Seitz, D.C., Knaevelsrud, C., Duran, G., Waadt, S., Loos, S., & Goldbeck, L. (2014). Efficacy of an internet-based cognitive-behavioral intervention for long-term survivors of pediatric cancer: A pilot study. Supportive Care in Cancer, 22, 2075–2083.

To evaluate the efficacy of an internet-based psychological intervention in reducing post-traumatic stress symptoms (PTSS) and anxiety

This study included cognitive-based therapy that included two Internet-based, 45-minute writing sessions per week (10 writing sessions total) with standardized text messaging and instructions. It included two modules, one to reproduce the cancer-related event and then another to build coping strategies. Treatment was provided by two trained psychologists via Internet messaging. Outcomes were assessed by several tools (listed under Measurement Instruments) and then analyzed.

• N = 20  
• MEAN AGE = 27.3 years (SD = 4.8 years)
• MALES: 30%, FEMALES: 70%
• KEY DISEASE CHARACTERISTICS: Long-term survivors of pediatric cancer; cancer diagnosis before patients were 19 years old
• OTHER KEY SAMPLE CHARACTERISTICS: Mean time since diagnosis = 13.8 years; education < 11 years (15%), high school 12–13 years (85%); types of cancer included leukemia (40%), lymphoma (30%), central nervous system tumor (20%), soft tissue sarcoma (5%), and germ cell tumor (5%); history of relapse = 20%

• SITE: Single-site    
• SETTING TYPE: Outpatient    
• LOCATION: Germany

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Pediatrics

Single-arm pilot study with a pre/post three-month follow-up design

• Post-traumatic stress Diagnostic Scale (PDS) 
• Hospital Anxiety and Depression Scale (HADS) 
• Short Form of the Fear of Progression and Relapse Questionnaire (FOP-SF) 
• Sociodemographic and medical information

Twenty participants completed the intervention. PTSS scores and anxiety/fear of progression/relapse significantly declined by the end of intervention. There was a significant decrease in symptoms of depression. All effects were sustained at three months postintervention except depression.

Internet-based psychological interventions (Onco-STEP) are an innovative way to address psychological late-term effects in young adult long-term survivors of pediatric cancer, specifically improving PTSS scores and anxiety. It also may help to reduce the fear of progression or relapse and symptoms of depression.

• Small sample (< 30)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition)  
• Risk of bias(sample characteristics)
• Key sample group differences that could influence results
• Findings not generalizable
• Subject withdrawals ≥ 10%
• Other limitations/explanation: Dropout rate 28.6%; single-arm pilot study with no control group; subjects were recruited from a former study; mostly female

Although this was a small study, it demonstrates an innovative way to reach young adult survivors and assist them with their psychological needs. As nurses, we need to be open to new methods of assessment and intervention for psychosocial care in various populations.