A Pilot Randomized Controlled Trial of Brief Cognitive-Behavioral Therapy for Anxiety in Patients with Terminal Cancer

Abstract

After completing this course, the reader will be able to:1. Explain the current state of evidence-based treatment for anxiety in patients with cancer and the need for tailored intervention, especially for those with terminal cancer.2. Discuss and utilize methods for increasing access to psychosocial intervention for patients with cancer who suffer significant physical and psychological morbidity.3. Describe the effect of a brief cognitive-behavioral therapy intervention tailored to the needs of patients with terminal cancer and comorbid anxiety symptoms.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTIntroduction. Patients with terminal cancer often experience marked anxiety that is associated with poor quality of life. Although cognitive-behavioral therapy (CBT) is an evidencebased treatment for anxiety disorders, the approach needs to be adapted to address realistic concerns related to having cancer, such as worries about disease progression, disability, and death. In this pilot randomized controlled trial (clinicaltrials. gov identifier NCT00706290), we examined the feasibility and potential efficacy of brief CBT to reduce anxiety in patients with terminal cancer.

Self-management, self-management support needs and interventions in advanced cancer: a scoping review

“…Advanced cancer was defined by stage (III/IV),35–37 by presence of metastases (bone,38 39 organs/lymph nodes,40 recurrence or progression of cancer33 41 and by life expectancy or prognosis) 42–44. Other criteria included presence of symptoms such as pain,39 45 fatigue,40 anxiety,46 dyspnoea,32 37 or multiple concurrent symptoms,47 functional status scores,32 48–50 type of treatment being received, scheduled to be received or completed (palliative care,51–53 radiotherapy,32 54 chemotherapy55 56 and surgery57 58), timing of advanced cancer diagnosis8 35 and potential for intensive care unit admission 48…”

Randomized Trial of a Tailored Cognitive-Behavioral Therapy Mobile Application for Anxiety in Patients with Incurable Cancer

“…Using the treatment manual from our prior trial and qualitative interviews with patients with incurable cancer and elevated anxiety, we adapted the CBT intervention to a mobile app platform in collaboration with the Partners Center for Connected Health, an MGH‐affiliated software developer. The first phase of this research involved an extensive, iterative process of app development with numerous rounds of user testing and review by the study team consisting of clinical researchers in psychology, psychiatry, and oncology.…”

Acute Cancer Cognitive Therapy

“…There is growing evidence to support the effectiveness of CT in psycho-oncology, although the majority of these studies enrolled patients who were well enough to attend regularly scheduled, protocol-driven, outpatient CT. For example, CT is efficacious for reducing cancer-related anxiety (Greer et al, 2012; Moorey et al, 2002; Traeger, Greer, Fernandez-Robles, Temel, & Pirl, 2012), depression (Osborn, Demoncada, & Feuerstein, 2006), and posttraumatic stress (DuHamel, et al, 2010). It improves severe chronic fatigue (van der Lee & Garssen, 2012) and insomnia among cancer patients, survivors (Matthews, Arnedt, McCarthy, Cuddihy, & Aloia, 2013) and bereaved family caregivers (Carter, Mikan, & Simpson, 2009), hot flashes and night sweats among men undergoing prostate cancer treatment (Yousaf, Stefanopoulou, Grunfeld, & Hunter, 2012), and breast cancer survivors (Mann et al, 2012), as well as sexual dysfunction among gynecologic cancer survivors (Brotto et al, 2012).…”

“…A challenge in acute cancer CT is there is often a “grain of truth” behind so-called “distorted” cognitions (Greer et al, 2012). For example, a patient who says, “I am worried that I will die from this cancer,” may indeed die from cancer.…”