Psychosocial Interventions for Cancer Patients 279be undermined by lack of knowledge and feelings of un-
certainty. For example, Messerli, Garamendi, and Romano
(1980) argued that a patient•s fear, anxiety, and distress
would decrease as a function of increased medical knowl-
edge and information accessibility. With these types of inter-
ventions, patient education has involved a variety of venues,
including written materials, “lms, audiotapes, videotapes,
and lectures. The protocols studied included topics cover-
ing technical aspects of the disease and its treatment, poten-
tial side effects, navigating the medical system, and the
physician-patient relationship.
An early study investigating the bene“ts of an educational
approach was conducted by Jacobs, Ross, Walker, and
Stockdale (1983). Patients with Hodgkin•s disease participat-
ing in the education sample were mailed a 27-page booklet
that included disease-related information. Three months
later, compared to a no-education control, these individuals
were found to show a decrease in depressive and anxiety
symptoms, as well as an increase in their knowledge about
Hodgkin•s disease.
Focusing on a population of Egyptian patients diagnosed
with bladder cancer, Ali and Khalil (1989) also found a re-
duction in anxiety symptoms as a function of a psychoeduca-
tional intervention. More speci“cally, compared to a control
group, patients receiving the education protocol were found
to be signi“cantly less anxious three days after sur gery and
prior to discharge.
Pruitt et al. (1992) focused on a group of newly diag-
nosed cancer patients undergoing radiation treatment in
order to assess the effects of a three-session (1 hour each)
education intervention. Their protocol involved information
about radiation therapy and cancer, coping strategies, and
communication skills. Patients receiving this intervention, as
compared to a control condition, were found three months
subsequent to show lower levels of depression, although no
differences between groups were found regarding level of
knowledge.
More recently, Hack et al. (1999) conducted a multicenter
study whereby patients were provided the choice to receive
an audiotape of the initial consultation session with their
oncologist. Such an approach was hypothesized to impact
positively on the physician-patient relationship, as well as to
provide the cancer patient with the opportunity to review the
information discussed during the consultation. Although a
trend was observed regarding a decrease in anxiety for pa-
tients who chose to receive the audiotape, this change was not
statistically signi“cant. However, at a six-week follow-up as-
sessment, patients receiving the tape recalled signi“cantly
more information and were found to report a higher degree of
satisfaction with the physician-patient relationship.
Cognitive-Behavioral InterventionsA. Nezu, Nezu, Friedman, and Haynes (1997) de“ned
cognitive-behavior therapy (CBT) as an empirical approach
to clinical case formulation, intervention, and evaluation
that focuses on the manner in which behavior, thoughts,
emotions, and biological events interact with each other
regarding the process of symptom, disorder, and disease de-
velopment and maintenance. As such, CBT, as applied to
psychosocial oncology, incorporates a wide array of inter-
vention strategies that focus on identifying and changing
those behavioral, cognitive, and affective variables that me-
diate the negative effects of cancer and its treatment. Many
strategies under the CBT rubric are theoretically based on
principles of respondent and operant conditioning, such as
contingency management, biofeedback, relaxation training,
and systematic desensitization, whereas other strategies are
more cognitive in nature, based on information-processing
models, and include techniques such as cognitive distraction,
cognitive restructuring, guided imagery, and problem-
solving therapy. Applications of CBT for cancer patients
have addressed both speci“c negative symptoms (e.g., antic-
ipatory nausea, pain), as well as overall distress and quality
of life.CBT for Anticipatory NauseaClinically, a negative side effect of emetogenic chemother-
apy is anticipatory nausea and vomiting. From a respondent
conditioning conceptualization, this occurs when previously
neutral stimuli (e.g., colors and sounds associated with
the treatment room) acquire nausea-eliciting properties due
to repeated association with chemotherapy treatments and its
negative aftereffects. Investigations conducted in the early
1980s by Burish and Lyles (1981; Lyles, Burish, Krozely, &
Oldham, 1982) found progressive muscle relaxation com-
bined with guided imagery to be effective in reducing antici-
patory nausea and vomiting among samples of patients
already experiencing such symptoms. Morrow and Morrell
(1982) further found systematic desensitization to be another
effective CBT approach for these symptoms. Further, in a
subsequent study, Morrow and Morrell (1982) replicated
their earlier “ndings and also observed no dif ferences in the
magnitude of the effects of systematic desensitization as a
function of what type of professional delivered the interven-
tion (i.e., psychologist, nurse, or physician). Research also
has indicated that conducting CBT prior to receiving
chemotherapy may prevent anticipatory nausea and vomit-
ing, as well as fostering improved posttreatment emotional
well-being (Burish, Carey, Krozely, & Greco, 1987).