nach oben

Journal of Cancer Survivorship

Erschienen in:

18.12.2019

Making Internet-delivered cognitive behaviour therapy scalable for cancer survivors: a randomized non-inferiority trial of self-guided and technician-guided therapy

verfasst von: D. Dirkse, H.D. Hadjistavropoulos, N. A. Alberts, E. Karin, L.H. Schneider, N. Titov, B.F. Dear

Erschienen in: Journal of Cancer Survivorship | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten

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.

Zucca AC, Boyes AW, Linden W, Girgis A. All’s well that ends well? Quality of life and physical symptom clusters in long-term cancer survivors across cancer types. J Pain Symptom Manag. 2012;43:720–31. https://doi.org/10.1016/j.jpainsymman.2011.04.023.CrossRef

Boyes AW, Girgis A, D'Este C, Zucca AC. Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6 months after diagnosis. J Affect Disord. 2011;135:184–92. https://doi.org/10.1016/j.jad.2011.07.016.CrossRefPubMed

Simard S, Savard J. Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv. 2015;9:481–91. https://doi.org/10.1007/s11764-015-0424-4.CrossRefPubMed

Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It’s not over when it’s over: long-term symptoms in cancer survivors—a systematic review. Int J Psychiatry Med. 2010;40:163–81. https://doi.org/10.2190/PM.40.2.c.CrossRefPubMed

Linden W, Girgis A. Psychological treatment outcomes for cancer patients: what do meta-analyses tell us about distress reduction? Psycho-Oncol. 2012;21:343–50. https://doi.org/10.1002/pon.2035.CrossRef

Muriel AC, Hwang VS, Kornblith A, et al. Management of psychosocial distress by oncologists. Psychiatr Serv. 2009;60:1132–4. https://doi.org/10.1176/appi.ps.60.8.1132.CrossRefPubMedPubMedCentral

Miller BE, 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;13:111–9.CrossRefPubMed

Ritterband LM, Tate DF. The science of internet interventions. Ann Behav Med. 2009;38:1–3. https://doi.org/10.1007/s12160-009-9132-5.CrossRefPubMed

Hedman E, Ljótsson B, Lindefors N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost–effectiveness. Expert Rev Pharmacoeconomics Outcomes Res. 2012;12:745–64. https://doi.org/10.1586/erp.12.67.CrossRef

10.

Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010;5:e13196. https://doi.org/10.1371/journal.pone.0013196.CrossRefPubMedPubMedCentral

11.

Păsărelu CR, Andersson G, Bergman Nordgren L, Dobrean A. Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials. Cogn Behav Ther. 2017;46:1–28.CrossRefPubMed

12.

Proudfoot J, Klein B, Barak A, et al. Establishing guidelines for executing and reporting internet intervention research. Cogn Behav Ther. 2011;40:82–97. https://doi.org/10.1080/16506073.2011.573807.CrossRefPubMed

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:e10939. https://doi.org/10.1371/journal.pone.0010942.CrossRefPubMedPubMedCentral

14.

Cuijpers P, Donker T, Johansson R, Mohr DC, van Straten A, Andersson G. Self-guided psychological treatment for depressive symptoms: a meta-analysis. PLoS One. 2011;6:e21274.CrossRefPubMedPubMedCentral

15.

Titov N, Dear BF, Johnston L, Lorian C, Zou J, Wootton B, et al. Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: randomised controlled trial. PLoS One. 2013;8:e62873. https://doi.org/10.1371/journal.pone.0062873.CrossRefPubMedPubMedCentral

16.

Dear BF, Staples LG, Terides MD, et al. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: a randomized controlled trial. J Anxiety Disord. 2015;36:63–77.CrossRefPubMed

17.

Titov N, Fogliati VJ, Staples LG, et al. Treating anxiety and depression in older adults: randomised controlled trial comparing guided v. self-guided internet-delivered cognitive–behavioural therapy. BJPsych Open. 2016;2:50–8.CrossRefPubMedPubMedCentral

18.

Dear BF, Foglaiti VJ, Fogliati R, et al. Treating anxiety and depression in young adults: a randomised controlled trial comparing clinician-guided versus self-guided internet-delivered cognitive behaviour therapy. Australia N Z J Psychiatry. 2018;52:668–79.CrossRef

19.

Baumeister H, Reichler L, Munzinger M, Lin J. The impact of guidance on Internet-based mental health interventions—a systematic review. Internet Interv. 2014;1:205–15. https://doi.org/10.1016/j.invent.2014.08.003.CrossRef

20.

Loughery J, Woodgate R. Supportive care needs of rural individuals living with cancer: a literature review. Can Oncol Nurs J. 2015;25:157–66.CrossRefPubMed

21.

Alberts NM, Hadjistavropoulos HD, Dear BF, Titov N. Internet-delivered cognitive-behaviour therapy for recent cancer survivors: a feasibility trial. Psycho-Oncol. 2015;26:137–9. https://doi.org/10.1002/pon.4032.CrossRef

22.

Duffecy J, Sanford S, Wagner L, Begale M, Nawacki E, Mohr DC. Project onward: an innovative e-health intervention for cancer survivors. Psycho-Oncol. 2013;22:947–51. https://doi.org/10.1002/pon.3075.CrossRef

23.

Seitz DCM, Knaevelsrud C, Duran G, Waadt S, Loos S, Goldbeck L. Efficacy of an internet-based cognitive-behavioral intervention for long-term survivors of pediatric cancer: a pilot study. Support Care Cancer. 2014;22:2075–83. https://doi.org/10.1007/s00520-014-2193-4.CrossRefPubMed

24.

Wootten AC, Abbott JAM, Chisholm K, et al. Development, feasibility and usability of an online psychological intervention for men with prostate cancer: my road ahead. Internet Interv. 2014;1:188–95. https://doi.org/10.1016/j.invent.2014.10.001.CrossRef

25.

Titov N, Dear BF, Schwencke G, et al. Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behav Res Ther. 2011;49:441–52. https://doi.org/10.1016/j.brat.2011.03.007.CrossRefPubMed

26.

Titov N, Dear BF, Johnston L, Terides M. Transdiagnostic internet treatment for anxiety and depression. Span J Clin Psychol. 2012;17:237–60.

27.

Hadjistavropoulos HD, Nugent MM, Alberts NM, Staples L, Dear BF, Titov N. Transdiagnostic Internet-delivered cognitive behaviour therapy in Canada: an open trial comparing results of a specialized online clinic and nonspecialized community clinics. J Anxiety Disord. 2016;42:19–29.CrossRefPubMed

28.

David N, Schlenker P, Prudlo U, Larbig W. Internet-based program for coping with cancer: a randomized controlled trial with hematologic cancer patients. Psycho-Oncol. 2013;22:1064–72. https://doi.org/10.1002/pon.3104.CrossRef

29.

van den Berg SW, Gielissen MF, Custers JA, van der Graaf WT, Ottevanger PB, Prins JB. BREATH: web-based self-management for psychological adjustment after primary breast cancer—results of a multicenter randomized controlled trial. J Clin Oncol. 2015;33:2763–71. https://doi.org/10.1200/JCO.2013.54.9386.CrossRefPubMed

30.

Willems RA, Bolman CA, Mesters I, Kanera IM, Beaulen AA, Lechner L. Short-term effectiveness of a web-based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial. Psycho-Oncol. 2017;26:222–30. https://doi.org/10.1002/pon.4113.CrossRef

31.

Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146:317–25. https://doi.org/10.7326/0003-4819-146-5-200703060-00004.CrossRefPubMed

32.

Thekkumpurath P, Walker J, Butcher I, et al. Screening for major depression in cancer outpatients: the diagnostic accuracy of the 9-item patient health questionnaire. Cancer. 2011;117:218–27. https://doi.org/10.1002/cncr.25514.CrossRefPubMed

33.

Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment. 2001;8:443–54. https://doi.org/10.1177/107319110100800409.CrossRefPubMed

34.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.CrossRefPubMedPubMedCentral

35.

Kroenke K, Spitzer RL, Williams JB, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32:345–59. https://doi.org/10.1016/j.genhosppsych.2010.03.006.CrossRefPubMed

36.

Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7. https://doi.org/10.1001/archinte.166.10.1092.CrossRefPubMed

37.

Richards DA, Suckling R. Improving access to psychological therapies: phase IV prospective cohort study. Br J Clin Psychol. 2009;48:377–96. https://doi.org/10.1348/014466509X405178.CrossRefPubMed

38.

Simard S, Savard J. Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer. 2009;17:241–51. https://doi.org/10.1007/s00520-008-0444-y.CrossRefPubMed

39.

Fardell JE, Jones G, Smith AB, et al. Exploring the screening capacity of the Fear of Cancer Recurrence Inventory-Short Form for clinical levels of fear of cancer recurrence. Psycho-Oncol. 2018;27:492–9. https://doi.org/10.1002/pon.4516.CrossRef

40.

Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.CrossRefPubMed

41.

Ashing-Giwa K, Lam CN, Xie B. Psycho-Oncol. 2013;22:704–7. https://doi.org/10.1002/pon.3030.CrossRef

42.

Rozental A, Andersson G, Boettcher J, et al. Consensus statement on defining and measuring negative effects of Internet interventions. Internet Interv. 2014;1:12–9.CrossRef

43.

Julious SA. Sample sizes for clinical trials with normal data. Stat Med. 2004;23:1921–86. https://doi.org/10.1002/sim.1783.CrossRefPubMed

44.

Dear BF, Gandy M, Karin E, et al. The pain course: a randomised controlled trial comparing a remote-delivered chronic pain management program when provided in online and workbook formats. Pain. 2017;158:1289–301. https://doi.org/10.1097/j.pain.0000000000000916.CrossRefPubMed

45.

Greene, C.J., Morland, L. A., Durkalski, V. L., & Frueh, B. C. (2008). Noninferiority and equivalence designs: issues and implications for mental health research. J Trauma Stress 2008;21:433-439. doi:https://doi.org/10.1002/jts.20367

46.

Liang KY, Seger S. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22. https://doi.org/10.2307/2336267.CrossRef

47.

Karin E, Dear BF, Heller GZ, Gandy M, Titov N. Measurement of symptom change following web-based psychotherapy: statistical characteristics and analytical methods for measuring and interpreting change. JMIR Mental Health. 2018;5:e10200. https://doi.org/10.2196/10200.CrossRefPubMedPubMedCentral

48.

Gyani A, Shafran R, Layard R, Clark DM. Enhancing recovery rates: lessons from year one of IAPT. Behav Res Ther. 2013;51:597–606. https://doi.org/10.1016/j.brat.2013.06.004.CrossRefPubMedPubMedCentral

49.

Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59:12.CrossRefPubMed

50.

Herschbach P, Berg P, Waadt S, et al. Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychother Psychosom. 2010;79:31–8. https://doi.org/10.1159/000254903.CrossRefPubMed

51.

Lebel S, Maheu C, Lefebvre M, et al. Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv. 2014;8:485–96.CrossRefPubMed

52.

Tomei C, Lebel S, Maheu C, Mutsaers B. Addressing fear of recurrence: improving psychological care in cancer survivors. Support Care Cancer. 2016;24:2815–8. https://doi.org/10.1007/s00520-016-3103-8.CrossRefPubMed

53.

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;35:2173–83.CrossRefPubMed

54.

Titov N, Dear BF, Staples LG, et al. Disorder-specific versus transdiagnostic and clinician-guided versus self-guided treatment for major depressive disorder and comorbid anxiety disorders: a randomized controlled trial. JAnxiety Disord. 2015;35:88–102. https://doi.org/10.1016/j.janxdis.2015.08.002.CrossRef

55.

Newby JM, Mewton L, Andrews G. Transdiagnostic versus disorder-specific internet-delivered cognitive behaviour therapy for anxiety and depression in primary care. J Anxiety Disord. 2017;46:25–34. https://doi.org/10.1016/j.janxdis.2016.06.002.CrossRefPubMed

56.

Titov N, Dear B, Nielssen O, et al. ICBT in routine care: a descriptive analysis of successful clinics in five countries. Internet Interv. 2018;13:108–15. https://doi.org/10.1016/j.invent.2018.07.006.CrossRefPubMedPubMedCentral

57.

van Straten A, Hill J, Richards DA, Cuijpers P. Stepped care treatment delivery for depression: a systematic review and meta-analysis. Psychol Med. 2015;45:231–46.CrossRefPubMed

58.

Urech C, Grossert A, Alder J, et al. Web-based stress management for newly diagnosed patients with cancer (STREAM): a randomized, wait-list controlled intervention study. J Clin Oncol. 2018;36:780–8. https://doi.org/10.1200/JCO.2017.74.8491.CrossRefPubMedPubMedCentral

59.

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;44:223–36. https://doi.org/10.1080/16506073.2015.1008033.CrossRefPubMed

60.

Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, et al. Framework for design and evaluation of complex interventions to improve health. BMJ (Clinical Research Ed). 2000;321:694–6.CrossRef

61.

Andersson G, Hedman E. Effectiveness of guided Internet-based cognitive behavior therapy in regular clinical settings. Verhaltenstherapie. 2013;23:140–8. https://doi.org/10.1159/000354779.CrossRef

62.

Andersen BL, Dorfman CS. Evidence-based psychosocial treatment in the community: considerations for dissemination and implementation. Psycho-Oncol. 2016;25:482–90.CrossRef

63.

Butow P, Shaw J, Shepherd HL, et al. Comparison of implementation strategies to influence adherence to the clinical pathway for screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP): study protocol of a cluster randomised controlled trial. BMC Cancer;18:1077.

Titel: Making Internet-delivered cognitive behaviour therapy scalable for cancer survivors: a randomized non-inferiority trial of self-guided and technician-guided therapy
verfasst von: D. Dirkse
H.D. Hadjistavropoulos
N. A. Alberts
E. Karin
L.H. Schneider
N. Titov
B.F. Dear
Publikationsdatum: 18.12.2019
Verlag: Springer US
Erschienen in: Journal of Cancer Survivorship / Ausgabe 2/2020
Print ISSN: 1932-2259
Elektronische ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-019-00810-9

Springer Medizin

Making Internet-delivered cognitive behaviour therapy scalable for cancer survivors: a randomized non-inferiority trial of self-guided and technician-guided therapy

Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2020

Survivorship objectives in comprehensive cancer control plans: a systematic review

Cancer-related cognitive problems at work: experiences of survivors and professionals

Predictors of post-cancer diagnosis resignation among Japanese cancer survivors

The challenge of return to work in workers with cancer: employer priorities despite variation in social policies related to work and health

Risk for unemployment at 10 years following cancer diagnosis among very long-term survivors: a population based study

Return to work after a cancer diagnosis: a meta-review of reviews and a meta-synthesis of recent qualitative studies

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie