title: Efficacy of an internet-based cognitive-behavioral intervention for long-term survivors of pediatric cancer: a pilot study.
abstract: OBJECTIVE
  Long-term survivors of pediatric cancer have an increased risk of post-traumatic stress symptoms (PTSS) and dysfunctional anxiety. However, there is a lack of evidence-based psychotherapy tailored to the needs of this target group. In this single-arm pilot study, an Internet-based psychological intervention ("Onco-STEP") for adolescent and young adult survivors was developed, and its efficacy in reducing PTSS and anxiety was evaluated.
  
  
  METHODS
  Former patients of pediatric cancer older than 15 years manifesting clinically relevant PTSS or anxiety were eligible. The cognitive-behavioral treatment consists of ten writing sessions and comprises two modules: the first aiming to reprocess the traumatic cancer-related experiences and the second aiming to build coping strategies with current cancer-related fears. Treatment was delivered via written messages on a secure Internet platform. Outcomes were assessed by the Post-traumatic Stress Diagnostic Scale, the Hospital Anxiety and Depression Scale, and the Fear of Progression/Relapse Questionnaire.
  
  
  RESULTS
  A total of 20 participants completed the intervention (mean age 27.3 ± 4.8 years at study; 13.8 ± 4.7 years since diagnosis; 70 % female). PTSS, anxiety, and fear of progression/relapse significantly declined at the end of the intervention, with pre-post effect sizes of 0.63, 0.74, and 0.48. In addition, we found a significant decrease in symptoms of depression. Except for the improvement in depression, all effects were sustained 3 months after the end of treatment.
  
  
  CONCLUSIONS
  The results show that the intervention is efficacious in reducing symptoms of post-traumatic stress and anxiety. Onco-STEP is a promising new way to treat young adult long-term survivors of pediatric cancer with late psychological effects. Future efforts need to focus on investigating specific evidence of the intervention in a randomized controlled trial.
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Steinhoevelstr. 5, 89075, Ulm, Germany, diana.seitz@uniklinik-ulm.de.
authors.forename: Diana Christine Maria
authors.initials: DC
authors.lastname: Seitz
authors.forename: Christine
authors.initials: C
authors.lastname: Knaevelsrud
authors.forename: Gabriele
authors.initials: G
authors.lastname: Duran
authors.forename: Sabine
authors.initials: S
authors.lastname: Waadt
authors.forename: Sabine
authors.initials: S
authors.lastname: Loos
authors.forename: Lutz
authors.initials: L
authors.lastname: Goldbeck
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D009369:Neoplasms / Q000523:psychology* / Q000534:rehabilitation*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology; D055815:Young Adult