P16.02 Internet-based guided self-help for glioma patients with depressive symptoms: a randomized controlled trial

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INTRODUCTION: Depressive symptoms are common in glioma patients, and can have negative consequences for their health-related quality of life (HRQOL). Evidence for the effectiveness of psychological treatment for depression in glioma is scarce, and the effectiveness of internet-based mental health care has not yet been explored in this population. Therefore, we performed a nation-wide randomized controlled trial to evaluate the effects of an internet-based, guided self-help intervention for depressive symptoms in glioma patients. MATERIALS AND METHODS: An existing 5-week course based on problem solving therapy, originally developed to treat depression in the general population, was adapted for use by adult glioma patients with mild to moderate depressive symptoms (Center for Epidemiology Studies Depression Scale (CES-D) score ≥12) but without suicidal ideation (Beck Scale for Suicidal Ideation score 0). Glioma patients were randomly allocated to the intervention or to the waiting list control group. Patients with hematologic cancer were recruited as a non-central nervous system (non-CNS) control group and also received the intervention, and were used to determine whether the effects of the intervention differed between patients with CNS and non-CNS tumors. Depressive symptoms (CES-D), fatigue (Checklist Individual Strength), and HRQOL (Short Form-36), were assessed by means of online questionnaires. Results from 6 and 12 weeks follow-up were analysed with intention-to-treat (ITT) and per protocol (PP) linear mixed models, corrected for baseline scores on outcome measures. RESULTS: In total, 96 glioma patients (intervention group N=45, waiting list controls N=44) and 26 hematologic cancer patients were included. At follow-up, almost 60% of glioma patients (N=22 (6 weeks); N=35 (12 weeks) and N=35 (6 weeks); N=38 (12 weeks) for the intervention and control group, respectively) and 54% (6 weeks) and 42% (12 weeks) of hematologic cancer patients completed assessments. We found no statistically significant changes over time for any outcome measure between the glioma intervention group and either control group. However, there was a trend (p<0.10) towards decreased depression scores in the glioma intervention group versus the waiting list control group at 6 weeks (ITT: p=0.078; PP: p=0.082), but not at 12 weeks. There was also a trend towards decreased fatigue at 6 weeks (ITT: p=0.073; PP: p=0.088). CONCLUSIONS: This was the first study to evaluate the effects of problem-solving therapy delivered through the internet as treatment for depressive symptoms in glioma patients. In this study with a small sample size and high attrition rates, no statistically significant improvement was found with regard to depression, fatigue, or HRQOL. After the intervention, only a trend towards improved mood and fatigue was found for glioma patients randomized to the intervention group.

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