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

The oncologist

article

Joseph A. Greer¹  Lara Traeger¹  Frank J. Penedo³  Areej El-Jawahri¹  Steven A. Safren⁴  William F. Pirl²  Jennifer S. Temel¹  Jamie Jacobs¹  Nicole Pensak⁶  James J. MacDonald⁷  Charn-Xin Fuh¹  Giselle K. Perez¹  Alina Ward⁸  Colleen Tallen⁸  Alona Muzikansky¹ 

[1] Massachusetts General Hospital Cancer Center;Harvard Medical School;Northwestern University Feinberg School of Medicine;University of Miami;Dana-Farber Cancer Institute;University of Colorado Anschutz Medical Campus;University of California;Lee Memorial Health System

关键词: Cognitive-behavioral therapy;    Anxiety;    Advanced cancer;   

DOI  :  10.1634/theoncologist.2018-0536

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

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.

【 授权许可】

CC BY|CC BY-NC