Impact of a psychosocial intervention on quality of life outcomes in cancer patients

Background and purpose: While a growing body of research indicates the existence of unmet psychosocial needs in cancer patients, there is a lack of high-quality studies that have demonstrated which services are effective in meeting these needs. Identifying specific program components to effectively manage the psychological, behavioral and social aspects of the cancer experience are needed. Pathfinders is a manualized, psychosocial care program for cancer patients that teaches: a focus on inner strengths; cognitive restructuring and coping skills; how to engage complementary/alternative providers; mind/body techniques; and, healthy lifestyle behaviors. Developed in Aspen, CO, the Pathfinders program was introduced to Duke University Medical Center in 2007.

The purpose of this pilot study was to gauge feasibility of incorporating the Pathfinders program into cancer care at Duke, and to estimate efficacy and impact of Pathfinders on self-reported measures like psychological distress and quality of life (QOL).

Methods: This prospective, single-arm, pilot study enrolled adult metastatic breast cancer patients with prognosis ≥6 months. Consenting participants met with trained master's level social workers (i.e., Pathfinders) at least monthly for 6 months. At baseline, month 3 and month 6, patients completed surveys including the Patient Care Monitor (PCM; a review of systems with 6 subscales and a global QOL score), and Functional Assessment of Chronic Illness Therapy - Fatigue subscale (FACIT-F).

Results: Participants (n=50) were: mean age 51.2 years (SD 11.5); 24% non-white; 74% married; 50% did not complete college; the cohort had advanced cancer and short prognosis with 6-month attrition from death, 18%. Scores on the PCM Distress subscale improved from baseline to 3 months with a mean change of -3.42 (n=36; p=0.008) and from baseline to 6 months of -4.11 (n=28; p=0.002). PCM Despair subscale scores also improved: mean change of -4.53 (p=0.006) and -6.93 (p=0.016), respectively. PCM QOL and FACIT-F scores improved from baseline to 3 months; the change at 6 months, with smaller sample, was not statistically significant. Mean change in QOL from baseline to 3 and 6 months was 2.88 (n=30; p=0.006) and 2.66 (n=25; p=0.079), respectively. Mean change in FACIT-F from baseline to 3 and 6 months was 2.91 (n=39; p=0.020) and 1.29 (n=32; p=0.407), respectively.

Conclusions and implications: Pathfinders had significant positive effect on key psychosocial and QOL outcomes, notably distress and despair, for cancer patients despite advanced disease and worsening symptoms. Plans are in place (in 2009) to proceed with a registry study (n=200) as the backdrop to a larger, prospective, randomized controlled trial, if results prove favorable.