Evaluation of adjuvant psychological therapy in patients with testicular cancer: randomised controlled trial
Authors: C Moynihan, J M Bliss, J Davidson, L Burchell, A Horwich
Journal: BMJ (1998)

<h3>Abstract</h3> <b>Objective:</b> To determine the efficacy of adjuvant psychological therapy in patients with testicular cancer and to compare the characteristics and psychosocial outcomes of men who agreed to participate with those who declined to participate in a randomised trial of psychological intervention. <b>Design:</b> Newly diagnosed patients were asked to participate in a randomised trial of psychological support compared with standard medical care. Participants and non-participants completed self assessment questionnaires at baseline and at 2, 4 and 12 months. <b>Setting:</b> Testicular Tumour Unit of the Royal Marsden Hospital. <b>Subjects:</b> 73 of 184 (40%) eligible patients agreed to enter the randomised trial (participants) and 81 (44%) declined to participate but agreed to complete further assessments (non-participants). 30 patients wanted no further contact with the researchers. <b>Outcome measures:</b> Hospital anxiety and depression scale, psychosocial adjustment to illness scale, Rotterdam symptom checklist, mental adjustment to cancer scale. Only scores on the hospital anxiety and depression scale are reported for evaluating treatment efficacy. <b>Results:</b> 111 of 184 (60%) eligible men declined to participate in the trial. Patients with stage I disease were most likely to refuse to participate. A patient was less likely to participate if he had low volume disease and was receiving no further treatment. Likelihood of participation was associated with stage of disease and with type of primary treatment (P&lt;0.001 for heterogeneity). Patients with early stage disease (P&lt;0.001) and fewer physical symptoms (P&lt;0.001) were less likely to participate. Psychosocial factors associated with participation included anxious preoccupation regarding disease (P=0.01). There were no differences in outcome between participants and non-participants during follow up. Patients seemed to gain little benefit from adjuvant psychological therapy. At 2 months change from baseline favoured the treated group in the anxiety subscale (mean difference between groups −1.41 (95% confidence interval −2.86 to 0.03)). This was not sustained when adjusted for factors related to the disease. By 12 months change from baseline seemed to favour the control group (mean difference between groups 1.66 (−0.18 to 3.50)). <b>Conclusions:</b> Patients with testicular cancer seem to have considerable coping abilities. Those who declined to participate in the trial differed from those who participated. Those who agreed to participate may comprise the clinical group who perceive a need for psychological support. No evidence was found to indicate a need for routinely offering adjuvant psychological therapy. <h3>Key messages</h3> Counselling for patients with cancer is widely advocated, although its effectiveness has not been fully evaluated No study of patients with cancer has evaluated a psychological intervention in young men or in a group of patients with a disease with an excellent prognosis Most patients with testicular cancer declined to participate in this randomised trial of adjuvant psychological therapy, and those who participated had more psychosocial dysfunction No evidence of benefit was observed after treatment with adjuvant psychological therapy in this group of patients There were no consistently significant differences in psychosocial outcome over one year between those who agreed to participate and those who declined to participate