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

Abstract

Background The aim of this study was to test the efficacy of a tailored cognitive‐behavioral therapy (CBT) mobile application (app) to treat anxiety in patients with incurable cancer. Materials and Methods Patients with incurable cancers (n = 145) who reported elevated anxiety symptoms at two cancer centers were randomized to receive either the CBT mobile app for anxiety or a mobile health education program (control) delivered via tablet computers, which patients self‐administered over 12 weeks. To assess anxiety, depression symptoms, and quality of life (QOL), we used the Hamilton Anxiety Rating Scale (HAM‐A, primary outcome), Clinical Global Impression Scale, Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire‐9, and Functional Assessment of Cancer Therapy‐General at baseline and 12 weeks. Analysis of covariance models were calculated to assess intervention effects on patient outcomes. Results Patients (73.8% female; 91.0% white; mean age = 56.45 years, SD = 11.30) in both study groups reported improvements in anxiety, depression symptoms, and QOL from baseline to postassessment, with no significant differences in any outcome measure between groups. Secondary analyses showed that, among the subgroup of patients with severe baseline anxiety, those randomized to the CBT app had greater improvements on the HAM‐A (Mean Difference = 7.44, standard error [SE] = 3.35, p = .037) and HADS‐Anxiety Subscale (Mean Difference = 4.44, SE = 1.60, p = .010) compared with the control group. Conclusion Both the tailored CBT app for anxiety and the health education program were associated with improvements in anxiety, mood, and QOL, but these outcomes did not differ between study groups. The CBT app was more beneficial than health education for patients with severe baseline anxiety. Implications for Practice A cognitive‐behavioral therapy mobile application tailored to treat anxiety in patients with advanced cancer helps improve access to evidence‐based supportive care in a convenient, private, and timely manner.

Can mHealth interventions improve quality of life of cancer patients? A systematic review and meta-analysis

“… ( Cheong et al, 2018 ) South Korea Colorectal cancer 102 / 41% women/ 58 ± 12 years Pre-post Wearable device and application that included rehabilitation exercise program and information on their disease and treatment None 12 weeks EORTC-C30 74% Improved EORTC symptoms of fatigue and nausea/vomiting. ( Park et al, 2019 ) Republic of Korea Lung cancer 90 / 54% women / 55.1 ± 8.7 years Pre-post App delivered physical rehabilitation program (Smart Aftercare app) None 12 weeks EORTC QLQ-C30 90% Improved role, emotional and social functioning, fatigue, appetite, diarrhea ( Trinh et al, 2018 ) Canada Prostate cancer 46 / all men / 73.2 ± 7.3 years Pre-post Accelerometer, wrist-worn activity tracker and Web based application None 12 weeks FACT-General 91% Improved emotional well-being ( Lozano-Lozano et al, 2019 ) Spain Breast cancer (Overweight/obese) 80 / all women / age 59 ± 9 years Pre-post Healthy eating and physical activity feedback app (BENECA) None 8 weeks EORT QLQ-C30 73% Improved global health, physical, emotional, social and cognitive functioning, fatigue, dyspnea, insomnia Cognitive behavioral therapy / behavioral change (6 studies) ( Greer et al, 2019 ) USA …”

“…We identified 17 RCTs ( Willems et al, 2017 ; Mendoza et al, 2017 ; Graetz et al, 2018 ; Ferrante et al, 2018 ; Admiraal et al, 2017 ; Compen et al, 2018 ; Frensham et al, 2018 ; Galiano-Castillo et al, 2016 ; Greer et al, 2019 ; Ham et al, 2019 ; Ji et al, 2019 ; Kubo et al, 2019 ; Rosen et al, 2018 ; Uhm et al, 2017 ; Urech et al, 2018 ; Yang et al, 2019 ; Zhu et al, 2018 ) and 8 pre-post design studies ( Børøsund et al, 2019 ; Cheong et al, 2018 ; Lozano-Lozano et al, 2019 ; McCarroll et al, 2015 ; Pappot et al, 2019 ; Park et al, 2019 ; Pope et al, 2019 ; Trinh et al, 2018 ). Nine studies (5 RCTs and 4 pre-post designs) tested physical activity / rehab / fitness interventions ( Mendoza et al, 2017 ; Frensham et al, 2018 ; Galiano-Castillo et al, 2016 ; Ji et al, 2019 ; Uhm et al, 2017 ; Cheong et al, 2018 ; Lozano-Lozano et al, 2019 ; Park et al, 2019 ; Trinh et al, 2018 ), six studies – CBT interventions (4 RCTs and 2 pre-post designs) ( McCarthy et al, 2018 ; Willems et al, 2017 ; Compen et al, 2018 ; Greer et al, 2019 ; Greer et al, 2019 ; Ham et al, 2019 ; Børøsund et al, 2019 ), three studies - mindfulness/stress management interventions (3 RCTs) ( Kubo et al, 2019 ; Rosen et al, 2018 ; Urech et al, 2018 ), two studies - social support (1 RCT and 1 pre-post design) ( Zhu et al, 2018 ; Pappot et al, 2019 ), two studies - information/psychoeducation (2 RCTs) ( Graetz et al, 2018 ; Admiraal et al, 2017 ), two studies – weight management (1 RCT and 1 pre-post design) ( Ferrante et al, 2018 ;…”

“…The majority of studies (15 RCTs and 7 pre-post designs) found that mHealth interventions were associated with improvement in at least one domain of HRQoL of cancer patients ( Willems et al, 2017 ; Graetz et al, 2018 ; Ferrante et al, 2018 ; Compen et al, 2018 ; Frensham et al, 2018 ; Galiano-Castillo et al, 2016 ; Greer et al, 2019 ; Greer et al, 2019 ; Ji et al, 2019 ; Kubo et al, 2019 ; Rosen et al, 2018 ; Uhm et al, 2017 ; Urech et al, 2018 ; Yang et al, 2019 ; Zhu et al, 2018 ; Børøsund et al, 2019 ; Cheong et al, 2018 ; Lozano-Lozano et al, 2019 ; McCarroll et al, 2015 ; Pappot et al, 2019 ; Park et al, 2019 ; Trinh et al, 2018 ).…”

Brief culturally informed smartphone interventions decrease breast cancer symptom burden among Latina breast cancer survivors

“…Therefore, there was potentially little room for improvement on this outcome. In fact, a recent study by Greer et al found that cancer patients who had the highest levels of distress at study entry benefited most from a mobile psychosocial application. It is possible that My Guide might be more beneficial for women experiencing poorer levels of health‐related quality of life, and this possibility should be further explored.…”

Evaluating a Web- and Telephone-based Personalised Exercise Intervention for Individuals Living With Metastatic Prostate Cancer (Exerciseguide): Protocol for a Pilot Randomised Controlled Trial

“…The Hospital Anxiety and Depression Scale will be used to evaluate changes in anxiety and depression by using two 7-item Depression and Anxiety sub-scales. (65). The reliability and validity has been shown to be acceptable in individuals with prostate cancer (66).…”