Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-08T14:33:10.408Z Has data issue: false hasContentIssue false

A cognitive–existential intervention to improve existential and global quality of life in cancer patients: A pilot study

Published online by Cambridge University Press:  22 July 2014

Pierre Gagnon*
Affiliation:
Faculty of Pharmacy, Laval University, Québec City, Quebec, Canada Department of Psychiatry, CHU de Québec – L'Hôtel-Dieu de Québec, Québec City, Quebec, Canada Équipe de recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs, Research Center, Oncology Division, CHU de Québec – L'Hôtel-Dieu de Québec, Québec City, Quebec, Canada Laval University Cancer Research Center, Québec City, Quebec, Canada
Lise Fillion
Affiliation:
Équipe de recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs, Research Center, Oncology Division, CHU de Québec – L'Hôtel-Dieu de Québec, Québec City, Quebec, Canada Laval University Cancer Research Center, Québec City, Quebec, Canada Faculty of Nursing, Laval University, Québec City, Quebec, Canada
Marie-Anik Robitaille
Affiliation:
Équipe de recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs, Research Center, Oncology Division, CHU de Québec – L'Hôtel-Dieu de Québec, Québec City, Quebec, Canada Laval University Cancer Research Center, Québec City, Quebec, Canada
Michèle Girard
Affiliation:
Department of Palliative Care, CHU de Québec – L'Hôtel-Dieu de Québec, Québec City, Quebec, Canada
François Tardif
Affiliation:
Équipe de recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs, Research Center, Oncology Division, CHU de Québec – L'Hôtel-Dieu de Québec, Québec City, Quebec, Canada Laval University Cancer Research Center, Québec City, Quebec, Canada
Jean-Philippe Cochrane
Affiliation:
Équipe de recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs, Research Center, Oncology Division, CHU de Québec – L'Hôtel-Dieu de Québec, Québec City, Quebec, Canada Laval University Cancer Research Center, Québec City, Quebec, Canada School of Psychology, Laval University, Québec city, Quebec, Canada
Joanie Le Moignan Moreau
Affiliation:
Équipe de recherche Michel-Sarrazin en Oncologie psychosociale et Soins palliatifs, Research Center, Oncology Division, CHU de Québec – L'Hôtel-Dieu de Québec, Québec City, Quebec, Canada Laval University Cancer Research Center, Québec City, Quebec, Canada
William Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York
*
Address correspondence and reprint requests to: Pierre Gagnon, CHU de Québec – L'Hôtel-Dieu de Québec, 11 Côte du Palais, Quebec City, Province of Quebec, Canada, G1R 2J6. E-mail: [email protected]

Abstract

Objective:

We developed a specific cognitive–existential intervention to improve existential distress in nonmetastatic cancer patients. The present study reports the feasibility of implementing and evaluating this intervention, which involved 12 weekly sessions in both individual and group formats, and explores the efficacy of the intervention on existential and global quality of life (QoL) measures.

Method:

Some 33 nonmetastatic cancer patients were randomized between the group intervention, the individual intervention, and the usual condition of care. Evaluation of the intervention on the existential and global QoL of patients was performed using the existential well-being subscale and the global scale of the McGill Quality of Life (MQoL) Questionnaire.

Results:

All participants agreed that their participation in the program helped them deal with their illness and their personal life. Some 88.9% of participants agreed that this program should be proposed for all cancer patients, and 94.5% agreed that this intervention helped them to reflect on the meaning of their life. At post-intervention, both existential and psychological QoL improved in the group intervention versus usual care (p = 0.086 and 0.077, respectively). At the three-month follow-up, global and psychological QoL improved in the individual intervention versus usual care (p = 0.056 and 0.047, respectively).

Significance of results:

This pilot study confirms the relevance of the intervention and the feasibility of the recruitment and randomization processes. The data strongly suggest a potential efficacy of the intervention for existential and global quality of life, which will have to be confirmed in a larger study.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aaronson, N.K., Ahmedzai, S., Bergman, B., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ–C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365376.Google Scholar
Andersen, B.L. (1992). Psychological interventions for cancer patients to enhance the quality of life. Journal of Consulting and Clinical Psychology, 60(4), 552568.Google Scholar
Breitbart, W. (2002). Spirituality and meaning in supportive care: Spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer, 10(4), 272280.Google Scholar
Breitbart, W., Gibson, C., Poppito, S.R., et al. (2004). Psychotherapeutic interventions at the end of life: A focus on meaning and spirituality. Canadian Journal of Psychiatry, 49(6), 366372.CrossRefGoogle ScholarPubMed
Breitbart, W., Rosenfeld, B., Gibson, C., et al. (2010). Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-Oncology, 19(1), 2128.Google Scholar
Chochinov, H.M. (2000). Psychiatry and terminal illness. Canadian Journal of Psychiatry, 45(2), 143150.Google Scholar
Chochinov, H.M., Hack, T., Hassard, T., et al. (2005). Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology, 23(24), 55205525.Google Scholar
Classen, C., Butler, L.D., Koopman, C., et al. (2001). Supportive–expressive group therapy and distress in patients with metastatic breast cancer: A randomized clinical intervention trial. Archives of General Psychiatry, 58(5), 494501.Google Scholar
Classen, C.C., Kraemer, H.C., Blasey, C., et al. (2008). Supportive–expressive group therapy for primary breast cancer patients: A randomized prospective multicenter trial. Psycho-Oncology, 17(5), 438447.Google Scholar
Cohen, S.R., Mount, B.M., Strobel, M.G., et al. (1995). The McGill Quality of Life Questionnaire: A measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliative Medicine, 9(3), 207219.Google Scholar
Cohen, S.R., Mount, B.M., Bruera, E., et al. (1997). Validity of the McGill Quality of Life Questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine, 11(1), 320.Google Scholar
Cole, B. & Pargament, K. (1999). Re-creating your life: A spiritual/psychotherapeutic intervention for people diagnosed with cancer. Psycho-Oncology, 8(5), 395407.Google Scholar
Cunningham, A.J. (2002). Bringing spirituality into your healing journey. Toronto, Ontario: Key Porter Books.Google Scholar
Cunningham, A.J. (2005). Integrating spirituality into a group psychological therapy program for cancer patients. Integrative Cancer Therapies, 4(2), 178186.Google Scholar
Cunningham, A.J., Edmonds, C.V., Jenkins, G.P., et al. (1998). A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer. Psycho-Oncology, 7(6), 508517.Google Scholar
Cunningham, A.J., Edmonds, C.V., Phillips, C., et al. (2000). A prospective, longitudinal study of the relationship of psychological work to duration of survival in patients with metastatic cancer. Psycho-Oncology, 9(4), 323339.Google Scholar
Edmonds, C.V., Lockwood, G.A. & Cunningham, A.J. (1999). Psychological response to long-term group therapy: A randomized trial with metastatic breast cancer patients. Psycho-Oncology, 8(1), 7491.Google Scholar
Edwards, A.G., Hailey, S. & Maxwell, M. (2004). Psychological interventions for women with metastatic breast cancer. Cochrane Database of Systematic Reviews, (3). doi: 1002/14651858.CD004253.pub3.Google Scholar
Fawzy, N.W. (1995). A psychoeducational nursing intervention to enhance coping and affective state in newly diagnosed malignant melanoma patients. Cancer Nursing, 18(6), 427438.Google Scholar
Fawzy, F.I. & Fawzy, N.W. (1998). Group therapy in the cancer setting. Journal of Psychosomatic Research, 45(3), 191200.Google Scholar
Fawzy, F.I., Fawzy, N.W., Arndt, L.A., et al. (1995). Critical review of psychosocial interventions in cancer care. Archives of General Psychiatry, 52(2), 100113.Google Scholar
Fekete, E.M., Antoni, M.H. & Schneiderman, N. (2007). Psychosocial and behavioral interventions for chronic medical conditions. Current Opinions in Psychiatry, 20(2), 152157.Google Scholar
Fillion, L., Dupuis, R., Tremblay, I., et al. (2006). Enhancing meaning in palliative care practice: A meaning-centered intervention to promote job satisfaction. Palliative & Supportive Care, 4(4), 333344.Google Scholar
Frankl, V.E. (1997). Man's search for meaning. New York: Washington Square Press.Google Scholar
Gagnon, P., Girard, M., Fillion, L., et al. (2008). La recherche de sens à la suite d'un diagnostic de cancer: Une intervention pour améliorer la qualité de vie existentielle et globale. Les Cahiers Francophones de Soins Palliatifs, 9(1), 5769.Google Scholar
Goodwin, P.J. (2004). Support groups in breast cancer: When a negative result is positive. Journal of Clinical Oncology, 22(21), 42444246.Google Scholar
Goodwin, P.J., Leszcz, M., Ennis, M., et al. (2001). The effect of group psychosocial support on survival in metastatic breast cancer. The New England Journal of Medicine, 345(24), 17191726.Google Scholar
Hellman, C.J., Budd, M., Borysenko, J., et al. (1990). A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints. Behavioral Medicine, 16(4), 165173.Google Scholar
Jacobsen, P.B. & Hann, D.M. (1998). Cognitive–behavioral interventions. In Psycho-Oncology. Holland, J. et al. (ed.), pp. 719729. New York: Oxford University Press.Google Scholar
Kissane, D.W. (2000). Psychospiritual and existential distress. The challenge for palliative care. Australian Family Physician, 29(11), 10221025.Google Scholar
Kissane, D.W. (2012). The relief of existential suffering. Archives of Internal Medicine, 172(19), 15011505.Google Scholar
Kissane, D.W., Bloch, S., Miach, P., et al. (1997). Cognitive–existential group therapy for patients with primary breast cancer: Techniques and themes. Psycho-Oncology, 6(1), 2533.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Kissane, D.W., Bloch, S., Smith, G.C., et al. (2003). Cognitive–existential group psychotherapy for women with primary breast cancer: A randomised controlled trial. Psycho-Oncology, 12(6), 532546.Google Scholar
Kissane, D.W., Grabsch, B., Clarke, D.M., et al. (2004 a). Supportive–expressive group therapy: The transformation of existential ambivalence into creative living while enhancing adherence to anti-cancer therapies. Psycho-Oncology, 13(11), 755768.Google Scholar
Kissane, D.W., Love, A., Hatton, A., et al. (2004 b). Effect of cognitive–existential group therapy on survival in early-stage breast cancer. Journal of Clinical Oncology, 22(21), 42554260.Google Scholar
Kissane, D.W., Grabsch, B., Clarke, D.M., et al. (2007). Supportive–expressive group therapy for women with metastatic breast cancer: Survival and psychosocial outcome from a randomized controlled trial. Psycho-Oncology, 16(4), 277286.Google Scholar
Lee, V., Cohen, S.R., Edgar, L., et al. (2006). Meaning making and psychological adjustment to cancer: Development of an intervention and pilot results. Oncology Nursing Forum, 33(2), 291302.Google Scholar
LeMay, K. & Wilson, K.G. (2008). Treatment of existential distress in life threatening illness: A review of manualized interventions. Clinical Psychological Review, 28(3), 472493.Google Scholar
Lepore, S.J. (2001). A social–cognitive processing model of emotional adjustment to cancer. In Psychosocial interventions for cancer. Baum, A. & Andersen, B.L. (eds.), pp. 99116. Washington, DC: American Psychological Association.Google Scholar
Levin, T. & Kissane, D.W. (2006). Psychooncology: The state of its development in 2006. The European Journal of Psychiatry, 20, 183197.Google Scholar
Lindemalm, C., Granstam-Bjorneklett, H., Bergkvist, L., et al. (2012). Existential aspects are neglected in the evaluation of support-intervention in breast cancer patients. Acta Oncologica, 51(6), 807809.Google Scholar
Manne, S.L., Sabbioni, M., Bovbjerg, D.H., et al. (1994). Coping with chemotherapy for breast cancer. Journal of Behavioral Medicine, 17(1), 4155.Google Scholar
Moadel, A., Morgan, C., Fatone, A., et al. (1999). Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically diverse cancer patient population. Psycho-Oncology, 8(5), 378385.Google Scholar
Mok, E., Lau, K.P., Lam, W.M., et al. (2010). Healthcare professionals' perceptions of existential distress in patients with advanced cancer. Journal of Advanced Nursing, 66(7), 15101522.Google Scholar
Park, C.L. & Folkman, S. (1997). Meaning in the context of stress and coping. Review of General Psychology, 1(2), 115144.Google Scholar
Parle, M. & Maguire, P. (1995). Exploring relationships between cancer, coping, and mental health. Journal of Psychosocial Oncology, 13(1–2), 2750.Google Scholar
Réseau canadien du cancer du sein et l'Initiative Ontarienne de Recherche Communautaire sur le cancer du sein (2003). “Rien ne me convenait”: Les besoins d'information et de soutien des jeunes canadiennes atteintes du cancer du sein: Consultation nationale menée auprès de jeunes femmes atteintes du cancer du sein. Available at http://www.cbcn.ca/index.php?pageaction=content.page&id=5722&lang=fr.Google Scholar
Sauer, R. & Seitz, M. (1988). Psychological and social support of cancer patients: Report on a program of the radiotherapy department, Erlangen. Recent Results in Cancer Research, 108, 311315.Google Scholar
Savard, J., Laberge, B., Gauthier, J.G., et al. (1998). Evaluating anxiety and depression in HIV-infected patients. Journal of Personality Assessment, 71(3), 349367.Google Scholar
Scogin, F., Morthland, M., Kaufman, A., et al. (2007). Improving quality of life in diverse rural older adults: A randomized trial of a psychological treatment. Psychology and Aging, 22(4), 657665.Google Scholar
Sheard, T. & Maguire, P. (1999). The effect of psychological interventions on anxiety and depression in cancer patients: Results of two meta-analyses. British Journal of Cancer, 80(11), 17701780.Google Scholar
Somerfield, M.R. (1997). The utility of systems models of stress and coping for applied research: The case of cancer adaptation. Journal of Health Psychology, 2(2), 133151.Google Scholar
Spiegel, D. & Classen, C. (2000). Group therapy for cancer patients: A research-based handbook of psychosocial care. New York: Basic Books.Google Scholar
Spiegel, D., Bloom, J.R., Kraemer, H.C., et al. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2(8668), 888891.Google Scholar
Spiegel, D., Morrow, G.R., Classen, C., et al. (1999). Group psychotherapy for recently diagnosed breast cancer patients: A multicenter feasibility study. Psycho-Oncology, 8(6), 482493.Google Scholar
Trijsburg, R.W., van Knippenberg, F.C. & Rijpma, S.E. (1992). Effects of psychological treatment on cancer patients: A critical review. Psychosomatic Medicine, 54(4), 489517.Google Scholar
Wilson, I.B. & Cleary, P.D. (1995). Linking clinical variables with health-related quality of life: A conceptual model of patient outcomes. The Journal of the American Medical Association, 273(1), 5965.Google Scholar
Wong, P.T.P. (1997). Meaning-centered counseling: A cognitive–behavioral approach to logotherapy. In International forum for logotherapy, Vol. 20, pp. 8594. Abilene, TX: Viktor Frankl Institute of Logotherapy.Google Scholar
Xiao, H., Kwong, E., Pang, S., et al. (2013). Effect of a life review program for Chinese patients with advanced cancer: A randomized controlled trial. Cancer Nursing, 36(4), 274283.Google Scholar
Yalom, I.D. (1980). Existential psychotherapy. New York: Basic Books.Google Scholar
Yang, J.A., Garis, J., Jackson, C., et al. (2009). Providing psychotherapy to older adults in home: Benefits, challenges, and decision-making guidelines. Clinical Gerontologist, 32(4), 333346.Google Scholar
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361370.Google Scholar