Oncology Nursing Society. Unauthorized reproduction, in part or in whole, is strictly prohibited. For permission to photocopy, post online, reprint, adapt, or otherwise reuse any or all content from this article, e-mail firstname.lastname@example.org. To purchase high-quality reprints, email email@example.com.
December 2014, Supplement to Volume 18, Number 6
Update on Research-Based Interventions for Anxiety in Patients With Cancer
Patsy R. Smith, PhD, RN, Diane Cope, PhD, ARNP-BC, AOCNP®, Tammie L. Sherner, MSN, APRN-CNS, and Deborah K. Walker, DNP, FNP-BC, AOCN®
Anxiety may begin at the moment a person is diagnosed with cancer and may fluctuate throughout the cancer trajectory as physical illness improves or declines. The purpose of this article is to present current evidence for nurses to implement interventions to reduce anxiety in patients who have cancer. The PubMed and CINAHL® databases were searched to identify relevant citations addressing interventions that treat or prevent anxiety symptoms in patients with cancer. Based on available evidence, the interventions addressed herein are categorized according to the Putting Evidence Into Practice (PEP®) rating schema. Interventions include pharmacologic and nonpharmacologic approaches to care, and meet criteria for three PEP categories: likely to be effective, effectiveness not established (the largest category of results), or effectiveness unlikely.
Oncology nurses may hear or utter the words “you have cancer” every day while working in oncology clinics. The nurse compassionately considers patients’ responses to that phrase and may ponder what effective actions are available to alleviate the inevitable anxiety, fear, or panic that patients and families experience. The purpose of this article is to highlight the latest evidence for nursing interventions that prevent or lessen anxiety among patients with cancer. The current article is a supplement to a broader undertaking wherein the body of evidence to support interventions across the spectrum of symptom management was explored (Eaton & Tipton, 2009). The goal is for oncology nurses to have ready access to resources to guide patients through anxiety management.
Anxiety, a predictable response to a cancer diagnosis, occurs in varying degrees and may increase as the disease progresses or as treatment becomes more aggressive or more debilitating (Breitbart, 1995). Investigators have found that 44% of patients reported some form of anxiety and 23% reported significant anxiety (Schag & Heinrich, 1989; Stark et al., 2002). The risk of developing anxiety disorders may represent a threat to patients’ social roles, relationships, and ideas about future health, plans, and goals. The risk increases during cancer treatment when the following factors exist: a history of anxiety disorder, severe pain, anxiety at the time of diagnosis, functional limitations, a lack of social support, advancing disease, or a history of trauma (National Cancer Institute, n.d.).
Nurses have a unique role in the cancer setting. Patients may be reluctant to talk with oncologists about personal fears and anxiety after a cancer diagnosis. However, patients often talk with a nurse while sitting in the infusion chair or waiting for the oncologist to arrive in the examination room. Oncology nurses are encouraged to be visible, articulate advocates for timely and effective assessment of psychosocial concerns in cancer care. Oncology nurses provide supportive care, assess psychosocial concerns, and pursue referral for significant concerns or changes in physical, emotional, and spiritual functioning (Sheldon, Harris, & Arcieri, 2012) even when they may not be formally trained in psychological or spiritual therapy. As a result, oncology nurses have a real and present responsibility to understand relevant evidence and apply appropriate interventions to reduce patient anxiety.
The literature was reviewed for evidence of effective interventions for anxiety management among patients, survivors, and caregivers. Teams of nurse specialist volunteers, adept in oncology nursing science and research, applied a sound, scientific research lens to review and evaluate current evidence on cancer symptom management and intervention. The PubMed and CINAHL® databases provided 634 and 1,462 citations, respectively, of which 119 studies were retained for final review to develop anxiety-related Putting Evidence Into Practice (PEP®) resources.
Consistent with previous PEP program publications (Sheldon, Swanson, Dolce, Marsh, & Summers, 2008), this article continues to build the evidence; therefore, citations reflect research published from larger studies, meta-analyses, and systematic reviews. Newer evidence supports changes and modifications from previously published PEP recommendations. A detailed description of the methods used to extract literature for review and evaluation is reported separately (Johnson, 2014). The current article includes studies of anxiolytics for effectiveness on anxiety in patients with cancer.
Levels of Evidence
Although none of the literature reviewed strongly supported recommendations for practice, the reviews resulted in evidence categorized into (a) interventions likely to be effective for management, reduction, or elimination of anxiety; (b) interventions for which effectiveness was not established; and (c) interventions for which effectiveness is unlikely (see Figure 1).
Likely to Be Effective
Coaching: Two studies evaluated coaching using verbal and written prompts to identify needs. In the smaller study (N = 44), Shields et al. (2010) found that use of a prompt sheet by the nurse making the coaching phone call had no significant effect on anxiety. In the larger randomized, controlled trial (RCT) (N = 635), however, the prevalence of anxiety significantly decreased (p < 0.01) after coaching involving a needs checklist and telephone consultation (White et al., 2012).
Cognitive-behavioral therapy interventions: These approaches included activities such as relaxation training, goal setting, problem solving, education, peer communication, guided imagery, and physical activity, which showed mixed results for decreases in anxiety for individuals (Arving et al., 2007; Greer et al., 2011, 2012; Hopko et al., 2011; Kangas, Milross, Taylor, & Bryant, 2013; Pitceathly et al., 2009; Serfaty, Wilkinson, Freeman, Mannix, & King, 2012), in group settings (Ames et al., 2011; Boesen et al., 2011; Dolbeault et al., 2009; Korstjens et al., 2011), and in one group within a videoconferencing setting (Shepherd et al., 2006). Significant improvement in anxiety with cognitive-behavioral therapy interventions also were found in two meta-analyses (Naaman, Radwan, Fergusson, & Johnson, 2009; Osborn, Demoncada, & Feuerstein, 2006).
Exercise: Exercise programs involved physical activities, such as aerobic fitness, flexibility, and muscle strength, in home settings, self-managed patient programs, and individual and group sessions. Specifically studied for its effects on anxiety, exercise has shown mixed results, with some studies suggesting a significant improvement (Burnham & Wilcox, 2002; Courneya et al., 2007; Mehnert et al., 2011) and others showing no significant improvement (Kolden et al., 2002; Midtgaard et al., 2005, 2011; Thorsen et al., 2005). A meta-analysis exploring the effectiveness of exercise interventions on health-related quality of life found beneficial effects on anxiety at follow-up time intervals (Mishra et al., 2012). Exercise interventions were generally positive; however, further research is needed to explore various patient groups and phases of the cancer trajectory.
Massage or aromatherapy massage: Two systematic reviews investigating the impact of traditional massage therapy and aromatherapy massage on anxiety in patients with cancer revealed sufficient evidence to support the effectiveness of massage in decreasing anxiety (Fellowes, Barnes, & Wilkinson, 2008; Wilkinson, Barnes, & Storey, 2008); however, the evidence was insufficient to support the effectiveness of aromatherapy massage in decreasing anxiety. Several studies showed that massage therapy significantly decreases anxiety immediately following the therapy session (Campeau et al., 2007; Hernandez-Reif et al., 2005; Jane et al., 2011; Kutner et al., 2008; Post-White et al., 2003; Sturgeon, Wetta-Hall, Hart, Good, & Dakhil, 2009). Only one study showed significant improvement in anxiety with the administration of aromatherapy massage (Wilkinson et al., 2007).
Mindfulness-based stress reduction: These interventions provide opportunities for self-expression, facilitate coping strategies, and encourage self-regulation. Several studies reported reduced anxiety or improved mood status (p range = 0.05–0.001) (Garland, Tamagawa, Todd, Speca, & Carlson, 2013; Hoffman et al., 2012; Monti et al., 2012; Würtzen et al., 2013), and Lengacher et al. (2012) reported an improved psychological symptom cluster involving distress, sadness, pain, and memory. However, the vast majority of studies evaluated female patients with breast cancer. Fewer than 16% of participants in one study were male and included patients with hematologic cancers and colon cancer (Garland et al., 2013). A systematic review and meta-analysis, with most studies involving women with breast cancer, reported a low to moderate significant effect in decreasing anxiety (Piet, Würtzen, & Zachariae, 2012). Study limitations included minimal participants with clinically significant anxiety at baseline and heterogeneity among the studies.
Music or music therapy: Several studies involving pediatric and adult patients suggest that listening to music prior to procedures, surgery, or chemotherapy can reduce anxiety (Bulfone, Quattrin, Zanotti, Regattin, & Brusaferro, 2009; Ferrer, 2007; Karagozoglu, Tekyasar, & Yilmaz, 2013; Li, Zhou, Yan, Wang, & Zhang, 2012; Lin, Hsieh, Hsu, Fetzer, & Hsu, 2011; Nguyen, Nilsson, Hellstrom, & Bengtson, 2010). Two systematic reviews and meta-analyses examined anxiety levels in experimental and control groups using music and found that anxiety decreased over time in both groups (Bradt, Dileo, Grocke, & Magill, 2011; Nightingale, Rodriguez, & Carnaby, 2013). One small RCT showed no significant difference in pre- and post-procedure anxiety or pain among patients undergoing cancer-related painful procedures (including tissue biopsy, hematoma evacuation, or insertion or removal of an access port) (Kwekkeboom, 2003), whereas another indicated anxiety reduction in patients with high anxiety prior to chemotherapy (Lin et al., 2011). Limitations of music-related studies include small effect and sample sizes, few that examined specific symptoms or outcomes, and varying interventions across studies.
Progressive muscle relaxation: Two RCTs examined effectiveness of progressive muscle relaxation on multiple variables, including anxiety (Chan, Richardson, & Richardson, 2011; Cheung, Molassiotis, & Chang, 2003). Progressive muscle relaxation training and practice in relaxing each muscle group were found to decrease anxiety as patients monitored tension in specific body muscle groups, deliberately inducing and relaxing tension in each (Cheung et al., 2003).
Psychoeducational interventions: Educational information and support pertaining to topics such as symptom management, coping, communication, and stress management or relaxation training, known as psychoeducational interventions, were used to examine effects on physical and psychological variables, including anxiety (Chien, Liu, Chien, & Liu, 2014; Hirai et al., 2012; Naaman et al., 2009; Osborn et al., 2006). Results are mixed because significant reductions in anxiety were reported in several studies (Chan et al., 2011; Galway et al., 2012; Katz, Irish, & Devins, 2004; Kim et al., 2013; Liu et al., 2008; Targ & Levine, 2002; Williams & Schreier, 2004) and others reported no significant effects (Goerling, Foerg, Sander, Schramm, & Schlag, 2011; Jones et al., 2006; Krischer, Xu, Meade, & Jacobsen, 2007; Oh & Kim, 2010; Rawl et al., 2002; Schofield et al., 2008). However, four systematic reviews revealed small but significant reductions in anxiety after psychoeducational interventions (Chien et al., 2014; Hirai et al., 2012; Naaman et al., 2009; Osborn et al., 2006). Support for a single type of psychoeducational intervention and duration of effect is not established.
Supportive care or support interventions: Support interventions include provision of emotional support to patients individually, via telephone conferences, and via support groups facilitated by healthcare professionals or trained volunteers. Studies suggest support group interventions may significantly reduce anxiety in women with breast cancer (Cameron, Booth, Schlatter, Ziginskas, & Harman, 2007; Chujo et al., 2005). Examples of topics addressed in the studies are cancer education, social support, and role transitions (Badger, Segrin, Dorros, Meek, & Lopez, 2007); awareness of anxiety symptoms, stress management, coping, and problem solving (Chujo et al., 2005); spiritual needs, feelings, and emotions (Miller, Chibnall, Videen, & Duckro, 2005); and emotional support (Liao, Chen, Chen, & Chen, 2010). Results indicated a significant decrease in anxiety for patients throughout the cancer trajectory (Ando, Morita, Okamoto, & Ninosaka, 2008; Badger et al., 2007; Cameron et al., 2007; Chujo et al., 2005; Liao et al., 2010; Liu et al., 2008; Miller et al., 2005; White et al., 2012).
Effectiveness Not Established
Pharmacologic and nonpharmacologic interventions, including complementary and alternative therapies, have resulted in mixed findings. Limitations include sample size and study design. Interventions for which only a single study was found for review are shown in Table 1. Effectiveness is not established for the pharmacologic and nonpharmacologic interventions discussed in the following sections.
Antidepressants: Used as an adjunctive treatment for cancer-related pain, nausea, and vomiting, antidepressants are a class of medications intended to treat depression (Cankurtaran et al., 2008). Researchers evaluated antidepressants for effect on depression, anxiety, and sleep (Cankurtaran et al., 2008; Suzuki et al., 2011; Torta, Leombruni, Borio, & Castelli, 2011), revealing significant improvement in anxiety with mirtazapine, fluvoxamine, or duloxetine. The studies were limited by non-randomized design and small samples. Results indicate antidepressants may be effective in the management of cancer-related anxiety, but larger RCTs are warranted.
Anxiolytics: Studies in this category contained design limitations or small sample size (i.e., less than 50 in multiple studies). Studies of alprazolam versus placebo or progressive muscle relaxation (Holland et al., 1991; Wald, Kathol, Noyes, Carroll, & Clamon, 1993) and fluoxetine versus placebo (Rasavi et al., 1996) resulted in no difference between groups on anxiety. An RCT of midazolam, propofol, or control reported decreased anxiety (Mentes, Unsal, Baran, Argun, & Ertunc, 2005), but the use of the measurement tool for anxiety was unclear. In addition, a small-sample study (N = 35) of sertraline resulted in a significant reduction (p < 0.05) in anxiety and anxious preoccupation (Torta, Siri, & Caldera, 2008).
Communication and care coordination interventions: Facilitating communication and coordinating care were explored as interventions to facilitate supportive cancer care and decrease anxiety, depression, and unmet needs (Girgis, Breen, Stacey, & Lecathelinais, 2009). Researchers examined a computer-assisted telephone interview among patients with breast and colorectal cancers. Patient feedback was provided by a caseworker or a physician at the next appointment. Results indicated that participants who worked with the caseworker (n = 120) were more likely to have referrals for unmet psychological needs (p < 0.01), including daily living, health service and information, and physical needs (p < 0.01). Participants who spoke with a physician (n = 119) reported fewer documented follow-up actions (p < 0.0001) compared to the caseworker group. No significant effect was found on anxiety with either model. Similarly, an RCT exploring the effect of patients’ full access to the medical record on anxiety, quality of life, and satisfaction revealed no significant reduction in anxiety compared to those who requested access (Gravis et al., 2011).
In contrast, D’Souza, Blouin, Zeitouni, Muller, and Allison (2013) reported positive results after investigating the effect of tailored information to patients with advanced head and neck cancer. Tailored information included a patient booklet; interactive computer software that stored patient input; computer animation describing cancer spread, staging, and surgical procedures; and a take-home DVD for the purpose of educating patients about diagnostic and adjuvant procedures, nutrition, and speech and swallowing practice. Findings suggest a significant reduction in anxiety (p = 0.001) in the intervention group assessed at three and six months.
Studies exploring the role of the nurse in providing information and supportive care showed mixed results in effectiveness of reducing distress and improving coping (Ferrante, Chen, & Kim, 2008; Fukui, Ogawa, Ohtsuka, & Fukui, 2008; Skrutkowski et al., 2008). Ferrante et al. (2008) found that the use of a patient navigator improved timeliness of diagnosis, reduced anxiety, and increased satisfaction in a sample of urban minority women following a suspicious mammogram. Skrutkowski et al. (2008) found no significant reduction in distress symptoms in a group of patients with lung and breast cancers when a nurse coordinator provided information, support, and coping skills. Similarly, no significant reduction in anxiety was found in patients who participated in interviews with nurses who had completed a communication skills training program (Fukui et al., 2008).
Complementary and Alternative Therapies
The following studies of complementary and alternative therapies related to anxiety have shown mixed results and incorporated small sample sizes that limit robust findings. Further randomized, large-scale studies are needed to confirm or clarify results.
Acupuncture: No significant effect on symptoms of fatigue, anxiety, or depression was found when acupuncture was performed following completion of chemotherapy (Deng et al., 2013; Molassiotis et al., 2013). Garcia et al. (2013) conducted a systematic review to evaluate the effectiveness of acupuncture for symptom control. Results indicated possible effectiveness for management of chemotherapy-induced nausea and vomiting but did not show acupuncture to be effective in the treatment of pain, fatigue, hot flashes, anxiety, depression, or insomnia.
Art and art therapy: Several studies examined the effect of art therapy sessions on anxiety in patients receiving oncologic therapy (Bar-Sela, Atid, Danos, Gabay, & Epelbaum, 2007; Lawson et al., 2012; Nainis et al., 2005; Thyme et al., 2009). Findings suggest that art therapy may help manage anxiety; however, the studies each had sample sizes ranging from 20–60 participants.
Caregiver and partner interventions: Studies exploring supportive care interventions provided to caregivers or partners of women with breast cancer suggest positive effect on anxiety (Cochrane, Lewis, & Griffith, 2011; Manne et al., 2005).
Expressive writing: Studies of expressive-writing interventions for effect on anxiety, fatigue, and depression (Jensen-Johansen et al., 2012; Mosher et al., 2012) suggested no significant reduction in anxiety.
Hypnosis or hypnotherapy: Hypnosis was examined for effects on anxiety, pain, or distress prior to surgery or bone marrow procedures (Schnur et al., 2008; Snow et al., 2012). One study (Schnur et al., 2008) conducted a hypnosis session 15 minutes before excisional breast biopsy; the other study (Snow et al., 2012) initiated the hypnosis session 15 minutes before the procedure and continued through completion of the procedure. Findings suggest that a brief hypnosis intervention, minimally 15 minutes, significantly reduced anxiety and distress (p < 0.001 and p = 0.026, respectively).
Meditation: Studies examining meditation included small samples and show mixed results for effects on anxiety, depression, and stress reduction (Ando et al., 2009; Hidderley & Holt, 2004; Ramachandra, Booth, Pieters, Vrotsou, & Huppert, 2009).
Progressive muscle relaxation and guided imagery: Progressive muscle relaxation was shown as likely to be effective in reducing anxiety (Chan et al., 2011; Cheung et al., 2003). However, research exploring the benefits of adding guided imagery to progressive muscle relaxation therapy did not confirm improvement (Naaman et al., 2009; Nunes et al., 2007; Sloman, 2002).
Reflexology: The technique of applying pressure to areas of the feet and hands has been studied for effects on pain, anxiety, and depression and has shown positive effects on anxiety (Quattrin et al., 2006; Stephenson, Swanson, Dalton, Keefe, & Engelke, 2007). Other studies showed no effect of reflexology on anxiety (Sharp et al., 2010; Wyatt, Sikorskii, Rahbar, Victorson, & You, 2012).
Reiki: Two small studies examining the effects of Reiki revealed no change in anxiety (Birocco et al., 2012; Potter, 2007). However, Tsang, Carlson, and Olson (2007) conducted a pilot study administering Reiki to women with various types and stages of cancer and reported a significant reduction in anxiety.
Relaxation therapy and relaxation and visual imagery interventions: Deep-breathing interventions to achieve a sense of relaxation were examined for effect on fatigue, anxiety, and depression (Hayama & Inoue, 2012; Kim & Kim, 2005). Results were mixed. Adding visual imagery to relaxation therapy was shown to significantly decrease anxiety in one nonrandomized study with a small sample size (N = 66) (Serra et al., 2012).
Structured rehabilitation services: Provided by multidisciplinary teams, structured rehabilitation services were studied for their effect on ameliorating physical impairments (Hanssens et al., 2011; Khan, Amatya, Pallant, Rajapaksa, & Brand, 2012; Rottman et al., 2012). The studies revealed mixed results for anxiety: significant improvement (Hanssens et al., 2011; Rottman et al., 2012) or no change (Khan et al., 2012).
Virtual reality: Schneider and Hood (2007) examined virtual reality interventions, a process intended to create a physical presence in an imaginary environment. The intervention, used during chemotherapy, revealed no significant difference in distress or anxiety. Virtual reality gaming provided to a group of pediatric patients who were hospitalized and undergoing active treatment revealed a significant decline in anxiety and depressive symptoms (Li, Chung, & Ho, 2011).
Yoga: Several studies explored the effect of yoga interventions on stress, anxiety, depression, and sleep disturbances (Banerjee et al., 2007; Cohen, Warneke, Foulacli, Rodriguez, & Chaoul-Reich, 2004; Dhruva et al., 2012; Rao et al., 2009; Ulger & Yagli, 2010; Vadiraja et al., 2009). Mixed results and study design limitations preclude conclusions regarding yoga’s effectiveness for decreasing anxiety.
Orientation and information provision: The process of sharing information about a facility or services to patients using print or electronic media was studied during orientation programs for its effect on anxiety and distress (Deshler et al., 2006; Hoff & Haaga, 2005; Schofield et al., 2008; Wysocki, Mitus, Komorowski, & Karolewski, 2012). In addition, two systematic reviews on information sharing provided nonsignificant effects on anxiety (Chan, Webster, & Marquart, 2012; Osborn et al., 2006).
Implications for Practice
The PEP anxiety team conducted a comprehensive review of the literature to identify interventions that can be applied to evaluating and treating anxiety in patients with cancer (see Figure 2). Moderate- and high-risk factors for patients were identified and can help guide nurses in determining which patients may benefit from closer evaluation or recommended interventions. Oncology nurses are encouraged to use assessment skills to evaluate patients for signs and symptoms of anxiety, with the understanding that patients generally have some level of anxiety at the time of diagnosis or early in treatment, which may decline over time without intervention. Effective communication is extremely important and should include patient education resources (see Figure 3). Oncology nurse responsibilities include reviewing and reinforcing educational materials.
Reported signs and symptoms suggestive of anxiety or depression may include insomnia, difficulty completing activities of daily living, poor concentration, or fatigue. Once signs and symptoms of anxiety are identified, validated assessment instruments are available. Effective instruments for comprehensive anxiety evaluation include the National Comprehensive Cancer Network’s Distress Thermometer screening tool, the General Anxiety Disorder–7 scale, the Hospital Anxiety and Depression Scale, and the State-Trait Anxiety Inventory.
Several studies identified practice interventions likely to be effective in reducing anxiety in patients with a cancer diagnosis. Nurses may recommend complementary methods, such as exercise, massage, aromatherapy, music therapy, progressive muscle relaxation, or mindfulness-based stress reduction, in an effort to reduce anxiety. Cognitive-behavioral therapy is likely to be effective for individuals or in group settings. Individual coaching or referral to support groups may provide benefit for some to reduce anxiety. Referral for psychological care may be warranted for patients with persistent anxiety.
Studies revealed mixed results for interventions historically applied in the treatment of anxiety, including pharmacotherapies and alternative therapies. A common characteristic among studies for which effectiveness was not established was poor design: nonrandomized studies, those conducted in small groups or with small sample sizes, or that otherwise did not meet criteria for likely effectiveness recommendation. Similarly, study participants may not have experienced clinically relevant anxiety levels at baseline or anxiety may have naturally improved over time. Additional research is needed in the area of pharmacotherapy to identify proper medications and dosages for patients with cancer and to develop recommendations for levels of anxiety requiring treatment. Large randomized, controlled studies are needed to explore complementary and alternative therapies, communication, and care coordination interventions that did not show effectiveness or that have shown mixed results in the literature.
Implications for Practice
Ø Explain to patients and family members that anxiety reactions are expected responses to a cancer diagnosis.
Ø Educate patients, friends, and family members about the importance of practicing interventions shown to be effective in reducing anxiety in patients with cancer.
Ø Encourage patients who practice interventions for which effectiveness is not established to report personal experiences in written format to share with healthcare professionals for future research purposes.
Ames, S.C., Tan, W.W., Ames, G.E., Stone, R.L., Rizzo, T.D., Jr., Crook, J.E., . . . Rummans, T.A. (2011). A pilot investigation of a multidisciplinary quality of life intervention for men with biochemical recurrence of prostate cancer. Psycho-Oncology, 20, 435–440. http://dx.doi.org/10.1002/pon.1769
Ando, M., Morita, T., Akechi, T., Ito, S., Tanaka, M., Ifuku, Y., & Nakayama, T. (2009). The efficacy of mindfulness-based meditation therapy on anxiety, depression, and spirituality in Japanese patients with cancer. Journal of Palliative Medicine, 12, 1091–1094. http://dx.doi.org/10.1089/jpm.2009.0143
Ando, M., Morita, T., Okamoto, T., & Ninosaka, Y. (2008). One-week short-term life review interview can improve spiritual well-being of terminally ill cancer patients. Psycho-Oncology, 17, 885–890. http://dx.doi.org/10.1002/pon.1299
Arving, C., Sjoden, P.O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B., & Brandberg, Y. (2007). Individual psychosocial support for breast cancer patients: A randomized study of nurse versus psychologist interventions and standard care. Cancer Nursing, 30, E10–E19. http://dx.doi.org/10.1097/01.NCC.0000270709.64790.05
Badger, T., Segrin, C., Dorros, S.M., Meek, P., & Lopez, A.M. (2007). Depression and anxiety in women with breast cancer and their partners. Nursing Research, 56, 44–53.
Banerjee, B., Vadiraj, H.S., Ram, A., Rao, R., Jayapal, M., Gopinath, K.S., . . . Hande, M.P. (2007). Effects of an integrated yoga program in modulating psychosocial stress and radiation-induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integrative Cancer Therapies, 6, 242–250. http://dx.doi.org/10.1177/1534735407306214
Bar-Sela, G., Atid, L., Danos, S., Gabay, N., & Epelbaum, R. (2007). Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psycho-Oncology, 16, 980–984. http://dx.doi.org/10.1002/pon.1175
Birocco, N., Guillame, C., Storto, S., Ritorto, G., Catino, C., Gir, N., . . . Ciuffreda, L. (2012). The effects of Reiki therapy on pain and anxiety in patients attending a day oncology and infusion services unit. American Journal of Hospice and Palliative Care, 29, 290–294. http://dx.doi.org/10.1177/1049909111420859
Boesen, E.H., Karlsen, R., Christensen, J., Paaschburg, B., Nielsen, D., Bloch, I.S., . . . Johansen, C. (2011). Psychosocial group intervention for patients with primary breast cancer: A randomised trial. European Journal of Cancer, 47, 1363–1372. http://dx.doi.org/10.1016/j.ejca.2011.01.002
Bradt, J., Dileo, C., Grocke, D., & Magill, L. (2011). Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, 8, CD006911. http://dx.doi.org/10.1002/14651858.CD006911.pub2
Breitbart, W. (1995). Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Supportive Care in Cancer, 3, 45–60.
Bulfone, T., Quattrin, R., Zanotti, R., Regattin, L., & Brusaferro, S. (2009). Effectiveness of music therapy for anxiety reduction in women with breast cancer in chemotherapy treatment. Holistic Nursing Practice, 23, 238–242. http://dx.doi.org/10.1097/HNP.0b013e3181aeceee
Burnham, T.R., & Wilcox, A. (2002). Effects of exercise on physiologic and psychological variables in cancer survivors. Medicine and Science in Sports and Exercise, 34, 1863–1867. http://dx.doi.org/10.1097/00005768-200212000-00001
Cameron, L.D., Booth, R.J., Schlatter, M., Ziginskas, D., & Harman, J.E. (2007). Changes in emotion regulation and psychological adjustment following use of a group psychosocial support program for women recently diagnosed with breast cancer. Psycho-Oncology, 16, 171–180. http://dx.doi.org/10.1002/pon.1050
Campeau, M.P., Gaboriault, R., Drapeau, M., Van Nguyen, T., Roy, I., Fortin, B., . . . Nguyen-Tan, P.F. (2007). Impact of massage therapy on anxiety levels in patients undergoing radiation therapy: Randomized controlled trial. Journal of the Society for Integrative Oncology, 5, 133–138. http://dx.doi.org/10.2310/7200.2007.018
Cankurtaran, E.S., Ozalp, E., Soygur, H., Akbiyik, D.I., Turhan, L., & Alkis, N. (2008). Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: Superiority over imipramine. Supportive Care in Cancer, 16, 1291-1298. http://dx.doi.org/10.1007/s00520-008-0425-1
Chan, C.W., Richardson, A., & Richardson, J. (2011). Managing symptoms in patients with advanced lung cancer during radiotherapy: Results of a psychoeducational randomized controlled trial. Journal of Pain and Symptom Management, 41, 347–357. http://dx.doi.org/10.1016/j.jpainsymman.2010.04.024
Chan, R.J., Webster, J., & Marquart, L. (2012). Information interventions for orienting patients and their carers to cancer care facilities. Cochrane Database of Systematic Reviews, 12, CD008273. http://dx.doi.org/10.1002/14651858.CD008273.pub2
Cheung, Y.L., Molassiotis, A., & Chang, A.M. (2003). The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psycho-Oncology, 12, 254–266. http://dx.doi.org/10.1002/pon.638
Chien, C.H., Liu, K.L., Chien, H.T., & Liu, H.E. (2014). The effects of psychosocial strategies on anxiety and depression of patients diagnosed with prostate cancer. International Journal of Nursing Studies, 51, 28–38. http://dx.doi.org/10.1016/j.ijnur stu.2012.12.019
Chujo, M., Mikami, I., Takashima, S., Saeki, T., Ohsumi, S., Aogi, K., & Okamura, H. (2005). A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence. Supportive Care in Cancer, 13, 503–514. http://dx.doi.org/10.1007/s00520-004-0733-z
Cochrane, B.B., Lewis, F.M., & Griffith, K.A. (2011). Exploring a diffusion of benefit: Does a woman with breast cancer derive benefit from an intervention delivered to her partner? Oncology Nursing Forum, 38, 207–214. http://dx.doi.org/10.1188/11.ONF.207-214
Cohen, L., Warneke, C., Foulacli, R.T., Rodriguez, M.A., & Chaoul-Reich, A. (2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer, 100, 2253–2260. http://dx.doi.org/10.1002cncr.20236
Courneya, K.S., Segal, R.J., Gelmon, K., Reid, R.D., Mackey, J.R., Friedenreich, C.M., . . . McKenzie, D.C. (2007). Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiology, Biomarkers and Prevention, 16, 2572–2578. http://dx.doi.org/10.1158/1055-9965.EPI-07-0413
Deng, G., Chan, Y., Sjoberg, D., Vickers, A., Yeung, K.S., Kris, M., . . . Cassileth, B. (2013). Acupuncture for the treatment of post-chemotherapy chronic fatigue: A randomized, blinded, sham-controlled trial. Supportive Care in Cancer, 21, 1735–1741. http://dx.doi.org/10.1007/s00520-013-1720-z
Deshler, A.M., Fee-Schroeder, K.C., Dowdy, J.L., Mettler, T.A., Novotny, P., Zhao, X., & Frost, M.H. (2006). A patient orientation program at a comprehensive cancer center. Oncology Nursing Forum, 33, 569–578. http://dx.doi.org/10.1188/06.ONF.569-578
Dhruva, A., Miaskowski, C., Abrams, D., Acree, M., Cooper, B., Goodman, S., & Hecht, F.M. (2012). Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: Results of a pilot randomized controlled trial. Journal of Alternative and Complementary Medicine, 18, 473–479. http://dx.doi.org/10.1089/acm.2011.0555
Dolbeault, S., Cayrou, S., Bredart, A., Viala, A.L., Desclaux, B., Saltel, P., . . . Dickes, P. (2009). The effectiveness of a psycho-educational group after early-stage breast cancer treatment: Results of a randomized French study. Psycho-Oncology, 18, 647–656. http://dx.doi.org/10.1002/pon.1440
D’Souza, V., Blouin, E., Zeitouni, A., Muller, K., & Allison, P.J. (2013). An investigation of the effect of tailored information on symptoms of anxiety and depression in head and neck cancer patients. Oral Oncology, 49, 431–437. http://dx.doi.org/10.1016/j.oraloncology.2012.12.001
Eaton, L.H., & Tipton, J.M. (Eds.). (2009). Putting Evidence Into Practice: Improving oncology patient outcomes. Pittsburgh, PA: Oncology Nursing Society.
Fellowes, D., Barnes, K., & Wilkinson, S.S. (2008). Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database of Systematic Reviews, CD002287. http://dx.doi.org/10.1002/14651858.CD002287.pub2
Ferrante, J.M., Chen, P.H., & Kim, S. (2008). The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: A randomized controlled trial. Journal of Urban Health, 85, 114–124. http://dx.doi.org/10.1007/s11524-007-9228-9
Ferrer, A.J. (2007). The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment. Journal of Music Therapy, 44, 242–255. http://dx.doi.org/10.1093/jmt/44.3.242
Fukui, S., Ogawa, K., Ohtsuka, M., & Fukui, N. (2008). A randomized study assessing the efficacy of communication skill training on patients’ psychologic distress and coping: Nurses’ communication with patients just after being diagnosed with cancer. Cancer, 113, 1462–1470. http://dx.doi.org/10.1002/cncr.23710
Galway, K., Black, A., Cantwell, M., Cardwell, C.R., Mills, M., & Donnelly, M. (2012). Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database of Systematic Reviews, 11, CD007064. http://dx.doi.org/10.1002/14651858.CD007064.pub2
Garcia, M.K., McQuade, J., Haddad, R., Patel, S., Lee, R., Yang, P., . . . Cohen, L. (2013). Systematic review of acupuncture in cancer care: A synthesis of the evidence. Journal of Clinical Oncology, 31, 952–960. http://dx.doi.org/10.1200/JCO.2012.43.5818
Garland, S.N., Tamagawa, R., Todd, S.C., Speca, M., & Carlson, L.E. (2013). Increased mindfulness is related to improved stress and mood following participation in a mindfulness-based stress reduction program in individuals with cancer. Integrative Cancer Therapies, 12, 31–40. http://dx.doi.org/10.1177/1534735412442370
Gehring, K., Patwardhan, S.Y., Collins, R., Groves, M.D., Etzel, C.J., Meyers, C.A., & Wefel, J.S. (2012). A randomized trial on the efficacy of methylphenidate and modafinil for improving cognitive functioning and symptoms in patients with a primary brain tumor. Journal of Neuro-Oncology, 107, 165–174. http://dx.doi.org/10.1007/s11060-011-0723-1
Girgis, A., Breen, S., Stacey, F., & Lecathelinais, C. (2009). Impact of two supportive care interventions on anxiety, depression, quality of life, and unmet needs in patients with nonlocalized breast and colorectal cancers. Journal of Clinical Oncology, 27, 6180–6190. http://dx.doi.org/10.1200/JCO.2009.22.8718
Goerling, U., Foerg, A., Sander, S., Schramm, N., & Schlag, P.M. (2011). The impact of short-term psycho-oncological interventions on the psychological outcome of cancer patients of a surgical-oncology department—A randomised controlled study. European Journal of Cancer, 47, 2009–2014. http://dx.doi.org/10.1016/j.ejca .2011.04.031
Gravis, G., Protiere, C., Eisinger, F., Boher, J.M., Tarpin, C., Coso, D., . . . Viens, P. (2011). Full access to medical records does not modify anxiety in cancer patients: Results of a randomized study. Cancer, 117, 4796–4804. http://dx.doi.org/10.1002/cncr.26083
Greer, J.A., Solis, J.M., Temel, J.S., Lennes, I.T., Prigerson, H.G., Maciejewski, P.K., & Pirl, W.F. (2011). Anxiety disorders in long-term survivors of adult cancers. Psychosomatics, 52, 417–423. http://dx.doi.org/10.1016/j.psym.2011.01.014
Greer, J.A., Traeger, L., Bemis, H., Solis, J., Hendriksen, E.S., Park, E.R., . . . Safren, S.A. (2012). A pilot randomized controlled trial of brief cognitive-behavioral therapy for anxiety in patients with terminal cancer. Oncologist, 17, 1337–1345. http://dx.doi.org/10.1634/theoncologist.2012-0041
Grob, C.S., Danforth, A.L., Chopra, G.S., Hagerty, M., McKay, C.R., Halberstadt, A.L., & Greer, G.R. (2011). Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Archives of General Psychiatry, 68, 71–78. http://dx.doi.org/10.1001/archgenpsychiatry.2010.116
Hanssens, S., Luyten, R., Watthy, C., Fontaine, C., Decoster, L., Baillon, C., . . . De Grève, J. (2011). Evaluation of a comprehensive rehabilitation program for post-treatment patients with cancer [Online exclusive]. Oncology Nursing Forum, 38, E418–E424. http://dx.doi.org/10.1188/11.ONF.E418-E424
Hayama, Y., & Inoue, T. (2012). The effects of deep breathing on ‘tension-anxiety’ and fatigue in cancer patients undergoing adjuvant chemotherapy. Complementary Therapies in Clinical Practice, 18, 94–98. http://dx.doi.org/10.1016/j.ctcp.2011.10.001
Hernandez-Reif, M., Field, T., Ironson, G., Beutler, J., Vera, Y., Hurley, J., . . . Fraser, M. (2005). Natural killer cells and lymphocytes increase in women with breast cancer following massage therapy. International Journal of Neuroscience, 115, 495–510. http://dx.doi.org/10.1080/00207450590523080
Hidderley, M., & Holt, M. (2004). A pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses. European Journal of Oncology Nursing, 8, 61–65. http://dx.doi.org/10.1016/j.ejon.2003.09.003
Hirai, K., Motooka, H., Ito, N., Wada, N., Yoshizaki, A., Shiozaki, M., . . . Akechi, T. (2012). Problem-solving therapy for psychological distress in Japanese early-stage breast cancer patients. Japanese Journal of Clinical Oncology, 42, 1168–1174.
Hoff, A.C., & Haaga, D.A. (2005). Effects of an education program on radiation oncology patients and families. Journal of Psychosocial Oncology, 23, 61–75.
Hoffman, C.J., Ersser, S.J., Hopkinson, J.B., Nicholls, P.G., Harrington, J.E., & Thomas, P.W. (2012). Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: A randomized, controlled trial. Journal of Clinical Oncology, 30, 1335–1342. http://dx.doi.org/10.1200/JCO.2010.34.0331
Holland, J.C., Morrow, G., Schmale, A., Derogatis, L., Stefanek, M., Berenson, S., . . . Feldstein, M. (1991). A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. Journal of Clinical Oncology, 9, 1004–1011.
Hopko, D.R., Armento, M.E., Robertson, S.M., Ryba, M.M., Carvalho, J.P., Colman, L.K., . . . Lejuez, C.W. (2011). Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: Randomized trial. Journal of Consulting and Clinical Psychology, 79, 834–849. http://dx.doi.org/10.1037/a0025450
Jane, S.W., Chen, S.L., Wilkie, D.J., Lin, Y.C., Foreman, S.W., Beaton, R.D., . . . Liao, M.N. (2011). Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain: A randomized clinical trial. Pain, 152, 2432–2442. http://dx.doi.org/10.1016/j.pain.2011.06.021
Jensen-Johansen, M.B., Christensen, S., Valdimarsdottir, H., Zakowski, S., Jensen, A.B., Bovbjerg, D.H., & Zachariae, R. (2012). Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors—Results from a nationwide randomized clinical trial. Psycho-Oncology, 22, 1492–1500. http://dx.doi.org/10.1002/pon.3193
Johnson, L.A. (2014). Putting evidence into practice: The process. Clinical Journal of Oncology Nursing, 18(3 Suppl.), 2–4. http://dx.doi.org/10.1188/14/CJON.S3.2-4
Jones, R.B., Pearson, J., Cawset, A.J., Bental, D., Barrett, A., White, J., . . . Gilmour, W.H. (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, 942–948. http://dx.doi.org/10.1136/bmj.38807.571042.68
Kangas, M., Milross, C., Taylor, A., & Bryant, R.A. (2013). A pilot randomized controlled trial of a brief early intervention for reducing posttraumatic stress disorder, anxiety and depressive symptoms in newly diagnosed head and neck cancer patients. Psycho-Oncology, 22, 1665–1673. http://dx.doi.org/10.1002/pon.3208
Karagozoglu, S., Tekyasar, F., & Yilmaz, F.A. (2013). Effects of music therapy and guided visual imagery on chemotherapy-induced anxiety and nausea-vomiting. Journal of Clinical Nursing, 22, 39–50. http://dx.doi.org/10.1111/jocn.12030
Katz, M.R., Irish, J.C., & Devins, G.M. (2004). Development and pilot testing of a psychoeducational intervention for oral cancer patients. Psycho-Oncology, 13, 642–653. http://dx.doi.org/10.1002/pon.767
Khan, F., Amatya, B., Pallant, J.F., Rajapaksa, I., & Brand, C. (2012). Multidisciplinary rehabilitation in women following breast cancer treatment: A randomized controlled trial. Journal of Rehabilitation Medicine, 44, 788–794. http://dx.doi.org/10.2340/16501977-1020
Kim, H.S., Shin, S.J., Kim, S.C., An, S., Rha, S.Y., Ahn, J.B., . . . Lee, S. (2013). Randomized controlled trial of standardized education and telemonitoring for pain in outpatients with advanced solid tumors. Supportive Care in Cancer, 21, 1751–1759. http://dx.doi.org/10.1007/s00520-013-1722-x
Kim, S., & Kim, H. (2005). Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. Cancer Nursing, 28, 79–83. http://dx.doi.org/10.1097/00002820-200501000-00012
Kolden, G.G., Strauman, T.J., Ward, A., Kuta, J., Woods, T.E., Schneider, K.L., . . . Mullen, B. (2002). A pilot study of group exercise training (GET) for women with primary breast cancer: Feasibility and health benefits. Psycho-Oncology, 11, 447–456. http://dx.doi.org/10.1002/pon.591
Korstjens, I., Mesters, I., May, A.M., van Weert, E., van den Hout, J.H., Ros, W., . . . van den Borne, B. (2011). Effects of cancer rehabilitation on problem-solving, anxiety and depression: A RCT comparing physical and cognitive-behavioural training versus physical training. Psychology and Health, 26(Suppl. 1), 63–82. http://dx.doi.org/10.1080/08870441003611569
Krischer, M.M., Xu, P., Meade, C.D., & Jacobsen, P.B. (2007). Self-administered stress management training in patients undergoing radiotherapy. Journal of Clinical Oncology, 25, 4657–4662. http://dx.doi.org/10.1200/JCO.2006.09.0126
Kutner, J.S., Smith, M.C., Corbin, L., Hemphill, L., Benton, K., Mellis, B.K., . . . Fairclough, D.L. (2008). Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: A randomized trial. Annals of Internal Medicine, 149, 369–379. http://dx.doi.org/10.7326/0003-4819-149-6-200809160-00003
Kwekkeboom, K.L. (2003). Music versus distraction for procedural pain and anxiety in patients with cancer. Oncology Nursing Forum, 30, 433–440. http://dx.doi.org/10.1188/03.ONF.433-440
Lavigne, J.E., Heckler, C., Mathews, J.L., Palesh, O., Kirshner, J.J., Lord, R., & Mustian, K. (2012). A randomized, controlled, double-blinded clinical trial of gabapentin 300 versus 900 mg versus placebo for anxiety symptoms in breast cancer survivors. Breast Cancer Research and Treatment, 136, 479–486. http://dx.doi.org/10.1007/s10549-012-2251-x
Lawson, L.M., Williams, P., Glennon, C., Carithers, K., Schnabel, E., Andrejack, A., & Wright, N. (2012). Effect of art making on cancer-related symptoms of blood and marrow transplantation recipients [Online exclusive]. Oncology Nursing Forum, 39, E353–E360. http://dx.doi.org/10.1188/12.ONF.E353-E360
Lengacher, C.A., Reich, R.R., Post-White, J., Moscoso, M., Shelton, M.M., Barta, M., . . . Budhrani, P. (2012). Mindfulness based stress reduction in post-treatment breast cancer patients: An examination of symptoms and symptom clusters. Journal of Behavioral Medicine, 35, 86–94. http://dx.doi.org/10.1007/s10865-011-9346-4
Li, W.H., Chung, J.O., & Ho, E.K. (2011). The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. Journal of Clinical Nursing, 20, 2135–2143. http://dx.doi.org/10.1111/j.1365-2702.2011.03733.x
Li, X.M., Zhou, K.N., Yan, H., Wang, D.L., & Zhang, Y.P. (2012). Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: A randomized clinical trial. Journal of Advanced Nursing, 68, 1145–1155. http://dx.doi.org/10.1111/j.1365-2648.2011.05824.x
Liao, M.N., Chen, P.L., Chen, M.F., & Chen, S.C. (2010). Effect of supportive care on the anxiety of women with suspected breast cancer. Journal of Advanced Nursing, 66, 49–59.
Lin, M.F., Hsieh, Y.J., Hsu, Y.Y., Fetzer, S., & Hsu, M.C. (2011). A randomized controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety. Journal of Clinical Nursing, 20, 988–999. http://dx.doi.org/10.1111/j.1365-2702.2010.03525.x
Liu, C.J., Hsiung, P.C., Chang, K.J., Liu, Y.F., Wang, K.C., Hsiao, F.H., . . . Chan, C.L. (2008). A study on the efficacy of body-mind-spirit group therapy for patients with breast cancer. Journal of Clinical Nursing, 17, 2539–2549. http://dx.doi.org/10.1111/j.1365-2702.2008.02296.x
Mañas, A., Ciria, J.P., Fernández, M.C., Gonzálvez, M.L., Morillo, V., Pérez, M., . . . López-Gómez, V. (2011). Post hoc analysis of pregabalin vs. non-pregabalin treatment in patients with cancer-related neuropathic pain: Better pain relief, sleep and physical health. Clinical and Translational Oncology, 13, 656–663. http://dx.doi.org/10.1007/s12094-011-0711-0
Manne, S.L., Ostroff, J.S., Winkel, G., Fox, K., Grana, G., Miller, E., . . . Frazier, T. (2005). Couple-focused group intervention for women with early stage breast cancer. Journal of Consulting and Clinical Psychology, 73, 634–646.
Mehnert, A., Veers, S., Howaldt, D., Braumann, K.M., Koch, U., & Schulz, K.H. (2011). Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients. Onkologie, 34, 248–253. http://dx.doi.org/10.1159/000327813
Mentes, S.D., Unsal, D., Baran, O., Argun, G., & Ertunc, F.N. (2005). Effect of sedation with midazolam or propofol on patient’s comfort during cancer chemotherapy: A prospective, randomized, double-blind study in breast cancer patients. Journal of Chemotherapy, 17, 327–333. http://dx.doi.org/10.1179/joc.2005.17.3.327
Midtgaard, J., Rørth, M., Stelter, R., Tveterås, A., Andersen, C., Quist, M., . . . Adamsen, L. (2005). The impact of a multidimensional exercise program on self-reported anxiety and depression in cancer patients undergoing chemotherapy: A phase II study. Palliative and Supportive Care, 3, 197–208. http://dx.doi.org/10.1017/S1478951505050327
Midtgaard, J., Stage, M., Møller, T., Andersen, C., Quist, M., Rörth, M., . . . Adamsen, L. (2011). Exercise may reduce depression but not anxiety in self-referred cancer patients undergoing chemotherapy. Post-hoc analysis of data from the ‘Body and Cancer’ trial. Acta Oncologica, 50, 660–669. http://dx.doi.org/10.3109/0284186X.2010.543145
Miller, D.K., Chibnall, J.T., Videen, S.D., & Duckro, P.N. (2005). Supportive-affective group experience for persons with life-threatening illness: Reducing spiritual, psychological, and death-related distress in dying patients. Journal of Palliative Medicine, 8, 333–343. http://dx.doi.org/10.1089/jpm.2005.8.333
Mishra, S.I., Scherer, R.W., Geigle, P.M., Berlanstein, D.R., Topaloglu, O., Gotay, C.C., & Snyder, C. (2012). Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews, 8, CD007566. http://dx.doi.org/10.1002/14651858.CD007566.pub2
Molassiotis, A., Bardy, J., Finnegan-John, J., Mackereth, P., Ryder, W.D., Filshie, J., . . . Richardson, A. (2013). A randomized, controlled trial of acupuncture self-needling as maintenance therapy for cancer-related fatigue after therapist-delivered acupuncture. Annals of Oncology, 24, 1645–1652. http://dx.doi.org/10.1093/annonc/mdt034
Monti, D.A., Kash, K.M., Kunkel, E.J., Brainard, G., Wintering, N., Moss, A.S., . . . Newberg, A.B. (2012). Changes in cerebral blood flow and anxiety associated with an 8-week mindfulness programme in women with breast cancer. Stress and Health, 28, 397–407. http://dx.doi.org/10.1002/smi.2470
Mosher, C.E., Duhamel, K.N., Lam, J., Dickler, M., Li, Y., Massie, M.J., & Norton, L. (2012). Randomised trial of expressive writing for distressed metastatic breast cancer patients. Psychology and Health, 27, 88–100. http://dx.doi.org/10.1080/08870446.2010.551212
Naaman, S.C., Radwan, K., Fergusson, D., & Johnson, S. (2009). Status of psychological trials in breast cancer patients: A report of three meta-analyses. Psychiatry, 72, 50–69. http://dx.doi.org/10.1521/psyc.2009.72.1.50
Nainis, N., Paice, J.A., Ratner, J., Wirth, J.H., Lai, J., & Shott, S. (2005). Relieving symptoms in cancer: Innovative use of art therapy. Journal of Pain and Symptom Management, 31, 162–169. http://dx.doi.org/10.1016/j.jpainsymman.2005.07.006
National Cancer Institute. (n.d.). Adjustment to cancer: Anxiety and distress (PDQ®). Retrieved from http://www.cancer.gov/cancertopics/pdq/supportivecare/adjustment/Patient/page1
Nguyen, T.N., Nilsson, S., Hellstrom, A.L., & Bengtson, A. (2010). Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: A randomized clinical trial. Journal of Pediatric Oncology Nursing, 27, 146–155. http://dx.doi.org/10.1177/1043454209355983
Nightingale, C.L., Rodriguez, C., & Carnaby, G. (2013). The impact of music interventions on anxiety for adult cancer patients: A meta-analysis and systematic review. Integrative Cancer Therapies, 12, 393–403. http://dx.doi.org/10.1177/1534735413485817
Nunes, D.F., Rodriquez, A.L., DaSilva Hoffman, F., Luz, C., Braga Filho, A.P., Muller, M.C., & Bauer, M.E. (2007). Relaxation and guided imagery program in patients with breast cancer undergoing radiotherapy is not associated with neuroimmunomodulatory effects. Journal of Psychosomatic Research, 63, 647–655. http://dx.doi.org/10.1016/j.jpsychores.2007.07.004
Oh, P.J., & Kim, S.H. (2010). Effects of a brief psychosocial intervention in patients with cancer receiving adjuvant therapy [Online exclusive]. Oncology Nursing Forum, 37, E98–E104. http://dx.doi.org/10.1188/10.ONF.E98-E104
Osborn, R.L., Demoncada, A.C., & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety and quality of life in cancer survivors: Meta-analysis. International Journal of Psychiatry in Medicine, 36, 13–34. http://dx.doi.org/10.2190/EUFN-RV1K-Y3TR-FK0L
Piet, J., Würtzen, H., & Zachariae, R. (2012). The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 80, 1007–1020. http://dx.doi.org/10.1037/a0028329
Pilkington, K., Kirkwood, G., Rampes, H., Fisher, P., & Richardson, J. (2006). Homeopathy for anxiety and anxiety disorders: A systematic review of the research. Homeopathy, 95, 151–162. http://dx.doi.org/10.1016/j.homp.2006.05.005
Pitceathly, C., Maguire, P., Fletcher, I., Parle, M., Tomenson, B., & Creed, F. (2009). Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomised controlled trial. Annals of Oncology, 20, 928–934. http://dx.doi.org/10.1093/annonc/mdn708
Post-White, J., Kinney, M.E., Savik, K., Gau, J.B., Wilcox, C., & Lerner, I. (2003). Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapies, 2, 332–344. http://dx.doi.org/10.1177/1534735403259064
Potter, P.J. (2007). Breast biopsy and distress: Feasibility of testing a Reiki intervention. Journal of Holistic Nursing, 25, 238–248. http://dx.doi.org/10.1177/0898010107301618
Quattrin, R., Zanini, A., Buchini, S., Turello, D., Annunziata, M.A., Vidotti, C., . . . Brusaferro, S. (2006). Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: Methodology and outcomes. Journal of Nursing Management, 14, 96–105. http://dx.doi.org/10.1111/j.1365-2934.2006.00557.x
Ramachandra, P., Booth, S., Pieters, T., Vrotsou, K., & Huppert, F.A. (2009). A brief self-administered psychological intervention to improve well-being in patients with cancer: Results from a feasibility study. Psycho-Oncology, 18, 1323–1326. http://dx.doi.org/10.1002/pon.1516
Rao, M.R., Raghuram, N., Nagendra, H.R., Gopinath, K.S., Srinath, B.S., Diwakar, R.B., . . . Varambally, S. (2009). Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: A randomized controlled trial. Complementary Therapies in Medicine, 17, 1–8. http://dx.doi.org/10.1016/j.ctim.2008.05.005
Rasavi, D., Allilaire, J.F., Smith, M., Salimpour, A., Verra, M., Desclaux, B., . . . Blin, P. (1996). The effect of fluoxetine on anxiety and depression symptoms in cancer patients. Acta Psychiatria Scandinavica, 94, 205–210. http://dx.doi.org/10.1111/j.1600-0447.1996.tb09850.x
Rawl, S.M., Given, B.A., Champion, V.L., Kozachik, S.L., Barton, D., Emsley, C.L., & Williams, S.D. (2002). Intervention to improve psychological functioning for newly diagnosed patients with cancer. Oncology Nursing Forum, 29, 967–975. http://dx.doi.org/10.1188/02.ONF.967-975
Rottmann, N., Dalton, S.O., Bidstrup, P.E., Würtzen, H., Høybye, M.T., Ross, L., . . . Johansen, C. (2012). No improvement in distress and quality of life following psychosocial cancer rehabilitation. A randomised trial. Psycho-Oncology, 21, 505–514. http://dx.doi.org/10.1002/pon.1924
Schag, C., & Heinrich, R. (1989). Anxiety in medical situations: Adult cancer patients. Journal of Clinical Psychology, 45, 20–27.
Schneider, S.M., & Hood, L.E. (2007). Virtual reality: A distraction intervention for chemotherapy. Oncology Nursing Forum, 34, 39–46. http://dx.doi.org/10.1188/07.ONF.39-46
Schnur, J.B., Bovbjerg, D.H., David, D., Tatrow, K., Goldfarb, A.B., Silverstein, J.H., . . . Montgomery, G.H. (2008). Hypnosis decreases presurgical distress in excisional breast biopsy patients. Anesthesia and Analgesia, 106, 440–444. http://dx.doi.org/10.1213/ane.0b013e31815edb13
Schofield, P., Jefford, M., Carey, M., Thomson, K., Evans, M., Baravelli, C., & Aranda, S. (2008). Preparing patients for threatening medical treatments: Effects of a chemotherapy educational DVD on anxiety, unmet needs, and self-efficacy. Supportive Care in Cancer, 16, 37–45. http://dx.doi.org/10.1007/s00520-007-0273-4
Serfaty, M., Wilkinson, S., Freeman, C., Mannix, K., & King, M. (2012). The ToT study: Helping with Touch or Talk (ToT): A pilot randomised controlled trial to examine the clinical effectiveness of aromatherapy massage versus cognitive behaviour therapy for emotional distress in patients in cancer/palliative care. Psycho-Oncology, 21, 563–569. http://dx.doi.org/10.1002/pon.1921
Serra, D., Parris, C.R., Carper, E., Homel, P., Fleishman, S.B., Harrison, L.B., & Chadha, M. (2012). Outcomes of guided imagery in patients receiving radiation therapy for breast cancer. Clinical Journal of Oncology Nursing, 16, 617–623. http://dx.doi.org/10.1188/12.CJON.617-623
Sharp, D.M., Walker, M.B., Chaturvedi, A., Upadhyay, S., Hamid, A., Walker, A.A., . . . Walker, L.G. (2010). A randomized, controlled trial of the psychological effects of reflexology in early breast cancer. European Journal of Cancer, 46, 312–322. http://dx.doi.org/10.1016/j.ejca.2009.10.006
Sheldon, L., Harris, D., & Arcieri, C. (2012). Psychosocial concerns in cancer care: The role of the oncology nurse. Clinical Journal of Oncology Nursing, 16, 316–319. http://dx.doi.org/10.1188/12.CJON.316-319
Sheldon, L.K., Swanson, S., Dolce, A., Marsh, K., & Summers, J. (2008). Putting Evidence Into Practice: Evidence-based interventions for anxiety. Clinical Journal of Oncology Nursing, 12, 789–797. http://dx.doi.org/10.1188/08.CJON.789-797.
Shepherd, L., Goldstein, D., Whitford, H., Thewes, B., Brummell, V., & Hicks, M. (2006). The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: Results of a pilot study. Journal of Pain and Symptom Management, 32, 453–461. http://dx.doi.org/10.1016/j.jpainsymman.2006.05.018
Shields, C.G., Ziner, K.W., Bourff, S.A., Schilling, K., Zhao, Q., Monahan, P., . . . Champion, V. (2010). An intervention to improve communication between breast cancer survivors and their physicians. Journal of Psychosocial Oncology, 28, 610–629. http://dx.doi.org/10.1080/07347332.2010.516811
Skrutkowski, M., Saucier, A., Eades, M., Swidzinski, M., Ritchie, J., Marchionni, C., & Ladouceur, M. (2008). Impact of a pivot nurse in oncology on patients with lung or breast cancer: Symptom distress, fatigue, quality of life, and use of healthcare resources. Oncology Nursing Forum, 35, 948–954. http://dx.doi.org/10.1188/08.ONF.948-954
Sloman, R. (2002). Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Cancer Nursing, 25, 432–435. http://dx.doi.org/10.1097/00002820-200212000-00005
Snow, A., Dorfman, D., Warbet, R., Cammarata, M., Eisenman, S., Zilberfein, F., . . . Navada, S. (2012). A randomized trial of hypnosis for relief of pain and anxiety in adult cancer patients undergoing bone marrow procedures. Journal of Psychosocial Oncology, 30, 281–293. http://dx.doi.org/10.1080/07347332.2012.664261
Stark, D., Kiely, M., Smith, A., Velikova, G., House, A., & Selby, P. (2002). Anxiety disorders in cancer patients: Their nature, associations, and relation to quality of life. Journal of Clinical Oncology, 20, 3137–3148.
Stephenson, N.L., Swanson, M., Dalton, J., Keefe, F.J., & Engelke, M. (2007). Partner-delivered reflexology: Effects on cancer pain and anxiety. Oncology Nursing Forum, 34, 127–132. http://dx.doi.org/10.1188/07.ONF.127-132
Sturgeon, M., Wetta-Hall, R., Hart, T., Good, M., & Dakhil, S. (2009). Effects of therapeutic massage on the quality of life among patients with breast cancer during treatment. Journal of Alternative and Complementary Medicine, 15, 373–380. http://dx.doi.org/10.1089/acm.2008.0399
Suzuki, N., Ninomiya, M., Maruta, T., Hosonuma, S., Yoshioka, N., Ohara, T., . . . Ishizuka, B. (2011). Clinical study on the efficacy of fluvoxamine for psychological distress in gynecologic cancer patients. International Journal of Gynecological Cancer, 21, 1143–1149. http://dx.doi.org/10.1097/IGC.0b013e3181ffbeb9
Targ, E.F., & Levine, E.G. (2002). The efficacy of a mind-body-spirit group for women with breast cancer: A randomized controlled trial. General Hospital Psychiatry, 24, 238–248. http://dx.doi.org/10.1016/S0163-8343(02)00191-3
Thorsen, L., Skovlund, E., Stromme, S.B., Hornslien, K., Dahl, A.A., & Fossa, S.D. (2005). Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy. Journal of Clinical Oncology, 23, 2378–2388. http://dx.doi.org/10.1200/JCO.2005.04.106
Thyme, K.E., Sundin, E.C., Wiberg, B., Öster, I., Åström, S., & Lindh, J. (2009). Individual brief art therapy can be helpful for women with breast cancer: A randomized controlled clinical study. Palliative and Supportive Care, 7, 87–95. http://dx.doi.org/10.1017/S147895150900011X
Torta, R., Leombruni, P., Borio, R., & Castelli, L. (2011). Duloxetine for the treatment of mood disorder in cancer patients: A 12-week case-control clinical trial. Human Psychopharmacology, 26, 291–299. http://dx.doi.org/10.1002/hup.1202
Torta, R., Siri, I., & Caldera, P. (2008). Sertraline effectiveness and safety in depressed oncological patients. Supportive Care in Cancer, 16, 83–91. http://dx.doi.org/10.1007/s00520-007-0269-0
Tsang, K.L., Carlson, L.E., & Olson, K. (2007). Pilot crossover trial of Reiki versus rest for treating cancer-related fatigue. Integrative Cancer Therapies, 6, 25–35. http://dx.doi.org/10.1177/1534735406298986
Ulger, O., & Yagli, N.V. (2010). Effects of yoga on the quality of life in cancer patients. Complementary Therapies in Clinical Practice, 16, 60–63. http://dx.doi.org/10.1016/j.ctcp.2009.10.007
Vadiraja, H.S., Raghavendra, R.M., Nagarathna, R., Nagendra, H.R., Rekha, M., Vanitha, N., . . . Kumar, V. (2009). Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: A randomized controlled trial. Integrative Cancer Therapies, 8, 37–46. http://dx.doi.org/10.1177/1534735409331456
Wald, T.G., Kathol, R.G., Noyes, R., Jr., Carroll, B.T., & Clamon, G.H. (1993). Rapid relief of anxiety in cancer patients with both alprazolam and placebo. Psychosomatics, 34, 324–332. http://dx.doi.org/10.1016/S0033-3182(93)71866-6
Weller, M., Cosmos, E., DeBruyn, J., & Brader, K. (2008). The use of energy healing for ovarian cancer patients. Society of Gynecologic Nurse Oncologists, 18, 29–33.
White, V.M., Macvean, M.L., Grogan, S., D’Este, C., Akkerman, D., Ieropoli, S., . . . Sanson-Fisher, R. (2012). Can a tailored telephone intervention delivered by volunteers reduce the supportive care needs, anxiety and depression of people with colorectal cancer? A randomised controlled trial. Psycho-Oncology, 21, 1053–1062. http://dx.doi.org/10.1002/pon.2019
Wilkinson, S., Barnes, K., & Storey, L. (2008). Massage for symptom relief in patients with cancer: Systematic review. Journal of Advanced Nursing, 63, 430–439. http://dx.doi.org/10.1111/j.1365-2648.2008.04712.x
Wilkinson, S.M., Love, S.B., Westcombe, A.M., Gambles, M.A., Burgess, C.C., Cargill, A., . . . Ramirez, A.J. (2007). Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: A multicenter randomized controlled trial. Journal of Clinical Oncology, 25, 532–539. http://dx.doi.org/10.1200/JCO.2006.08.9987
Williams, S.A., & Schreier, A.M. (2004). The effect of education in managing side effects in women receiving chemotherapy for treatment of breast cancer [Online exclusive]. Oncology Nursing Forum, 31, E16–E23. http://dx.doi.org/10.1188/04.ONF.E16-E23
Würtzen, H., Dalton, S.O., Elsass, P., Sumbundu, A.D., Steding-Jensen, M., Karlsen, R.V., . . . Johansen, C. (2013). Mindfulness significantly reduces self-reported levels of anxiety and depression: Results of a randomised controlled trial among 336 Danish women treated for stage I–III breast cancer. European Journal of Cancer, 49, 1365–1373. http://dx.doi.org/10.1016/j.ejca.2012.10.030
Wyatt, G., Sikorskii, A., Rahbar, M.H., Victorson, D., & You, M. (2012). Health-related quality-of-life outcomes: A reflexology trial with patients with advanced-stage breast cancer. Oncology Nursing Forum, 39, 568–577. http://dx.doi.org/10.1188/12.ONF.568-577
Wysocki, W.M., Mitus, J., Komorowski, A.L., & Karolewski, K. (2012). Impact of preoperative information on anxiety and disease-related knowledge in women undergoing mastectomy for breast cancer. Acta Chirurgica Belgica, 112, 111–115.
Patsy R. Smith, PhD, RN, is an assistant professor in the College of Nursing at the University of Oklahoma Health Sciences Center in Oklahoma City; Diane Cope, PhD, ARNP-BC, AOCNP®, is an oncology nurse practitioner at Florida Cancer Specialists in Fort Myers; Tammie L. Sherner, MSN, APRN-CNS, is an advanced oncology practice nurse at the Saint Alphonsus Regional Medical Center in Boise, ID; and Deborah K. Walker, DNP, FNP-BC, AOCN®, is an assistant professor and nurse practitioner in the School of Nursing at the University of Alabama at Birmingham. The authors take full responsibility for the content of the article. The authors did not receive honoraria for this work. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or editorial staff. Smith can be reached at firstname.lastname@example.org, with copy to editor at CJONEditor@ons.org. (Submitted May 2014. Revision submitted July 2014. Accepted for publication July 11, 2014.)
Key words: cancer-related anxiety; psychosocial aspects; distress; nursing interventions; summary of evidence; complementary and alternative therapies