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In order to be truly effective, a psychosocial intervention for cancer patients must have a positive impact that lasts for a significant time. While brief interventions have many benefits (feasibility, limiting attrition, allowing patients to return to their usual lives) they may lack long-term efficacy. This study addresses the question of the sustainability of brief interventions with known effectiveness in the short term. The aim is also to consider survivors' views on how these brief interventions impact them over an extended period of time. Adopting a mixed methods design, the quantitative findings are discussed in the light of participants' subjective perspectives of change, as well as other issues encountered in long-term survivorship.
Methods
Chinese breast cancer patients were randomized into 5 to 8-week psychosocial group interventions (i) Eastern Body-mind-spirit intervention, (ii) Supportive-expressive group therapy, (iii) Non-facilitated peer support groups and (iv) Control group. 135 participants were followed up for a period of 3 years completing measurements on emotional well-being and cancer coping (on the Hospital anxiety and depression scale (Leung, Wing, Kwong, Lo, & Shum, 1999), Perceived stress scale (Cohen, Karmack, & Mermelstein, 1983), the Mini-mental adjustment to cancer scale (Ho, Fung, Chan, Watson, & Tsui, 2003) and the Cancer coherence scale (Chan, Ho, & Chan, 2007) at baseline and 4 post-intervention intervals during the period. Quantitative findings were enriched by focus group interviews at the end of the current 3-year study, which qualitatively explored participants' perspectives of the intervention and on cancer survivorship throughout the 3-year period. Quantitative measures were analyzed using repeated-measures ANCOVA. Focus group interviews were transcribed and content analysis was used to identify emerging themes.
Results
Over the 3 years, both the Body-mind-spirit and the Supportive-expressive group therapies effectively sustained psychosocial improvements. Emotional well-being, particularly perceived stress, was effectively alleviated after the Body-mind-spirit intervention whereas positive cancer coping gradually became more pronounced after the Supportive-expressive therapy. This can be attributed to differences in the intervention mechanisms of change as perceived by participants. When compared to the control group, however, their 3-year trends were less distinctive. Intervention appeared to have played a smaller role than expected on how survivors, in the long run, viewed their cancer experience. Participants, irrespective of the group they were in, shared similar themes of how they viewed gains and losses and most also acknowledged personal strengths in coping with cancer. The results also showed that peer support groups have a negative impact on cancer coping.
Conclusions and Implications
This study enriched understanding of the long-term impact of brief psychosocial interventions with important implications on their durations as well as the mechanisms of change well-received by patients of this culture. Findings would complement a similar study by Helgeson, Cohen, Schulz and Yasko (2001), where the effects of brief education intervention were sustained but had dissipated over their 3-year follow-up. The study further highlights the confounding issues in conducting long-term follow up studies.