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

Irene Korstjens, Ilse Mesters, Anne M May, Ellen van Weert, Johanna H C van den Hout, Wynand Ros, Josette E H M Hoekstra-Weebers, Cees van der Schans, Bart van den Borne

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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.

Original languageEnglish
Pages (from-to)63-82
JournalPsychology & health
Volume26 Suppl 1
Publication statusPublished - 2011



  • adult
  • anxiety
  • cognitive therapy
  • depression
  • female
  • humans
  • male
  • middle aged
  • neoplasms
  • physical therapy modalities
  • problem solving
  • treatment outcome
  • journal article
  • multicenter study
  • randomized controlled trial
  • research support, non-U.S. Gov't

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