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Patients feel mightier with SWORD: behavioural therapy trial reduces fear of relapse

By ecancer reporter Will Davies

Cognitive behavioural therapy, delivered face-to-face and through an online portal, has helped cancer patients reduce their anxiety over possible disease recurrence according to research published in the Journal of Clinical Oncology.

The SWORD trial offered blended cognitive behaviour therapy (bCBT) to breast, prostate or colorectal cancer survivors with high reported fear of cancer recurrence (FCR), between 6 months and 5 years after treatment.

Compared to those who received care as usual, survivors who participated in five face-to-face CBT sessions and 3 online sessions reported significantly less FCR, clinically significant improvement and higher self-rated improvement in a survey at 3 months.

Commenting in a podcast for the JCO, Prof Lynne Wagner of Wake Forest Medical Centre said “This innovative trial offers a promising new direction for the treatment of FCR, a prevalent and distressing concern among a significant proportion of cancer survivors.”

Many cancer patients report anxiety and depression, and mental wellbeing has been linked to chemotherapy response and overall mortality among lung cancer patients.

CBT employs a range of interventions such as group discussion and personal journals to encourage self-awareness in patients, and frame sources of anxiety as solvable problems, where possible.

Where worry doesn’t work as a motivator, it can also act as a buffer, and a benchmark against which relief and positive experiences are set.

“CBT teaches patients to use negative emotional states to engage in problem solving and adaptive coping behaviours” describes Wagner. “In the context of FCR, this approach fits well in teaching cancer survivors to leverage health anxiety to increase motivation to engage in health promoting behaviours such as medical surveillance, physical activity and weight management.”

Among the patients receiving bCBT sessions, only 66% completed all of their sessions, and those who did had better outcomes than early discontinuation.

The online portion of the therapy was utilised often by those with access, with participant logging in a median of 12 times, and submitting a median of  47 assignments.

The range of participation in the online portal was wide, however, with some users only logging once where other ‘super-users’ logged in almost thirty times

The 16% of participants who requested paper versions of the online assignments is also of note, with comfort and access to online interventions a known barrier to E-Health approaches.

The blended approach in the SWORD trial utilises a range of interventions, and further research may identify which approaches are best suited to different concerns, tailoring therapy to the individual.

Reference:
Efficacy of Blended Cognitive Behaviour Therapy for High Fear of Recurrence in Breast, Prostate, and Colorectal Cancer Survivors: The SWORD Study, a Randomized Controlled Trial, Marieke van de Wal, Belinda Thewes, Marieke Gielissen, Anne Speckens, and Judith Prins
DOI: 10.1200/JCO.2016.70.5301 Journal of Clinical Oncology - published online before print May 4, 2017

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Cancer Intelligence