Supportive Care in Cancer

, Volume 22, Issue 8, pp 2297–2308 | Cite as

Interventions for preparing patients for chemotherapy and radiotherapy: a systematic review

  • Amy WallerEmail author
  • Kristy Forshaw
  • Jamie Bryant
  • Shannon Mair
Review Article



Undergoing chemotherapy and radiotherapy can be physically and psychologically stressful for people with cancer. Providing preparatory information to cancer patients as they face treatment and its aftermath has the potential to improve patient outcomes. This study assessed the methodological quality and effectiveness of interventions providing preparatory information about chemotherapy and/or radiotherapy to cancer patients in improving patient outcomes and health care use.


MEDLINE, EMBASE, and Cochrane databases were systematically searched from January 1995 until October 2012. Inclusion criteria: (1) met Effective Practice and Organisation of Care (EPOC) criteria for study design; (2) included adults with a current cancer diagnosis; (3) delivered preparatory information via a health care provider or was self-directed; (4) examined psychological well-being, quality of life, physical symptoms, satisfaction, knowledge, or health service utilisation. Studies were assessed for methodological quality using the EPOC criteria.


Eighteen studies involving 3,443 cancer patients met inclusion criteria. Interventions included written information, audiotapes, videotapes, and computer programs. Interventions improved patient satisfaction (6/7 studies), information needs and patient knowledge (5/6 studies), physical symptoms (3/4 studies) and cost (1/1 study). More than half of the interventions improved psychological outcomes and quality of life (10/17 studies).


Providing preparatory information can improve patient-reported outcomes in cancer patients undergoing chemotherapy and radiotherapy, especially with respect to satisfaction and knowledge. Some, but not all, studies improved psychological outcomes and physical symptoms. There is a need for methodologically rigorous research to determine the most effective timing and method of delivery of preparatory information to improve patient outcomes.


Neoplasm Chemotherapy Radiotherapy Patient education Preparatory information Systematic review 



This research was supported by a Strategic Research Partnership Grant from Cancer Council NSW to the Newcastle Cancer Control Collaborative (New-3C), and infrastructure funding from the Hunter Medical Research Institute (HMRI). Dr. Jamie Bryant is supported by an Australian Research Council Post-Doctoral Industry Fellowship. Ms. Kristy Forshaw is supported by a University of Newcastle Postgraduate Research Scholarship.

Conflict of interest

The authors have declared no conflicts of interest. The authors have full control of all primary data and agree to allow the journal to review their data if requested.


  1. 1.
    Mazzotti E et al (2012) Treatment-related side effects and quality of life in cancer patients. Support Care Cancer 20(10):2553–2557PubMedCrossRefGoogle Scholar
  2. 2.
    Aranda S et al (2012) Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: results from a randomised, controlled trial. Ann Oncol 23(1):222–231PubMedCrossRefGoogle Scholar
  3. 3.
    Butow PN et al (2012) Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support Care Cancer 20(1):1–22PubMedCrossRefGoogle Scholar
  4. 4.
    Gritz ER et al (1999) First year after head and neck cancer: quality of life. J Clin Oncol 17(1):352–360PubMedGoogle Scholar
  5. 5.
    Dhruva A et al (2012) A longitudinal study of measures of objective and subjective sleep disturbance in patients with breast cancer before, during, and after radiation therapy. J Pain Symptom Manag 44(2):215–228CrossRefGoogle Scholar
  6. 6.
    Wright P et al (2012) Managing social difficulties: roles and responsibilities of patients and staff. Psycho-Oncology 21(1):20–28PubMedCrossRefGoogle Scholar
  7. 7.
    Munro AJ, Potter S (1996) A quantitative approach to the distress caused by symptoms in patients treated with radical radiotherapy. Br J Cancer 74(4):640–647PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Chen AM et al (2009) Prospective study of psychosocial distress among patients undergoing radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 73(1):187–193PubMedCrossRefGoogle Scholar
  9. 9.
    Breen S et al (2009) Is symptom burden a predictor of anxiety and depression in patients with cancer about to commence chemotherapy? MJA 190:S99–S104PubMedGoogle Scholar
  10. 10.
    Hofman M et al (2004) Cancer patients’ expectations of experiencing treatment-related side effects: a University of Rochester Cancer Center—Community Clinical Oncology Program study of 938 patients from community practices. Cancer 101(4):851–857PubMedCrossRefGoogle Scholar
  11. 11.
    Olver IN (2005) Update on anti-emetics for chemotherapy-induced emesis. Intern Med J 35(8):478–481PubMedCrossRefGoogle Scholar
  12. 12.
    Passik SD et al (2001) The changeable nature of patients’ fears regarding chemotherapy: implications for palliative care. J Pain Symptom Manag 21(2):113–120CrossRefGoogle Scholar
  13. 13.
    von Blanckenburg P et al (2013) Optimizing expectations to prevent side effects and enhance quality of life in breast cancer patients undergoing endocrine therapy: study protocol of a randomized controlled trial. BMC Cancer 13:426CrossRefGoogle Scholar
  14. 14.
    Roscoe JA et al (2006) The role of patients’ response expectancies in side effect development and control. Curr Probl Cancer 30(2):40–98PubMedCrossRefGoogle Scholar
  15. 15.
    Harrison JD et al (2009) What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 17(8):1117–1128PubMedCrossRefGoogle Scholar
  16. 16.
    McCaughan EM, Thompson KA (2000) Information needs of cancer patients receiving chemotherapy at a day-case unit in Northern Ireland. J Clin Nurs 9(6):851–858CrossRefGoogle Scholar
  17. 17.
    Halkett GK et al (2010) Meeting breast cancer patients’ information needs during radiotherapy: what can we do to improve the information and support that is currently provided? Eur J Cancer Care (Engl) 19(4):538–547CrossRefGoogle Scholar
  18. 18.
    National Health Service (2012) Cancer Patient Experience Survey 2011/12. NHS, LondonGoogle Scholar
  19. 19.
    Cancer Institute NSW (2009) New South Wales Cancer Patient Satisfaction Survey 2008. Cancer Institute NSW, SydneyGoogle Scholar
  20. 20.
    PHIDU (Public Health Information Development Unit) (2012) Messages from research: a review of the research literature concerning differences in cancer outcomes between metropolitan and country residents in South Australia, and factors that might underlie such differences. (Produced for Cancer Council SA). PHIDU, The University of Adelaide, AdelaideGoogle Scholar
  21. 21.
    Cancer Institute NSW, Evaluating the role of cancer care coordinator: summary report 2011, Cancer Institute NSW: Alexandria, NSWGoogle Scholar
  22. 22.
    Iconomou G et al (2006) Impact of providing booklets about chemotherapy to newly presenting patients with cancer: a randomized controlled trial. Ann Oncol 17(3):515–520PubMedCrossRefGoogle Scholar
  23. 23.
    Greer JA et al (2008) Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer. J Psychosom Res 65(6):549–552PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Lotfi-Jam K et al (2008) Nonpharmacologic strategies for managing common chemotherapy adverse effects: a systematic review. J Clin Oncol 26(34):5618–5629PubMedCrossRefGoogle Scholar
  25. 25.
    Wydra EW (2001) The effectiveness of a self-care management interactive multimedia module. Oncol Nurs Forum 28(9):1399–1407PubMedGoogle Scholar
  26. 26.
    Ruddy K, Mayer E, Partridge A (2009) Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin 59(1):56–66PubMedCrossRefGoogle Scholar
  27. 27.
    Jacobsen PB et al (2002) Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. J Clin Oncol 20(12):2851–2862PubMedCrossRefGoogle Scholar
  28. 28.
    Ream E, Richardson A (1996) The role of information in patients’ adaptation to chemotherapy and radiotherapy: a review of the literature. Eur J Cancer Care 5(3):132–138CrossRefGoogle Scholar
  29. 29.
    Schofield MJ, Sanson-Fisher R (1996) How to prepare cancer patients for potentially threatening medical procedures: consensus guidelines. NSW Cancer Council Cancer Education Research Program. J Cancer Educ 11(3):153–158PubMedGoogle Scholar
  30. 30.
    National Breast Cancer Centre and National Cancer Control Initiative (2003) Clinical practice guidelines for the psychosocial care of adults with cancer. National Breast Cancer Centre, CamperdownGoogle Scholar
  31. 31.
    Schofield P et al (2008) Preparing patients for threatening medical treatments: effects of a chemotherapy educational DVD on anxiety, unmet needs, and self-efficacy. Support Care Cancer 16(1):37–45PubMedCrossRefGoogle Scholar
  32. 32.
    Higgins J et al (2011) Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration. Available from
  33. 33.
    Bennenbroek FTC et al (2003) Audiotaped social comparison information for cancer patients undergoing radiotherapy: differential effects of procedural, emotional and coping information. Psycho-Oncology 12(6):567–579PubMedCrossRefGoogle Scholar
  34. 34.
    Chan CW, Richardson A, Richardson J (2011) Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial. J Pain Symptom Manag 41(2):347–357CrossRefGoogle Scholar
  35. 35.
    D’Haese S et al (2000) The effect of timing of the provision of information on anxiety and satisfaction of cancer patients receiving radiotherapy. J Cancer Educ 15(4):223–227Google Scholar
  36. 36.
    De Lorenzo F et al (2004) Improving information to Italian cancer patients: results of a randomized study. Ann Oncol 15(5):721–725PubMedCrossRefGoogle Scholar
  37. 37.
    Haggmark C et al (2001) Effects of information supply on satisfaction with information and quality of life in cancer patients receiving curative radiation therapy. Patient Educ Couns 45(3):173–179PubMedCrossRefGoogle Scholar
  38. 38.
    Halkett GK et al (2013) Pilot randomised controlled trial of a radiation therapist-led educational intervention for breast cancer patients prior to commencing radiotherapy. Support Care Cancer 21(6):1725–1733PubMedCrossRefGoogle Scholar
  39. 39.
    Harrison R et al (2001) Randomized controlled trial to assess the effectiveness of a videotape about radiotherapy. Br J Cancer 84(1):8–10PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Johnson JE (1996) Coping with radiation therapy: optimism and the effect of preparatory interventions. Res Nurs Health 19(1):3–12PubMedCrossRefGoogle Scholar
  41. 41.
    Jones R et al (1999) Randomised trial of personalised computer based information for cancer patients. BMJ 319(7219):1241–1247PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Jones RB et al (2006) Effect of different forms of information produced for cancer patients on their use of the information, social support, and anxiety: randomised trial. BMJ 332(7547):942–948PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Kim Y, Roscoe JA, Morrow GR (2002) The effects of information and negative affect on severity of side effects from radiation therapy for prostate cancer. Support Care Cancer 10(5):416–421PubMedCrossRefGoogle Scholar
  44. 44.
    Kinnane N, Thompson L (2008) Evaluation of the addition of video-based education for patients receiving standard pre-chemotherapy education. Eur J Cancer Care (Engl) 17(4):328–339CrossRefGoogle Scholar
  45. 45.
    Poroch D (1995) The effect of preparatory patient education on the anxiety and satisfaction of cancer patients receiving radiation therapy. Cancer Nurs 18(3):206–214PubMedCrossRefGoogle Scholar
  46. 46.
    Ream E, Richardson A, Alexander-Dann C (2006) Supportive intervention for fatigue in patients undergoing chemotherapy: a randomized controlled trial. J Pain Symptom Manag 31(2):148–161CrossRefGoogle Scholar
  47. 47.
    Thomas R et al (2000) Forewarned is forearmed—benefits of preparatory information on video cassette for patients receiving chemotherapy or radiotherapy—a randomised controlled trial. Eur J Cancer 36(12):1536–1543PubMedCrossRefGoogle Scholar
  48. 48.
    Zissiadis Y, Harper E, Kearney E (2010) Impact of more intensive written information in patients having radical radiation therapy: results of a prospective randomized phase III trial. Radiother Oncol 96(2):254–258PubMedCrossRefGoogle Scholar
  49. 49.
    Chan R, Webster J, Bennett L (2009) Effects and feasibility of a multi-disciplinary orientation program for newly registered cancer patients: design of a randomised controlled trial. BMC Health Serv Res 9:203PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Prouse J (2010) The impact of methods of information on chemotherapy-related side effects. Clin J Oncol Nurs 14(2):206–211PubMedCrossRefGoogle Scholar
  51. 51.
    Suls J, Wan CK (1989) Effects of sensory and procedural information on coping with stressful medical procedures and pain: a meta-analysis. J Consult Clin Psychol 57(3):372–379PubMedCrossRefGoogle Scholar
  52. 52.
    Meyer TJ, Mark MM (1995) Effects of psychosocial interventions with adult cancer patients: a meta-analysis of randomized experiments. Health Psychol 14(2):101–108PubMedCrossRefGoogle Scholar
  53. 53.
    O’Brien L et al (2014) Education for cancer-related fatigue: could talking about it make people more likely to report it? Support Care Cancer 22(1):209–15Google Scholar
  54. 54.
    Gordon LG, Beesley VL, Scuffham PA (2011) Evidence on the economic value of psychosocial interventions to alleviate anxiety and depression among cancer survivors: a systematic review. Asia Pac J Clin Oncol 7(2):96–105PubMedCrossRefGoogle Scholar
  55. 55.
    Miller SM (1987) Monitoring and blunting: validation of a questionnaire to assess styles of information seeking under threat. J Pers Soc Psychol 52(2):345–353PubMedCrossRefGoogle Scholar
  56. 56.
    Coulter A, Ellins J (2007) Effectiveness of strategies for informing, educating, and involving patients. BMJ 335(7609):24–27PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Halkett GK et al (2012) Development and pilot testing of a radiation therapist-led educational intervention for breast cancer patients prior to commencing radiotherapy. Asia Pac J Clin Oncol 8(3):e1–e8PubMedCrossRefGoogle Scholar
  58. 58.
    Gustafson DH et al (2002) CHESS: 10 years of research and development in consumer health informatics for broad populations, including the underserved. Int J Med Inform 65(3):169–177PubMedCrossRefGoogle Scholar
  59. 59.
    Paul CL et al (2011) Improving access to information and support for patients with less common cancers: hematologic cancer patients’ views about Web-based approaches. J Med Internet Res 13(4):e112PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Amy Waller
    • 1
    Email author
  • Kristy Forshaw
    • 1
  • Jamie Bryant
    • 1
  • Shannon Mair
    • 1
  1. 1.Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research InstituteUniversity of NewcastleCallaghanAustralia

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