Online support for newly diagnosed cancer patients : development, feasibility and efficacy of the intervention "STREss-Aktiv-Mindern" (STREAM)

Abstract

Cancer is associated with high individual and societal burden worldwide, caused not only by mortality but also by morbidity and physical impairment of the patients. In addition, cancer frequently causes major psychological distress. Although distress screening programs aim to ensure appropriate psycho-oncological support, cancer patients often do not use these services. Therefore, the majority of newly diagnosed cancer patients lack psychological support. The development and testing of the first web-based stress management intervention (STREAM: STREss-Aktiv-Mindern) for newly diagnosed cancer patients forms the main part of this thesis. The rationale for this early intervention was three-fold: First, distress in patients with cancer peaks shortly after the diagnosis, irrespective of the cancer type. Second, the period immediately after the diagnosis tends to be busy with diagnostic and therapeutic appointments. Therefore, self-management of time, location, and autonomy facilitated by web-based interventions might be of particular value to these patients. Third, successful early psychosocial interventions have shown a substantial potential to affect the course of the disease beyond psychosocial outcomes. Although various web-based psychological tools have been available for at least a decade, such instruments have retained their evolutionary character. Healthcare professionals often fear to lose the therapeutic relationship with the patient which is known to play a role in the therapeutic effectiveness. In line with the growing literature on web-based interventions for many mental and physical diseases, we aimed to include those patients who are currently not reached by conventional support options by providing web-based support that does not exclude the helpful therapeutic relationship. Our findings showed that a web-based, minimal-contact stress management program is an attractive as well as time- and cost-effective way to provide psycho-oncological support to newly diagnosed cancer patients. Use of our tool resulted in significant and clinically relevant improvement of the patient’s quality of life and distress reduction.