Who benefits from an eHealth-based stress management intervention in advanced prostate cancer? Results from a randomized controlled trial

Objective: Conduct a secondary analysis to examine the effects of a tablet-delivered, group-based cognitive-behavioral stress management (CBSM) intervention for reducing symptom burden among men with advanced prostate cancer (APC) and elevated baseline levels of symptom burden. Methods: A total of 192 men with APC were randomized to either a CBSM or a health promotion condition and followed for one year. Six analytical samples were included in our study, each including participants who reported elevated levels of burden for the corresponding outcome at baseline. Outcomes included five domains of symptom-related quality of life (urinary incontinence n = 98; urinary irritation n = 61; bowel function n = 43; sexual function n = 177; and hormonal function n = 149) and depression (n = 31). Repeated measures mixed models were used to detect within- and between-group changes in outcomes. Results: Regardless of condition, participants with elevated symptom burden or mild-to-severe depression showed short-term (6-month) improvements in urinary irritation, bowel function, hormonal function, and depression scores. Only participants in the CBSM condition showed short-term (6-month) improvements in urinary incontinence, and long-term (12-month) improvements in urinary irritation, bowel function, hormonal function, and depression scores. Conclusions: Our findings suggest that targeting a web-based CBSM intervention to recipients most likely to benefit (elevated levels of symptom burden) can improve several domains of symptom-related quality of life and depressive symptoms in men with APC.