Researchers from the University of Wisconsin-Madison conducted a pilot randomized controlled trial to assess the initial efficacy of a patient-controlled cognitive-behavioral (CB) intervention for the pain, fatigue, and sleep disturbance symptom cluster that often accompanies advanced cancer treatment.

Eighty-six patients with advanced lung, prostate, colorectal, or gynecologic cancers, receiving treatment at a comprehensive cancer center, were stratified by recruitment clinics (chemotherapy and radiation therapy) and randomized to the intervention or control groups.

Forty-three patients were assigned to receive training in and use of up to 12 relaxation, guided imagery or distraction exercises, delivered via an MP3 player for two weeks during cancer treatment.
 
Forty-three patients were assigned to a waitlist control condition for the same two week period. Outcomes included symptom cluster severity and overall symptom interference with daily life, measured at baseline (Time 1) and two weeks later (Time 2).

Eight participants dropped out; 78 completed the study and were analyzed (36 intervention and 42 control subjects). Participants used the Cognitive Behavioral strategies an average of 13.65 times (SD=6.98). Controlling for baseline symptom cluster severity and other relevant covariates, investigators found that the symptom cluster severity at Time 2 was lower in the intervention group (M(Adj)=2.99, SE=0.29) than in the waitlist group (M(Adj)=3.87, SE=0.36), F(1, 65)=3.57, P=0.032.
 
Symptom interference with daily life did not differ between groups. No significant adverse events were noted with the CB intervention.

The findings from this pilot suggest that a cognitive behavioral intervention may be an effective approach to treating this pain, fatigue, and sleep disturbance symptom cluster.  Future research is planned to confirm efficacy and test mediators and moderators of these intervention effects.

Citation: Kwekkeboom KL, Abbott-Anderson K, Cherwin C, Roiland R, Serlin RC, Ward SE. Pilot randomized controlled trial of a patient-controlled cognitive-behavioral intervention for the pain, fatigue, and sleep disturbance symptom cluster in cancer. Journal of Pain and Symptom Management 2012 Dec;44(6):810-22. doi: 10.1016/j.jpainsymman.2011.12.281. Epub 2012 Jul 7. [email protected]