A Cognitive-Existential Telephone Intervention to Improve Existential Quality of Life in Advanced Cancer

Background: Advanced cancer raises significant spiritual, existential, and death-related concerns that are poorly addressed in routine cancer care (Wexler & Corn, 2012). We developed an 8-weeks manualized cognitive existential intervention (CEI) for advanced cancer patients to be delivered by telephone to improve existential and global quality of life (QoL).

Methods: Patients with advanced cancer and with prognosis and health status that allow CEI completion, without significant cognitive impairments or active psychiatric conditions, were randomly assigned to the intervention arm (1-hour weekly session with a trained social worker by telephone) or the usual-care (UC) arm (routine care that allowed to received regular psychosocial help). Global, psychological and existential QoL were measured by the McGill Quality of Life questionnaire, while emotional distress and anxiety were measured by the Hospital Anxiety and Depression Scale at baseline (T0), mid-intervention (T1), end-of-intervention (T2), and at 6-weeks post-intervention (T3). Analysis were performed using SAS version 9.4 using repeated-measures with generalized estimating equations (GEEs) model.

Results: A total of 137 participants (mean age=54.8 years; 65.7% women) were randomized. CEI arm improved significantly their psychological, existential and global QoL at T2 (d=0.74, p =.02, d=0.47, p=.03 and d=0.39, p=.04) and at T3 for psychological and existential QoL (d=0.88; p=.01 and d=0.56, p=.02) compared to baseline. When compared to UC arm, CEI arm reported less anxiety at T2 than T0 (d=-1.36, p=.03). Anxiety and emotional distress similarly decreased in the CEI arm at T2 (d=-1.47, p< .01 and d=-1.83, p< .01) and at T3 (d=-1.37, p=.01 and d=-1.93, p=.04), in comparison to T0. The difference in anxiety between T2 and T0 was significantly more important in the ICE arm versus the UC arm (d=-1.36, p= 0.03). Over 96% of participants believed that CEI led them to think about life meaning, 94% and 92% stated that participating in the CEI helped them cope with their illness and in their personal life, respectively.

Discussion: Our study confirmed the acceptability, the satisfaction and the efficacy of the intervention. Data suggest that intervention improved psychological, existential and global QoL, but also reduced anxiety and emotional distress. The deterioration of patients’ health status may explain the difficulty to maintain significant detectable improvement over time.

Conclusion: A manualized, pragmatic, telephone intervention can be of significant help for advanced cancer patients to confront existential and psychological distress. This format can also reach patients in remote area or that cannot attend face-to-face sessions, while potentially reducing the cost of specialized psychosocial care. The deterioration of patients’ health status may explain the difficulty to maintain significant detectable improvement over time.

References:

Wexler ID & Corn BW. (2012). An existential approach to oncology: meeting the needs of our patients. Curr Opin Support Palliat Care 6(2): 275-279.