Psychosocial Interventions for Cancer Patients 281events and dif“cult problems, such as cancer, has been in-
cluded as part of various multicomponent CBT treatment
packages (e.g., Fawzy, Cousins, et al., 1990; Telch & Telch,
1986), it has never been empirically evaluated as a sole inter-
vention. As such, A. Nezu, Nezu, Felgoise, et al. (2001; see
also A. Nezu et al., 1998), based on previous research that
highlighted the ef“cacy of PST for major depression (e.g.,
A. Nezu, 1986; A. Nezu & Perri, 1989) conducted a study
whereby adult cancer patients who were experiencing signif-
icant distress (e.g., depression) were randomly assigned to
one of three conditions: (a) ten 1.5 hr sessions of individual
PST; (b) ten 1.5 hr sessions of PST provided simultaneously
to both the patient and his or her designated signi“cant other
(e.g., spouse, family member); and (c) waiting-list control.
The condition that involved a signi“cant other was included
to assess the enhanced effects of •formalizingŽ a social
support system where the role of the signi“cant other was
conceptualized as a •problem-solving coach.Ž Results at
posttreatment across self-report, clinician-ratings, and ratings
by the signi“cant other provided evidence in support of the
ef“cacy of PST for decreasing emotional distress and im-
proving the overall quality of life of patients with cancer.
Speci“cally, patients in both treatment conditions were found
to evidence signi“cant improvement as compared to indi-
viduals in the wait-list control„no dif ferences were found
between these two conditions. However, at a six-month
follow-up assessment, on approximately half of the measures
assessed, patients who received PST along with a signi“cant
other continued to improve signi“cantly beyond those indi-
viduals receiving PST by themselves.
Group Therapy Approaches
The potential strengths of group psychotherapy for cancer
patients are threefold: (a) it can provide for a milieu in which
people with similar experiences can provide emotional sup-
port to each other, (b) it is cost-effective for the patient, and
(c) it is time-ef“cient for the mental health professional
(Spira, 1998). However, research evaluating these approaches
provides limited evidence for their ef“cacy to reduce distress
and improve psychological adjustment (Helgelson & Cohen,
1996). Further, the empirical literature suggests that group
therapy protocols that focus primarily on providing peer sup-
port and emphasize the shared expression of emotions are less
effective than either educational protocols (e.g., Helgelson,
Cohen, Schulz, & Yasko, 1999) or programs teaching coping
skills (Edelman, Craig, & Kidman, 2000).
One study that is often cited as underscoring the ef“cacy
of a •supportive-expressiveŽ group therapy protocol was
conducted by Spiegel, Bloom, and Yalom (1981). Their
investigation included 86 women with metastatic breast
cancer who were randomly assigned to one of two condi-
tions: a weekly group therapy program or a no-treatment
control. The group therapy program included supportive in-
teraction among the participants, encouragement to express
one•s emotions, and discussion of cancer-related problems.
At 100 and 200 days after entry into the protocol, trends were
observed regarding improvements in mood only for the
treated patients. However, at a 300-day evaluation, treated
patients reported signi“cantly less anxiety, depression, con-
fusion, and fatigue, as well as fewer phobias and less mal-
adaptive coping responses as compared to the control group.
Despite these positive results, concerns about a high drop-out
rate (i.e., at 300 days, only 16 women remained in the therapy
condition and 14 women remained in the control condition)
point to the tentative nature of these “ndings (e.g., Edelman
et al., 2000; Fox, 1998). On the other hand, Spiegel et al.
(1999) published another study that does supports the ef“-
cacy of this approach, as well as highlighting the feasibility
of implementing such a protocol in community settings
across the United States.Telephone CounselingDespite the literature documenting the ef“cacy of psychoso-
cial interventions for cancer patients, a major obstacle to the
potential utilization of such protocols is accessibility. In re-
sponse to such barriers, various programs using the telephone
as a communication tool have been developed to provide
health education, referral information, counseling, and group
support (Bucher, Houts, Glajchen, & Blum, 1998). Few stud-
ies, however, have been reported in the literature that have
empirically evaluated the ef“cacy of such approaches, al-
though at present, two different studies are underway, one
assessing the effects of a multicomponent CBT intervention
(Marcus et al., 1998), and the second evaluating interpersonal
psychotherapy (which focuses on role transitions, interper-
sonal con”icts, and grief precipitated by cancer) for breast
cancer patients (Donnelly et al., 2000). In addition, a recently
completed investigation evaluating the effects of a combined
face-to-face (two sessions) and telephone (four sessions)
problem-solving-based intervention provides support for its
ef“cacy in reducing cancer -related dif“culties for young
breast cancer patients (Allen et al., 2001).Effects of Psychosocial Interventions
on Health OutcomeThis review strongly underscores the ef“cacy of a variety of
psychosocial interventions for cancer patients with speci“c