Randomised controlled trial of internet‐delivered cognitive behaviour therapy for clinical depression and/or anxiety in cancer survivors (iCanADAPT Early)

Abstract

Purpose: To evaluate internet-delivered cognitive behavioural therapy (iCBT) on clinical depression and/or anxiety, distress, fear of cancer recurrence, and quality of life in cancer survivors. Methods: Random assignation of 114 participants to iCBT or treatment-as-usual (TAU). The clinician-supervised iCBT program (iCanADAPT Early) consisted of eight lessons over 16 weeks. Self-report questionnaires occurred at baseline, midpoint, and posttreatment for both groups with 3-month follow-up for iCBT participants. A mixed modelling approach to compare groups occurred. Results: iCBT was superior to TAU on all outcome measures at posttreatment. Compared with TAU, the iCBT group showed a significant decrease over time in anxiety and depression symptoms (primary outcome, Hospital Anxiety and Depression Scale, Hedges g = 1.51). Additionally the iCBT group had significantly lower general distress (Kessler-10, g = 1.56), fear of cancer recurrence (Fear of Cancer Recurrence Inventory, g = 0.39), and significantly higher quality of life (Functional Assessment of Cancer Therapy-General, g = 0.74) at posttreatment compared with the TAU group. High adherence and satisfaction were found for iCBT with low clinician time.Conclusion: Clinician-supervised iCBT has significant benefits for cancer survivors with clinical depression and anxiety disorders.

Cocreated internet‐based stepped care for individuals with cancer and concurrent symptoms of anxiety and depression: Results from the U‐CARE AdultCan randomized controlled trial

“…32 Thus, it seems important to adjust the program to the user's life situation. A recent RCT investigating iCBT in individuals with cancer 35 included fewer, predetermined modules over a longer period of time (16 weeks) and showed positive results for both anxiety and depression at an early follow-up.…”

A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy (iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety

“…Similarly, an increase in research into online interventions addressing the psychological aspects of cancer survivorship has occurred. By 2020, a systematic review identified 33 publications relating to internet interventions for cancer-related distress ( Willems et al, 2020 ), and another 2019 systematic review identified four such interventions addressing the fear of cancer recurrence ( Tauber et al, 2019 ) with further randomized controlled trials (RCTs) into insomnia ( Zachariae et al, 2018 ) and clinical depression and/or anxiety in cancer survivors ( Murphy et al, 2020 ). The explosion of research into online interventions relating to cancer survivorship is not mirrored for those living with advanced cancer.…”

“…Both of these recent trials targeted a single disorder, whereas our intervention adopts a transdiagnostic approach targeting both depression and anxiety simultaneously ( Clark, 2009 ). Transdiagnostic CBT uses “ universally applied therapeutic principles, empirically based modular strategies, and targeting shared mechanisms across classes of disorders ” ( Sauer-Zavala et al, 2017 ) and this approach was chosen as a) many people living with advanced cancer have symptoms of both depression and anxiety ( Cheung et al, 2009 ; Bender et al, 2005 ) b) cancer patient focus groups confirmed this was acceptable ( Karageorge et al, 2017 ) c) transdiagnostic iCBT is effective in community samples ( Newby et al, 2016 ; Pasarelu et al, 2017 ) and cancer survivors ( Murphy et al, 2020 ; Dirkse et al, 2019 ).…”

Special issue on eHealth innovations and psycho‐oncology

“…The fact that five of the articles are reviews points to the depth of the extant literature in this rapidly growing area. A number of the studies compared eHealth interventions to face‐to‐face approaches to manage distress, anxiety, depression, and other psychological issues faced by people affected by cancer . Interestingly, numerous studies targeted fear of recurrence, either as a primary or secondary focus .…”

“…A number of the studies compared eHealth interventions to face‐to‐face approaches to manage distress, anxiety, depression, and other psychological issues faced by people affected by cancer . Interestingly, numerous studies targeted fear of recurrence, either as a primary or secondary focus . Other studies targeted diverse symptoms and treatment side effects, including pain, insomnia, and neurotoxicity .…”