Abstract
BackgroundSymptoms of anxiety and depression are common in patients with cancer, and associated with impaired quality of life (QoL). The aim was to evaluate the effect of internet-based stepped care (iCAN-DO) on symptoms of anxiety and depression and QoL in patients with cancer, compared to standard care (SC). MethodsiCAN-DO was developed in cooperation between professionals and patients with cancer. Consecutive patients (N=245), with self-reported symptoms of anxiety and/or depression, according to the Hospital Anxiety and Depression Scale, were randomized to iCAN-DO or SC. iCAN-DO comprised interactive support, including psycho-education and self-care strategies (Step 1), and cognitive behavioural therapy (Step 2) for those with persistent symptoms 1, 4 and/or 7 months post randomization. Data was collected before randomization and at 1, 4, 7 and 10 months post randomization. ResultsOne-hundred and five of 124 patients (85%) used iCAN-DO to some extent and 49% completed the 10 months assessment. Patients randomized to iCAN-DO reported lower levels of symptoms of depression (mean 7.3 vs 6.2), and a clinically significant decrease of depression from baseline to 10 months (decrease 23% vs 8%), compared to standard care (p<0.05). In addition, the proportion of patients with clinical depression was smaller in iCAN-DO (15% vs 23%) compared to SC, at 10 months (p<0.05). There was now difference between iCAN-DO and SC with regard to symptoms of anxiety and QoL. ConclusionsInternet-based stepped care for patients with cancer who self-report symptoms of anxiety and/or depression is effective to decrease depression, for some patients. Further studies are needed to develop internet-based support to suit different needs, and competence to use information technologies. Clinical trial identificationNCT01630681. Legal entity responsible for the studyUppsala University Psychosocial Care Programme. FundingSwedish government, Forte Research Council, Swedish Cancer Society, Uppsala County Council. DisclosureAll authors have declared no conflicts of interest.
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