Managing the psychological aspects of cancer
medwireNews: In this report from the 2017 annual meeting of the American Society of Clinical Oncology we focus on three studies that evaluated interventions to help patients and their families manage the psychological toll of cancer through the disease continuum.
ASCO Expert Don Dizon (Massachusetts General Hospital, Boston, USA) told the press in Chicago: “As oncologists, our job isn’t just to treat our patients’ physical symptoms. It’s also to connect them with other forms of support to help them cope and plan for the future.”
Dealing with diagnosis-associated distress
Viviane Hess, from the University Hospital of Basel in Switzerland, presented the results of a trial comparing the immediate versus delayed deployment of a web-based stress-management program in patients newly diagnosed with cancer.
She said in a press release that “[d]elivery of psychological support to patients at this early time in the course of their cancer care is hampered with lack of accessibility, time, and resources on both the patient’s and the provider’s side. With this online intervention, we aim to close this gap.”
The program – called STREAM – is based on the principles of cognitive behavioral therapy and involves patients working through eight online modules, receiving weekly personalized feedback from psychologists reviewing the progress, Hess explained.
A total of 129 participants, the majority (71.3%) of whom were women with early-stage breast cancer, were randomly assigned within 12 weeks of initiating anticancer treatment to either receive the intervention immediately or with a delay of 2 months.
At the 2-month time point, quality of life (QoL), as measured by the Functional Assessment of Chronic Illness Therapy - Fatigue tool, was improved for participants who did versus did not receive the intervention, with “a statistically significant and clinically meaningful” average increase of 8.59 points, said Hess.
Patients in the intervention group also reported a decrease in Distress Thermometer scores, from a median of 6 to 4 points, whereas the score remained unchanged for control participants.
However, there was no significant difference between groups with respect to improvements in mood.
Noting that three quarters of patients were highly distressed at baseline, Hess concluded that with this intervention “we reached a target population in need of support.”
Keep CALM and carry on
A short psychological intervention, termed Managing Cancer And Living Meaningfully (CALM), can alleviate distress in patients with advanced cancer and help them to face the challenges of their situation, suggest trial results.
Presenting author Gary Rodin, from the Princess Margaret Cancer Centre in Toronto, Ontario, Canada, reported that a significantly higher proportion of the 151 patients who received the intervention, in addition to usual care, had a clinically meaningful decrease in depressive symptoms at 3 and 6 months compared with the 154 who received usual care alone, at 52% versus 33% and 64% and 35%, respectively.
CALM also reduced the risk for developing depression – of the 137 participants who were not depressed at intake, 13% of those in the intervention arm developed depressive symptoms compared with 30% of control participants.
The psychotherapeutic intervention consists of three to six individual sessions, lasting between 45 and 60 minutes, and delivered by a trained healthcare professional over a course of 3–6 months. The sessions focus on four domains ranging from symptom control and medical decision-making to the concerns and hopes for the future.
“This brief talking therapy helps patients facing advanced cancer, and their loved ones, sustain what is meaningful in their life despite its limitations, and face the future,” Rodin said in a press release.
He added: “The next steps for this research will include enhancing understanding of the therapeutic process of CALM, the optimal approaches to training clinicians in the intervention, the refinement of measurement tools that best capture the clinical outcomes, and the effectiveness of implementation in diverse clinical settings and geographic regions.”
Conquer Fear of recurrence
The final study focused on addressing the fear of recurrence faced by cancer recurrence. Jane Beith, from the University of Sydney in New South Wales, Australia, and co-investigators identified 222 survivors of stage I–III breast cancer, colorectal cancer, or melanoma with a high fear of recurrence, as indicated by a score of 13 or more on the Fear of Cancer Recurrence Inventory (FCRI) questionnaire.
Participants were randomly assigned to receive either the Conquer Fear intervention, delivered one-on-one by trained therapists in five 60–90 minute sessions over 10 weeks, or to participate in the relaxation arm, which involved five 60-minute individual face-to-face relaxation sessions.
The average FCRI score was significantly reduced among those in the Conquer Fear than the relaxation group immediately after the intervention, with an average decrease of 18.1 versus 7.6 points. This was also the case at 6 months, with corresponding mean reductions of 27.2 and 17.8.
The intervention also improved other outcomes, such as cancer-specific anxiety and QoL, relative to relaxation training immediately after treatment but not at later time points, said Beith.
Noting that the program is time and resource intensive in its current face-to-face format, she commented that the team is exploring other forms of delivery, such as via the internet, in a group, or over the phone.
Commenting on the study, Dizon said that the improvements seen in the relaxation group also give hope – even if we are unable to provide an intervention like Conquer Fear, we can at least advise our patients that something as simple as relaxation techniques can improve their lives now.
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