Abstract
Purpose
This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments.
Methods
Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include ‘self-management patient education’ or ‘patient education’.
Results
Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review.
Conclusion
Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.
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References
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. Globocan 2012, Cancer incidence and mortality worldwide: IARC CancerBase No. 11. Lyon, France: International Agency for Research on Cancer. 2014
Health Council of Canada Self-management support for Canadians with chronic health conditions: a focus for primary health care Toronto: Health Council of Canada, 2012
Davis K, Schoen C, Schoenbaum SC (2000) A 2020 vision for American health care. Arch Intern Med 160(22):3357–3362
Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D (2008) Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the US. Support Care Cancer 16(7):791–801
Reilly CM, Bruner DW, Mitchell SA, Minasian LM, Basch E, Dueck AC et al (2013) A literature synthesis of symptom prevalence and severity in persons receiving active cancer treatment. Support Care Cancer 21(6):1525–1550
Spoelstra SL, Given BA, Given CW, Grant M, Sikorskii A, You M et al (2013) An intervention to improve adherence and management of symptoms for patients prescribed oral chemotherapy agents: an exploratory study. Cancer Nurs 36(1):18–28
Brearley S, Stamataki Z, Addington-Hall J, Foster C, Hodges L, Jarrett N et al (2011) The physical and practical problems experienced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs 15(3):204–212
Phillips JL, Currow DC (2010) Cancer as a chronic disease. Collegian 17(2):47–50
Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J (2002) Self-management approaches for people with chronic conditions: a review. Patient Educ Couns 48(2):177–187
Foster C, Fenlon D (2011) Recovery and self-management support following primary cancer treatment. Br J Cancer 105:S21–SS8
Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH et al (2015) Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator 41(4):417–430
Redman BK. Patient self-management of chronic disease: the health care provider’s challenge: Jones & Bartlett Learning; 2004.
Lorig KR, Holman H (2003) Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 26(1):1–7
Howell D, Bezjak A, Sidani S, Dudgeon D, Husain A, Fernandez G et al (2014) Self-management interventions for breathlessness in adult cancer patients: a systematic review and meta-analysis. Support Care Cancer 1:S218
Fenlon D, Foster C (2009) Self-management support: a review of the evidence. University of Southampton, Southampton
Reed E, Corner J, Simmonds P Defining the illness trajectory of metastatic breast cancer. BMJ supportive & palliative care. 2013:bmjspcare-2012-000415.
Creer TL, Holroyd KA (2006) Self-management of chronic conditions: the legacy of Sir William Osler. Chronic Illn 2(1):7–14
Adams RJ (2010) Improving health outcomes with better patient understanding and education. Risk Management and Healthcare Policy 3:61–72
Gao WJ, Yuan CR (2011) Self-management programme for cancer patients: a literature review. Int Nurs Rev 58(3):288–295
Hammer MJ, Ercolano EA, Wright F, Dickson VV, Chyun D, Melkus GD (2015) Self-management for adult patients with cancer: an integrative review. Cancer Nurs 38(2):E10–E26
McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K et al (2011) Self-management: enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin 61(1):50–62
Adams K, Greiner A, Corrigan J (eds) (2004) 1st Annual Crossing the Quality Chasm Summit: a focus on communities. National Academies Press, Washington D.C.
McGowan EL, Prapavessis H, Campbell N, Gray C, Elkayam J (2012) The effect of a multifaceted efficacy intervention on exercise behavior in relatives of colon cancer patients. Int J Behav Med. 19(4):550–562
Davies NJ, Batehup L, Thomas R (2011) The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer 105(Suppl 1):S52–S73
Hibbard JH, Stockard J, Mahoney ER, Tusler M (2004) Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 39(4p1):1005–1026
Barlow JH, Bancroft GV, Turner AP (2005) Self-management training for people with chronic disease: a shared learning experience. J Health Psychol 10(6):863–872
Davies NJ, Batehup L. Self-management support for cancer survivors: guidance for developing interventions 2010.
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928
Antoni MH, Lechner S, Diaz A, Vargas S, Holley H, Phillips K et al (2009) Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer. Brain Behav Immun 23(5):580–591
Boesen EH, Ross L, Frederiksen K, Thomsen BL, Dahlstrom K, Schmidt G et al (2005) Psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. J Clin Oncol 23(6):1270–1277
Brown JC, Cheville AL, Tchou JC, Harris SR, Schmitz KH (2014) Prescription and adherence to lymphedema self-care modalities among women with breast cancer-related lymphedema. Support Care Cancer 22(1):135–143
Ell K, Xie B, Quon B, Quinn DI, Dwight-Johnson M, Lee PJ (2008) Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. J Clin Oncol 26(27):4488–4496
Koller A, Miaskowski C, De Geest S, Opitz O, Spichiger E (2013) Supporting self-management of pain in cancer patients: methods and lessons learned from a randomized controlled pilot study. Eur J Oncol Nurs 17(1):1–8
Korstjens I, May AM, van Weert E, Mesters I, Tan F, Ros WJ et al (2008) Quality of life after self-management cancer rehabilitation: a randomized controlled trial comparing physical and cognitive-behavioral training versus physical training. Psychosom Med 70(4):422–429
Kravitz RL, Tancredi DJ, Grennan T, Kalauokalani D, Street RL Jr, Slee CK et al (2011) Cancer health empowerment for living without pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment. Pain 152(7):1572–1582
Mishel MH, Germino BB, Gil KM, Belyea M, Laney IC, Stewart J et al (2005) Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psychooncology 14(11):962–978
Phillips KM, Antoni MH, Lechner SC, Blomberg BB, Llabre MM, Avisar E et al (2008) Stress management intervention reduces serum cortisol and increases relaxation during treatment for nonmetastatic breast cancer. Psychosom Med 70(9):1044–1049
Rustoen T, Valeberg BT, Kolstad E, Wist E, Paul S, Miaskowski C (2012) The PRO-SELF(©) Pain Control Program improves patients’ knowledge of cancer pain management. J Pain Symptom Manag 44(3):321–330
Sikorskii A, Given CW, Siddiqi AE, Champion V, McCorkle R, Spoelstra SL et al (2015) Testing the differential effects of symptom management interventions in cancer. Psychooncology 24(1):25–32
Stagl JM, Bouchard LC, Lechner SC, Blomberg BB, Gudenkauf LM, Jutagir DR et al (2015) Long-term psychological benefits of cognitive-behavioral stress management for women with breast cancer: 11-year follow-up of a randomized controlled trial. Cancer 121(11):1873–1881
Vargas S, Antoni MH, Carver CS, Lechner SC, Wohlgemuth W, Llabre M et al (2014) Sleep quality and fatigue after a stress management intervention for women with early-stage breast cancer in southern Florida. Int J Behav Med. 21(6):971–981
Ames SC, Tan WW, Ames GE, Stone RL, Rizzo TD, Crook JE et al (2011) A pilot investigation of a multidisciplinary quality of life intervention for men with biochemical recurrence of prostate cancer. Psycho-Oncology 20(4):435–440
Antoni MH, Wimberly SR, Lechner SC, Kazi A, Sifre T, Urcuyo KR et al (2006) Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. Am J Psychiatry 163(10):1791–1797
Aranda S, Jefford M, Yates P, Gough K, Seymour J, Francis P 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):222–231
Armes J, Chalder T, Addington-Hall J, Richardson A, Hotopf M (2007) A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer-related fatigue. Cancer 110(6):1385–1395
Boesen EH, Boesen SH, Frederiksen K, Ross L, Dahlstrom K, Schmidt G et al (2007) Survival after a psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. J Clin Oncol 25(36):5698–5703
Boesen EH, Karlsen R, Christensen J, Paaschburg B, Nielsen D, Bloch IS et al (2011) Psychosocial group intervention for patients with primary breast cancer: a randomised trial. Eur J Cancer 47(9):1363–1372
Borosund E, Cvancarova M, Moore SM, Ekstedt M, Ruland CM (2014) Comparing effects in regular practice of e-communication and Web-based self-management support among breast cancer patients: preliminary results from a randomized controlled trial. J Med Internet Res 16(12):e295
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):347–357
Crawford D, Texter T, Hurt K, VanAelst R, Glaza L, Vander Laan KJ (2012) Traditional nurse instruction versus 2 session nurse instruction plus DVD for teaching ostomy care: a multisite randomized controlled trial. J Wound Ostomy Continence Nurs 39(5):529–537
Dodd MJ, Cho MH, Miaskowski C, Painter PL, Paul SM, Cooper BA et al (2010) A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy. Cancer Nurs 33(4):245–257
Dolbeault S, Cayrou S, Bredart A, Viala AL, Desclaux B, Saltel P et al (2009) The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. Psychooncology 18(6):647–656
Doorenbos A, Given B, Given C, Verbitsky N, Cimprich B, McCorkle R (2005) Reducing symptom limitations: a cognitive behavioral intervention randomized trial. Psychooncology 14(7):574–584
Ell K, Xie B, Kapetanovic S, Quinn DI, Lee PJ, Wells A et al (2011) One-year follow-up of collaborative depression care for low-income, predominantly Hispanic patients with cancer. Psychiatr Serv 62(2):162–170
Gaston-Johansson F, Fall-Dickson JM, Nanda JP, Sarenmalm EK, Browall M, Goldstein N (2013) Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy. Psychooncology 22(3):530–539
Gil KM, Mishel MH, Belyea M, Germino B, Porter LS, Clayton M (2006) Benefits of the uncertainty management intervention for African American and White older breast cancer survivors: 20-month outcomes. Int J Behav Med 13(4):286–294
Howell D, Bezjak A, Sidani S, Dudgeon D, Mayo S, Bourbeau J, et al. Abstracts of the 2014 International MASCC/ISOO Symposium, June 26–28, 2014, Miami, Florida. Support Care Cancer. 2014;22 Suppl 1:1–238
Jacobsen PB, Phillips KM, Jim HS, Small BJ, Faul LA, Meade CD et al (2013) Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial. Psychooncology 22(6):1229–1235
Jahn P, Kuss O, Schmidt H, Bauer A, Kitzmantel M, Jordan K et al (2014) Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: a cluster-randomized multicenter trial. Pain 155(4):746–754
Jahn P, Renz P, Stukenkemper J, Book K, Kuss O, Jordan K et al (2009) Reduction of chemotherapy-induced anorexia, nausea, and emesis through a structured nursing intervention: a cluster-randomized multicenter trial. Support Care Cancer 17(12):1543–1552
Koller A, Miaskowski C, De Geest S, Opitz O, Spichiger E (2013) Results of a randomized controlled pilot study of a self-management intervention for cancer pain. Eur J Oncol Nurs 17(3):284–291
Korstjens I, Mesters I, May AM, van Weert E, van den Hout JH, Ros W et al (2011) Effects of cancer rehabilitation on problem-solving, anxiety and depression: a RCT comparing physical and cognitive-behavioural training versus physical training. Psychol Health 26(Suppl 1):63–82
Kravitz RL, Tancredi DJ, Jerant A, Saito N, Street RL, Grennan T et al (2012) Influence of patient coaching on analgesic treatment adjustment: secondary analysis of a randomized controlled trial. J Pain Symptom Manag 43(5):874–884
Krischer MM, Xu P, Meade CD, Jacobsen PB (2007) Self-administered stress management training in patients undergoing radiotherapy. J Clin Oncol 25(29):4657–4662
Kurtz ME, Kurtz JC, Given CW, Given B (2006) Effects of a symptom control intervention on utilization of health care services among cancer patients. Med Sci Monit 12(7):CR319–CR324
Lee MK, Yun YH, Park HA, Lee ES, Jung KH, Noh DY (2014) A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial. Int J Nurs Stud 51(12):1557–1567
Loprinzi CE, Prasad K, Schroeder DR, Sood A (2011) Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer 11(6):364–368
McCorkle R, Dowd M, Ercolano E, Schulman-Green D, Williams AL, Siefert ML et al (2009) Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers. Psychooncology 18(1):62–70
Penedo FJ, Molton I, Dahn JR, Shen BJ, Kinsinger D, Traeger L et al (2006) A randomized clinical trial of group-based cognitive-behavioral stress management in localized prostate cancer: development of stress management skills improves quality of life and benefit finding. Ann Behav Med 31(3):261–270
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):148–161
Risendal BC, Dwyer A, Seidel RW, Lorig K, Coombs L, Ory MG (2014) Meeting the challenge of cancer survivorship in public health: results from the evaluation of the chronic disease self-management program for cancer survivors. Front Public Health 2:214
Rissanen R, Nordin K, Ahlgren J, Arving C. A stepped care stress management intervention on cancer-related traumatic stress symptoms among breast cancer patients—a randomized study in group versus individual setting. Psychooncology. 2015.
Rustoen T, Valeberg BT, Kolstad E, Wist E, Paul S, Miaskowski C (2014) A randomized clinical trial of the efficacy of a self-care intervention to improve cancer pain management. Cancer Nurs 37(1):34–43
Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L et al (2009) Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med 361(7):664–673
Schou Bredal I, Karesen R, Smeby NA, Espe R, Sorensen EM, Amundsen M et al (2014) Effects of a psychoeducational versus a support group intervention in patients with early-stage breast cancer: results of a randomized controlled trial. Cancer Nurs 37(3):198–207
Sherwood P, Given BA, Given CW, Champion VL, Doorenbos AZ, Azzouz F et al (2005) A cognitive behavioral intervention for symptom management in patients with advanced cancer. Oncol Nurs Forum 32(6):1190–1198
Sikorskii A, Given CW, Given B, Jeon S, Decker V, Decker D et al (2007) Symptom management for cancer patients: a trial comparing two multimodal interventions. J Pain Symptom Manag 34(3):253–264
Stanton AL, Ganz PA, Kwan L, Meyerowitz BE, Bower JE, Krupnick JL et al (2005) Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. J Clin Oncol 23(25):6009–6018
Strong V, Waters R, Hibberd C, Murray G, Wall L, Walker J et al (2008) Management of depression for people with cancer (SMaRT oncology 1): a randomised trial. Lancet 372(9632):40–48
van Waart H, Stuiver MM, van Harten WH, Geleijn E, Kieffer JM, Buffart LM et al (2015) Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol 33(17):1918–1927
Wang YJ, Boehmke M, Wu YW, Dickerson SS, Fisher N (2011) Effects of a 6-week walking program on Taiwanese women newly diagnosed with early-stage breast cancer. Cancer Nurs 34(2):E1–13
Yates P, Aranda S, Hargraves M, Mirolo B, Clavarino A, McLachlan S et al (2005) Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 23(25):6027–6036
Zhang M, Chan SW, You L, Wen Y, Peng L, Liu W et al (2014) The effectiveness of a self-efficacy-enhancing intervention for Chinese patients with colorectal cancer: a randomized controlled trial with 6-month follow up. Int J Nurs Stud 51(8):1083–1092
Ream E, Gargaro G, Barsevick A, Richardson A (2015) Management of cancer-related fatigue during chemotherapy through telephone motivational interviewing: modeling and randomized exploratory trial. Patient Educ Couns 98(2):199–206
Hibbard JH, Mahoney ER, Stock R, Tusler M (2007) Do increases in patient activation result in improved self-management behaviors? Health Serv Res 42(4):1443–1463
Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH (2004) Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med 164(15):1641–1649
Howell DM, Bezjak A, Sidani S, Dudgeon D, Husain A, Fernandes G, et al. Self management interventions for breathlessness in adult cancer patients. The Cochrane Library. 2012.
Corner J (2008) Addressing the needs of cancer survivors: issues and challenges. Expert Rev Pharmacoecon Outcomes Res 8(5):443–451
Schwarzer R (2001) Social-cognitive factors in changing health-related behaviors. Curr Dir Psychol Sci 10(2):47–51
Taylor D, Bury M (2007) Chronic illness, expert patients and care transition. Sociol Health Illn 29(1):27–45
Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G et al (2007) The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. J Epidemiol Community Health 61(3):254–261
Acknowledgements
We would like to extend our appreciation to the researchers who conducted the studies included in this review and the patients with cancer who participated in them. We would also like to thank the Program in Evidence-Based Care (PEBC) for their support and guidance in conducting this research.
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The authors and members of the expert panel from the Program in Evidence-Based Care, McMaster University, Hamilton, ON, Canada and the Cancer Care Ontario, Patient Education Program, Toronto, ON, Canada reported that they had no conflicts of interest.
Funding
The PEBC is a provincial initiative of Cancer Care Ontario supported by the Ontario Ministry of Health and Long-Term Care. All work produced by the PEBC is editorially independent from the Ontario Ministry of Health and Long-Term Care.
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Doris Howell and Tamara Harth were co-chairs for this evidence summary.
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Howell, D., Harth, T., Brown, J. et al. Self-management education interventions for patients with cancer: a systematic review. Support Care Cancer 25, 1323–1355 (2017). https://doi.org/10.1007/s00520-016-3500-z
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DOI: https://doi.org/10.1007/s00520-016-3500-z