month as reported from beginning to end of the study compared with the 2 control groups. We examined symptom intensity, distress, self-efficacy, and symptom barriers as intermediate outcomes. We analyzed data using random-effects models and analysis of variance.

Results: The sample of 534 patients (group 1, n = 178; group 2, n = 184; group 3, n = 172) was predominantly White and had a variety of cancers. COPE showed no significant improvements in primary outcome variables of QOL, anxiety, or depression compared with the usual care and supportive care control groups. A decrease in an intermediate outcome (symptom intensity) over time was significantly greater in the COPE group compared with the usual care control group.

Conclusions: COPE had little beneficial effect on the primary outcomes of QOL, anxiety, and depression but significantly reduced symptom intensity. The primary outcome results might have occurred because patients were too overwhelmed to be able to focus on what they were being taught about self-management. In addition, our intervention was considerably shorter (3 sessions) than previous interventions that have demonstrated positive effects on similar variables with cancer patients. The briefer format might have delivered an insufficient dose of the intervention to improve QOL and emotional outlook.

Limitations and Subpopulation Considerations: The sample was largely White non-Hispanic individuals (88.1%), decreasing external validity. We did not test patient understanding of symptom management after the intervention, and it is possible that learning was insufficient to effect change. We also did not collect timing of intervention visits, so we could not assess the effect of intervention intervals on outcomes.