Aim: Clinically significant psychological distress is prevalent among 30-40% of patients after cancer diagnosis, and impacts on medical, quality of life, and health service outcomes. However, numerous access barriers to uptake exist, including workforce shortfalls, geography for those residing rurally, and personal preferences/stigma. Online delivery of cognitive behaviour therapy (CBT) holds promise for overcoming some of the access barriers to conventional therapist-administered psychosocial interventions in cancer. We conducted a multiphase program of research to develop and evaluate a 6-module/6-week online program (‘Finding My Way’).
Methods: The program of work comprised a phase I pre-post feasibility trial (n=12); a phase II single site pilot RCT (n=60); and a phase III multisite RCT of heterogeneous cancer patients treated with curative intent (n=191) recruited between October 2013 and November 2015, and randomised to receive either the intervention or attention-control. We then subsequently implemented the program into routine clinical and community practice, and collected uptake and adherence data over a matched timeframe to the clinical trial.
Results: Phases I and II outcomes supported the feasibility and potential efficacy of the program. The phase III RCT demonstrated an uptake rate of 41%, moderate-to-high adherence, and high satisfaction rates (82%). Finding My Way led to reduced health service utilisation at post-treatment, and improved emotional functioning at 3-month follow-up. Ongoing implementation has had similar uptake, but lower adherence than during the clinical trial. FMW is currently being piloted for feasibility among women receiving endocrine therapy in the USA (n=12), with data to date suggesting high usage and resulting improvements in depression symptoms. Our group has recently developed Finding My Way-Advanced - an adaptation for women with metastatic breast cancer – which is currently undergoing usability testing. Updated results of these latest trials will be presented.
Conclusion: This research program demonstrates the promise of web-based CBT for increasing the reach of psychological therapies after cancer, but also highlights the current challenges this field faces regarding ongoing implementation and dissemination.