Psychoeducation Intervention to Improve Adjustment to Cancer among Turkish Stage I-II Breast Cancer Patients: A Randomized Controlled Trial

  • Dastan, Nihal Bostanci (Nursing, Health High School, Kafkas University) ;
  • Buzlu, Sevim (Psychiatric Nursing, Florence Nightingale Faculty of Nursing, Istanbul University)
  • Published : 2012.10.31


Psycho-educational interventions are not a substitute for analgesics, but they may serve as adjuvant therapy. Nurses can provide psychoeducational programmes to cancer patients to assist them in optimizing behavior that strengthen adjustment. The aim here was to determine the effects of psychoeducation on levels of adjustment to cancer in stage I-II breast cancer patients who met the study criteria (experimental group: 38 women, control group:38 women). The psychoeducational program consisted of eight 90 minute weekly sessions and data were collected using a questionnaire and the Mental Adjustment to Cancer Scale three times: before, six weeks and six months after the intervention. Data analysis was performed using descriptive statistical methods as well as the Chi square test, the Mann Whitney U test, repeated measures analysis of variance, the matched pairs t test and the Post Hoc Bonferroni test. The results at 6 weeks and 6 months after the program revealed that the experimental group had higher levels of "fighting spirit", lower levels of "helplessness/hopelessness, anxious preoccupation and fatalism" but there was no significant change in levels of "avoidance/denial" compared to the control group with regard to adjustment to cancer. In this study, psychoeducation was shown to cause positive changes in levels of adjustment to cancer in breast cancer patients


  1. Akın (Ozcan) S (2003). Breast cancer patients'assessment of psychosocial adjusment. Cukurova University Faculty of Medicine Department of Family Medicine Unpublished Thesis, Adana.
  2. Aydemir O, Guvenir T, Kuey L, et al (1997). Validity and reliability of Turkish version of Hospital Anxiety and Depression Scale. Turkish J Psychiatry, 8, 280-7.
  3. Baider L, Peretz T, Hadani PE, et al (2001). Psychological intervention in cancer patients: A randomized study. Gen Hosp Psychiatry, 23, 272-7.
  4. Bultz BD, Speca M, Brasher PM, et al (2000). A randomized controlled trial of a brief psychoeducational support group for partners of early stage breast cancer patients. Psycho-Oncology, 9, 303-13.<303::AID-PON462>3.0.CO;2-M
  5. Classen C, Butler LD, Kopman C, et al (2001). Supportiveexpressive group therapy and distress in patients with metastatic breast cancer "a randomized clinical ıntervention trial". Arch Gen Psychiatry, 58, 494-501.
  6. Coward DD (1998). Facilitation of self-transcendence in a breast cancer support group. Oncol Nurs Forum, 25, 75-84.
  7. Coward DD (2003). Facilitation of self-transcendence in a breast cancer support group:II. Oncol Nurs Forum, 30, 291-300.
  8. Fawzy FI, Cousins N, Fawzy N, et al (1990). A structed psyciatric intervention for cancer patients:I. Changes over time in methods of coping and affective disturbance. Arch Gen Psychiatry, 47, 720-5.
  9. Fawzy FI, Fawzy NW, Hyun CS, et al (1993). Malignant melanoma "effects of an early structured psychiatric intervention, coping and affective state on recurrence and survival 6 years later". Arch Gen Psychiatry, 50, 681-9.
  10. Frost MH, Suman VJ, Rummans TA, et al (2000). Physical, psychological and social well-being of women with breast cancer: The influence of disease phase. Psycho-Oncology, 9, 221-31.<221::AID-PON456>3.0.CO;2-T
  11. Fukui S, Kugaya A, Okamura H, et al (2000). A psychosocial group intervention for Japanese women with primary breast carcinoma "A randomized controlled trial". Cancer, 89, 1026-36.<1026::AID-CNCR12>3.0.CO;2-5
  12. Galjchen M (1999). Psychosocial issues in cancer care. In "Oncology Nursing Assessment and Clinical Care", Eds Miaskowski C and Buchsel P. Mosby Year Book, Missouri, pp.305-17.
  13. Goodwin PJ, Leszcz M, Enis M, et al (2001). The effect of group psychosocial support on survival in metastatic breast cancer. New Engl J Med, 345, 1719-26.
  14. Greer S, Watson M (1987). Mental adjustment to cancer: Its measurement and prognostic importance. Cancer Surv, 6, 439-53.
  15. Holland J (1997). Principles of psycho-oncology. In "Cancer Medicine", Eds Holland J, Bast R, Morton D et al. Lippincott Williams and Wilkins USA, 1327-43.
  16. Hosaka T, Sugiyama Y, Hirai K, et al (2001). Effects of a modified group intervention with early-stage breast cancer patients. Gen Hosp Psychiatry, 23, 145-51.
  17. Hosaka T, Sugiyama Y, Tokuda Y, et al (2000). Persistent effects of a structured psychiatric intervention on breast cancer patients'emotions. Psychiatry Clin Neurosci, 54, 559-63.
  18. Kunkel EJ, Chen EI, Okunla TB (2002). Psychosocial concerns of women with breast cancer. Primer Care Update Obs / Gyns, 9, 129-34.
  19. Lesko L (1997). Psychologic Issues. In "Cancer Principles & Practice of Oncology", Eds DeVita V, Hellman S and Rosenberg S. Lippincott Raven Publishers, Philadelphia, 2879-90.
  20. Lewis PE, Sheng M, Rhodes MM, et al (2012). Psychosocial concerns of young African American breast cancer survivors. J Psychosoc Oncol, 30, 168-84.
  21. Mor V, Laliberte L, Marris JN (1984). The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer, 53, 2002-07.<2002::AID-CNCR2820530933>3.0.CO;2-W
  22. Natan I (2000). Validy and reability studies of the Mental Adjustment to Cancer Scale on cancer diagnosed patients. Istanbul University Institute of Health Sciences at Psycho-Oncology Department Unpublished Master's Thesis, Istanbul.
  23. Ohaeri BM, Ofi AB, Campbell OB (2012). Relationship of knowledge of psychosocial issues about cancer with psychic distress and adjustment among breast cancer clinic attendees in a Nigerian teaching hospital. Psycho-Oncology, 21, 419-26.
  24. Ozkan S (1999). Psychiatric and psychosocial aspects of cancer. In "Consultation-Liaison Psychiatry Congress Book 1998-1999", Ed Ozkan S. Novartis Pharmaceuticals Corporation, Istanbul, 140-52.
  25. Reid J, Lloyd C, De Groot L (2005). The psychoeducation needs of parents who have an adult son or doughter with a mental illness. Australian e-J Adv Mental Hlth, 4, 1-13.
  26. Ross L, Boesen EH, Dalton SO, et al (2002). Mind and cancer: Does psychosocial intervention improve survival and psychological well-being? Eur J Cancer, 38, 1447-57.
  27. Spira JL (1998). Group therapies. In "Psycho-oncology", Ed Holland J. Oxford University Press, Oxford, 701-16.
  28. Taylor K, Lamdan RM, Siegel JE, et al (2003). Psychological adjustment among African-American breast cancer patients: One-Year follow-up results of a randomized psychoeducational group intervention. Hlth Psychol, 22, 316-23.
  29. Tel H (1999). The evaluation of the effects of psychoeducational implication about handling of disease symptoms and coping with stress at the families of schizophrenic patients. Hacettepe University Institute of Health Sciences Unpublished Doctoral Thesis, Ankara.
  30. Todd K, Roberts S, Black C (2002). The living with cancer education programme. I. development of an Australian education and support programme for cancer patients and their family and friends. Eur J Cancer Care, 11, 271-79.
  31. Yurtsever UE (1999). Taking charge of the suffering from bipolar disorder patients and their families with structural psychoeducational aproaches. Marmara University Institute of Education Sciences Unpublished Thesis, Istanbul.
  32. Zigmond AS, Snaith PR (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand, 67, 361-70.

Cited by

  1. Effectiveness of psychoeducational support on quality of life in early-stage breast cancer patients: a systematic review and meta-analysis of randomized controlled trials vol.23, pp.1, 2014,
  2. Psychological effects of a cosmetic education programme in patients with breast cancer vol.24, pp.4, 2015,
  3. A protocol for a cluster-randomized controlled trial of a self-help psycho-education programme to reduce diagnosis delay in women with breast cancer symptoms in Indonesia vol.17, pp.1, 2017,
  4. Quality of life and anxiety in women with breast cancer before and after treatment vol.25, pp.0, 2017,
  5. Effects of a Psychoeducational Intervention in Patients With Breast Cancer Undergoing Chemotherapy vol.26, pp.4, 2018,
  6. Psychoeducational Approach to Distress Management of Newly Diagnosed Patients with Breast Cancer vol.48, pp.6, 2018,
  7. The Efficacy of Cognitive Behavioral Therapy to Treat Depression and Anxiety and Improve Quality of Life Among Early-Stage Breast Cancer Patients vol.18, pp.1552-695X, 2019,