CBT_cancer_metanalysis

CBT_cancer_metanalysis - Journal of Behavioral Medicine Vol...

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Journal of Behavioral Medicine, Vol. 29, No. 1, February 2006 ( C 2006) DOI: 10.1007/s10865-005-9036-1 Cognitive Behavioral Therapy Techniques for Distress and Pain in Breast Cancer Patients: A Meta-Analysis Kristin Tatrow 1 , 2 , 3 , 4 and Guy H. Montgomery 2 , 3 Accepted for publication: April 18, 2005 Published online: January 7, 2006 This meta-analysis is the first to examine cognitive behavioral therapy (CBT) techniques for distress and pain specifically in breast cancer patients. Twenty studies that used CBT tech- niques with breast cancer patients were identified and effect sizes were calculated to de- termine (1) whether CBT techniques have a significant impact on distress and pain, (2) if individual or group treatments are more effective, (3) whether severity of cancer diagno- sis influences distress and pain outcomes, and, (4) if there is a relationship between CBT technique efficacy for distress and pain. Results revealed effect sizes of d = 0.31 for distress ( p < 0.05) and .49 for pain ( p < 0.05), indicating that 62 and 69% of breast cancer patients in the CBT techniques treatment groups had less distress and less pain (respectively) relative to the control groups. Studies with individual treatment approaches had significantly larger ef- fects compared to studies that employed group approaches for distress ( p = 0.04), but not for pain ( p > 0.05). There were no significant differences in effects between those with or without metastases ( p > 0.05). The correlation between effect sizes for distress and pain was not sig- nificant ( p = 0.07). Overall, the results support the use of CBT techniques administered indi- vidually to manage distress and pain in breast cancer patients. However, more well-designed studies are needed. KEY WORDS: breast cancer; distress; pain; cognitive behavioral; meta-analysis. Breast cancer is the most commonly diag- nosed cancer among women in the United States (American Cancer Society [ACS], 2004 ). It is esti- mated that there will be over 215,000 new breast can- cer cases in the United States and close to 40,000 deaths from breast cancer in 2004 (ACS, 2004 ). De- spite improvements in oncology treatments and sur- vival rates (from 75% 5-year survival rates in the 1970s to 87% survival rates in the 1990s; ACS, 2004 ), breast cancer and its treatment are still associated 1 Psychology Department, Good Shepherd Rehabilitation Hospi- tal, Allentown, PA. 2 Integrative Behavioral Medicine Program, Department of Onco- logical Sciences, Mount Sinai School of Medicine, New York. 3 Biobehavioral Medicine Program, Department of Oncological Sciences, Mount Sinai School of Medicine, New York. 4 To whom correspondence should be addressed at, Psychol- ogy Department, Good Shepherd Rehabilitation Hospital, 501 Saint John St., Allentown, Pennsylvania, 18103; e-mail: [email protected] with numerous highly aversive symptoms and side ef- fects. Perhaps the most prominent of these are dis- tress and pain (Glanz and Lerman, 1992 ).
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