The Effects of Communication on Clinical Cancer Patients' Chemotherapy Outcomes Over Time: A Randomised Proof-of-Principle Study

Relevance: Efficacy of doctor empathy and nocebo education on treatment outcomes of people with cancer has been established across experimental and randomised-controlled trials (RCT). Objective: i) to test whether distinct effects of clinician empathy and nocebo information can also improve psychological and side effect outcomes of clinical advanced breast cancer patients undergoing chemotherapy and ii) to explore whether potential positive effects are persistent over treatment time. Methods: In this 2x2 proof-of-principle study, before treatment start, a total of 23 Dutch, chemonaïve, female breast cancer patients undergoing chemotherapy were randomised (1:1:1:1) to short information videos on chemotherapy side effects. The four videos varied on levels of empathy (+ / -) and nocebo information (+ / -). During treatment, participants’ psychological (primary outcomes: anxiety, distress) and side effect outcomes were assessed by self-report questionnaires at 7-days, 21-days, and 52...Show moreRelevance: Efficacy of doctor empathy and nocebo education on treatment outcomes of people with cancer has been established across experimental and randomised-controlled trials (RCT). Objective: i) to test whether distinct effects of clinician empathy and nocebo information can also improve psychological and side effect outcomes of clinical advanced breast cancer patients undergoing chemotherapy and ii) to explore whether potential positive effects are persistent over treatment time. Methods: In this 2x2 proof-of-principle study, before treatment start, a total of 23 Dutch, chemonaïve, female breast cancer patients undergoing chemotherapy were randomised (1:1:1:1) to short information videos on chemotherapy side effects. The four videos varied on levels of empathy (+ / -) and nocebo information (+ / -). During treatment, participants’ psychological (primary outcomes: anxiety, distress) and side effect outcomes were assessed by self-report questionnaires at 7-days, 21-days, and 52-days after treatment start. Results: Repeated linear mixed model analyses indicated that empathy generally did not affect the level of anxiety (p = .440) or distress (p = .056). Empathy increased overall intensity (β = 0.76, 95% CI [.07; 1.44], p = .032) and number of side effects (β = 0.78, 95% CI [.11; 1.45], p = .025). Nocebo information did not seem to influence intensity (p = .269) or number of side effects (p = .975). Only anxiety levels were indicated to increase over time (p = .008), both at 21-days (β = 0.86, 95% CI [.25; 1.47]) and 52-days (β = 1.18, 95% CI [.38; 1.98]) post-treatment start. Conclusions: In clinical settings, advanced breast cancer patients may not profit from empathy or nocebo information. Repeating the study with a larger sample is recommended to gain clarity on communication effects. The information videos may benefit training of clinical staff and treatment consultations.Show less

Leiden University Student Repository

Documents

In Collections

The Effects of Communication on Clinical Cancer Patients' Chemotherapy Outcomes Over Time: A Randomised Proof-of-Principle Study