title: An integrated psychological strategy for advanced colorectal cancer patients.
abstract: BACKGROUND
  There is evidence regarding the usefulness of psychosocial intervention to improve health related quality of life (HRQOL) in adult cancer patients. The aim of this report is to describe an integrated approach and to evaluate its feasibility in routine clinical practice in 98 advanced colorectal cancer (ACC) patients during chronomodulated chemotherapy.
  
  
  METHODS
  A prospective non-randomised design was developed and applied in a cancer out-patient setting. The intervention consisted of an integrated approach, whereby the psycho-oncologist had an active role in the health care team with the physician and routinely included psychological understanding in the medical treatment program. The psychological evaluation assessed: a) adaptation, awareness, psychopathological disorders through a psychodynamic interview; b) anxiety and depression using the HAD scale; c) subjective perception of care quality through a structured interview and d) HRQOL evaluation assessment with the EORTC QLQ C30. Outcomes data were collected before and after 18 weeks of chemotherapy.
  
  
  RESULTS
  After 18 weeks of chemotherapy a significant improvement of adaptation and awareness was observed. The HADs results showed a significant decrease in anxiety when compared to pre-treatment. The structured interview showed a significant increase of patients who positively experienced the impact of medical treatment on HRQOL, anxiety, depression, interpersonal relationships, free-time and who positively experienced the care quality. Indeed, a majority of patients positively experienced the team relationship modality during the whole treatment. All scales on the EORTC questionnaire remained unchanged during the entire treatment.
  
  
  CONCLUSIONS
  Our results suggest that it is feasible to carry out an integrated approach during chemotherapy. These results seem to support the integrated approach as a tool in aiding advanced colorectal cancer patients' ability to cope with their diagnosis and treatment although an appropriately designed study is required to confirm this.
authors.affiliation: Service of Psychology, Regina Elena Cancer Institute, Via Elio Chianesi, 53, 00144 Rome, Italy. pugliese@ifo.it
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pugliese
authors.forename: Maria
authors.initials: M
authors.lastname: Perrone
authors.forename: Enrica
authors.initials: E
authors.lastname: Nisi
authors.forename: Carlo
authors.initials: C
authors.lastname: Garufi
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.forename: Andrew
authors.initials: A
authors.lastname: Bottomley
authors.forename: Edmondo
authors.initials: E
authors.lastname: Terzoli
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D001007:Anxiety; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007260:Infusion Pumps; D007407:Interviews as Topic; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010043:Outcome and Process Assessment, Health Care; D000077150:Oxaliplatin; D010348:Patient Care Team; D011446:Prospective Studies; D011586:Psychology, Clinical; D011788:Quality of Life; D012384:Rome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil