Project onward: an innovative e-health intervention for cancer survivors
Open accessAbstract
Objective: This study examined the feasibility and acceptability of an Individual Internet Intervention (III) embedded and integrated into an Internet Support Group (ISG) with the ultimate goal of enhancing adherence and learning, compared with an individual internet invention alone. Method: Thirty‐one posttreatment cancer survivors were randomized in groups of seven to nine to either the 8‐week III + ISG intervention or the 8‐week III condition. Seventeen participants met the Hospital Anxiety and Depression Scale (HADS) criteria for depressive symptoms (HADS ≥ 8). Results: Among all participants, the mean number of logins over 8 weeks was 20.8 ± 17.7 logins for the III + ISG compared with 12.5 ± 12.5 in III‐only (p = 0.15). Two participants in the III + ISG dropped out, compared with five in III (p = 0.39). Among the 17 participants with depressive symptoms at baseline, both the Onward and the III‐only condition showed large reductions in the depression scale of HADS (d = 1.27 and 0.89, respectively). Improvement over time and time x treatment effects only reached trend significance levels (p s = 0.07 & 0.12) as this pilot was not powered to detect these differences. Conclusion: Both the III + ISG and III‐only demonstrated pre‐post reductions in depressive symptoms and high rates of utilization compared with other web‐based treatments for depression. Although it is premature to make any determination as to the efficacy of the interventions tested in this feasibility study, these results indicate that pursuing the III + ISG model, as well as standard IIIs, may be fruitful areas of future research. Copyright © 2012 John Wiley & Sons, Ltd.
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Effectiveness studies of iCBT interventions for depression and anxiety among cancer patients and survivors are only recently emerging, and most studies have included people with all cancer types rather than focusing only on one type of cancer.
“Effectiveness studies of iCBT interventions for depression and anxiety among cancer patients and survivors are only recently emerging, and most studies have included people with all cancer types rather than focusing only on one type of cancer”
From A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol (2021) · cites this paper as Duffecey et al., 2013
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Experimental — accuracy not yet measuredSome evidence suggests peer support can increase adherence to internet interventions and lower depression.
“there has been some evidence that peer support can improve adherence to internet interventions and reduce depression (22)”
From Harnessing Peer Support in an Online Intervention for Older Adults with Depression (2017) · cites this paper as [22]
Preliminary results suggest that harnessing peer social networks to encourage collaborative learning and adherence to web-based interventions may prove useful.
“Preliminary results, while limited due to small sample sizes, suggest harnessing peer social networks to encourage collaborative learning and adherence to web-based interventions may prove useful (38).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [38]
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Cites
The Hospital Anxiety and Depression Scale
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“Although this study was not powered to detect differences in depressive symptoms outcomes, trends suggest that integration of ISGs and IIIs to create collaborative learning environments [15] and enhance supportive accountability [9] may prove useful in enhancing both adherence and outcomes.”
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Self-citationA systematic review of types and efficacy of online interventions for cancer patients.
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“Overall these studies demonstrated that the use of online interventions for support or therapy in this population was feasible to implement and acceptable to the recipients in a general sense [5,23–30].”
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InfluentialHarnessing Peer Support in an Online Intervention for Older Adults with Depression
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Effects of web-based interventions on cancer patients’ symptoms: review of randomized trials
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“Delivery of a psychosocial intervention through a technology-based platform provides many advantages for oncology patients.(16) The intervention can be accessed at a location of the patient’s choice; this will enhance accessibility for patients who would otherwise not be able to attend in person because of disease-rel…”
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Theoretical Perspectives of Adherence to Web-Based Interventions: a Scoping Review
Ryan, C., Bergin, M., & Wells, J. S. (2018) · International Journal of Behavioral Medicine · doi:10.1007/s12529-017-9678-8 · Cited by 86 · see citing works
“Similar support for the model has also been reported in other studies with cancer survivors [57], patient with multiple sclerosis [58], in trials for weight management [39] and in interventions for depression [59] and stress management [60].”
ResultWootten, A. C., Abbott, J.-A. M., Meyer, D., Chisholm, K., Austin, D. W., Klein, B., McCabe, M., Murphy, D. G., & Costello, A. J. (2015) · European Urology · doi:10.1016/j.eururo.2014.10.024 · Cited by 77 · see citing works
“There has also been limited research on the role of online support such as Internet support conditions and moderated forums, although it is widely accepted that peer support can play a major role in supporting men who have PCa [27].”
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Lee, K., Kim, S., Kim, S. H., Yoo, S., Sung, J. H., Oh, E. G., Kim, N. W., & Lee, J. (2023) · Journal of Medical Internet Research · doi:10.2196/38333 · Cited by 79 · see citing works
Syrjala, K. L., Yi, J. C., Artherholt, S. B., Romano, J. M., Crouch, M.-L., Fiscalini, A. S., Hegel, M. T., Flowers, M. E. D., Martin, P. J., & Leisenring, W. M. (2018) · Journal of Cancer Survivorship · doi:10.1007/s11764-018-0693-9 · Cited by 76 · see citing works
Chambers, S. K., Ritterband, L. M., Thorndike, F., Nielsen, L., Aitken, J. F., Clutton, S., Scuffham, P. A., Youl, P., Morris, B., Baade, P. D., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.8850 · Cited by 74 · see citing works
“The CancerCope program reported in this trial differs from much of the previously reported Web-based psycho-oncology intervention research in that it was a fully automated and tailored intervention and did not include therapist or nurse support or guidance [30], support group forums [31], discussion boards [32,33], or…”
MethodPurple: A Modular System for Developing and Deploying Behavioral Intervention Technologies
Schueller, S. M., Begale, M. J., Penedo, F. J., & Mohr, D. C. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3376 · Cited by 74 · see citing works
Self-citationWagner, L. I., Tooze, J. A., Hall, D. L., Levine, B. J., Beaumont, J., Duffecy, J., Victorson, D., Gradishar, W., Leach, J., Saphner, T., et al. (2021) · JNCI: Journal of the National Cancer Institute · doi:10.1093/jnci/djab100 · Cited by 67 · see citing works
“We included Relaxation because we previously found relaxation promotes eHealth intervention engagement.(46) Given the potential for non-adherence and known decay in eHealth use(50), we sought to maximize engagement and adherence through including Relaxation.”
Self-citationDuffecy, J., Grekin, R., Hinkel, H., Gallivan, N., Nelson, G., & O'Hara, M. W. (2019) · JMIR Mental Health · doi:10.2196/10778 · Cited by 60 · see citing works
“There have been a number of small trials that suggest that peer support has the potential to improve adherence and depressive outcomes [23,27,28], and this study sought to examine the use of this approach in the perinatal population.”
BackgroundSelf-citationBeatty, L., Kemp, E., Butow, P., Girgis, A., Schofield, P., Turner, J., Hulbert‐Williams, N. J., Levesque, J. V., & Koczwara, B. (2018) · Psycho-Oncology · doi:10.1002/pon.4445 · Cited by 65 · see citing works
Mobile applications for breast cancer survivorship and self-management: A systematic review
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“As recently shown in a study with adult posttreatment cancer survivors, guided interventions are more effective than self-help programs [31].”
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Kinner, E. M., Armer, J. S., McGregor, B. A., Duffecy, J., Leighton, S., Corden, M. E., Gauthier Mullady, J., Penedo, F. J., & Lutgendorf, S. K. (2018) · JMIR Cancer · doi:10.2196/cancer.8430 · Cited by 51 · see citing works
“Internet-based group interventions have been found to be beneficial for women with breast cancer [23], men with prostate cancer [24,25], and posttreatment cancer survivors [26].”
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Kang, H. S., Kim, H. K., Park, S. M., & Kim, J. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-2972-6 · Cited by 55 · see citing works
“In line with this finding, previous studies showed benefits of web-based educational interventions for increasing knowledge of the disease [24, 50], as well as reducing depression [51], and cancer-related fatigue and anxiety [52].”
Resultvan den Berg, S. W., Peters, E. J., Kraaijeveld, J. F., Gielissen, M. F., & Prins, J. B. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2566 · Cited by 53 · see citing works
“These unguided generic Web-based self-management interventions for breast cancer survivors are emerging and promising [10-12].”
Backgroundvan den Berg, S. W., Gielissen, M. F. M., Ottevanger, P. B., & Prins, J. B. (2012) · BMC Cancer · doi:10.1186/1471-2407-12-394 · Cited by 50 · see citing works
“Pilot evidence suggests that an Internet intervention specially designed for posttreatment survivors (Project Onward [24]) can have high utilization rates and reduce depressive symptoms.”
BackgroundBeatty, L., Kemp, E., Coll, J. R., Turner, J., Butow, P. N., Milne, D., Yates, P. M., Lambert, S., Wootten, A. C., Yip, D., et al. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4526-1 · Cited by 40 · see citing works
Dissecting an Online Intervention for Cancer Survivors
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“Research has focused on reporting engagement as number of times logged in (Duffecy et al., 2012) and number of messages posted (Classen et al.”
BackgroundZhang, Y., Flannery, M. A., Zhang, Z., Underhill-Blazey, M. L., Bobry, M. D., Leblanc, N. M., Rodriguez, D., & Zhang, C. (2024) · JMIR Cancer · doi:10.2196/46116 · Cited by 39 · see citing works
“[35-37,39-50, 53,55,59-62,64,67,68,70,72,75,77,81,82,85,88-91,93,95-99] or smart device app (n=8) [43,52,56,57,63,69,80,87].”
MethodLazarou, I., Krooupa, A.-M., Nikolopoulos, S., Apostolidis, L., Sarris, N., Papadopoulos, S., & Kompatsiaris, I. Y. (2024) · Cancers · doi:10.3390/cancers16132293 · Cited by 35 · see citing works
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Self-citationAdvances in Pain Medicine: a Review of New Technologies
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Web-based interventions for comorbid depression and chronic illness: a systematic review
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“Five studies based participant recruitment on clinical cut-off scores indicative of problematic depression from baseline self-report, clinical-interview or both.26,28,33,34,35 Duffecy et al.19 removed such criteria to aid recruitment.”
BackgroundMethodInfluentialMontalescot, L., Baussard, L., & Charbonnier, É. (2024) · Journal of Medical Internet Research · doi:10.2196/52542 · Cited by 33 · see citing works
“%) studies that investigated this topic [74,84].”
Integrating Social Media in Modern Oncology Practice and Research
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“…et al., 2008;Webb et al., 2010), research investigating online interventions for patients with cancer has only recently begun emerging (Beatty et al., 2011; Carpenter et al., 2012; Duffecy et al., 2013; Leykin et al., 2012; Owen et al., 2005; Ritterband et al., 2012; van den Berg et al., 2013).”
BackgroundSeitz, D. C. M., Knaevelsrud, C., Duran, G., Waadt, S., & Goldbeck, L. (2014) · Cyberpsychology, Behavior, and Social Networking · doi:10.1089/cyber.2014.0066 · Cited by 23 · see citing works
“The pretreatment dropout rate and number of persons with only partial participation were comparable to other individualized e-health interventions.(21,23) The majority rated Onco-STEP—and both modules to the same degree—as very helpful.”
Wan, S. W., Chng, Y. J. D., Lim, S. H., Chong, C. S., Pikkarainen, M., & He, H. (2022) · Journal of Advanced Nursing · doi:10.1111/jan.15258 · Cited by 24 · see citing works
Engagement with a Social Networking Intervention for Cancer-Related Distress
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“tackled this problem successfully by means of supportive accountability [46].”
BackgroundAdmiraal, J. M., Bouma, G., Schroeder, C. P., de Vries, E. G. E., Walenkamp, A., & Reyners, A. K. L. (2014) · University of Groningen research database (University of Groningen / Centre for Information Technology) · Cited by 22 · see citing works
Advancing Oncology Nursing Practice Through the Adoption of Patient Monitoring Digital Tools
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Engagement with INSPIRE, an Online Program for Hematopoietic Cell Transplantation Survivors
Syrjala, K. L., Crouch, M.-L., Leisenring, W. M., Flowers, M. E. D., Artherholt, S. B., Fiscalini, A. S., Romano, E. M., Romano, J. M., Martin, P. J., & Yi, J. C. (2018) · Transplantation and Cellular Therapy · doi:10.1016/j.bbmt.2018.05.004 · Cited by 19 · see citing works
Duffecy, J., Grekin, R., Long, J. D., Mills, J. A., & O'Hara, M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.05.123 · Cited by 19 · see citing works
Self-citationon behalf of the Finding My Way study investigators, Beatty, L., Kemp, E., Wade, T., & Koczwara, B. (2015) · BMC Cancer · doi:10.1186/s12885-015-1322-x · Cited by 16 · see citing works
“However, the evidence-base for selfguided iCBT-based psychological therapy in cancer is only now emerging [25-28].”
BackgroundMethodWang, X., Li, M., Shi, Q., Ji, H., Kong, S., Zhu, L., & Zhang, H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.880978 · Cited by 17 · see citing works
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“Web-based CBT for cancer patients, and prostate cancer in particular, is a less-developed area compared with other chronic physical conditions [27-31].”
BackgroundManne, S. L., Heckman, C. J., Kashy, D. A., Ritterband, L. M., Thorndike, F. P., Lozada, C., & Coups, E. J. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaa103 · Cited by 17 · see citing works
Telemedicine in Tinnitus: Feasibility, Advantages, Limitations, and Perspectives
Guitton, M. J. (2013) · ISRN Otolaryngology · doi:10.1155/2013/218265 · Cited by 17 · see citing works
“A way to enhance adherence to Internet-based cognitive intervention is to integrate it with an online support group [41].”
BackgroundMurphy, M. J., Newby, J. M., Butow, P. N., Kirsten, L. T., Allison, K. C., Loughnan, S. A., Price, M., Shaw, J., Shepherd, H. L., Smith, J. S., et al. (2017) · BMC Cancer · doi:10.1186/s12885-017-3182-z · Cited by 17 · see citing works
“A pilot program looking an CBT principles in a cancer survivor population with varying depressive symptoms [23] “suggests that properly designed web-based interventions may be effective for reducing depressive symptoms among cancer patients” and a Canadian feasibility open trial using a transdiagnostic iCBT interventi…”
BackgroundMurphy, M. J., Newby, J. M., Butow, P., Joubert, A., Kirsten, L., Shaw, J., Shepherd, H. L., & Andrews, G. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100449 · Cited by 15 · see citing works
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“FoRtitude content and functionality was informed by our prior webbased intervention research on depression post-cancer treatment.(8) Content review: BCS (n = 5) were provided with web-based FoRtitude site didactic content, which included psychoeducational materials on FoR and three CBT-based coping strategies (Relaxat…”
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“These studies focused on a variety of populations, such as cancer survivors (e.g., Duffecy et al., 2013; Høybye et al., 2010), caregivers of mental health patients (e.g., Clifford & Minnes, 2013; O ’ Connor, Arizmendi, & Kaszniak, 2014), and college students (e.g., Ellis, Campbell, Sethi, & O ’…”
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“Furthermore, internet-delivered interventions would enhance accessibility for patients with chronic pain in rural areas that have difficulty with transportation or other physical limitations [58-61].”
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“Furthermore, number of visits (M=13.4, SD=9.1), 51 percentage of participants using live sessions (31%), 32 overall contributions (n=233), 29 and time spent with features (M=2 hours 40 min) 50 were reported in one study each.”
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“To do this, they either performed a purely theoretical approach through cognitive behavioral therapy 12–14, 18, 36 The main interventions in the physical and emotional sphere focus on addressing problems such as pain, fatigue, anxiety and depression, fear of recurrence, sleep problems,…”
Developing peer support in film for cancer self-management: what do men want other men to know?
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Psychological Support for Cancer Patients
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InfluentialSelf-citationAn Integrative Review of Self-Management Interventions for Treatment Sequelae in Adult Survivors
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BackgroundMethodInfluentialMembers' experiences of a neuromuscular disorder online support group
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- Authors
- Duffecy, J., Sanford, S., Wagner, L., Begale, M., Nawacki, E., & Mohr, D. C.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Mohr, David C.
- Venue
- Psycho-Oncology
- Publisher
- Wiley
- Published
- 2012-03-21
- Volume
- 22
- Issue
- 4
- Pages
- 947-951
- ISSN
- 1057-9249 (ISSN-L)
- 1099-1611
- PMC
- PMC3387296
- OpenAlex
- W1933438552
- Cited by
- 89
- References
- 17
- Citations by year
- 2025: 3 · 2024: 5 · 2023: 3 · 2022: 8 · 2021: 4 · 2020: 5 · 2019: 2 · 2018: 12 · 2017: 12 · 2016: 4 · 2015: 10 · 2014: 11 · 2013: 8 · 2012: 1
- FWCI
- 13.45
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Psycho-Oncology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Northwestern University
- National Institutes of Health (UL1TR000150)
- Robert H. Lurie Comprehensive Cancer Center
- Cancer Institute and Hospital, Chinese Academy of Medical Sciences
- National Institute of Mental Health (P20MH090318, R34MH078922)
- National Cancer Institute (5 P30 CA60553-16, P30CA060553)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- cancer survivors, online intervention, online support groups, depressive symptoms, feasibility, acceptability, intervention adherence
- MeSH terms
- Adult, Aged, Depression, Diffusion of Innovation, Feasibility Studies, Female, Humans, Male, Middle Aged, Neoplasms, Patient Compliance, Psychiatric Status Rating Scales, Quality of Life, Self-Help Groups, Socioeconomic Factors, Treatment Outcome, Telemedicine, Survivors, Internet
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