A new smartphone app helps ease fears of cancer recurrence

A new ‘smartphone psychotherapy’ has been shown to reduce the anxiety and fear of cancer recurrence (FCR) that often causes distress in cancer survivors.

The intervention consists of a smartphone problem-solving and behavioral activation app and was tested in a study involving 447 breast cancer survivors. The results showed that the group of survivors who used the app had statistically greater improvement on a scale measuring fear of cancer recurrence as well as several measures of anxiety and depression at week 8 compared to controls.

“To our knowledge, this study is the first to demonstrate the efficacy of a smartphone-based psychological treatment in reducing FCR among breast cancer survivors,” say the authors.

It also showed that the intervention had potential effects on depression and psychological needs among breast cancer survivors,” they write.

“Given the number of cancer survivors and the limited number of therapists to provide appropriate psychotherapy, a new smartphone therapy may be a promising way to reduce the fear of cancer recurrence,” they suggested.

The study was published online on November 2 in Journal of Clinical Oncology.

Commenting on the study, Erica L. Mayer, MD, MPH, director of clinical research at the Dana-Farber Cancer Institute, Boston, Massachusetts, said, “Use of a new 8-week cognitive behavioral therapy smartphone app significantly reduced measures of psychological distress, particularly in those who reported anxiety in the beginning.”

“These findings suggest that increased use of smartphone-based mental health support is feasible and effective and may be an effective platform for providing mental health support to young breast cancer survivors,” Mayer said in a statement.

Results from randomized trials

The study was led by Tatsuo Akechi, MD, PhD, from the Department of Psychiatry and Cognitive Behavioral Medicine and the Department of Palliative Care and Psycho-Oncology, Nagoya City University Hospital, Nagoya, Japan.

They had conducted a previous study in which they demonstrated that the common unmet need reported by ambulatory breast cancer patients was psychological—and specifically, fear of the cancer returning. ( Psycho-Oncology 2011; 20:497-505 ). More than half of the participants cited these issues, and it has also been reported in other papers and associated with poor quality of life. Additionally, they point out that while research supports a number of psychological interventions that help survivors with fear of recidivism, one problem is low participation rates due to time and distance issues (eg, more than 60% of potentially eligible participants decline participation). Another problem is that the number of therapists who can provide such specialized care may be limited.

So, the team developed a Problem Solving (PST) program as a smartphone app. Its acceptability and efficacy were demonstrated in a single-arm pilot study in breast cancer survivors (Jpn J Clin Oncol 2019; 49:537-544).

Based on these findings, they now conducted a randomized trial to further investigate the efficacy of smartphone-based PST and behavioral activation (BA) interventions to reduce fear of recurrence among breast cancer survivors.

For this study, they randomly assigned disease-free breast cancer survivors aged 20-49 years to a smartphone-based intervention (n = 223) or a waitlist control (n = 224). Both groups received treatment as usual, and the control group was able to access the smartphone apps during week 8-24.

Initial outcome data at 8 weeks were obtained for 444 randomly assigned participants (99.7% of the total 447 participants). Of the 223 participants who received the intervention, 213 (95.5%) completed the follow-up assessment at week 24.

Their results showed that women who used the smartphone app experienced a statistically significant improvement in the primary endpoint, Concerns About Recurrence Scale (CARS-J) scores at week 8 compared to the control group (difference -1.39, P < .001; ES = 0.32).

The intervention group also had a statistically significant improvement at week 8 in the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) score (difference -1.65; P < .001; ES = 0.25), Hospital Anxiety and Depression Scale (HADS) score (difference –0.49; P < .05; ES = 0.19), and Brief Formative Supportive Treatment Need (SCNS-SF34) psychological domain score (difference -1.49; P < .05; ES = 0.16).

At week 24, these differences between the smartphone group and the control group were no longer significant, except for HADS depression, which was significant at 24 weeks compared to 8 weeks (P <.05).

Overall satisfaction with treatment in the intervention and control groups was rated at 73.4 (SD = 17.3) and 73.9 (SD = 17.7), respectively, but did not reach statistical significance (P = .26).

The study was supported by Grant-in-Aid for Japan Agency for Medical Research and Development, and in part supported by Grants for Scientific Research and Young Researchers from the Japanese Ministry of Education, Culture, Science and Technology; a grant from the Nagoya City University Foundation to promote cancer research in Japan; and the Cancer Center’s Research and Development Fund. Several of the co-authors report industry connections, as noted in the original article.

J Clin Oncol. Published online 2 November 2022. Full text

Roxanne Nelson is a registered nurse and award-winning medical writer who has written for many major news outlets and is a regular contributor to Medscape.

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