Estrategias de enfermería para apoyar la adaptación psicológica en pacientes adultos con cáncer: una revisión del alcance

Peixoto, Tiago André dos Santos Martins; Peixoto, Nuno Miguel dos Santos Martins; Pinto, Cândida Assunção Santos; Santos, Célia Samarina Vilaça de Brito

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Revista da Escola de Enfermagem da USP

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Sumário

REVIEW • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2019039203690 copiar

Estrategias de enfermería para apoyar la adaptación psicológica en pacientes adultos con cáncer: una revisión del alcance

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Mapear la evidencia científica publicada en la literatura sobre estrategias y programas de intervención de enfermería dirigidos a apoyar la adaptación psicológica en pacientes adultos con cáncer.

Método:

Se realizó una revisión de alcance basada en la metodologia 2015 del Manual de revisores del Joanna Briggs Institute para revisiones de alcance del JBI. Se realizaron búsquedas en doce bases de datos entre el 1 de enero de 2012 y el 31 de enero de 2019.

Resultados:

De 2203 estudios, se incluyeron 32. La evidencia se agrupó en cinco temas: procedimientos, medidas de evaluación de resultados, viabilidad de enfermería, efectividad y costo-efectividad. La terapia cognitivo-conductual fue la intervención más frecuente. Estas intervenciones se desarrollaron entre 5 y 10 semanas, incluyeron de 3 a 6 sesiones y duraron hasta 60 minutos. A pesar de una amplia gama de medidas de resultado empleadas, se identificaron tres áreas principales, ajuste y afrontamiento; estrés, ansiedad y miedo a la recurrencia; y calidad de vida.

Conclusión:

Esta revisión permitió identificar estrategias de enfermería para apoyar la adaptación psicológica en pacientes adultos con cáncer, evaluar vulnerabilidades y dificultades relacionadas con las intervenciones de enfermería y reconocer la necesidad de mayores conocimientos sobre la efectividad y la rentabilidad.

DESCRIPTORES:
Neoplasias; Enfermería Oncológica; Adaptación Psicológica; Revisión

Author/s and Aim	Results and Conclusions
Decker et al.(³⁷37 Decker CL, Pais S, Miller KD, Goulet R, Fifea BL. A brief intervention to minimize psychosexual morbidity in dyads coping with breast cancer. Oncol Nurs Forum. 2012;39(2):176-85. doi: https://doi.org/10.1188/12.ONF.176-185 https://doi.org/10.1188/12.ONF.176-185... ) - To develop and evaluate the feasibility of a brief intervention to attenuate the incidence of psychosexual morbidity within the dyad secondary to the diagnosis and treatment of breast cancer.	Interesting trends concerning differences between the intervention and comparison groups on the dyadic adjustment were obtained. The intervention was feasible and acceptable. Intervention by telephone was shown to be as effective as face-to-face mode of delivery.
Lambert et al.(³⁸38 Lambert SD, Girgis A, McElduff P, Turner J, Levesque JV, Kayser K, et al. A parallel-group, randomized controlled trial of a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners: design and rationale. BMJ Open. 2013;3(7):1-13. doi: https://doi.org/10.1136/bmjopen-2013-003337 https://doi.org/10.1136/bmjopen-2013-003... ) - To test the efficacy of Coping-Together: a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners.	Not applicable. No results. Protocol study.
Lambert et al.(³⁹39 Lambert SD, McElduff P, Girgis A, Levesque JV, Regan TW, Turner J, et al. A pilot, multisite, randomized controlled trial of a self-directed coping skills training intervention for couples facing prostate cancer: accrual, retention, and data collection issues. Support Care Cancer. 2016;24(2):711-22. doi: https://doi.org/10.1007/s00520-015-2833-3 https://doi.org/10.1007/s00520-015-2833-... ) - To examine acceptability of methods used to evaluate Coping-Together, one of the first selfdirected coping skill intervention for couples facing cancer, and to collect preliminary efficacy data.	For patients, results suggested that Coping-Together may improve distress (intrusion and avoidance) and contribute to potentially appraising cancer as less challenging. Although both groups reported a consensus decrease, Coping-Together couples decline was lower than minimal ethical care (MEC) participants. Some improvements in the MEC group were also noted in terms of mental quality of life, uncertainty, harm/loss appraisal, and supportive dyadic coping by oneself.
McCaughan et al.(⁴⁰40 McCaughan E, Prue G, McSorley O, Northouse L, Schafenacker A, Parahoo K. A randomized controlled trial of a self-management psychosocial intervention for men with prostate cancer and their partners: a study protocol. J Adv Nurs. 2013;69(11):2572-83. doi: https://doi.org/10.1111/jan.12132 https://doi.org/10.1111/jan.12132... ) - To describe development and evaluation of the content of a self-management psychosocial intervention for men with prostate cancer and their partners.	Not applicable. No results. Protocol study.
Chambers et al.(⁴¹41 Chambers SK, Girgis A, Occhipinti S, Hutchison S, Turner J, McDowell M, et al. A randomized trial comparing two low-intensity psychological interventions for distressed patients with cancer and their caregivers. Oncol Nurs Forum. 2014;41(4):256-66. doi: https://doi.org/10.1188/14.ONF.E256-E266 https://doi.org/10.1188/14.ONF.E256-E266... ) - To compare the effectiveness of two low-intensity approaches for distressed patients with cancer and caregivers who called cancer helplines seeking for support.	For low-education patients, only the psychologist intervention was associated with a significant distress drop. For all other participants, distress decreased over time in both arms with small to large effect sizes. Post-traumatic growth increased over time for all participants.
Isardas et al.(⁴²42 Isardas G, Holle MN. Breast cancer: psychological adjustment. CINAHL Nursing Guide; 2017.) - Not applicable. No aim. Evidence-based care sheet (recommendations).	Not applicable. No results. Evidence-based care sheet (recommendations).
Dorros et al.(⁴³43 Dorros SM, Segrin C, Badger TA. Cancer survivors' and partners' key concerns and quality of life. Health Psychol Rev. 2017;32(11):1407-27. doi: https://doi.org/10.1080/08870446.2017.1338345 https://doi.org/10.1080/08870446.2017.13... ) - To identify primary concerns of dyads coping with cancer, how they differ by role and sex, and whether concerns expressed during counselling are associated with survivors’ psychosocial well-being and adjustment.	Survivors’ concerns focused on cancer and treatment-related issues, whereas partners’ concerns centered on the spouse/partner with cancer well-being, and what they were doing to help their loved one cope with his/her illness. Key concerns for all consisted of relationship maintenance and communication issues. Further, discussion of these concerns was predictive of significant improvements in post- counselling adjustment for women with breast cancer. Discussion of interpersonal concerns may play a more important role in the well-being of women, rather than men, coping with cancer.
Von et al.(⁴⁴44 Von AhD, Storey S, Jansen CE, Allen DH. Coping strategies and interventions for cognitive changes in patients with cancer. Semin Oncol Nurs. 2013;29(4):288-99. doi: https://doi.org/10.1016/j.soncn.2013.08.009 https://doi.org/10.1016/j.soncn.2013.08.... ) - To provide a comprehensive summary of coping strategies and evidence-based interventions used to address cognitive impairment following cancer and cancer treatment.	Survivors identified a structured environment and validation of their cognitive concerns as essential to adjustment. Although interventional research is still limited, non-pharmacological approaches such as cognitive training programs show the greatest promise.
Horii et al.(⁴⁵45 Horii N, Maekawa A. Development of a nursing model for life adjustment in patients with lung cancer in Japan. Nurs Health Sci. 2013;15(3):300-8. doi: https://doi.org/10.1111/nhs.12033 https://doi.org/10.1111/nhs.12033... ) - To retrieve basic data about support for life adjustment in lung cancer patients in Japan.	Although requiring further testing, findings suggested that improvements in lung cancer patients’ quality of life can be achieved by combining the use of this model with positive self-evaluation and interventions to raise self-adjustment ability.
Sekse et al.(⁴⁶46 Sekse RJT, Blaaka G, Buestad I, Tengesdal E, Paulsen A, Vika M. Education and counselling group intervention for women treated for gynaecological cancer: does it help? Scand J Caring Sci. 2014;28(1):112-21. doi: https://doi.org/10.1111/scs.12024 https://doi.org/10.1111/scs.12024... ) - To provide insights about women’s self-experience in participating in an education and counselling group intervention after curative treatment for gynaecological cancer.	Main findings indicated that participation in the rehabilitation group was considered a special community moment of mutual understanding and belonging. Education and knowledge sharing endowed women with a clearer vocabulary and a better understanding of women’s self-lived experiences. Attending a nurse-led education and counselling group intervention had a positive impact on various aspects of women’s experiences.
Chen et al.(⁴⁷47 Chen HL, Liu K, You QS. Effects of couple based coping intervention on self-efficacy and quality of life in patients with resected lung cancer. Patient Educ Couns. 2017;100(12):2297-302. doi: https://doi.org/10.1016/j.pec.2017.07.002 https://doi.org/10.1016/j.pec.2017.07.00... ) - To assess couple-, compared with individual-based coping intervention on self-efficacy and quality of life in patients with resected lung cancer.	Couple coping intervention is more effective than individual coping intervention for improving self-efficacy and quality of life in patients with resected lung cancer.
Jefford et al.(⁴⁸48 Jefford M, Aranda S, Gough K, Lotfi-Jam K, Butow P, Krishnasamy M, et al. Evaluating a nurse-led survivorship care package (SurvivorCare) for bowel cancer survivors: study protocol for a randomized controlled trial. Trials. 2013;14(1):260. doi: https://doi.org/10.1186/1745-6215-14-260 https://doi.org/10.1186/1745-6215-14-260... ) - To examine the effectiveness of an innovative supportive care program (SurvivorCare) comprising survivorship educational materials, provision of a tailored survivorship care plan (SCP), an individually tailored nurse-led end-of-treatment consultation and telephone follow-up for people with potentially cured colorectal cancer, aiming to reduce psychological distress and unmet needs in the six months following treatment completion.	Not applicable. No results. Protocol study.
Smith et al.(⁴⁹49 Smith SK, O'Donnell JD, Abernethy AP, MacDermott K, Staley T, Samsa GP. Evaluation of Pillars4life: a virtual coping skills program for cancer survivors. Psycho-Oncol. 2015;24(11):1407-15. doi: https://doi.org/10.1002/pon.3750 https://doi.org/10.1002/pon.3750... ) - Pillars4Life is an educational program that teaches coping skills to cancer patients in a virtual group setting. The cost-effective, scalable, and assessable Pillars4Life curriculum targets psychosocial resources as a way to reduce symptoms and enhance quality of life.	At 3- and 6-month follow-up, mean scores improved for all key outcome measures, including depression, anxiety, posttraumatic stress, fatigue, and well-being from baseline. Results were most pronounced among participants who reported ≥4/10 on the Distress Thermometer at baseline. Changes in each targeted resource were associated with 3-month improvements in, at least, one outcome. Participation in the Pillars4Life program was associated with statistical and clinically significant improvements in scores on pre-specified outcomes and targeted resources.
Whitehead et al.(⁵⁰50 Whitehead L, Walker DK. Home-based multidimensional survivorship programmes for breast cancer survivors. Int J Nurs Pract. 2019;25(6):e12756. doi: 10.1111/ijn.12756) - To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving quality of life in breast cancer survivors.	Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment up to 10 years earlier. A total of 22 RCTs and four quasi-RCTs comprising 2272 participants were included. Intervention components were categorised into four groups: educational and psychological; educational and physical; physical and psychological; and educational, physical and psychological. Results revealed that HBMS programmes seem to have a short-term beneficial effect in improving breast cancer global quality of life in survivors. In addition, HBMS programmes were associated with anxiety, fatigue and insomnia reduction immediately after the intervention.
Gaston-Johansson et al.(⁵¹51 Gaston-Johansson F, Fall-Dickson JM, Nanda JP, Sarenmalm EK, Browall M, Goldstein N. 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. Psycho-Oncol. 2013;22(3):530-9. doi: https://doi.org/10.1002/pon.3031 https://doi.org/10.1002/pon.3031... ) - To examine effectiveness of a self-management multimodal comprehensive coping strategy program (CCSP) on quality of life (QoL) among breast cancer patients 1 year after treatment.	A model measuring effectiveness of CCSP on QoL at 1-year follow-up showed that the CCSP group significantly improved overall QoL, health and functioning, and socioeconomic and psycho-logical/spiritual well-being compared with the control group. CCSP patients frequently used the CCSP to manage psychological and sleep problems. CCSP improved QoL for patients at 1-year follow-up. Patients overwhelmingly reported that CCSP was beneficial. CCSP showed potential as a self- management program for breast cancer survivors.
Thomas et al.(⁵²52 Thomas LPM, Meier EA, Irwin SA. Meaning-centered psychotherapy: a form of psychotherapy for patients with cancer. Curr Psychiatry Rep. 2014;16(10):488-8. doi: https://doi.org/10.1007/s11920-014-0488-2 https://doi.org/10.1007/s11920-014-0488-... ) - To describe the key components of meaning-centered psychotherapy, summarize current research pertaining to this therapy and offer suggestions for future directions of this intervention.	Meaning-centered psychotherapy appeared to effectively enhance meaning and spiritual well-being for cancer patients. Authors showed that psychotherapy can be offered in group or individual format and modified for patients with advanced cancer, cancer survivors, or even nursing staff. The longer-term benefits of treatment, its impact on emotional or physical distress, its level of cost-effectiveness, and its potential for dissemination remained unclear.
Scott et al.(⁵³53 Scott DA, Mills M, Black A, Cantwell M, Campbell A, Cardwell CR, et al. Multidimensional rehabilitation programmes for adult cancer survivors. Cochrane Database Syst Rev. 2013;(3):CD007730. doi: https://doi.org/10.1002/14651858.CD007730.pub2 https://doi.org/10.1002/14651858.CD00773... ) - To conduct a systematic review of studies examining effectiveness of multidimensional rehabilitation programmes (MDRP) in maintaining or improving the physical and psychosocial well-being of adult cancer survivors.	Participating in a MDRP was associated with an increase in physical health component scores. Findings from the narrative analysis suggested that MDRPs with a single domain or outcome focus appeared to be more successful than programmes with multiple aims. In addition, programmes that comprised participants with different types of cancer compared to cancer site-specific programmes were more likely to show positive improvements in physical outcomes. The most effective mode of service delivery appeared to be face-to-face contact supplemented with at least one follow-up telephone call. There was no evidence that MDRPs which lasted longer than six months improved outcomes beyond the level attained at six months. There was also no evidence that services were more effective if delivered by a particular type of health professional.
de Leeuw et al(⁵⁴54 Leeuw J, Prins JB, Teerenstra S, Merkx MAW, Marres HAM, van Achterberg T. Nurse-led follow-up care for head and neck cancer patients: a quasi-experimental prospective trial. Support Care Cancer. 2013;21(2):537-47. doi: https://doi.org/10.1007/s00520-012-1553-1 https://doi.org/10.1007/s00520-012-1553-... ) - To compare conventional medical follow-up with follow-up including additional nursing consultations regarding psychosocial adjustment and health-related quality of life (HRQoL) of head and neck cancer patients.	Intervention group had a larger score improvement, which was significant for one of the seven adjustment scales and 19 of the 33 HRQoL scales at 6 and 12 months, respectively. These results suggested that nurse-led consultations for patients with head and neck cancer have a positive effect, primarily concerning HRQoL. Nurse- led follow-up leads to a similar psychosocial adjustment as conventional follow-up, even among patients with worse performance at follow-up start. Authors concluded that nurse-led follow-up may be a cost-effective way to improve follow-up care for this patient population.
Mustafa et al.(⁵⁵55 Mustafa M, Carson-Stevens A, Gillespie D, Edwards AG. Psychological interventions for women with metastatic breast cancer. Cochrane Database Syst Rev. 2013;(6):CD004253. doi: https://doi.org/10.1002/14651858.CD004253.pub4 https://doi.org/10.1002/14651858.CD00425... ) - To assess the effects of psychological interventions on psychosocial and survival outcomes for women with metastatic breast cancer.	Ten RCTs was included, seven of which on group psychological interventions, three on cognitive behavioural therapy and four on supportive-expressive group therapy. The remaining three studies were individual-based and types of psychological interventions were not common to either cognitive behavioural or supportive-expressive therapy. The overall effect of psychological interventions across six studies on one-year survival favoured the psychological intervention group. Pooled data from four studies did not show any survival benefit at five-year follow-up. There was evidence of a short-term benefit for some psychological outcomes and pain score improvements. Psychological interventions appeared to be effective in improving survival at 12 months but not at longer-term follow-up and were effective in reducing psychological symptoms only in some assessed outcomes in women with metastatic breast cancer.
Jassim et al.(⁵⁶56 Jassim GA, Whitford DL, Hickey A, Carter B. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev. 2015;(5):CD008729. doi: https://doi.org/10.1002/14651858.CD008729.pub2 https://doi.org/10.1002/14651858.CD00872... ) - To assess the effects of psychological interventions on psychological morbidity, quality of life and survival among women with non- metastatic breast cancer.	A total of 28 studies were included. A wide range of interventions were evaluated, with 24 trials investigating a cognitive behavioural therapy and four trials investigating psychotherapy compared to controls. A psychological intervention, namely cognitive behavioural therapy, produced favourable effects on some psychological outcomes, particularly anxiety, depression and mood disturbance. However, evidence for a survival improvement was still lacking. The authors emphasise that study findings are open to criticism due to the notable heterogeneity and shortcomings of studies included.
Parahoo et al.(⁵⁷57 Parahoo K, McDonough S, McCaughan E, Noyes J, Semple C, Halstead EJ, et al. Psychosocial interventions for men with prostate cancer. Cochrane Database Syst Rev. 2013;(12):CD008529. doi: https://doi.org/10.1002/14651858.CD008529.pub3 https://doi.org/10.1002/14651858.CD00852... ) - To evaluate the effectiveness of psychosocial interventions for men with prostate cancer in improving QoL, self-efficacy and knowledge and in reducing distress, uncertainty and depression.	Nineteen studies comparing psychosocial interventions versus usual care in a total of 3204 men with prostate cancer were included in this review. Results showed that psychosocial interventions result in small improvements in QoL at the end of intervention, although it was not clear whether they actually made a difference to participants. Interventions were also effective in increasing knowledge up to three months after the intervention. No evidence suggested that these interventions improved self-efficacy or reduced uncertainty, distress and depression in men with prostate cancer. No clear evidence showed that group-based were more effective than individual-based interventions for most outcomes measured in this review.
Semple et al.(⁵⁸58 Semple C, Parahoo K, Norman A, McCaughan E, Humphris G, Mills M. Psychosocial interventions for patients with head and neck cancer. Cochrane Database Syst Rev. 2013;(7):CD009441. doi: https://doi.org/10.1002/14651858.CD009441.pub2 https://doi.org/10.1002/14651858.CD00944... ) - To assess effectiveness of psychosocial interventions to improve quality of life and psychosocial well-being for patients with head and neck cancer.	Seven trials, accounting for 542 participants, met eligibility criteria. Analysis of these studies showed no evidence that psychosocial interventions promotes global quality of life for patients with head and neck cancer at the end of intervention as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. There was no significant change in levels of anxiety or depression following intervention. Authors concluded that, at present, there is insufficient evidence to refute or support the effectiveness of psychosocial interventions for patients with head and neck cancer.
Northouse et al.(⁵⁹59 Northouse LL, Mood DW, Schafenacker A, Kalemkerian G, Zalupski M, LoRusso P, et al. Randomized clinical trial of a brief and extensive dyadic intervention for advanced cancer patients and their family caregivers. Psycho-Oncol. 2013;22(3):555-63. doi: https://doi.org/10.1002/pon.3036 https://doi.org/10.1002/pon.3036... ) - To determine whether patient- caregiver dyads, randomly assigned to either a brief or extensive dyadic intervention (FOCUS Program), had better intermediary outcomes (i.e. less negative appraisals and increased resources) and better primary outcomes (i.e. improved QOL) than control dyads receiving only usual care; and to determine whether risk for distress and other antecedent factors (e.g. gender, type of dyadic relationship and cancer type) moderated effect of the brief or extensive program on intermediary and primary outcomes.	Significant group by time interactions showed that there was an improvement in dyads’ coping, self-efficacy, and social QoL, as well as in caregivers’ emotional QoL. Effects varied by intervention dose. Most effects were found at 3 months only. Risk for distress accounted for very few moderation effects. Both brief and extensive programs had positive outcomes for patient-caregiver dyads, but few sustained effects.
Sherman et al.(⁶⁰60 Sherman DW, Haber J, Hoskins CN, Budin WC, Maislin G, Shukla S, et al. The effects of psychoeducation and telephone counseling on the adjustment of women with early-stage breast cancer. Appl Nurs Res. 2012;25(1):3-16. doi: https://doi.org/10.1016/j.apnr.2009.10.003 https://doi.org/10.1016/j.apnr.2009.10.0... ) - To examine physical, emotional and social adjustment of women with early-stage breast cancer who received psychoeducation by videotapes, telephone counseling or psychoeducation plus telephone counseling as interventions addressing women’s specific needs during diagnostic, postsurgery, adjuvant therapy, and ongoing recovery phases of breast cancer.	Improvements were observed for patients in all groups concerning overall health, psychological well-being and social adjustment. No significant group differences were observed in physical adjustment, as measured by side effect incidence and severity or overall health. Poorer emotional adjustment over time was registered in the usual care (control) compared to the intervention groups concerning distress side effect. Telephone counseling group showed a marked decline in psychological well- being from the adjuvant therapy phase through the ongoing recovery phase. There were no significant group differences in t social adjustment dimensions.
Antoni(⁴4 Antoni MH. Psychosocial intervention effects on adaptation, disease course and biobehavioral processes in cancer. Brain Behav Immun. 2013;30 Suppl:S88-98. doi: https://doi.org/10.1016/j.bbi.2012.05.009 https://doi.org/10.1016/j.bbi.2012.05.00... ) - To summarize current knowledge on psychological and physiological adaptation processes affected by cancer-related stress, and the effects of psychosocial interventions on psychological adaptation, cancer disease progression, and changes in stress-related biobehavioural processes that may mediate intervention effects on clinical cancer outcomes.	According to authors, behavioural research suggests the importance of cognitive, behavioural, and social factors in facilitating adaptation during active treatment and throughout cancer survivorship, which forms the rationale for the use of many psychosocial interventions in cancer patients. Changes in adaptation may alter tumor growth-promoting processes (increased angiogenesis, migration and invasion and inflammation) and tumor defense processes (decreased cellular immunity) relevant for cancer progression and QoL of cancer patients. Some evidence suggests that psychosocial interventions can improve psychological and physiological adaptation indicators in cancer patients. Available evidence shows the ability of many different psychosocial interventions in improving stress and adversity responses to cancer experience as a way to improve psychological adaptation. Improvements in psychological adaptation (decreased negative affect and social disruption and increased positive affect and QoL) have been linked to an improved physiological profile during and after treatment, which may increase the odds for disease-free survival in some cancers.
Salgado(⁶¹61 Salgado A. Intervenções de enfermagem promotoras da adaptação à doença oncológica mamária [Internet]. Lisboa: ICBAS; 2013 [cited 2019 Dec 17]. Available from: https://repositorio-aberto.up.pt/handle/10216/70855?locale=pt) - To contribute to the development of a set of nursing interventions promoting breast cancer adaptation as a way to improve patients’ QoL.	A total of 79 nursing interventions for women with breast cancer were suggested, which remain to be tested in the clinical practice for clinical efficacy assessment.
Beatty et al.(⁶²62 Beatty L, Koczwara B, Wade T. Evaluating the efficacy of a self-guided Web-based CBT intervention for reducing cancer-distress: a randomized controlled trial. Support Care Cancer. 2016;24(3):1043-51. doi: https://doi.org/10.1007/s00520-015-2867-6 https://doi.org/10.1007/s00520-015-2867-... ) - To evaluate the efficacy of a self-guided web-based cognitive behavioural therapy intervention, designated as intervention Cancer Coping Online (CCO), compared with an attention control in improving cancerrelated distress, HRQoL and maladaptive coping among individuals with a recent diagnosis of cancer.	Significant effects were found for cancer distress, global QoL, physical function, role function, social function and anxious preoccupation. Post hoc between-group comparisons showed that CCO participants had statistically significantly higher physical functioning compared to controls at 3-month follow-up. Furthermore, compared to controls, post hoc comparisons found a moderate between-group size effect favouring CCO post-interventions for cancer distress and anxious preoccupation, and at 6 months of follow-up for global QoL.
García et al.(⁶³63 García A, Hurtado A, Aranda B. Eficacia de la terapia cognitivo conductual en mujeres con cáncer de mama. Psicooncología. 2015;12(1):129-40. doi: https://doi.org/10.5209/rev_PSIC.2015.v12.n1.48908 https://doi.org/10.5209/rev_PSIC.2015.v1... ) - To demonstrate the efficacy of cognitive- behavioral therapy in a sample of patients diagnosed with breast cancer in anxiety and depression reduction and in developing positive coping skills to improve QoL perception.	Patients who participated in the individual intervention had statistically significant differences in QoL, physical health, interpersonal relations, anxiety subscale and Hospital Anxiety and Depression Scale (HADS). Authors concluded that cognitivebehavioral therapy was efficacious in the sample studied.
David et al.(⁶⁴64 David N, Schlenker P, Prudlo U, Larbig W. Internet-based program for coping with cancer: a randomized controlled trial with hematologic cancer patients. Psycho-Oncol. 2012;22(5):1064-72. doi: https://doi.org/10.1002/pon.3104 https://doi.org/10.1002/pon.3104... ) - To test the effectiveness of an internetbased program for hematologic cancer patients tested in a randomized controlled trial under field experimental conditions.	At registration, most participants displayed clinically significant distress and lacked alternative access concerning psychosocial care. In contrast to the waiting list, the intervention group displayed a significant increase in fighting spirit. The effect was confirmed by intention-to-treat analysis. Otherwise, no effects were observed. Patient satisfaction with the program was high. Results demonstrated the potential efficacy of internet-based programs, also highlighting their limitations.
Carpenter et al.(⁶⁵65 Carpenter KM, Stoner SA, Schmitz K, McGregor BA, Doorenbos AZ. An Online Stress Manage Workbook Breast Cancer. J Behav Med. 2014;37(3):458-68. doi: https://doi.org/10.1007/s10865-012-9481-6 https://doi.org/10.1007/s10865-012-9481-... ) - To develop an interactive web-based version of a Cognitive Behavioral Stress Management (CBSM) intervention for breast cancer survivors − the Coping with Cancer Workbook − and to evaluate its effectiveness in a randomized waitlist-controlled trial.	An internet intervention based on an empirically supported CBSM intervention appeared to be effective in helping breast cancer patients live with more confidence in their ability to cope with stress. Given the increasing demands on healthcare and the fact that breast cancer patients are living longer as survivors, it is critical to find low impact ways to improve their lives. More research is needed to ascertain the long-term effects of such interventions, whether women are able to maintain these positive changes, and whether such an intervention can help prevent incidence of depression and other disorders in cancer patients.
Brandão et al.(⁶⁶66 Brandão T, Schulz MS, Matos PM. Psychological intervention with couples coping with breast cancer: a systematic review. Psychol Health. 2014;29(5):491-516. doi: https://doi.org/10.1080/08870446.2013.859257 https://doi.org/10.1080/08870446.2013.85... ) - To identify and describe psychological interventions for couples coping with breast cancer and evaluate their efficacy	Ten studies were included. Conflicting results were obtained regarding efficacy, although the large majority of studies (n=8) found benefits for both women and their partners in some dimensions, including QoL, psychological distress, relationship functioning, and physical symptoms associated with cancer. Psychological interventions for couples coping with breast cancer appear to be effective for women and their partners. However, further studies are needed to evaluate the efficacy of couple-based interventions and to identify for whom and how they are more effective.
Tomei et al.(⁶⁷67 Tomei C, Lebel S, Maheu C, Mutsaers B. Addressing fear of recurrence: improving psychological care in cancer survivors. Support Care Cancer. 2016;24(7):2815-8. doi: https://doi.org/10.1007/s00520-016-3103-8 https://doi.org/10.1007/s00520-016-3103-... ) - To determine the feasibility, acceptability and satisfaction of individual interventions to reduce fear of cancer recurrence.	General trends in baseline and intervention stages were compared. Individual interventions appeared to help survivors lower their high fear of cancer recurrence (FCR) and cancer-specific distress. Qualitative exit interviews conducted with study participants showed that the intervention was acceptable and satisfactory. This clinical intervention allows researchers to systematically focus on evidence-based treatments for managing FCR and displays treatment options availability in different therapeutic modalities. However, further research is needed to identify active therapeutic ingredients and mechanisms of change in the intervention. Overall, intervention studies suggested it is possible to help cancer survivors manage their FCR.

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Tiago André Peixoto, Escola de Enfermagem do Porto, Rua Dr. António Bernardino de Almeida, 4200-072 - Porto, Portugal. tiago.andre.peixoto@hotmail.com