Cognitive Behavioral Intervention For Coping Styles In Gastric And Colonrectal Cancer Patients Undergoing Chemotherapy

Objectives: With the increasing incidence of gastric cancer and colonrectal cancer,more and more patients are receiving adjuvant chemotherapy.There were planty of symptoms with low quality of life of gastric cancer and colonrectal cancer patients undergoing chemotherapy.Gastric and colonrectal cancer patients have negative coping styles,which may decrease their quality of life and increase their distress.Most interventions were improved symptoms while less intervention were paid attention to coping styles.Intervetnions of coping styles were most using cognitive behavioral intervention.However,these interventions were short of structure and difficult to carry out.The aim of this study is to build an intervention based on problem solving therapy for gastric and colonrectal cancer patients undergoing chemotherapy,and evaluate the effect of intervention,and provide a suggestions to other interventions for coping styles in cancer care.Methods:1.Literatures published before March 2014 were searched in the following databases:PubMed,EMBASE,CINAHL,BIOSIS Previews and Chinese Biological Medical.Nine randomised controlled trials used problem solving therapy for cancer patients in english included in systemreview by 2 reviewers independently appraised with methodological quailty to develop the structure and form of our project.2.Semi-structured interview was used to explore the cognitive and behavioral experience of gastric and colonrectal cancer patients(n=15)receiving chemotherapy to develop the content of our project.3.An expert group meeting(n=7)was used to modify the structure and content of preliminary intervention established by the results of systematic review and semi-structured interview before intervention and confirm the final project.4.Quasi-experimental study is used to implement and evaluate our intervention project.63 gastric cancer and colorectal cancer patients undergoing chemotherapy of a grade A tertiary hospital in Shanghai were semi-randomly assigned with parity of hospital number to intervention group(n=32)and control group(n=31).Besides usual cancer care,an individual intervention using problem solving therapy was implemented to intervention group,while usual cancer care was implemented to control group.Medical Coping Modes Questionnaire(MCMQ),Functional Assessment of Cancer Therapy-General(FACT-G)and Social Problem Solving Inventory-Revised(SPSI-R)were used to measure the coping strategy quality of life and problem solving ability at baseline and six weeks after the intervention respectively.Data was analyzed by SPSS19.0 with two independent samples t-test to test the effect of intervention between two groups.The paired samples t-test was used to test the effect of intervention in groups before and after intervention.5.Semi-structured interview in intervention group patients(n=23)was used to explore the cognitive and behavioral changes of intervention group after intervention.Results:1.System Review Results: Patients included newly diagnosed with cancer in stage of Ⅰ~Ⅲ.The intervention duration time was 9.2 weeks and intervention times was 7.3.Individualized intervention combined of telephone was used.The content of intervention was aimed to symptoms of chemotherapy.Relaxation therapy,manual and worksheet were used in intervention.Quality of life and emotional state were common mesured.Baseline and after intervention were usual measurement time.Interveners had psychological knowledge or oncological experience.2.Results of semi-structured interview: There were 4 themes emerged,which were cognition experience,emotion experience,symptom experience,coping experience.3.Expert group meeting results: Experts affirmed structure,content and effect of problem solving therapy.They suggested to reduce times of intervention from 8 to 6.The content of manual was also needed to be simplifed and illustrated with pictures.They emphasized on the timing of intervention and included patients with strong willingness to seek help.Encouragement was needed to the motivate enthusiasm of patients during intervention.4.Quasi-experiment results:(1)Result of comparison before intervention: Differences were not statistically significant in the demographic and disease-related information,coping styles,quality of life,problem solving ability between two groups before intervention.(2)Results of the implementation: According to the work sheet recorded in each intervention,a total of 147 problems occurred in 32 patients of intervention group,which were consist of 112 physical problems and 35 psychological problems.The average score of severity of the 147 problems was 4.38(0 ~10).Physical and psychological problems most frequently occurred were lost appetite,hand-foot syndrome,being worried about subsequent chemotherapy,deterioration and recurrence.95 problems were solved after the intervention by patients assessed themselves.The average score of problems severity was 2.60 after intervention.Physical and psychological problems most frequently solved were poor appetite,hand-foot syndrome,fear of recrudescence and worried about wound.52 problems were unresolved after the intervention.Physical and psychological problems most frequently unsolved were discomfort of stomach,worried about the finacial burden and work.The average time in the intervention was 30.15 minutes for each patient.(3)Result of comparison after intervention:(1)Coping styles.There were statistically significant differences in changes of confrontation coping style before and after intervention between two groups.There were statistically significant differences in changes of confrontation coping style in intervention group(P<0.05);(2)Quality of life.There were statistically significant differences in changes of total quality of life,emotion condition and fuctional condition of quality of life before and after intervention between two groups(P <0.05).Family-social condition of quality of life had statistically significant difference in intervention group.Physical condition of quality of life has statistically significant difference in control group.(3)Problem solving ability.There were no statistically significant differences in changes of problem solving ability before and after intervention in each domains between two groups.5.Results of semi-structured interview in intervention group: There were 4 themes emerged,which were patients’ changes of coping,patients’ changes of quality of life,patients’ changes of problem solving ability,patients’ high appraise for intervention.Conclusion:We used system review,semi-structured interview and expert group meeting to built intervention.Quasi-experimental study was used to implement intervention.Semi-structured interview was used in intervention group patients to supply the quasi-experiment results.Cognitive behavioral intervention with gastric and colonrectal cancer patients undergoing chemotherapy based on problem solving therapy can help patients to manage their physical and emotional problems,increase positive coping style,improve quality of life and promote problem solving ability.Patients in intervention group showed higher satisfaction and more demands of intervention.