Group versus individual stress management intervention in breast cancer patients for fatigue and emotional reactivity: A randomised intervention study

Figures & data

Figure 1. Flowchart of the patients throughout the study. Focus of this paper indicated in grey.

Table I. A description of the subjects of the intervention and when they were introduced and discussed in the GSM and ISM, respectively.

GSM sessions	ISM sessions	Subjects	Description	Techniques/Home assignments
1–2	1	Introduction to stress and stress responses	Both physiological and psychological responses to stress and the differences between short- and long-term stress were introduced. Common stress responses due to cancer diagnosis were also highlighted.	Relaxation exercise ‘the stop button’ and a stress diary
3–4	2–4	Negative thoughts and stress behaviour	Typical characteristics for stress behaviour and automatic negative thoughts were discussed. Participants used a diary to become aware of and to identify their negative thoughts.	Worksheet to monitor one’s actions for thought and behaviour change
4–5	2–7	Irritability and anger including typical stress behaviours	The focal point was time urgency and irritability with other people's behaviour. Participants were to identify what are anger, situations and reactions connected to one's own anger reactions, and alternatives to these reactions.	Worksheets to aid identification of situations causing anger and actions for changing these reactions
6–7	2–7	Quality of life and expectations of life	Focus was on quality of life and expectations of life post-diagnosis. What was important to each participant, what did they want for their future, and how could they accomplish their goals.	Expressing their thoughts in writing
7–8	3–7	Reactions to a cancer diagnosis	This subject dealt with common psychological reactions to a breast cancer diagnosis. The participants discussed how and with whom to share one's thoughts and feelings about the cancer and from whom they want/expect support.	Worksheet for identifying from whom they want/expect support and actions needed to highlight the need for support
9	3–7	Sexuality	Physiological and psychological aspects of breast cancer surgery and treatments in relation to one's identity and sexuality were discussed.
10	8	Recapturing	Finally, key points from previous sessions were recaptured and participants were asked to reflect on aspects of the intervention, which were important and useful to them.

Table II. Demographic and medical background data at inclusion for the total study participants and different subgroups in the intervention.

		Intervention
	Total study participants	GSM	ISM	Declined intervention (not randomised)
	n = 425 (%)	n = 77 (%)	n = 78 (%)	n = 149 (%)
Age, years
Mean	59	57	58	59
Minimum-Maximum	29–82	29–78	37–79	32–81
Residential area
Dalarna	126 (30)	25 (32)	25 (32)	44 (30)
Gävleborg	158 (37)	30 (39)	29 (37)	54 (36)
Uppsala	141 (33)	22 (29)	24 (31)	51 (34)
Social Status
Annual household income (EUR), mean^a	55 727	57 742	55 409	53 769
Annual household income (EUR), range^a	3110 – 167 464	3110– 131 578	13 705 – 131 579	11 483 – 167 464
NHG^b
1	80 (19)	11 (14)	12 (15)	33 (22)
2	208 (49)	33 (43)	38 (49)	74 (50)
3	116 (27)	28 (36)	25 (32)	36 (24)
Type of surgery
Sector resection + ax. surgery	287 (68)	54 (70)	45 (58)	35 (24)
Mastectomy	124 (29)	21 (27)	32 (41)	108 (72)
Adjuvant treatment
Chemotherapy	211 (50)	49 (64)*	40 (51)	69 (47)
Radiation therapy	313 (74)	59 (77)	55 (71)	111 (75)
Hormonal therapy	233 (55)	39 (51)	45 (58)	83 (56)
Other health complaints	87 (20)	13 (17)	24 (31)*	26 (18)

^a1 EUR = 8.36 SEK (Exchange rate 4 October 2013); ^b NHG, Nottingham Histologic Grade, range 1–3 (1 = better prognosis, 3 = worst prognosis).

*Statistical significant difference p < 0.05.

Table III. Mean (SD) and median (range) for subgroups of study participants on the MFI and ELSS subscales at inclusion, 3-month post-inclusion and 12-month post-inclusion.

	Group intervention (randomised)	Individual intervention (randomised)	Declined intervention (not randomised)
Inclusion	M(SD)/Median(Range) n = 77	M(SD)/Median(Range) n = 78	M(SD)/Median(Range) n = 149
MFI–20^a General fatigue Physical fatigue Mental fatigue Reduced activity Reduced motivation ELSS^b	11.4 (2.2) / 11.0 (5–20) 12.6 (2.2) / 13.0 (4–19) 11.2 (1.9) / 11.0 (6–15) 12.9 (1.8) / 13.0 (9–20) 13.1 (2.2) / 13.0 (7–19) 18.4 (10.4) / 18.0 (0–47)	11.6 (1.9) / 12.0 (6–16) 12.5 (1.8) / 12.0 (8–18) 11.0 (1.9) / 12.0 (6–15) 12.4 (1.8) / 12.0 (7–18) 12.6 (2.2) / 12.5 (7–18) 19.1 (11.7) / 19.0 (1–48)	11.0 (2.3) / 11.0 (4–19) 12.1 (2.2) / 12.0 (4–20) 11.3 (1.8) / 12.0 (4–16) 12.9 (1.8) / 13.0 (8–18) 13.2 (2.3) / 13.0 (7–19) 16.4 (11.6) / 13.0 (0–50)
3-month post-inclusion	n = 77	n = 78	n = 149
MFI–20^a General fatigue Physical fatigue Mental fatigue Reduced activity Reduced motivation ELSS^b	11.3 (2.2) / 11.0 (6–20) 12.5 (1.7) / 12.0 (8–17) 11.0 (1.8) / 11.0 (6–15) 13.4 (1.9) / 13.0 (9–18) 13.1 (2.2) / 13.0 (7–18) 19.0 (10.2) / 16.0 (0–44)	11.1 (1.9) / 12.0 (4–17) 12.5 (1.7) / 12.0 (4–18) 11.2 (1.9) / 12.0 (5–15) 13.1 (1.8) / 13.0 (8–16) 12.9 (2.4) / 13.0 (6–19) 19.6 (12.6) / 19.0 (0–53)	11.0 (1.9) / 11(5–19) 12.3 (1.9) / 12.0 (5–17) 11.2 (2.1) / 12.0 (4–17) 12.6 (1.8) / 12.0 (8–19)* 12.8 (2.2) / 13.0 (5–18) 16.6 (12.2) / 15.0 (0–50)
12-month post-inclusion	n = 70	n = 72	n = 120
MFI–20^a General fatigue Physical fatigue Mental fatigue Reduced activity Reduced motivation ELSS^b	10.9 (2.0) / 11.0 (4–16) 12.2 (1.5) / 12.0 (9–16) 11.0 (1.9) / 11.0 (5–15) 13.0 (1.8) / 13.0 (9–17) 12.6 (2.0) / 13.0 (8–17) 21.0 (12.2) / 21.0 (0–50)	11.2 (2.1) / 11.0 (4–16) 12.5 (1.9) / 13.0 (4–17) 11.3 (2.1) / 12.0 (4–16) 12.9 (2.1) / 13.0 (4–18) 12.6 (2.5) / 13.0 (4–18) 19.1 (12.2) / 18.5 (0–53)	11.1 (1.8) / 11.0 (5–15) 12.1 (1.8) / 12.0 (7–17) 11.0 (1.9) / 11.0 (5–20) 12.8 (1.6) / 13.0 (7–17) 12.6 (2.1) / 13.0 (5–17) 16.6 (12.2) / 14.5 (0–50)

^aScores 4–20; ^bScores 0–60. *Statistical significant difference p < 0.05.