Web-Delivered cognitive behavioral therapy for distressed cancer patients: randomized controlled trial
Open accessAbstract
BACKGROUND: Web-based interventions present a potentially cost-effective approach to supporting self-management for cancer patients; however, further evidence for acceptability and effectiveness is needed. OBJECTIVE: The goal of our research was to assess the effectiveness of an individualized Web-based cognitive behavioral therapy (CBT) intervention on improving psychological and quality of life outcomes in cancer patients with elevated psychological distress. METHODS: A total of 163 distressed cancer patients (111 female, 68.1%) were recruited through the Queensland Cancer Registry and the Cancer Council Queensland Cancer Helpline and randomly assigned to either a Web-based tailored CBT intervention (CancerCope) (79/163) or a static patient education website (84/163). At baseline and 8-week follow-up we assessed primary outcomes of psychological and cancer-specific distress and unmet psychological supportive care needs and secondary outcomes of positive adjustment and quality of life. RESULTS: Intention-to-treat analyses showed no evidence of a statistically significant intervention effect on primary or secondary outcomes. However, per-protocol analyses found a greater decrease for the CancerCope group in psychological distress (P=.04), cancer-specific distress (P=.02), and unmet psychological care needs (P=.03) from baseline to 8 weeks compared with the patient education group. Younger patients were more likely to complete the CancerCope intervention. CONCLUSIONS: This online CBT intervention was associated with greater decreases in distress for those patients who more closely adhered to the program. Given the low costs and high accessibility of this intervention approach, even if only effective for subgroups of patients, the potential impact may be substantial. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613001026718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364768&isReview=true (Archived by WebCite at http://www.webcitation.org/6uPvpcovl).
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E-mental health interventions enable patients with cancer to better cope with psychological distress.
“E-mental health interventions try to overcome some of these barriers and the limitation of healthcare offers, enabling patients with cancer to better cope with psychological distress.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [13]
The Results (Effectiveness; page not provided) report reduced psychological and cancer-specific distress among patients who used at least three CancerCope modules, supporting a possible benefit. But the intention-to-treat analysis found no significant intervention effect, and the Discussion says the authors could not conclude that CancerCope was effective as a standalone intervention. The claim presents the benefit more generally than this trial supports. (LLM, conf=0.87)
Experimental — accuracy not yet measuredE-mental health interventions have proven to be feasible and effective in improving quality of life.
“E-mental health interventions have proven to be feasible and effective in improving quality of life.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [13]
The Results > Effectiveness section reports that patients generally found the CancerCope web program easy to use and that technical problems were infrequent, supporting feasibility in this cancer-patient trial. But quality of life was a measured secondary outcome, and the intention-to-treat analysis found no statistically significant intervention effect on any secondary outcome. The paper therefore does not establish that the intervention improved quality of life, let alone that e-mental health interventions generally have proven to do so. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPatients with cancer who used e-mental health interventions experienced significantly reduced levels of distress, depression, pain, fatigue and anxiety.
“Patients with cancer who used e-mental health interventions experienced significantly reduced levels of distress, depression, pain, fatigue and anxiety.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [13]
The Results > Effectiveness section reports significantly greater decreases in psychological and cancer-specific distress only among CancerCope participants who accessed at least three program cores. It reports no statistically significant intervention effect in the intention-to-treat analysis and does not establish significant reductions in depression, pain, fatigue, or anxiety. (LLM, conf=0.89)
Experimental — accuracy not yet measuredRecent scientific findings suggest significant effects on well-being in terms of distress, depression and anxiety, especially for web-based interventions that included CBT, ACT and MBSR.
“Recent scientific findings extend their effectiveness by suggesting significant effects on well-being in terms of distress, depression and anxiety,11 16–20 especially for web-based interventions that included cognitive behavioural therapy (CBT) techniques, acceptance and commitment therapy (ACT) and mindfulness-based stress reduction (MBSR).”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [13]
The Results > Effectiveness section reports significant reductions in psychological and cancer-specific distress only in a per-protocol subgroup using the web-based CBT intervention; the intention-to-treat analysis found no significant effect. The paper does not establish significant effects on depression or anxiety separately, or evaluate ACT or MBSR. Our copy provides no page numbers for these passages. (LLM, conf=0.89)
Experimental — accuracy not yet measuredPrevious research shows that web-based interventions to reduce psychological distress in patients with cancer including CBT, MBSR or ACT have been proven to be effective.
“Previous research shows that web-based interventions to reduce psychological distress in patients with cancer including CBT, MBSR or ACT have been proven to be effective.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [13]
The Results > Effectiveness section reports reduced distress for patients who used at least three modules of the web-based CBT program, but no statistically significant effect in the intention-to-treat analysis. The paper does not establish that web-based MBSR or ACT interventions are effective, so the claim is broader and more certain than its findings. (LLM, conf=0.89)
Experimental — accuracy not yet measured
Various studies have found benefits of CBT to apply to web-delivered CBT for cancer patients.
“Various studies have found these benefits to apply to web-delivered CBT for cancer patients (18, 28, 29).”
From Mindfulness and skills-based eHealth intervention to reduce distress in cancer-affected patients in the Reduct trial: Intervention protocol of the make it training optimized (2022) · cites this paper as [28]
The Results > Effectiveness section reports greater reductions in psychological and cancer-specific distress among participants who accessed at least three program cores. But the intention-to-treat analysis found no statistically significant intervention effect, so this study supports benefits for a more-adherent subgroup, not cancer patients generally. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWithin these web-based interventions, different combinations such as CBT and MBSR, CBT and ACT or ACT and MBSR have been used.
“Within these web-based interventions, different combinations such as CBT and MBSR, CBT and ACT or ACT and MBSR have been used.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [13]
The Methods > Intervention passage describes CancerCope as a web-based CBT program, but it does not describe combining CBT with MBSR or ACT, or ACT with MBSR. Searches for those combinations and their expanded names found no passage in our copy addressing them; page numbers were not provided. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Chow, P. I., Drago, F., Kennedy, E. M., & Cohn, W. F. (2019) · JMIR Cancer · doi:10.2196/15750 · Cited by 28 · see citing works
“Similar rates of dropout have been noted in Web- and app-based interventions for cancer populations as in the general population [59-61].”
BackgroundPromoting Emotional Well-Being in Older Breast Cancer Patients: Results From an eHealth Intervention
Villani, D., Cognetta, C., Repetto, C., Serino, S., Toniolo, D., Scanzi, F., & Riva, G. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.02279 · Cited by 27 · see citing works
Integrative Approaches to Stress Management
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Yun, Y. H., Kang, E., Cho, Y. M., Park, S. M., Kim, Y.-J., Lee, H., Kim, K. H., Lee, K., Koo, H. Y., Kim, S., et al. (2019) · Journal of Medical Internet Research · doi:10.2196/15057 · Cited by 26 · see citing works
“Second, a user centered electronic program has the potential to improve clinical indicators among those living with chronic diseases by allowing users to obtain information from the mobile- and Web-based pages at their own pace, to flexibly review material as needed [29,30] and by facilitating the management of multip…”
BackgroundWu, J., Liu, Z., Shen, D., Luo, Z., Xiao, Z., Liu, Y., & Huang, H. (2022) · Nursing Open · doi:10.1002/nop2.1317 · Cited by 24 · see citing works
“…UEE As modern medicine has changed from a “disease- centred biomedical model” to a “human- centred biopsychosocial medical model” (Miao et al., 2020), psychological care has gradually been emphasized (Chambers et al., 2018; Thomas et al., 2018) and has become an essential part of daily care.”
BackgroundYu, S., Liu, Y., Cao, M., Tian, Q., Xu, M., Yu, L., Yang, S., & Zhang, W. (2025) · Cancer Nursing · doi:10.1097/ncc.0000000000001274 · Cited by 22 · see citing works
Lally, R. M., Kupzyk, K. A., Gallo, S. M., & Berry, D. L. (2020) · Journal of Medical Internet Research · doi:10.2196/19734 · Cited by 21 · see citing works
“Published reports on completely unguided, web-based psychosocial distress self-management interventions for adults with cancer are limited [9-13].”
BackgroundEngelhard, M., & Kollins, S. H. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1077-1 · Cited by 20 · see citing works
Yang, Y., Zhang, H., Li, Y., Liu, Z., Liu, S., Li, X., Fan, G., Xu, Y. J., & Wang, B. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.12.068 · Cited by 20 · see citing works
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Wang, Y., Bao, S., & Chen, Y. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1166776 · Cited by 20 · see citing works
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Kamalumpundi, V., Saeidzadeh, S., Chi, N., Nair, R., & Gilbertson‐White, S. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06496-z · Cited by 16 · see citing works
Paley, C. A., Keshwala, V., Arango, M., Hodgson, E., Chapman, E., & Birtwistle, J. C. (2023) · Progress in Palliative Care · doi:10.1080/09699260.2023.2286418 · Cited by 13 · see citing works
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Dong, M., Huang, Y., Zhang, X., Wu, L., Ghazal, L., & Cao, F. (2025) · Psycho-Oncology · doi:10.1002/pon.70166 · Cited by 12 · see citing works
Svendsen, K., Nes, L. S., Meland, A., Larsson, I. M., Gjelsvik, Y. M., Børøsund, E., Rygg, C. M., Myklebust, T. Å., Reinertsen, K. V., Kiserud, C. E., et al. (2023) · JMIR Research Protocols · doi:10.2196/47195 · Cited by 11 · see citing works
Chemotherapy-related symptom networks in distinct subgroups of Chinese patients with gastric cancer
Li, X., Zou, Y., Zhang, Z., Li, Y., Wang, X., Yang, L., & Duan, P. (2023) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2023.100366 · Cited by 12 · see citing works
“42, 43 Increasing resilience offers patients more con fi dence in self-management of symptoms, which could be a crucial step in smoothing the transition to the low class.”
Beatty, L., Kemp, E., Turner, J., Butow, P. N., Milne, D., Yates, P. M., Lambert, S., Wootten, A. C., & Koczwara, B. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06291-w · Cited by 12 · see citing works
van Helmondt, S. J., Lodder, P., van Woezik, R., de Vries, J., & van der Lee, M. L. (2023) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac078 · Cited by 10 · see citing works
“One of the papers from the literature review did not find an interventioneffect in the primary analysis, but secondary per-protocol analysis restricted to patients who accessed at least half of the intervention resulted in a greater decrease in psychological and cancer specific distress compared to a control group [49…”
BackgroundResultHeinen, J., Bäuerle, A., Schug, C., Krakowczyk, J. B., Strunk, S. E., Wieser, A., Beckord, J., Jansen, C., Dries, S., Pantförder, M., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1037158 · Cited by 7 · see citing works
Harnas, S. J., Knoop, H., Evertsz, F. B., Booij, S. H., Dekker, J., van Laarhoven, H. W. M., van der Lee, M. L., Meijer, E., Sharpe, L., Sprangers, M. A. G., et al. (2021) · Trials · doi:10.1186/s13063-021-05657-z · Cited by 9 · see citing works
Wagner, J. B., Kim, M., & Tassé, M. J. (2019) · Intellectual and developmental disabilities · doi:10.1352/1934-9556-57.5.463 · Cited by 8 · see citing works
Krakowczyk, J. B., Truijens, F. L., Teufel, M., Lalgi, T. J., Heinen, J., Schug, C., Erim, Y., Pantförder, M., Graf, J., & Bäuerle, A. (2024) · JMIR Cancer · doi:10.2196/53117 · Cited by 5 · see citing works
“Most of these eHealth interventions consist of (web) applications that are based on psychotherapeutic approaches such as cognitive behavioral therapy (CBT) [24-28].”
BackgroundWu, V. S., Smith, A. B., Russell, H., Bamgboje‐Ayodele, A., Beatty, L., Pearce, A. M., Dhillon, H. M., Shaw, J., Antony, J., Fardell, J. E., et al. (2025) · BMC Cancer · doi:10.1186/s12885-025-13639-6 · Cited by 8 · see citing works
“In contrast, a web-delivered cognitive behavioural therapy for cancer patients with distress (CancerCope) which used the same measure for acceptability found that patients rated the acceptability and usefulness of the program more favourably [57].”
Tsiouris, A., Mayer, A. C., Wiltink, J., Ruckes, C., Beutel, M. E., & Zwerenz, R. (2023) · JMIR Cancer · doi:10.2196/42123 · Cited by 7 · see citing works
Davies, F., Harris, M., Shepherd, H. L., Butow, P. N., Beatty, L., Kemp, E., & Shaw, J. (2022) · Psycho-Oncology · doi:10.1002/pon.5900 · Cited by 6 · see citing works
The biopsychosocial‐digital continuum of foot orthosis practice and research: the VALUATOR model
Deschamps, K., Nester, C., Newton, V., Gijón-Noguerón, G., Simsek, E., & Brabants, A. (2021) · Journal of Foot and Ankle Research · doi:10.1186/s13047-021-00468-6 · Cited by 6 · see citing works
Børøsund, E., Meland, A., Eriksen, H. R., Rygg, C. M., Ursin, G., & Nes, L. S. (2023) · JMIR Formative Research · doi:10.2196/48719 · Cited by 5 · see citing works
“eHealth interventions for survivors of cancer exist, but findings are still somewhat mixed and inconclusive [15-21].”
BackgroundLi, M., Liu, F., Han, X., Li, J., & Fan, Y. (2024) · Psycho-Oncology · doi:10.1002/pon.70014 · Cited by 5 · see citing works
“Furthermore, therapist‐guided ICBT offers advanced technical support and functionalities, inclusive of real‐time communication and data analysis [48], which further enhance the intervention's effectiveness.”
RetractedCoombs, L. A., & Kim, M. (2025) · Psycho-Oncology · doi:10.1002/pon.70321 · Cited by 3 · see citing works
Canter, K. S., Ritterband, L. M., Freyer, D. R., Askins, M. A., Bava, L., Loucas, C., Arasteh, K., You, W., & Kazak, A. E. (2023) · JMIR Research Protocols · doi:10.2196/46339 · Cited by 3 · see citing works
“This platform has been developed by the Center for Behavioral Health and Technology at the University of Virginia and is used successfully to manage numerous behavioral and psychosocial digital health intervention trials, including large studies in adult oncology and adolescent oncology [60-62].”
MethodTechnology-Based Cancer Survivorship Care Interventions: A Systematic Review and Meta-Analysis
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Betz, L. T., Rischer, K. M., Jacob, G. A., Faßbinder, A., Specht, A., Weis, J., von Blanckenburg, P., & Jauch‐Chara, K. (2025) · Journal of Health Psychology · doi:10.1177/13591053251356885 · Cited by 3 · see citing works
“…in cancer patients or survivors that failed to find significant effects on QoL despite observing larger reductions in psychological distress (Chambers et al., 2018; Springer et al., 2024; van Den Berg et al., 2015) and fatigue (Boele et al., 2018; van Den Berg et al., 2015) as well as…”
Understanding survivors’ needs and outcomes: the role of routinely collected data
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“10,11 Moreover, CBT-based interventions increased the quality of life in patients with breast cancer.”
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- Authors
- 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., & Dunn, J.
- Affiliations
- Griffith University (AU)
- University of Virginia (US)
- Cancer Council Queensland (AU)
- Queensland University of Technology (AU)
- Menzies School of Health Research (AU)
- Corresponding author
- Chambers, Suzanne K
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2018-01-31
- Volume
- 20
- Issue
- 1
- Pages
- e42
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC5812983
- OpenAlex
- W2787147185
- Cited by
- 74
- References
- 34
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 7 · 2023: 16 · 2022: 9 · 2021: 13 · 2020: 6 · 2019: 7 · 2018: 5
- FWCI
- 9.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by)
- Australasian Journal of Paramedicine (submittedVersion, cc-by)
- Griffith Research Online (submittedVersion, cc-by)
- OPUS - Open Publications of UTS Scholars (University of Technology Sydney) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council (1056756, 1054038)
- Cancer Council Queensland
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- internet-based cognitive behavioral therapy, cancer patients, psychological distress, cancer-specific distress, quality of life, patient education websites, intervention adherence, self-management
- MeSH terms
- Female, Humans, Male, Neoplasms, Quality of Life, Surveys and Questionnaires, Cognitive Behavioral Therapy, Internet
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