After an initial diagnosis of cancer most patients experience significant distress caused by their struggle to process and comprehend the amount of information they receive as well as unfamiliarity with, sometimes confusing, medical language. This distress may not only erode the patient’s Quality of Life, but may also negatively affect the course of the disease as well as the patient’s ability to tolerate treatment.
Now, results from a prospective study presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting showed that pairing cancer care and treatment with high-quality psychological support may directly benefit patients.
But today, only a few patients with cancer receive psychological support.
The study by Viviane Hess, MD, a medical oncologist at the University Hospital of Basel in Basel, Switzerland and colleagues showed that a web-based stress management program may be a great tool to help relieve distress and, in turn, markedly improve quality of life for patients.
“Delivery of psychological support to patients at this early time in the course of their cancer care is hampered with lack of accessibility, time, and resources on both the patient’s and the provider’s side,” Hess, who is the lead study author, noted. Convinced of the potential benefits, Hess added: “With this online intervention, we aim to close this gap.”
The program, called STREAM intervention, is an eight-week, web-based stress management program developed by oncologists and psychologists. It is based upon well-established cognitive behavior approaches used in face-to-face psychotherapy and covers eight different topics, including bodily reaction to stress, cognitive stress reduction, feelings, and social interactions. As part of the program, participants received written and audio information. Based on this information they complete exercises and questionnaires covering one of the weekly topics.
Psychologists reviewed patients’ progress weekly and provided personalized, written guidance and support through a secure online portal. The psychologists were all based in Basel, but patients were located in Germany, Switzerland, and Austria. The patients also had the opportunity to write to the psychologists directly through the online program.
Therapist-guided online intervention
Internet-based interventions are considered a viable treatment option for various mental problems. For example, results from a randomized controlled trial examining the efficacy of a structured and therapist-guided internet intervention, based on solution-focused and cognitive-behavioral therapy, for individuals with symptoms of burnout, showed that such intervention helped ameliorate symptoms of work-related stress and burnout. 
Application in Cancer
And while the remote therapy model known as “therapist-guided online intervention,” such as the STREAM Intervention, is relatively new, the authors of the study believe that the program is already becoming a standard approach for certain psychological disorders such as anxiety. Furthermore, the program appears to be as effective as traditional face-to-face therapy. Finally, being noted as a real benefit, it is less time consuming for the therapist and more convenient for patients, particularly at the time they are handling many other medical appointments following a diagnosis of cancer.
“New technologies open new opportunities. With this intervention we can deliver much needed psychological support in the comfort of the patients’ living rooms or other favorite Wi-Fi spots. It seems that patients and psychologists can still form a therapeutic bond through this online contact,” Hess explained.
Study design and results
In the Swiss study, 129 patients were assigned to either the STREAM intervention group or the control group within 12 weeks of starting cancer their treatment. The media age of participating patients was 52 years of age (22 – 77). The majority of participants (108; 84%) were women with early-stage breast cancer, although the study also included patients with lung, ovarian, and gastrointestinal cancers, as well as those with lymphoma and melanoma. Most participating patients were treated in the curative setting (117pts; 91%) with with chemotherapy (74; 58%), for breast cancer (91; 71%).
In both groups, the researchers used FACIT-F (Functional Assessment of Chronic Illness Therapy), validated scales to measure Quality of Life (QoL), distress (DT), and anxiety/depression (HADS) at study entry and two months after the intervention. They predefined a nine-point difference in the FACIT-F score as a clinically meaningful improvement in quality of life. The DT scale is routinely used to screen for distress in patients with cancer. A score of 0-4 is considered low distress, whereas 5-10 is considered high distress. The control group did not receive psychological support during the first two months of enrolling in the study.
After two months, participating patients in the intervention group had a greater improvement in Quality of Life than patients in the control group. The researchers observed that the mean FACIT-F score increased by a mean of 8.59 points more in the intervention group than in the control group. In addition, the distress score decreased from 6 to 4 points in the intervention group but stayed the same (6 points) in the control group. There were no significant differences in anxiety or depression between the two groups.
Based on the results, the researchers plan to make the intervention, which is currently only available in German, accessible to more patients. As part of this plan, they consider are translating the program into other languages and develop specific online programs where psychologists can be trained to use it.
“I think online psychological support will be much more important in the years to come, as the digital generation reaches the age when they are at higher risk of cancer. For them, it will be natural to use such online tools and communicate without face-to-face interaction, and so now is the time to standardize and validate the tools,” Hess concluded.
Don S. Dizon, MD, FACP, an ASCO Expert not involved with this study, noted: “When the doctor says cancer, it can bring on a wave of emotions, fear, and uncertainty. Cancer care and treatment must be paired with high-quality psychological support. Online tools are an excellent new way to provide this support to more patients, especially those who otherwise might not have the opportunity to see a therapist.”
The trial results discussed in this article were presented during an oral presentation at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting during the session Patient and Survivor Care on Friday June 2, 3:00 PM to 6:00 PM
Last editorial review: June 4, 2017
Featured Image: Psychologist supporting young man. Courtesy: © 2017 Fotolia. Used with permission. Photo 1.0: Attendees networking during at the American Society of Clinical Oncology (ASCO) Annual Meeting Thursday June 1, 2017. Courtesy: © 2017 ASCO/Danny Morton 2017. Used with permission
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