PMID- 37273929
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230606
IS  - 2214-7829 (Electronic)
IS  - 2214-7829 (Linking)
VI  - 32
DP  - 2023 Apr
TI  - Long-term effects on depression and anxiety of an internet-based stepped care 
      intervention for patients with cancer and symptoms of depression and anxiety. The 
      U-CARE AdultCan trial.
PG  - 100625
LID - 10.1016/j.invent.2023.100625 [doi]
LID - 100625
AB  - BACKGROUND: Cancer is a serious disease that commonly causes significant 
      psychological distress. The internet-based intervention (iCAN-DO), utilizing a 
      stepped care approach for the treatment of anxiety and depression in individuals 
      with cancer, has been shown to have favorable results for symptoms of depression 
      at the primary endpoint, 10 months after randomization compared to standard care 
      (SC). The aim of the present study was to evaluate the long-term effects of the 
      intervention 18 and 24 months after randomization. METHODS: Patients with breast, 
      colorectal, or prostate cancer and a score > 7 on either of the Hospital Anxiety 
      and Depression Scale (HADS) subscales (n = 245) were recruited to the study in 
      conjunction with a regular hospital visit. They were randomized to access to the 
      stepwise iCAN-DO intervention for 24 months or to SC. Step 1 of the intervention 
      comprised psycho-educative online material. In Step 2, internet-based 
      cognitive-behavioral therapy with individual online support from a therapist was 
      added. Step 2 was offered to those who reported persistent anxiety or depression 
      symptoms (>7 on HADS), also at 1, 4, and/or 7 months after randomization. Missing 
      data were imputed using the last rank carried forward method and used for the 
      main analyses according to the intention-to-treat approach. Effects sizes 
      (Cohen's d), and minimally clinically important difference (MCID) were 
      calculated. Linear mixed models were used to analyze intervention effects over 
      time. RESULTS: Symptoms of depression decreased significantly (p < 0.05) in the 
      iCAN-DO group compared with the SC group from baseline to 18 months (d = 0.29), 
      but not to 24 months (d = 0.27). Even though the average iCAN-DO group 
      participant surpassed a MCID in symptoms of anxiety (>2 p) at both long-term 
      follow-ups, the differences did not reach statistical significance, either at 
      18 months (p = 0.10) or 24 months (p = 0.09). Positive effects of iCAN-DO 
      compared with the SC were also shown for some secondary HRQoL-outcomes; social 
      functioning at 18 months (p = 0.02) and 24 months (p = 0.001), and sleep problems 
      at 24 months (p = 0.01). CONCLUSION: A stepped-care internet-based intervention 
      that has previously shown positive results for symptoms of depression at 
      10 months did show similar positive long-term effects also at 18 months. For 
      symptoms of anxiety, no effect could be shown. The internet may provide an 
      effective format for interventions to reduce symptoms of depression after cancer 
      at patients' own choice of time, regardless of distance to a psycho-oncology 
      clinic.
CI  - (c) 2023 The Authors.
FAU - Igelstrom, Helena
AU  - Igelstrom H
AD  - Department of Women's and Children's Health, Uppsala University, Akademiska 
      sjukhuset, 751 85 Uppsala, Sweden.
FAU - Carlsson, Maria
AU  - Carlsson M
AD  - Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 
      22 Uppsala, Sweden.
FAU - Hauffman, Anna
AU  - Hauffman A
AD  - Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, 
      Entrance 78, 1st floor, 751 85 Uppsala, Sweden.
FAU - von Essen, Louise
AU  - von Essen L
AD  - Department of Women's and Children's Health, Uppsala University, Akademiska 
      sjukhuset, 751 85 Uppsala, Sweden.
FAU - Gronqvist, Helena
AU  - Gronqvist H
AD  - Department of Women's and Children's Health, Uppsala University, Akademiska 
      sjukhuset, 751 85 Uppsala, Sweden.
FAU - Johansson, Birgitta
AU  - Johansson B
AD  - Department of Immunology, Genetics, and Pathology, Uppsala University, 
      Rudbecklaboratoriet, 75185 Uppsala, Sweden.
FAU - Olsson, Erik M G
AU  - Olsson EMG
AD  - Department of Women's and Children's Health, Uppsala University, Akademiska 
      sjukhuset, 751 85 Uppsala, Sweden.
LA  - eng
PT  - Journal Article
DEP - 20230502
PL  - Netherlands
TA  - Internet Interv
JT  - Internet interventions
JID - 101631612
PMC - PMC10235429
OTO - NOTNLM
OT  - Anxiety
OT  - Cancer
OT  - Depression
OT  - Long-term follow-up
OT  - Psycho-educational intervention
OT  - Randomized controlled trial
COIS- The authors declare that they have no known competing financial interests or 
      personal relationships that could have appeared to influence the work reported in 
      this paper.
EDAT- 2023/06/05 13:04
MHDA- 2023/06/05 13:05
PMCR- 2023/05/02
CRDT- 2023/06/05 11:54
PHST- 2022/06/23 00:00 [received]
PHST- 2023/02/28 00:00 [revised]
PHST- 2023/04/21 00:00 [accepted]
PHST- 2023/06/05 13:05 [medline]
PHST- 2023/06/05 13:04 [pubmed]
PHST- 2023/06/05 11:54 [entrez]
PHST- 2023/05/02 00:00 [pmc-release]
AID - S2214-7829(23)00025-8 [pii]
AID - 100625 [pii]
AID - 10.1016/j.invent.2023.100625 [doi]
PST - epublish
SO  - Internet Interv. 2023 May 2;32:100625. doi: 10.1016/j.invent.2023.100625. 
      eCollection 2023 Apr.