Chicago, IL—A brief, Internet-based psychological intervention improved quality of life, reduced fatigue, and reduced distress levels in patients with newly diagnosed cancer, according to the results of a study reported at the 2017 American Society of Clinical Oncology Annual Meeting. This technique has been studied in other psychological disorders, and was found to be as effective as a personal visit to a therapist.
STREAM (Stress aktiv mindern), the 8-week intervention, is therapist-guided and requires only a minimal amount of the therapist’s time. STREAM was developed at the University Hospital of Basel, Switzerland, and is potentially accessible to individuals with a computer and Internet service.
“Seventy percent of cancer patients use the Internet to get information. This therapist-guided, web-based intervention overcomes many patient and physician barriers, and is as effective as face-to-face therapy for a variety of mental disorders, including anxiety and depression,” said lead investigator Viviane Hess, MD, Leading Doctor, Oncology, University Hospital of Basel, who was involved in the development of STREAM.
“An Internet-based, minimal-contact stress management program is potentially an attractive time- and cost-effective way to deliver psychological support to newly diagnosed patients with cancer, and an opportunity to include those who are not currently reached by conventional support,” Dr Hess commented.
Within 12 weeks of initiating anticancer treatment, 129 patients with newly diagnosed cancer were randomized to STREAM or to a control group with delayed Internet-based intervention.
STREAM includes 8 weekly modules based on well-established cognitive behavior approaches for stress management. Topics covered by the modules include bodily reaction to stress, cognitive stress reduction, feelings, and social interactions. For each weekly module, participants received written and audio information, and then completed exercises and questionnaires. Patients received weekly written feedback from a psychologist through a secure online portal, and could contact the psychologists directly, if needed.
The majority (84%) of patients were women being treated in the curative setting (91%) for breast cancer (71%), and the median age was 52 years.
At 2 months, patients in the intermediate intervention group had greater improvement in quality of life compared with the control group, according to the Functional Assessment of Chronic Illness Therapy-Fatigue score (FACIT-F). The mean FACIT-F score decreased by 8.59 points more in the intervention group than in controls. On the National Comprehensive Cancer Network Distress Thermometer, the distress score decreased from 6 points to 4 points in the intervention group, but did not change from the baseline score of 6 in the control group.
However, no significant differences in anxiety or depression were observed between the 2 groups, according to the Hospital Anxiety and Depression Scale.
“The study shows this intervention is feasible during active treatment, and that we could recruit patients via the Internet. At baseline, 75% of patients had high levels of distress. This intervention reduced distress levels, fatigue levels, and improved quality of life,” Dr Hess said.
“This randomized trial looks at something oncologists recognize—distress. But we assume that the initial level of distress at diagnosis will fall naturally. Three out of 4 patients have significant distress on being diagnosed with cancer, and trying to get support to these patients can be challenging in terms of time and available resources. Utilizing an online system is feasible and holds promise of effectiveness in a randomized trial. This fills an unmet need,” added Don S. Dizon, MD, Director, Oncology Sexual Health Clinic, Massachusetts General Hospital, Boston.