Effect of Smartphone Psychotherapy Apps on Fear of Recurrence Among Young Breast Cancer Survivors

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In a Japanese trial (J-SUPPORT 1703) reported in the Journal of Clinical Oncology, Akechi et al found that 8-week use of smartphone psychotherapy apps was associated with significant benefits in reducing the fear of recurrence in breast cancer survivors aged 20 to 49 years.

Study Details

In the multicenter trial, 444 evaluable patients free of disease were individually randomly assigned with no in-person contact to the smartphone intervention (n = 220) or waitlist control group (n = 224) for 8 weeks, with both groups receiving usual care. The smartphone intervention consisted of problem-solving therapy and behavioral activation apps. The problem-solving therapy app consisted of nine approximately 10-minute sessions, providing patients with a structured five-step strategy for solving their problems; the behavioral activation app, which encourages patients to increase pleasurable and meaningful behaviors, consisted of six approximately 10-minute sessions.

The primary endpoint was score on the Japanese version of the Concerns About Recurrence Scale (CARS-J) at week 8. Secondary outcomes included the Fear of Cancer Recurrence Inventory–Short Form (FCRI-SF), Hospital Anxiety and Depression Scale (HADS), short-form Supportive Care Needs Survey (SCNS-SF34), and Posttraumatic Growth Inventory at week 8. The intervention group was evaluated again at week 24 (n = 213).

Key Findings

The intervention group exhibited significantly greater improvements vs the control group at week 8 on the CARS-J (difference = –1.39, 95% confidence interval [CI] = –1.93 to –0.85, P < .001), FCRI-SF (difference = –1.65, 95% CI = –2.41 to –0.89, P < .001), HADS depression (difference = –0.49, 95% CI = –0.98 to 0, P < .05), and SCNS-SF34 psychological domain (difference = –1.49, 95% CI = –2.67 to –0.32, P < .05). No significant differences were observed in other measures.

In the intervention group, additional improvements were observed between week 8 and week 24 on the CARS-J, FCRI-SF, SCNS-SF34 psychological domain, and HADS depression, but reached significance only for the latter (P = .03).

The investigators concluded, “Novel smartphone psychotherapy offers a promising way to reduce fear of cancer recurrence given the large number of survivors and a limited number of therapists to competently conduct psychotherapy.”

Tatsuo Akechi, MD, PhD, of the Nagoya City University Graduate School of Medical Sciences, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the Japan Agency for Medical Research and Development; Japanese Ministry of Education, Culture, Science, and Technology; and others. For full disclosures of the study authors, visit


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