Promise, pitfalls and progress of on-line cognitive behavioural therapy: Lessons learned from a paediatric oncology unit

Abstract

A cancer diagnosis during child and adolescent years fundamentally disrupts normal development, and can result in several adverse mental health sequelae. Cognitive-behavioural therapy has proven efficacy in addressing a range of psychological issues relevant to paediatric and adolescent oncology, including depression and different forms of anxiety. However, numerous barriers hinder many patients and families from being able to access specialised clinical psychology services, tailored to the unique psychosocial considerations of paediatric oncology. To address this gap in evidence-based clinical service-provision, our paediatric psycho-oncology research unit has developed several CBT-based interventions tailored to theneeds of children and adolescents with cancer and their families. In this commentary, we provide an overview of our clinical-research program, examining how on-line CBT-based programs are feasible, acceptable, safe, and promising models of support for this patient population. We also examine some of the limitations or pitfalls involved in delivering on-line, CBT-based programs, including how we have navigated the ethical management of challenging, clinically-concerning events within our trials. Finally, we examine several future potential applications to extend the impact of on-line, CBT-based interventions to several other currently unmet needs in paediatric oncology. Drawing from several of our CBT-aligned, health-behaviour-focused intervention programs, we propose that on-line CBT holds significant potential in supporting the health behaviours and quality of life of young people and their families, both during and after cancer treatment. The future impact of on-line CBTbased interventions will rely upon clinicians and researchers effectively collaborating to effectively evaluate - and implement - these programs in real-world settings.