Effect of a nurse-led pre-chemotherapy education programme on quality of life and psychological distress of patients with breast cancer; a pilot based randomized controlled trial

Ruchika Rani, Sukhpal Kaur, Manoj Gupta


Background: Breast cancer has seized the whole world and affecting almost one in four women, globally. Many patients receive chemotherapy as treatment regimen. Oncology nurses are responsible to meet the educational needs of newly diagnosed patients and alleviate their anxiety. Objectives of the study were to assess the effects of Nurse-led pre-chemotherapy education programme on quality of life and psychological distress among breast cancer patients receiving chemotherapy.

Methods: A randomized controlled trial was conducted on newly diagnosed breast cancer patients receiving chemotherapy for the first time at AIIMS, Rishikesh India. Data was obtained from thirty patients (16 in experimental and 14 in control group) by using standardized scale i.e., European organization for research and treatment of cancer quality of life questionnaire C-30 (EORTC QLQ C-30)-version-3 and hospital anxiety and distress scale (HADS) to assess quality of life and psychological distress among patients at baseline (before first cycle of chemotherapy) and at chemotherapy cycle 4.

Results: The mean scores of qualities of life significantly enhanced in experimental group as compared to control group, in terms of global health status (p=0.00), functional scores (p=0.00) and symptom scores. Similarly, the mean HADS score was significantly less in experimental group as compared to control group (p=0.05).

Conclusions: It is concluded that the nurse-led pre-chemotherapy education programme is effective to improve quality of life and reduce psychological distress among patients receiving chemotherapy.


Breast cancer, Nurse-led, Pre-chemotherapy education, Psychological distress, Quality of life

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Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.

American Cancer Society. Breast Cancer Facts and Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.

Dubashi B, Vidhubala E, Cyriac S, Sagar TG. Quality of life among young women with breast cancer: Study from a tertiary cancer institute in South India. Indian J Cancer. 2010;47(2):142-7.

Cleeland CS. Symptom Burden: Multiple symptoms and their impact as patient-reported outcomes. JNCI Monographs. 2007;37:16-21.

Rani R, Kaur S. Nurse-led clinics in India, an innovative approach in patient management. Int J Adv Res. 2019;7(9):1190-92.

Ho PJ, Gernaat SA, Hartman M, Verkooijen HM. Health-related quality of life in Asian patients with breast cancer: A systematic review. BMJ Open. 2018;8(4):e020512.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70.

Galiano-CN, Cantarero-VI, Fernandez-LC, Ariza-GA, Diaz-RL, Del-Moral-AR et al. Evaluating the Impact of an Internet-Based Exercise Intervention on Quality of Life, in Breast Cancer Survivors, A Randomized Controlled Trial. Wiley Online Library. 2016;122(20):3091-248.

Whitehead A, Julious S, Cooper C, Campbell M. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods Med Res. 2016;25(3):1057-73.

Yarbro CH, Wujcik D, Gobel BH. Cancer Nursing: Principles and Practice. 8th ed. Jones and Barlett learning, Cancer related distress. 2015;24:760.

Loh SY, Packer T, Chinna K, Quek KF. Effectiveness of a patient self-management programme for breast cancer as a chronic illness: a non-randomised controlled clinical trial. J Cancer Surviv. 2013;7(3):331-42.

Park JH, Bae SH, Jung YS, Kim KS. Quality of life and symptom experience in breast cancer survivors after participating in a psychoeducational support program: a pilot study. Cancer Nursing. 2012;35(1):E34-41.

Sharif F, Abshorshori N, Tahmasebi S, Hazrati M, Zare N, Masoumi S. The effect of peer-led education on the life quality of mastectomy patients 6 referred to breast cancer-clinics in Shiraz, Iran 2009. Health Qual Life Outcomes. 2010;8(1):74.

Matsuda A, Yamaoka K, Tango T, Matsuda T, Nishimoto H. Effectiveness of psychoeducational support on quality of life in early-stage breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Qual Life Res. 2014;23:21-30.

Cox K, Wilson E. Follow-up for people with cancer: Nurse-led services and telephone interventions. J Adv Nursing. 2003;43(1):51-61.

Zhu J, Ebert, L, Liu, X, Chan S. A mobile application of breast cancer e-support program versus routine Care in the treatment of Chinese women with breast cancer undergoing chemotherapy: Study protocol for a randomized controlled trial. BMC Cancer. 2017;17(1).

Aranda S, Jefford M, Yates P, Gough K, Seymour J, Francis P. Impact of a novel nurse-led pre-chemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: Results from a randomised, controlled trial. Ann Oncol. 2012;23(1):222-31.

Apor E, Connell NT, Faricy-Anderson K, Barth P, Youssef R, Fenton M et al. Prechemotherapy Education: Reducing Patient Anxiety through Nurse-Led Teaching Sessions. Clin J Oncol Nurs. 2018;22(1):76-82.