Effects of cancer rehabilitation on problem-solving, anxiety and depression: A RCT comparing physical and cognitive-behavioural training versus physical training

We tested the effects on problem-solving, anxiety and depression of 12-week group-based self-management cancer rehabilitation, combining comprehensive physical training (PT) and cognitive-behavioural problem-solving training (CBT), compared with PT. We expected that PT+CBT would outperform PT in improvements in problem-solving (Social Problem- Solving Inventory-Revised (SPSI-R)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), and that more anxious and/or depressed participants would benefit most from adding CBT to PT. Cancer survivors (aged 48.8±10.9 years, all cancer types, medical treatment completed) were randomly assigned to PT+CBT (n=76) or PT (n=71). Measurement occasions were: before and post-rehabilitation (12 weeks), 3- and 9-month follow-up. A non-randomised usual care comparison group (UCC) (n=62) was measured at baseline and after 12 weeks. Longitudinal intention-to-treat analyses showed no differential pattern in change between PT+CBT and PT. Post-rehabilitation, participants in PT and PT+CBT reported within-group improvements in problem-solving (negative problem orientation; p<0.01), anxiety (p<0.001) and depression (p<0.001), which were maintained at 3- and 9-month follow-up (p<0.05). Compared with UCC post-rehabilitation, PT and PT+CBT only improved in anxiety (p<0.05). CBT did not add to the effects of PT and had no extra benefits for higher distressed participants. PT was feasible and sufficient for durably reducing cancer survivors' anxiety.

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