Using the internet for nonpharmacologic symptom management in breast cancer asco annual meeting liver biopsy recovery time

Purpose: Many breast cancer survivors experience an array of chronic symptoms, including pain, insomnia, and fatigue. Few effective therapies have been identified. Behavioral management programs to address similar symptom clusters in other chronic conditions have been shown to be effective. The objective was to determine the effect of an internet-based lifestyle and behavioral self-management program on cancer-related symptoms.

Patients and Methods: Women with stage 0-III breast cancer who reported insomnia, pain, or fatigue as their primary symptom of concern during the 7 days prior to enrollment were enrolled. Local therapies and/or chemotherapy were completed at least 3 months prior to enrollment. Patients were assessed at baseline and after 8 weeks, and completed the PROMIS-29 Profile and Patient Global Impression of Change (PGIC) questionnaire electronically.

Change in each of the eight symptom domains was assessed.

Results: Fifty patients enrolled. In the 45 patients with both baseline and 8-week PROMIS data, statistically significant improvements in anxiety, sleep, fatigue, activity level, and pain severity were reported. Of the 35 patients who responded to the PGIC, 62.9% reported improvement in their primary symptom. Those who reported fatigue as their primary symptom reported greatest overall benefit in multiple symptom improvement, including improvements in fatigue, anxiety, pain severity, pain interference, and participation in social activities.

Conclusion: These findings suggest that this lifestyle and behavioral management may improve multiple symptoms in breast cancer survivors when delivered via the internet. Randomized studies are warranted to evaluate the efficacy of the online intervention compared to standard symptom management approaches, and to identify patients most likely to benefit. Author Perspective

Dr. Henry: Traditionally, nonpharmacologic symptom management has employed methods such as cognitive behavioral therapy that are typically administered in person, in individual or group settings. More recently, data have emerged that support use of cognitive-behavioral therapy administered through the telephone or the internet to ease symptoms such as insomnia and pain. In our small pilot study, we specifically examined use of a cognitive behavioral therapy–based intervention (PROSPECT) administered through the internet for the management of pain, insomnia, and fatigue in breast cancer survivors. Our intervention is not strictly an educational intervention, but rather it is intended to provide users with tools, such as relaxation, pacing, goal-setting, and communication, to improve their behavior and lifestyle.

We were able to demonstrate improvement in multiple symptoms with use of the intervention for 8 weeks, especially in patients with fatigue. We also assessed acceptability of the intervention and found that most patients felt it was acceptable and convenient to use. By administering this intervention using the internet, it is accessible to patients who may not have the time or the financial capability to attend individual or group sessions or who may live far from the treating facility. It also means that more patients are able to access the intervention, since it doesn’t require that the facility have trained staff to administer it.

Dr. Henry: We plan to test this intervention in larger controlled trials in order to better assess the impact in populations of patients with cancer. Ideally, an intervention such as this could be available to patients on a cancer center’s website or in a mobile app, and patients could access the intervention intermittently as they work to develop and reinforce their tools for behavior and lifestyle management. At the University of Utah, we are currently testing the intervention in combination with exercise in patients with metastatic cancer.

Dr. Henry: Our pilot was designed to provide initial data about the efficacy of the intervention, which is required information for planning subsequent, well-controlled trials. Because there is the potential that patients’ symptoms could improve on their own over time, or simply because the investigators were interacting more with the participating patients compared to usual clinical care, it is possible that the intervention itself did not provide the benefit. Therefore, well-designed, randomized trials that validate the findings are necessary before the intervention can be widely adopted.

Dr. Henry: The results were somewhat surprising because we expected to find more of an effect in patients with pain, since the intervention that PROSEPCT was adapted from was originally developed for management of fibromyalgia, a chronic pain condition. It is possible that the sample size was too small or that the improvement in pain takes longer than the 8-week duration of the study. Another possibility is that the underlying reason for pain in enrolled subjects was likely quite heterogeneous (surgery, neuropathy, and aromatase inhibitor therapy), and the intervention may have had differential effects depending on the etiology of the pain.