Cited by 35Cancer survivorship and careDigital Mental Health InterventionsMobile Health and mHealth Applications

Digital stress management in cancer: testing StressProffen in a 12-month randomized controlled trial

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Børøsund, Elin, Ehlers, Shawna L., Clark, Matthew M., Andrykowski, Michael A., Cvancarova Småstuen, Milada, Solberg Nes, Lise·2022·Cancer

Abstract

BACKGROUND: Cognitive-behavioral stress management interventions are associated with improved psychological well-being for cancer survivors. The availability of, access to, and outreach of these in-person interventions are limited, however. The current study, therefore, evaluated the efficacy of StressProffen, a digital application (app)-based stress management intervention for cancer survivors, in a 12-month randomized controlled trial. METHODS: Cancer survivors 1 year or less after their treatment (N = 172) were randomized to the StressProffen intervention (n = 84) or a usual-care control group (n = 88). The intervention was delivered in a simple blended care model: 1) 1 in-person introduction session, 2) 10 app-based cognitive-behavioral stress management modules, and 3) 2 follow-up phone calls. Stress (Perceived Stress Scale), anxiety and depression (Hospital Anxiety and Depression Scale), self-regulatory fatigue (Self-Regulatory Fatigue 18), and health-related quality of life (HRQOL; RAND-36) were examined at the baseline and at 6 and 12 months. Generalized linear models for repeated measures were fitted to compare effects over time. RESULTS: Participants were mainly female (82%), had a mean age of 52 years (standard deviation, 11.3 years; range, 20-78 years), and had a variety of cancer types (mostly breast cancer [48%]). Over the 12-month study time, the intervention group reported significantly decreased stress (P < .001), depression (P = .003), and self-regulatory fatigue (P = .002) as well as improved HRQOL (for 6 of 8 domains, P ≤ .015) in comparison with controls. The largest favored effects for the intervention group were observed at 6 months: stress (estimated mean difference [MD], -5.1; P < .001), anxiety (MD, -1.4; P = .015), depression (MD, -2.1; P < .001), self-regulatory fatigue (MD, -4.9; P < .001), and HRQOL (7 of 8 domains; P ≤ .037). CONCLUSIONS: Digital stress management interventions such as StressProffen have the potential to extend the outreach of psychological interventions and provide easily available and effective psychosocial support for cancer survivors.

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Crossref · 10.1002/cncr.34046

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  • Evidence-based biopsychosocial treatment methods, including psychosocial self-management approaches such as CBT and ACT, have been recommended.

    “Evidence-based biopsychosocial treatment methods have therefore been recommended, including psychosocial self-management approaches such as cognitive behavioral therapy (CBT)6,25,72 and more recently also acceptance and commitment therapy (ACT).20,25,27,32”

    From Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO (2024) · cites this paper as [6]

    The ‘Psychosocial Interventions for Stress Management and Coping in Cancer’ section (page not specified) describes benefits of psychosocial interventions, and ‘The StressProffen Intervention’ section describes cognitive-behavioral self-management modules. Our copy does not identify ACT as a recommended approach, so it supports the psychosocial and CBT portions but not the ACT portion. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • The Self-Regulatory Fatigue 18 has been translated and tested in Norwegian cancer populations and has acceptable internal consistency and reliability.

    “The measure has been translated and tested in Norwegian cancer populations [42,43] and has acceptable internal consistency and reliability [41]”

    From Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial (2023) · cites this paper as [43]

    The Design and Participants section describes Norwegian-speaking cancer survivors, and Secondary outcomes says the trial measured self-regulatory fatigue with the SRF-18. Those passages support its use in a Norwegian cancer population, but do not say the scale was translated or that its Norwegian version was validated. The paper also reports acceptable internal consistency and reliability, though the citing sentence assigns that clause to [41], not this citation. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • Other CBT-based digital interventions combining educational and relaxation-based content, tested in other patient groups, support the notion that EPIO targets self-regulation, showing positive self-regulatory impact.

    “Other CBT-based digital interventions combining educational and relaxation-based content, tested in other patient groups, support this notion, showing positive self-regulatory impact [42,43].”

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Authors
Børøsund, E., Ehlers, S. L., Clark, M. M., Andrykowski, M. A., Cvancarova Småstuen, M., & Solberg Nes, L.
Affiliations
  • Oslo University Hospital (NO)
  • Mayo Clinic (US)
  • University of Kentucky (US)
  • Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
  • Department of Digital Health Research Division of Medicine Oslo University Hospital Oslo Norway
Corresponding author
Børøsund, Elin
Venue
Cancer
Publisher
Wiley
Published
2021-12-02
Volume
128
Issue
7
Pages
1503-1512
ISSN
  • 0008-543X (ISSN-L)
  • 1097-0142
OpenAlex
W3216871262
Cited by
35
References
37
Citations by year
2026: 5 · 2025: 12 · 2024: 5 · 2023: 10 · 2022: 3
FWCI
1.64
Type
journal article
Language
en
Open access
Locations
  • Cancer (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • UKnowledge (University of Kentucky) (submittedVersion, cc-by-nc-nd)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc-nd)
Funders
  • Kreftforeningen (4602492‐2013)
  • Universitetet i Oslo
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
cancer survivors, cognitive-behavioral stress management, mobile health apps, perceived stress, depression, anxiety, self-regulatory fatigue, health-related quality of life, blended care, psychosocial support
MeSH terms
Cancer Survivors, Anxiety, Breast Neoplasms, Depression, Female, Humans, Middle Aged, Psychotherapy, Quality of Life

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