Web-Based Stress Management for Newly Diagnosed Patients With Cancer (STREAM): A Randomized, Wait-List Controlled Intervention Study

Abstract

PurposeBeing diagnosed with cancer causes major psychological distress; however, a majority of patients lack psychological support during this critical period. Internet interventions help patients overcome many barriers to seeking face-to-face support and may thus close this gap. We assessed feasibility and efficacy of Web-based stress management (STREAM [Stress-Aktiv-Mindern]) for newly diagnosed patients with cancer.Patients and MethodsIn a randomized controlled trial, patients with cancer who had started first-line treatment within the previous 12 weeks were randomly assigned to a therapist-guided Web-based intervention or a wait-list (control), stratified according to distress level (≥ 5 v < 5 on scale of 0 to 10). Primary efficacy end point was quality of life after the intervention (Functional Assessment of Chronic Illness Therapy–Fatigue). Secondary end points included distress (Distress Thermometer) and anxiety or depression (Hospital Anxiety and Depression Scale). Treatment effect was assessed with analyses of covariance, adjusted for baseline distress.ResultsA total of 222 of 229 screened patients applied online for participation. Between September 2014 and November 2016, 129 newly diagnosed patients with cancer, including 92 women treated for breast cancer, were randomly assigned to the intervention (n = 65) or control (n = 64) group. Adherence was good, with 80.0% of patients using ≥ six of eight modules. Psychologists spent 13.3 minutes per week (interquartile range, 9.5-17.9 minutes per week) per patient for online guidance. After the intervention, quality of life was significantly higher (Functional Assessment of Chronic Illness Therapy–Fatigue: mean, 8.59 points; 95% CI, 2.45 to 14.73 points; P = .007) and distress significantly lower (Distress Thermometer: mean, −0.85; 95% CI, −1.60 to −0.10; P = .03) in the intervention group as compared with the control. Changes in anxiety or depression were not significant in the intention-to-treat population (Hospital Anxiety and Depression Scale: mean, −1.28; 95% CI, −3.02 to 0.45; P = .15). Quality of life increased in the control group with the delayed intervention.ConclusionThe Web-based stress management program STREAM is feasible and effective in improving quality of life.

Finding My Way: results of a multicentre RCT evaluating a web-based self-guided psychosocial intervention for newly diagnosed cancer survivors

“…Cancerspecific distress did not significantly moderate outcomes at any time point. Table 3 These outcomes add to the findings from three recent RCTs of online programs for recently diagnosed acute cancer survivors [19,15,18]. In contrast with the CancerCope trial for newly diagnosed distressed-patients [19], where no QOL impact was found, our study found FMW significantly improved emotional functioning.…”

“…Phase I and II trials demonstrated feasibility and pilot efficacy of the first iteration of this unguided program, Cancer Coping Online, in improving distress, maladaptive coping, and select quality of life domains [14,15]. Two further RCTs have recently been published; a German study comparing the therapist-guided CBT and mindfulness program "STREAM" against a waitlist control in 129 patients [18]; and an Australian study of an unguided web-based CBT program 'CancerCope' for 163 patients screened with high distress, compared to a static cancer education website [19]. The STREAM program led to improved quality of life and reduced distress, but no impact on anxiety or depression [18].…”

“…Two further RCTs have recently been published; a German study comparing the therapist-guided CBT and mindfulness program "STREAM" against a waitlist control in 129 patients [18]; and an Australian study of an unguided web-based CBT program 'CancerCope' for 163 patients screened with high distress, compared to a static cancer education website [19]. The STREAM program led to improved quality of life and reduced distress, but no impact on anxiety or depression [18]. CancerCope did not yield significant group differences for any primary or secondary outcome, however sub-group analyses showed higher program-adherence was associated with reduced psychological and cancer-specific distress, and unmet needs [19].…”

Effect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer: a randomized controlled clinical trial

“…It can be considered as an advantage of this study that the educational effect was persistent after three months of intervention. In other studies that have examined the impact of Web-based or Internet-based interventions on QoL of cancer survivors, social performance has not changed significantly after interventions [41][42][43]. Although these methods and social network-based methods are not ineffective and they have a high rate of patient participation due to their ease of access, one of their biggest challenges is low treatment adherence, which affects treatment effectiveness [19].…”

Mindfulness and Skills Based Distress Reduction in Oncology: Das Webbasierte Psychoonkologische Make It Training

“…Weiterhin wurden Ergebnisse über zu geringe Fallzahlen, ungenaue primäre Outcomes sowie fehlende Kontrollgruppen berichtet, sodass es momentan schwierig ist, eindeutige Aussagen über Effektivität von eHealth Interventionen in der Psychoonkologie zu treffen [20]. Die neueren eHealth Studien STREAM [21] und BREATH [22] die im RCT Design durchgeführt worden sind zeigen, dass eHealth Interventionen im Umgang mit psychoonkologischen Belastungen und bei der Krankheitsverarbeitung hilfreich sind und einen klaren klinischen Benefit für die Patientinnen zeigen. In den verschiedenen Studien wird allerdings klar formuliert, dass es einen großen Bedarf an weiterer Forschung und RCT Studien gibt, um webbasierte Interventionen der Evidenz folgend zu verbessern und um eindeutige Schlussfolgerungen über die Wirksamkeit von eHealth Interventionen machen zu können [23][24][25][26][27].…”