Jacobsen et al., 2006). The review of Jacobsen and colleagues (2006) found that antidepressants and anxiolytics are effective in preventing and relieving depression and anxiety and may be recommended in clinical practice guidelines. A similar conclusion was reached by Australia’s National Breast Cancer Centre and National Cancer Control Initiative (2003) and the National Comprehensive Cancer Network in the United States (Distress Management Guidelines Panel, 2003). Of note, one trial found that use of an SSRI prevented the development of depression in patients vulnerable to interferon-induced depressive symptoms/depression (Musselman et al., 2001). There is no evidence suggesting greater efficacy of one drug over others (Pirl, 2004; Jacobsen et al., 2006; Williams and Dale, 2006).

It will be necessary to have more multicenter controlled randomized trials using larger patient cohorts studied over longer periods to better assess the potential efficacy of drugs that may be slow in achieving clinical effects. Trials should be limited to patients with clearly defined significant levels of anxious or depressive symptoms at baseline, such as severe adjustment disorder with anxious or depressive symptoms or anxiety disorder, post-traumatic stress disorder, or mood disorder, to ensure the opportunity to observe a reduction in symptoms. Studies also are needed to compare the efficacy of one drug over another for a targeted symptom. Given the efficacy of psychotherapeutic services and psychotropic drugs in cancer patients, trials comparing the effectiveness of medications alone, psychotherapy alone, and the two combined should be conducted, as has been done in cardiac patients. Moreover, there is a critical need to examine the use of SSRIs and anxiolytics in adolescents with cancer since currently there is virtually no information base to generalize to pediatric oncology.

Help in Managing Illness Comprehensively

Illness self-management is defined as an individual’s “ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition” (Barlow et al., 2002:178). In general, interventions designed to support illness self-management include providing basic information about the illness and its treatment; providing education and coaching in skills needed to manage the illness, control symptoms, and interact with the health care system; and increasing patient self-efficacy (Lev et al., 2001). Education and coaching are generally tailored to the needs and learning styles of individual patients, encourage patients’ active participation in their care, and involve some form of problem-solving assistance. These basic elements of self-management support have often been combined with specific psychological or physical modalities, such as relaxation response or exercise. There is now considerable evidence for many chronic diseases other than cancer



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