Internet-based guided self-help for glioma patients with depressive symptoms: a randomized controlled trial

Abstract

Depressive symptoms are common in glioma patients, and can negatively affect health-related quality of life (HRQOL). We performed a nation-wide randomized controlled trial to evaluate the effects of an online guided self-help intervention for depressive symptoms in adult glioma patients. Glioma patients with depressive symptoms were randomized to a 5-week online course based on problem-solving therapy, or a waiting list control group. After having received the intervention, the glioma patient groups combined were compared with patients with cancer outside the central nervous system (non-CNS cancer controls), who also received the intervention. Sample size calculations yielded 63 participants to be recruited per arm. The primary outcome [depressive symptoms (CES-D)] and secondary outcomes [fatigue (Checklist Individual Strength (CIS)) and HRQOL (Short Form-36)], were assessed online at baseline, post-intervention, and 3 and 12 months follow-up. In total, 89 glioma patients (intervention N = 45; waiting list N = 44) and 26 non-CNS cancer controls were included, of whom 35 and 54% completed the intervention, respectively. Recruitment could not be extended beyond 3.5 years due to funding. On depression, no statistically significant differences between the groups were found. Fatigue decreased post-treatment in the glioma intervention group compared with the waiting list group (p = 0.054, d = 0.306). At 12 months, the physical component summary (HRQOL) remained stable in glioma patients, while scores improved in non-CNS cancer controls (p = 0.035, d = 0.883). In this underpowered study, no evidence for the effectiveness of online guided self-help for depression or HRQOL in glioma patients was found, but it may improve fatigue. Trial registration Netherlands Trial Register NTR3223.

Effectiveness of e‐health based self‐management to improve cancer‐related fatigue, self‐efficacy and quality of life in cancer patients: Systematic review and meta‐analysis

“…The trials were published between 2005–2018. Trials were undertaken in the USA (Bantum et al, ; Owen et al, ; Smith et al, ; Somers et al, ; Syrjala et al, ), Netherlands (Admiraal et al, ; van der Berg et al, ; Boele et al, ; Golsteijn et al, ; Willems et al, ), UK (Foster et al, ), Canada (Vallerand et al, ), China (Zhang et al, ; Zhu et al, ), and South Korea (Lee et al, ).…”

“…Participants in four trials were patients with any cancer (Foster et al, ; Bantum et al, ; Somers et al, ; Willems et al, ). The other eleven trials focused on specific cancers: breast cancer (Admiraal et al, ; van den Berg et al, ; Lee et al, ; Owen et al, ; Smith et al, ; Zhu et al, ), glioma (Boele et al, ), haematological cancer (Syrjala et al, ; Vallerand et al, ), rectal cancer (Zhang et al, ), and both colorectal cancer and prostate cancer (Golsteijn et al, ). Nine trials reported participants who completed primary treatment (Admiraal et al, ; van der Berg et al, ; Foster et al, ; Lee et al, ; Bantum et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ; Zhang et al, ); the time since treatment completion was 4 weeks to 18 years.…”

“…Interventions in trials focused on behaviour change (Golsteijn et al, ; Lee et al, ; Bantum et al, ; Vallerand et al, ), medical management (Foster et al, ; Smith et al, ; Somers et al, ; Zhang et al, ; Zhu et al, ), and psychological management (Admiraal et al, ; van der Berg et al, ; Boele et al, ; Owen et al, ; Syrjala et al, ) while one trial focused on both behaviour and psychological management (Willems et al, ). Most studies were web‐based (Admiraal et al, ; van der Berg et al, ; Boele et al, ; Foster et al, ; Golsteijn et al, ; Lee et al, ; Bantum et al, ; Owen et al, ; Smith et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ) and two trial was telephone‐based (Vallerand et al, ; Zhang et al, ), and one was APP‐based (Zhu et al, ). The intervention duration lasted for 4 weeks to 6 months.…”

“…The intervention duration lasted for 4 weeks to 6 months. Interventions were implemented according to a regular schedule by week (Boele et al, ; Foster et al, ; Lee et al, ; Bantum et al, ; Vallerand et al, ; Zhang et al, ) or by month (Golsteijn et al, ), while other interventions were accessible at any time study completion (Admiraal et al, ; van der Berg et al, ; Owen et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ; Zhu et al, ).…”

“…Control groups comprised waiting list or usual care groups (van der Berg et al, ; Boele et al, ; Golsteijn et al, ; Bantum et al, ; Owen et al, ; Smith et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ; Zhang et al, ; Zhu et al, ), and other additional care: printed materials (Foster et al, ; Lee et al, ) or face‐to‐face conversation (Admiraal et al, ; Vallerand et al, ). Waiting list means receiving usual care and then being treated as an intervention group after the trial completed.…”