Effects of a Comprehensive Coping Strategy on Clinical Outcomes in Breast Cancer Bone Marrow Transplant Patients and Primary Caregiver

摘要

The major purpose of this 4-year study was to determine the effects of the Comprehensive Coping Strategy Program (CCSP) on pain, fatigue, psychological distress, nausea, health status, burden of care and quality of life in breast cancer patients and their primary caregivers. A randomized controlled clinical trial design was used. 138 patients and 102 primary caregivers participated in the study. Seventy patients were randomly assigned to the CCSP treatment group and 68 to the control group. Data were collected 20 days before hospitalization (baseline), during hospitalization (7 days after the ABMT), and again during the post hospitalization period which was one year following the ABMT. The results showed that breast cancer patients experienced pain, fatigue, nausea and psychological distress prior to, during and post- hospitalization for ABMT. Depression, pain, fatigue and negative coping (catastrophizing) accounted for 41% to 65% of the variance in health status. The CCSP treated group of patients experienced less nausea (p < .01), less fatigue and nausea (p < .05), were 9% times less likely to die (p = .05), and had a higher quality of life (p < .05 to p < .01) than patients in the control group. The patients' primary caregivers at baseline suffered from moderate anxiety. Anxiety and fatigue were more severe in female PCGs and those who were single (p < 0.05 to p < 0.01). Family, a subscale of quality of life, was predictive of objective burden of care (p < 0.05). Age and trait anxiety were significant predictors of subjective burden of care (p < .05). The mean total quality of life score was higher in the treatment group (M = 43.61) at 1 year follow-up than in the Control group (M = 21.52). Quality of life was lower in the control group at follow-up than at baseline, whereas in the treatment group we found the opposite. At 2 years follow-up, 21 subjects in the treatment group and 21 subjects in the control group had died.