Smartphone Psychotherapy Reduces Fear of Cancer Recurrence Among Breast Cancer Survivors: A Fully Decentralized Randomized Controlled Clinical Trial (J-SUPPORT 1703 Study)
Smartphone Psychotherapy Reduces Fear of Cancer Recurrence Among Breast Cancer Survivors: A Fully Decentralized Randomized Controlled Clinical Trial (J-SUPPORT 1703 Study)
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DOI：
10.1200/jco.22.00699
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发表时间：
2023-02-10
影响因子：
45.3
通讯作者：
Iwata, Hiroji
中科院分区：
文献类型：
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作者：
Akechi, Tatsuo;Yamaguchi, Takuhiro;Iwata, Hiroji
对癌症复发的恐惧（FCR）是一种常见的痛苦状况。我们调查了智能手机解决问题的治疗和行为激活应用程序在乳腺癌survivor.METHODS这是一个分散的随机试验的疗效。参与者是年龄在20 - 49岁之间的无病乳腺癌幸存者，他们被随机分配到基于智能手机的干预或候补名单对照组。两组均按常规治疗。对照组可以在第8 - 24周访问智能手机应用程序。干预包括智能手机问题解决疗法和行为激活应用程序。主要终点是第8周的复发担忧量表。次要结局包括癌症复发恐惧量表-简表（FCRI-SF）、医院焦虑和抑郁量表（HADS）、支持性护理需求简表调查（SCNS-SF34），以及第8周和第24周的创伤后成长量表（试验注册号：UMIN-CTR：UMIN000031140）。干预组包括223名参与者，对照组包括224名参与者。获得了444名参与者的主要结局数据，干预组中的213名参与者完成了第24周的评估。在第8周，干预组在复发问题量表上的改善程度在统计学上大于对照组（差异-1.39; 95% CI，-1.93至-0.85; P <.001），FCRI-SF（差异-1.65; 95% CI，-2.41至-0.89; P <.001），HADS抑郁（差异-0.49; 95%CI，-0.98至0; P <.05），SCNS-SF34心理领域（差异-1.49; 95%CI，-2.67至0.32; P <.05）。这些分数在第24周与第8周相比，没有统计学意义，虽然HADS抑郁评分在第24周显着降低（P =.03）。CONCLUSIONNovel智能手机心理治疗提供了一种有前途的方法，以减少FCR给予大量的幸存者和数量有限的治疗师胜任进行心理治疗。
PURPOSEFear of cancer recurrence (FCR) is a common distressing condition. We investigated the efficacy of smartphone problem-solving therapy and behavioral activation applications in breast cancer survivors.METHODSThis was a decentralized randomized trial. Participants were disease-free breast cancer survivors age 20-49 years who were randomly assigned to the smartphone-based intervention or waitlist control. Both groups received treatment as usual. The control group could access the smartphone apps during weeks 8-24. The intervention comprised smartphone problem-solving therapy and behavioral activation apps. The primary end point was the Concerns About Recurrence Scale at week 8. Secondary outcomes included the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), the Hospital Anxiety and Depression Scale (HADS), the Short-form Supportive Care Needs Survey (SCNS-SF34), and the Posttraumatic Growth Inventory at weeks 8 and 24 (trial registration: UMIN-CTR: UMIN000031140).RESULTSThe intervention group included 223 participants, and the control group included 224 participants. Primary outcome data were obtained for 444 participants, and 213 participants in the intervention arm completed the week 24 assessment. The intervention group had statistically greater improvements than controls at week 8 on the Concerns About Recurrence Scale (difference -1.39; 95% CI, -1.93 to -0.85; P < .001), FCRI-SF (difference -1.65; 95% CI, -2.41 to -0.89; P < .001), HADS depression (difference -0.49; 95% CI, -0.98 to 0; P < .05), and SCNS-SF34 psychological domain (difference -1.49; 95% CI, -2.67 to -0.32; P < .05). These scores at week 24 were not statistically significant compared with week 8 although the HADS depression score at week 24 was significantly reduced (P = .03).CONCLUSIONNovel smartphone psychotherapy offers a promising way to reduce FCR given the large number of survivors and a limited number of therapists to competently conduct psychotherapy.