Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Aug;24(8):1111-1120.
doi: 10.1634/theoncologist.2018-0536. Epub 2019 Jan 25.

Randomized Trial of a Tailored Cognitive-Behavioral Therapy Mobile Application for Anxiety in Patients with Incurable Cancer

Joseph A Greer  1   2 , Jamie Jacobs  3   2 , Nicole Pensak  4 , James J MacDonald  5 , Charn-Xin Fuh  3 , Giselle K Perez  3   2 , Alina Ward  6 , Colleen Tallen  6 , Alona Muzikansky  3   2 , Lara Traeger  3   2 , Frank J Penedo  7 , Areej El-Jawahri  3   2 , Steven A Safren  8 , William F Pirl  2   9 , Jennifer S Temel  3   2
Affiliations
Randomized Controlled Trial

Randomized Trial of a Tailored Cognitive-Behavioral Therapy Mobile Application for Anxiety in Patients with Incurable Cancer

Joseph A Greer et al. Oncologist. 2019 Aug.

Abstract

Background: The aim of this study was to test the efficacy of a tailored cognitive-behavioral therapy (CBT) mobile application (app) to treat anxiety in patients with incurable cancer.

Materials and methods: Patients with incurable cancers (n = 145) who reported elevated anxiety symptoms at two cancer centers were randomized to receive either the CBT mobile app for anxiety or a mobile health education program (control) delivered via tablet computers, which patients self-administered over 12 weeks. To assess anxiety, depression symptoms, and quality of life (QOL), we used the Hamilton Anxiety Rating Scale (HAM-A, primary outcome), Clinical Global Impression Scale, Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9, and Functional Assessment of Cancer Therapy-General at baseline and 12 weeks. Analysis of covariance models were calculated to assess intervention effects on patient outcomes.

Results: Patients (73.8% female; 91.0% white; mean age = 56.45 years, SD = 11.30) in both study groups reported improvements in anxiety, depression symptoms, and QOL from baseline to postassessment, with no significant differences in any outcome measure between groups. Secondary analyses showed that, among the subgroup of patients with severe baseline anxiety, those randomized to the CBT app had greater improvements on the HAM-A (Mean Difference = 7.44, standard error [SE] = 3.35, p = .037) and HADS-Anxiety Subscale (Mean Difference = 4.44, SE = 1.60, p = .010) compared with the control group.

Conclusion: Both the tailored CBT app for anxiety and the health education program were associated with improvements in anxiety, mood, and QOL, but these outcomes did not differ between study groups. The CBT app was more beneficial than health education for patients with severe baseline anxiety.

Implications for practice: A cognitive-behavioral therapy mobile application tailored to treat anxiety in patients with advanced cancer helps improve access to evidence-based supportive care in a convenient, private, and timely manner.

Keywords: Advanced cancer; Anxiety; Cognitive‐behavioral therapy.

PubMed Disclaimer

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Participant flow diagram.Abbreviations: CBT, cognitive‐behavioral therapy; HADS, Hospital Anxiety and Depression Scale; HADS‐A, Hospital Anxiety and Depression Scale‐Anxiety Subscale.
Figure 2.
Figure 2.
Cognitive‐behavioral therapy mobile app use within intervention group (n = 72).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Tang ST, Chen JS, Chou WC et al. Longitudinal analysis of severe anxiety symptoms in the last year of life among patients with advanced cancer: relationships with proximity to death, burden, and social support. J Natl Compr Canc Netw 2016;14:727–734. - PubMed
    1. Delgado‐Guay M, Parsons HA, Li Z et al. Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Support Care Cancer 2009;17:573–579. - PubMed
    1. Nipp RD, El‐Jawahri A, Moran SM et al. The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer. Cancer 2017;123:4720–4727. - PMC - PubMed
    1. Smith EM, Gomm SA, Dickens CM. Assessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer. Palliat Med 2003;17:509–513. - PubMed
    1. Buzgova R, Jarosova D, Hajnova E. Assessing anxiety and depression with respect to the quality of life in cancer inpatients receiving palliative care. Eur J Oncol Nurs 2015;19:667–672. - PubMed

Publication types

MeSH terms