Randomized trial of a cognitive-behavioral therapy mobile app for anxiety in patients with incurable cancer
Abstract
175 Background: Patients with incurable cancer often experience marked anxiety that is associated with poor quality of life (QOL), high symptom burden, and complications with medical treatment. The aim of this study was to test the efficacy of a mobile app-based cognitive-behavioral therapy (CBT) intervention to treat anxiety symptoms in patients with incurable cancer. Methods: From 2/15 to 8/16, 145 patients with incurable cancers (e.g., advanced lung, breast, GI/GU, sarcoma, melanoma) who screened positive for at least mild anxiety symptoms (Hospital Anxiety & Depression Scale-Anxiety subscale, HADS-A > 7) were randomized 1:1 at two cancer centers to receive either the CBT mobile app for anxiety or a mobile health education program (control), delivered via tablet computers. The CBT app consisted of 7 modules teaching skills to relax the body, reduce worry, stay present-focused, improve communication, and plan/pace activities, which patients completed over 12 weeks. To assess anxiety, mood, and QOL, we administered the Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression Scale (CGI), HADS, and Functional Assessment of Cancer Therapy-General at baseline and 12 weeks. General linear models were used to assess the effect of the intervention on patient outcomes over time. Results: The sample was predominantly female (73.8%) and white (91.7%), with a mean age of 56.45 ( SD= 11.30) years. Both study groups reported significant improvements in anxiety, depression, and QOL from baseline to post-assessment (all p-values < .002), with no differences in the improved outcomes between groups. Secondary analyses revealed interaction effects on anxiety between the intervention and baseline HAM-A scores. Among patients with higher baseline anxiety, those randomized to the CBT app had greater improvements on the HAM-A ( p= .043), CGI ( p= .048), and HADS-A ( p= .001) compared to the health education control group. Conclusions: Patients with incurable cancer who received either a CBT mobile app intervention or mobile health education program reported improvements in anxiety, depression, and QOL. However, the CBT mobile app had better outcomes than health education for patients with higher baseline anxiety. Clinical trial information: NCT02286466.
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Most psychosocial interventions for those with advanced cancer are delivered face-to-face, which has barriers for broader dissemination including lack of suitably trained clinicians, high cost and low accessibility.
“Most psychosocial interventions for those with advanced cancer are delivered in a face-to-face setting (individual or group) which is advantageous for some but also has barriers for broader dissemination including a lack of suitably trained clinicians, high cost and low accessibility (Andrews, 2011; Greer et al., 2017).”
From A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy (iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety (2021) · cites this paper as Greer et al., 2017
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- Authors
- Greer, J., Jacobs, J. M., Pensak, N., MacDonald, J. J., Fuh, C.-X., Perez, G. K., Ward, A., Holt, A., Tallen, C., Muzikansky, A., Traeger, L., Penedo, F. J., Safren, S. A., Pirl, W. F., & Temel, J. S.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- University of Colorado Denver (US)
- University of California, Los Angeles (US)
- Lee Memorial Hospital (US)
- Northwestern University (US)
- University of Miami (US)
- University of Miami Health System (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2017-11-01
- Volume
- 35
- Issue
- 31_suppl
- Pages
- 175-175
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2761707494
- Cited by
- 9
- References
- 0
- Citations by year
- 2023: 1 · 2021: 2 · 2020: 4 · 2018: 2
- Type
- conference abstract
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- 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 › Mobile Health and mHealth Applications
- Keywords
- cognitive behavioral therapy, mobile health apps, cancer-related anxiety, incurable cancer, quality of life, depression, health education, symptom burden
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