Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA.
Division of Cancer Prevention and Control, University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
J Palliat Med. 2024 Aug;27(8):1009-1017. doi: 10.1089/jpm.2023.0658. Epub 2024 Apr 5.
Adults with advanced cancer experience profound future uncertainty, reflected in elevated fear of cancer progression (FoP) and cancer-related trauma symptoms. These symptoms are associated with physical symptom burden and poorer quality of life, and few interventions exist to manage them. To develop and pilot a written exposure-based coping intervention (EASE) focused on worst-case scenarios among adults with advanced cancer reporting elevated cancer-related trauma symptoms or FoP. A single-arm intervention development and pilot trial. The trial enrolled 29 U.S. adults with stage III or stage IV solid tumor cancer ( = 24) or incurable or higher-risk blood cancer ( = 5) reporting elevated cancer-related trauma symptoms or FoP. Among those screened, 74% were eligible, with an eligible-to-enrolled rate of 85%. EASE was delivered over five 1:1 videoconferencing sessions. Feasibility and acceptability were evaluated via attendance, surveys, and exit interviews. Outcomes were assessed at five time points through 3-month (FU1, main assessment of interest) and 4.5-month (FU2) follow-up. Participant and interventionist feedback was used to iteratively refine EASE. Among participants, 86% (25/29) completed all five sessions and FU1; surveys and exit interviews indicated high acceptability. Primary outcomes of cancer-related trauma symptoms and FoP improved significantly from pre to both follow-ups by predominantly large effect sizes. Secondary outcomes of anxiety, depression, hopelessness, fear of death/dying, and fatigue, and most process measures improved significantly by FU1 or FU2. EASE, a novel adaptation of written exposure therapy, is a promising approach to reducing FoP and cancer-related trauma symptoms among adults with advanced cancer that warrants further study.
成人晚期癌症患者面临着严重的未来不确定性，表现为对癌症进展的恐惧（FoP）和癌症相关创伤症状的增加。这些症状与身体症状负担和较差的生活质量有关，目前几乎没有干预措施可以治疗这些症状。本研究旨在开发和试点一项针对晚期癌症患者的书面暴露为基础的应对干预（EASE），该干预针对报告癌症相关创伤症状或 FoP 较高的成年人的最坏情况。
这是一项单臂干预措施的开发和试点研究。该试验纳入了 29 名美国成年人，这些成年人患有 III 期或 IV 期实体瘤癌症（ = 24）或无法治愈或高危血液癌症（ = 5），报告有较高的癌症相关创伤症状或 FoP。在筛选出的人群中，有 74%符合条件，合格入组率为 85%。EASE 通过五次 1:1 的视频会议进行。通过出勤率、调查和退出访谈评估可行性和可接受性。在五个时间点评估结果，包括 3 个月（FU1，主要评估点）和 4.5 个月（FU2）随访。参与者和干预者的反馈用于迭代改进 EASE。在参与者中，86%（25/29）完成了所有五次会议和 FU1；调查和退出访谈表明接受度很高。从基线到两次随访，癌症相关创伤症状和 FoP 的主要结果都显著改善，主要表现在效应量较大。焦虑、抑郁、绝望、对死亡/濒死的恐惧和疲劳的次要结果以及大多数过程测量在 FU1 或 FU2 时都显著改善。
EASE 是书面暴露疗法的一种新颖改编，是一种有前途的方法，可以减少晚期癌症患者的 FoP 和癌症相关创伤症状，值得进一步研究。
