E-health Intervention for Cancer Survivors

Nearly 65% of those with cancer diagnoses will survive for at least 5 years, with
approximately 10.5 million cancer survivors in the United States. The time of transition
for cancer patients, from active treatment to survivorship, has been identified as a time of
high risk for depression and anxiety. Cancer survivors experience higher rates of anxiety
and depression than those without a cancer history. Research has identified fear of
recurrence, perceived loss of support, and social pressure to resume a "normal" life, among
other phenomena, as sources for this emotional distress. However, only about 20% of all
patients referred for psychotherapy ever enter treatment and of those who initiate
treatment, nearly half drop out before completion. This suggests that there are significant
barriers to receiving care. These barriers may be even higher for cancer survivors
struggling with issues related to re-entry, such as returning to work, resuming household
responsibilities and managing residual symptoms such as fatigue or pain.

The internet promises to provide inexpensive access to treatment at any time of the day or
night. Unfortunately, the potential for internet delivered services has not been realized.
Studies examining treatments that simply provide access to an internet site commonly result
in very high dropout after the first site visit, and typically little or no improvement
target symptoms. A variety of methods to improve responses to internet interventions have
been examined. In general, e-mail support improves adherence and telephone support can
improve adherence even more. Another type of support that has only begun to be investigated
is the use of social networks to help maintain adherence.

This intervention will combine a variety of outreach methods, including telephone, email and
an online social network, to increase adherence and promote the use of the website and the
skills it teaches.