Psychosocial Telephone Counseling for Survivors of Cervical Cancer: Results of a Randomized Biobehavioral Trial

Abstract

Purpose Survivors of cervical cancer experience quality-of-life (QOL) disruptions that persist years after treatment. This study examines the effect of a psychosocial telephone counseling (PTC) intervention on QOL domains and associations with biomarkers. Patients and Methods We conducted a randomized clinical trial in survivors of cervical cancer, who were ≥ 9 and less than 30 months from diagnosis (n = 204), to compare PTC to usual care (UC). PTC included five weekly sessions and a 1-month booster. Patient-reported outcomes (PROs) and biospecimens were collected at baseline and 4 and 9 months after enrollment. Changes in PROs over time and associations with longitudinal change in cytokines as categorical variables were analyzed using multivariable analysis of variance for repeated measures. Results Participant mean age was 43 years; 40% of women were Hispanic, and 51% were non-Hispanic white. Adjusting for age and baseline scores, participants receiving PTC had significantly improved depression and improved gynecologic and cancer-specific concerns at 4 months compared with UC participants (all P < .05); significant differences in gynecologic and cancer-specific concerns (P < .05) were sustained at 9 months. Longitudinal change in overall QOL and anxiety did not reach statistical significance. Participants with decreasing interleukin (IL) -4, IL-5, IL-10, and IL-13 had significantly greater improvement in QOL than those with increasing cytokine levels. Conclusion This trial confirms that PTC benefits mood and QOL cancer-specific and gynecologic concerns for a multiethnic underserved population of survivors of cancer. The improvement in PROs with decreases in T-helper type 2 and counter-regulatory cytokines supports a potential biobehavioral pathway relevant to cancer survivorship.

Health Behaviors in Cervical Cancer Survivors and Associations with Quality of Life

“…The intervention, based on the transactional model of stress and coping, included a QOL/psychosocial interview, 3 sessions focused on managing stress and emotions, health and wellness, and relationship/sexuality concerns, a summary/integration session, and a final booster session to review progress. Further detail is provided elsewhere 31 .…”

“…Data collected included sociodemographics, patient-reported outcome (PRO) measures and health behaviors. 31,32 Age, ethnicity, marital status, education, and income data were collected on the baseline questionnaire. Comorbidities prior to cancer diagnosis were self-reported by patients using a 29-item checklist.…”

Anxiety and Depression in Cancer Survivors

“…70,92–99 Telehealth approaches may improve access to mental health resources especially for those with limited online access or lack of online skill. 84,100,101 . Physical activity interventions also reduce depressive and anxiety symptoms in breast cancer survivors.…”

Nonsurgical Management of Cervical Cancer: Locally Advanced, Recurrent, and Metastatic Disease, Survivorship, and Beyond

“…The improvement in patient-reported outcomes with decreases in T-helper type 2, and counter-regulatory cytokines support a potential bio-behavioral pathway relevant to cancer survivorship. 74 Providing supportive care during treatment, and evaluating the effects of supportive care, may reduce the prevalence and magnitude of long-term sequelae of cervical cancer, which will in turn improve QOL and quality of care.…”