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A Cognitive-Behavioral Intervention for the Symptom Clusters of Chinese Patients With Gastrointestinal Tract Cancer Undergoing Chemotherapy

A Pilot Study

Zhang, Xinqiong MD, RN; Wang, Qin BSN, RN; Zhang, Xiaomin BSN, RN; Wu, Xiaoting BSN, RN; Wang, Qiuping MD, RN; Hong, Jingfang PhD, MPHM, RN

doi: 10.1097/NCC.0000000000000625

Background Patients with gastrointestinal tract (GIT) cancer undergoing chemotherapy often experience several symptoms that constitute symptom clusters and can cause patients to suffer. Effective interventions are lacking for this kind of patients.

Objective The aims of this study were to test the feasibility and acceptability of a cognitive-behavioral (CB) intervention developed for Chinese patients with GIT cancer undergoing chemotherapy and to estimate the efficacy of the intervention for symptom clusters.

Methods In this pilot, quasi-randomized controlled trial, 40 patients were assigned to the CB intervention or control group. The CB intervention, considering characteristics of patients and Chinese culture, contained 4 sections including cognitive reframing, cancer-diet education, relaxation, and exercise techniques. Symptom clusters, illness perception, anxiety, and depression were measured.

Results Thirty-nine patients (97.5%) completed the study program and expressed willingness to follow the intervention. Compared with the control group, all outcomes were improved (all P < .05) in the CB group after the intervention, except for the gastrointestinal symptom cluster (t = 0.25, P = .802). In the CB group, the scores of all outcomes (all P < .05) decreased except for depression (t = 1.76, P = .095).

Conclusion The CB intervention is partially feasible and acceptable. It may also help to improve part of the symptom clusters of Chinese patients with GIT cancer undergoing chemotherapy. However, some modifications are needed in future studies to better test effectiveness.

Implications for Practice Symptom management remains a major problem in clinical nursing. Such a CB intervention can be beneficial to the clinical management of symptom clusters.

Author Affiliations: School of Nursing, Anhui Medical University, Hefei, Anhui, China.

The study was funded by the National Natural Science Foundation of China (grant 81573017) and The Anhui Natural Science Foundation (grant 1608085MH183).

Xinqiong Zhang and Qin Wang are co–first authors and contributed equally to this work.

The authors have no conflicts of interest to disclose.

Trial Registration: WHO ICTRP ChiCTR-IPQ-17010448.

Correspondence: Jingfang Hong, PhD, MPHM, RN, School of Nursing, Anhui Medical University, No. 81 Mei Shan Road, Shu Shan District, Hefei, Anhui, China (

Accepted for publication April 11, 2018.

Online date: July 25, 2018

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