A multi-site feasibility study of a stepped-care telehealth intervention for depression and anxiety in post-treatment cancer survivors at community cancer clinics (WF-30917CD)

Suzanne C Danhauer; Gretchen A Brenes; Kathryn E Weaver; Emily V Dressler; Grace Westcott; Zhang Zhang; Lingyi Lu; Cheyenne R Wagi; Rakhee Vaidya; Amarinthia Curtis; Pamala A Pawloski; Sara Adams; Glenn J Lesser; Janet A Tooze

doi:10.1007/s11764-024-01721-0

A multi-site feasibility study of a stepped-care telehealth intervention for depression and anxiety in post-treatment cancer survivors at community cancer clinics (WF-30917CD)

J Cancer Surviv. 2025 Jan 14. doi: 10.1007/s11764-024-01721-0. Online ahead of print.

Authors

Affiliations

¹ Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA. danhauer@wakehealth.edu.
² Department of Internal Medicine, Section On Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
³ Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁴ Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁵ Department of Psychology, Wake Forest University, Winston-Salem, NC, USA.
⁶ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Department of Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁹ Upstate Carolina Community Oncology Research Consortium, Greer, SC, 29650, USA.
¹⁰ Metro-MN Community Oncology Research Consortium, Minneapolis, MN, 55416, USA.
¹¹ Tidelands Health System, Murrells Inlet, SC, 29576, USA.
¹² Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

PMID: 39810026
DOI: 10.1007/s11764-024-01721-0

Abstract

Purpose: This feasibility study estimated accrual, retention, adherence, and summarized preliminary efficacy data from a stepped-care telehealth intervention for cancer survivors with moderate or severe levels of anxiety and/or depressive symptoms.

Methods: Participants were randomized to intervention or enhanced usual care (stratified by symptom severity). In the intervention group, those with moderate symptoms received a cognitive-behavioral therapy (CBT) workbook/6 bi-weekly check-in calls (low intensity) and severe symptoms received the workbook/12 weekly therapy sessions (high intensity). Depression, anxiety, insomnia, fatigue, quality of life (QOL), fear of recurrence, and cancer-related distress were assessed pre- and post-intervention.

Results: Participants (N = 68; ages 36-82; 88% White) were randomized to telehealth (n = 34) or enhanced usual care (EUC, n = 34), stratified by symptoms (moderate, n = 38; severe, n = 30). Accrual was 1.8/month with 88% retention and > 75% adherence. For those with moderate symptoms, the low-intensity intervention was associated with better cancer-related distress post-intervention but worse fatigue, insomnia, and physical QOL and and minimal differences for anxiety, depression, fear of recurrence, and mental QOL compared with EUC using clinically meaningful values to assess differences. For those with severe symptoms, the high-intensity intervention was associated with better fatigue, fear of recurrence, cancer-related distress, and physical/mental QOL.

Conclusions: Accrual to a stepped-care telehealth intervention for distressed cancer survivors was lower than expected, but retention and adherence were strong. Data suggest potential impact of the high-intensity intervention.

Implications for cancer survivors: A telephone-based CBT intervention where cancer survivors worked with a therapist yielded improvements in fatigue, fear of recurrence, distress, and quality of life.

Keywords: Anxiety/depression; Cancer; Cognitive-behavioral therapy; Psychosocial oncology; Survivorship; Telehealth.

Abstract

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