Abstract
Cancer patients experience various psychological and social difficulties, the most common being depression and anxiety. The purpose of this study was to develop and evaluate the effectiveness of an app-based cognitive behavioral therapy program for depression and anxiety in cancer patients. For this purpose, 63 participants who met the inclusion criteria were randomly assigned to either a mobile-application-based cognitive behavioral therapy program (HARUToday), a simple information-provision mobile-application-based program (HARUCard), or a waitlist control group. Self-report questionnaires including the Beck Depression Inventory, State-Trait Anxiety Inventory, Health-Related Quality of Life Scale, Dysfunctional Attitude Scale, and two computer tasks including the dot-probe task and the Implicit Association Test, were administered before and after 66 days of intervention. The results showed that the Beck Depression Inventory and State-Trait Anxiety Inventory scores of the cognitive behavioral therapy program (HARUToday) group decreased significantly after the intervention compared to the attention control (HARUCard) and waitlist control groups. However, there were no significant changes in scores of the Health-Related Quality of Life Scale and Dysfunctional Attitude Scale, and the two computer tasks. Such results suggest that a mobile-application-based cognitive behavioral therapy program may be an effective intervention for alleviating depression and anxiety, but not the general quality of life of cancer patients. Taking into consideration that psychosocial problems may not the topmost priority for cancer patients who are facing a chronic and possibly mortal disease, a mobile-application cognitive behavioral therapy program may be a possible solution for the alleviation of depression and anxiety in cancer patients who have many restraints in terms of time and space.
Highlights
Cancer is one of the most common diseases worldwide and is the second leading cause of adult death (World Health Organization [WHO], 2016)
The results showed that there were no statistically significant differences between the groups on the pre-intervention assessment self-report questionnaires (BDI-II: F = 0.51, p = 0.60; State-Trait Anxiety Inventory (STAI)-State: F = 0.062, p = 0.94; STAI-Trait: F = 0.077, p = 0.93; SF-36: F = 2.55, p = 0.09; Dysfunctional Attitudes Scale (DAS): F = 3.40, p = 0.09) or on the computer tasks [Dot Probe Task-Positive: H(2) = 1.10, p = 0.58; Dot Probe Task-Negative: H(2) = 1.32, p = 0.52; Dot Probe Task-Threatening: H(2) = 0.66, p = 0.72; Implicit Association Test-Positive: H(2) = 0.95, p = 0.62; Implicit Association Test-Negative: H(2) = 4.58, p = 0.10]
The pre-intervention scores and standard deviation scores of the self-report questionnaires and computer tasks are presented in Tables 2, 3, respectively
Summary
Cancer is one of the most common diseases worldwide and is the second leading cause of adult death (World Health Organization [WHO], 2016). In Korea, cancer is the number one cause of adult deaths, accounting for 27.8% of total deaths in 2016, and the incidence is increasing steadily (World Health Organization [WHO], 2016). The 5-year survival rate of cancer patients is increasing due to recent advances in medicine, rising from 41.2% in a survey from the 1990s to 70.7% in 2018 (South Korea Ministry of Health Welfare, 2018), which is lower than but comparable to the report of the CONCORD-3 study (Allemani et al, 2018). In the case of cancer patients, roughly between 8 and 33% are reported to experience depression (Linden et al, 2012; Krebber et al, 2014), and between 17 and 23% are reported to suffer from anxiety (Linden et al, 2012). Previous studies have shown that cancer patients with depression and anxiety experienced during diagnosis and treatment show low adherence to treatment or even refuse treatment (DiMatteo et al, 2000; Kennard et al, 2004; Greer et al, 2008), in addition to higher cancer recurrence or metastasis; depression and anxiety consequentially have a negative impact on patient survival (Groenvold et al, 2007; Satin et al, 2009; Pinquart and Duberstein, 2010)
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