Transdiagnostic Internet-Delivered Cognitive-Behaviour Therapy for Recent Cancer Survivors: A Feasibility Trial and Examination of Clinician Perspectives

Abstract

Increased attention has been drawn to the challenges faced by cancer survivors following treatment completion. Although most survivors adjust well to these challenges over time, a subset of individuals experience clinical levels of anxiety and depression. Cognitive-behaviour therapy (CBT) has been shown as effective in reducing anxiety and depression among individuals who have received a cancer diagnosis. Despite the availability of this treatment, a large proportion of cancer patients and survivors do not seek treatment for emotional distress due to reasons such as geographical distance from providers, and the stigma of seeking help for mental health problems. Internet-based CBT (ICBT) programs employ the same principles and components as face-to-face CBT, but are administered via a computer and the Internet. This dissertation is presented in the form of two studies. Each study contains a literature review and discussion, and both are followed by a general discussion. Given the potential benefits of ICBT for cancer survivors and the absence of existing programs, Study 1 evaluated the effectiveness and acceptability of a new ICBT protocol, Wellbeing After Cancer, designed to treat anxiety and depression among recent cancer survivors. Utilizing a within-groups pre-post design, the protocol comprised 5 online lessons delivered over 8 weeks and was based on an established ICBT treatment course (the Wellbeing Course). Eighteen individuals who completed primary cancer treatment within the past 18 months received CBT-based online lessons, homework assignments, once weekly contact from a therapist via e-mail or phone, and automated emails. Posttreatment data were collected from 18/18 (100%) participants. Participants improved significantly on the primary outcome measures, the Patient Health Questionnaire 9-Item and Generalized Anxiety Disorder 7-Item, with within-groups effect sizes (Cohen’s d) at post-treatment of 0.71, and 0.90, respectively. The program was also rated as highly acceptable with all 18 participants reporting it was worth their time and they would recommend it to a friend. Patient feedback on the program provided further support for its acceptability, with participants identifying several strengths of the program. Clinician attitudes towards Wellbeing After Cancer and ICBT more generally may impact program implementation efforts. Study 2 therefore evaluated the acceptability of Wellbeing After Cancer among clinicians currently working within cancer care. Using a qualitative research approach, 10 clinicians viewed a brief online video outlining the results of Study1. Semi-structured interviews were conducted to obtain clinicians’ perspectives on the program and future implementation. ICBT and the program were viewed as acceptable by clinicians, with most envisioning themselves referring clients to the program rather than acting as therapists. Several program strengths as well as areas for improvement were identified. Approval from directors as well as clinician availability and time were seen as factors likely to influence training, delivery, and implementation. The results of Study 1 provide preliminary support for the acceptability and effectiveness of ICBT for cancer survivors following treatment completion. Moreover, they lay the ground work for future research focused on determining the efficacy of the program via a randomized controlled trial. The results of Study 2 provide preliminary support for the acceptability of ICBT interventions among clinicians within cancer care. Together, the results of both studies indicate to researchers, clinicians, and healthcare providers that ICBT is a viable avenue for offering mental health services to cancer survivors.