Psychosocial interventions

Psychological distress is frequently reported by patients diagnosed with cancer. Psychological symptoms including depression, anxiety, and anger have been reported in 70% of cancer patient populations (Telch and Telch 1986; Derogatis 1986). These cognitions can alter their perceptions of, and reactions to, both their symptoms and any side-effects of their treatment and can tax their ability to cope with them. Patients frequently find their symptoms distressing, yet symptom distress is often underestimated by nurses caring for them (Vogelzang et al. 1997; Tanghe et al. 1998). Low mood is not only correlated with fatigue in patients with cancer (Richardson 1995;Blesch et al. 1991) but in patients with other chronic diseases (Ream and Richardson 1997) and it can impinge on their ability to perform self-care activities for its relief.

A number of psychological interventions have been implemented to relieve patients' psychological reactions to cancer, and these have been evaluated in literature reviews (Watson 1983; Trijsburg et al. 1992; Burish and Tope 1992) and meta-analyses (Smith et al. 1994; Devine and Westlake 1995). These interventions were not aimed specifically at reducing fatigue, but they resulted in higher energy levels and reduced feelings of tiredness. Forester et al. (1985) evaluated weekly individual psychotherapy sessions for patients receiving radiotherapy and reported significantly reduced emotional and physical symptoms, including fatigue. They proposed that this serendipitous finding occurred either because symptoms like fatigue are essentially of emotional origin, or because emotional state influences perception and reporting of them.

Trijsburg et al. (1992) evaluated 22 studies in a review exploring the effectiveness of psychological treatment for populations with cancer. This review concluded that 'tailored counselling', where counselling and support were provided according to patients' needs, was effective not only for the reduction of distress and the enhancement of self-concept, but also for the reduction of fatigue. A further review (Burish and Tope 1992), exploring a decade of research examining the role of progressive muscle relaxation training (PMRT) in the control of the adverse side-effects of chemotherapy, also concluded that this form of psychosocial intervention can be effective in not only reducing the distress of chemotherapy but also the distress of symptoms including fatigue. This has also been evident in research evaluating group psychiatric support for cancer patients (Spiegel et al. 1981; Fawzy et al. 1990) where the experimental group has shown significantly less depression and fatigue, and significantly greater vigour, than patients in the control group. However, Watson (1983) was more cautious following her review of psychosocial intervention with cancer patients. She suggests that psychological interventions may not be practical or suitable for all and thus a blanket service would be inappropriate. Furthermore, she advocates a selective service targeted at those at risk of psychological morbidity.

These psychosocial studies suggest unequivocally that psychological support should form one aspect of a programme for the management of fatigue. However, it does also raise the point that the programme should be tailored to the needs of individual patients, for otherwise it may prove ineffective. Through further testing of the relationship between mental affect and fatigue, the mechanism associating them will become better understood, furthering understanding of the manifestation of fatigue and the role that psychosocial interventions may play in its management.

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