Making Internet-delivered Cognitive Behaviour Therapy Scalable for Cancer Survivors: a Randomized Non-inferiority Trial of Self-guided and Technician-guided Therapy

Overview

Journal J Cancer Surviv

Specialty Oncology

Date 2019 Dec 20

PMID 31853727

Citations 14

Authors

D Dirkse

H D Hadjistavropoulos

N A Alberts

E Karin

L H Schneider

N Titov

B F Dear

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare the effectiveness and acceptability of two low-intensity methods of offering a transdiagnostic Internet-delivered cognitive behaviour therapy (ICBT) intervention for treating symptoms of anxiety and depression among cancer survivors.

Methods: Cancer survivors with symptoms of anxiety or depression (n = 86) were randomly assigned to receive a transdiagnostic ICBT programme (Wellbeing After Cancer) that was either guided by a technician (n = 42) or self-guided (n = 44). Measures of anxiety, depression, fear of cancer recurrence, and quality of life were completed at pre-treatment, post-treatment, and 4 weeks following treatment completion.

Results: Large within-group effect sizes were observed on measures of depression, anxiety, and mental health-related quality of life (d range, 0.98-1.86) at post-treatment. Medium effects were found for reductions in fear of cancer recurrence (d range, 0.65-0.78). Non-inferiority was established for the primary outcome measures of anxiety and depression. All participants reported high satisfaction ratings of the programme; however, technician-guided participants were slightly more satisfied with their level of support (d = 0.57, p = .014).

Conclusions: The Wellbeing After Cancer Course was associated with improved levels of anxiety, depression, fear of cancer recurrence, and quality of life, regardless of how ICBT was offered.

Implications For Cancer Survivors: ICBT is emerging as an accessible and effective treatment for depression, anxiety, and fear of cancer recurrence in cancer survivors. The success of non-therapist-guided options increases the potential scalability of ICBT, which is particularly valuable for cancer survivors from rural areas who have less access to mental health services.

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References

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

Julious S . Sample sizes for clinical trials with normal data. Stat Med. 2004; 23(12):1921-86. DOI: 10.1002/sim.1783. View

Thekkumpurath P, Walker J, Butcher I, Hodges L, Kleiboer A, OConnor M . Screening for major depression in cancer outpatients: the diagnostic accuracy of the 9-item patient health questionnaire. Cancer. 2010; 117(1):218-27. DOI: 10.1002/cncr.25514. View

Miller B, Pittman B, Strong C . Gynecologic cancer patients' psychosocial needs and their views on the physician's role in meeting those needs. Int J Gynecol Cancer. 2003; 13(2):111-9. DOI: 10.1046/j.1525-1438.2003.13001.x. View

van de Wal M, Thewes B, Gielissen M, Speckens A, Prins J . Efficacy of Blended Cognitive Behavior Therapy for High Fear of Recurrence in Breast, Prostate, and Colorectal Cancer Survivors: The SWORD Study, a Randomized Controlled Trial. J Clin Oncol. 2017; 35(19):2173-2183. DOI: 10.1200/JCO.2016.70.5301. View

Rozental A, Boettcher J, Andersson G, Schmidt B, Carlbring P . Negative effects of internet interventions: a qualitative content analysis of patients' experiences with treatments delivered online. Cogn Behav Ther. 2015; 44(3):223-36. DOI: 10.1080/16506073.2015.1008033. View

Titov N, Dear B, Johnston L, Lorian C, Zou J, Wootton B . Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: randomised controlled trial. PLoS One. 2013; 8(7):e62873. PMC: 3701078. DOI: 10.1371/journal.pone.0062873. View

Kroenke K, Spitzer R, Williams J . The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-13. PMC: 1495268. DOI: 10.1046/j.1525-1497.2001.016009606.x. View

Loughery J, Woodgate R . Supportive care needs of rural individuals living with cancer: A literature review. Can Oncol Nurs J. 2015; 25(2):157-78. DOI: 10.5737/23688076252157166. View

10.

van den Berg S, Gielissen M, Custers J, van der Graaf W, Ottevanger P, Prins J . BREATH: Web-Based Self-Management for Psychological Adjustment After Primary Breast Cancer--Results of a Multicenter Randomized Controlled Trial. J Clin Oncol. 2015; 33(25):2763-71. DOI: 10.1200/JCO.2013.54.9386. View

11.

Lebel S, Maheu C, Lefebvre M, Secord S, Courbasson C, Singh M . Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv. 2014; 8(3):485-96. DOI: 10.1007/s11764-014-0357-3. View

12.

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

13.

Titov N, Andrews G, Davies M, McIntyre K, Robinson E, Solley K . Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PLoS One. 2010; 5(6):e10939. PMC: 2882336. DOI: 10.1371/journal.pone.0010939. View

14.

Jacobson N, Truax P . Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991; 59(1):12-9. DOI: 10.1037//0022-006x.59.1.12. View

15.

Muriel A, Hwang V, Kornblith A, Greer J, Greenberg D, Temel J . Management of psychosocial distress by oncologists. Psychiatr Serv. 2009; 60(8):1132-4. PMC: 2871534. DOI: 10.1176/ps.2009.60.8.1132. View

16.

Urech C, Grossert A, Alder J, Scherer S, Handschin B, Kasenda B . Web-Based Stress Management for Newly Diagnosed Patients With Cancer (STREAM): A Randomized, Wait-List Controlled Intervention Study. J Clin Oncol. 2018; 36(8):780-788. PMC: 5844668. DOI: 10.1200/JCO.2017.74.8491. View

17.

Boyes A, Girgis A, DEste C, Zucca A . Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6months after diagnosis. J Affect Disord. 2011; 135(1-3):184-92. DOI: 10.1016/j.jad.2011.07.016. View

18.

Titov N, Dear B, Schwencke G, Andrews G, Johnston L, Craske M . Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behav Res Ther. 2011; 49(8):441-52. DOI: 10.1016/j.brat.2011.03.007. View

19.

Richards D, Suckling R . Improving access to psychological therapies: phase IV prospective cohort study. Br J Clin Psychol. 2009; 48(Pt 4):377-96. DOI: 10.1348/014466509X405178. View

20.

Newby J, Mewton L, Andrews G . Transdiagnostic versus disorder-specific internet-delivered cognitive behaviour therapy for anxiety and depression in primary care. J Anxiety Disord. 2016; 46:25-34. DOI: 10.1016/j.janxdis.2016.06.002. View