title: A cognitive behavioral intervention for symptom management in patients with advanced cancer.
abstract: OBJECTIVE
  To evaluate the effectiveness of a cognitive behavioral intervention in decreasing symptom severity in patients with advanced cancer undergoing chemotherapy.
  
  
  METHODS
  Prospective, randomized clinical trial based on cognitive behavioral theory.
  
  
  METHODS
  Six urban cancer centers in the midwestern United States.
  
  
  METHODS
  124 patients 21 years of age or older were recruited and randomized to receive conventional care or conventional care and an intervention. Participants were newly diagnosed with stage III, stage IV, or recurrent cancer (solid tumor or non-Hodgkin lymphoma), undergoing chemotherapy, cognitively intact, and able to read and speak English.
  
  
  METHODS
  Data were gathered via telephone interviews at baseline and 10 and 20 weeks after randomization. Nurses with experience in oncology delivered a five-contact, eight-week intervention aimed at teaching patients problem-solving techniques to affect symptom severity.
  
  
  METHODS
  Gender, site of cancer, age, symptom severity and depressive symptoms at baseline, group (i.e., experimental versus control), and total symptom severity.
  
  
  RESULTS
  Patients in the experimental group and those with lower symptom severity at baseline had significantly lower symptom severity at 10 and 20 weeks; the experimental difference at 20 weeks occurred primarily in those 60 years of age and younger. Depressive symptoms at baseline predicted symptom severity at 20 weeks; however, age, gender, and site of cancer did not affect symptom severity at either time point.
  
  
  CONCLUSIONS
  A cognitive behavioral intervention to teach problem-solving skills can be effective for patient symptom self-management during and following an intervention.
  
  
  CONCLUSIONS
  Problem-solving strategies should be included in educational programs for patients with advanced cancer, particularly those 60 years of age and younger.
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA. prs11@pitt.edu
authors.forename: Paula
authors.initials: P
authors.lastname: Sherwood
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Given
authors.forename: Charles W
authors.initials: CW
authors.lastname: Given
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Champion
authors.forename: Ardith Z
authors.initials: AZ
authors.lastname: Doorenbos
authors.forename: Faouzi
authors.initials: F
authors.lastname: Azzouz
authors.forename: Sharon
authors.initials: S
authors.lastname: Kozachik
authors.forename: Kim
authors.initials: K
authors.lastname: Wagler-Ziner
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Monahan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005221:Fatigue / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology / Q000517:prevention & control; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents