Targeted eHealth Intervention to Reduce Breast Cancer Survivors' Fear of Recurrence: Results From the FoRtitude Randomized Trial

被引:33
|
作者
Wagner, Lynne, I [1 ]
Tooze, Janet A. [2 ]
Hall, Daniel L. [3 ]
Levine, Beverly J. [1 ]
Beaumont, Jennifer [4 ]
Duffecy, Jenna [5 ]
Victorson, David [6 ]
Gradishar, William [7 ]
Leach, Joseph [8 ]
Saphner, Thomas [9 ]
Sturtz, Keren [10 ]
Smith, Mary Lou [11 ]
Penedo, Frank [12 ,13 ]
Mohr, David C. [14 ,15 ]
Cella, David [6 ]
机构
[1] Wake Forest Sch Med, Dept Social Sci & Hlth Policy, Med Ctr Blvd, Winston Salem, NC 27101 USA
[2] Wake Forest Sch Med, Dept Biostat & Data Sci, Winston Salem, NC 27157 USA
[3] Harvard Med Sch, Dept Psychiat, Boston, MA 02115 USA
[4] Clin Outcomes Solut, Tucson, AZ USA
[5] Univ Illinois, Dept Psychiat, Chicago, IL 60612 USA
[6] Northwestern Univ, Feinberg Sch Med, Dept Med Social Sci, Chicago, IL 60611 USA
[7] Northwestern Univ, Feinberg Sch Med, Dept Med, Div Hematol & Oncol, Chicago, IL 60611 USA
[8] Minnesota Oncol, Minneapolis, MN USA
[9] Aurora NCORP, Milwaukee, WI USA
[10] Western States NCORP, Denver, CO USA
[11] Res Advocacy Network, Plano, TX USA
[12] Univ Miami, Dept Med, Coral Gables, FL 33124 USA
[13] Univ Miami, Dept Psychol, Coral Gables, FL 33124 USA
[14] Northwestern Univ, Feinberg Sch Med, Dept Prevent Med, Chicago, IL 60611 USA
[15] Northwestern Univ, Feinberg Sch Med, Ctr Behav Intervent Technol, Chicago, IL 60611 USA
基金
美国国家卫生研究院;
关键词
COGNITIVE-BEHAVIOR THERAPY; OLDER AFRICAN-AMERICAN; QUALITY-OF-LIFE; HEALTH; VALIDATION; PREDICTORS; INVENTORY; DISTRESS; STRATEGY; EFFICACY;
D O I
10.1093/jnci/djab100
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Fear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS), yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, "FoRtitude," to reduce FoR using cognitive behavioral skills training and telecoaching. Methods: BCS (N = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years postprimary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomly assigned to 3 cognitive behavioral skills (relaxation, cognitive restructuring, worry practice) vs an attention control condition (health management content [HMC]) and to telecoaching (motivational interviewing) vs no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory at baseline and at 4 and 8 weeks. Fear of Cancer Recurrence Inventory scores over time were compared using mixed-effects models. All statistical tests were 2-sided. Results: FCRI scores [SD] decreased statistically significantly from baseline to postintervention (T0 = 53.1 [17.4], T2 = 41.9 [16.2], P < .001). The magnitude of reduction in FCRI scores was comparable across cognitive behavior therapy (CBT) and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score [SD] = 26.6 [7.2] vs 21.0 [10.5], P < .001). Conclusions: BCS experienced statistically significant reductions in FoR postintervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research is needed on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.
引用
收藏
页码:1495 / 1505
页数:11
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