Closing the COVID-19 Psychological Treatment Gap for Cancer Patients in Alberta: Protocol for Implementation and Evaluation of Text4Hope-Cancer Care (Preprint)

BACKGROUND: Background: Cancer diagnoses and treatments usually engender significant anxiety and depressive symptoms in patients, close relatives, and caregivers. During the COVID-19 pandemic providing psychological support in this context presents additional challenges due to self-isolation and social or physical distancing measures in place to limit viral spread. This protocol describes the use of text messaging (Text4Hope-Cancer Care) as a convenient, cost-effective, and accessible population-level mental health intervention. This program is evidence-based with prior research supporting good outcomes and high user satisfaction. OBJECTIVE: We will implement daily supportive text messaging (Text4Hope-Cancer Care) as a way of reducing/managing anxiety and depression related to cancer diagnosis and treatment in Alberta. Prevalence of anxiety and depressive symptoms, their demographic correlates, and Text4Hope-Cancer Care induced changes in anxiety and depression will be evaluated. METHODS: Alberta residents with a cancer diagnosis and loved ones of those dealing with cancer diagnosis can self-subscribe to the Text4Hope-Cancer Care program by texting "CancerCare" to a dedicated text number. Self-administered, anonymous, online questionnaires will be used to assess anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). Data will be collected at onset of individuals receiving text messages, and at the mid and endpoints of the program (i.e., 6- and 12-weeks). RESULTS: Data will be analyzed with parametric and non-parametric statistics for primary outcomes (i.e., anxiety and depressive symptoms) and metrics of use, including number of subscribers and user satisfaction. In addition, data-mining and machine learning analysis will focus on determining characteristics of subscribers that predict high levels of symptoms of mental disorders, and may subsequently predict changes in those measures in response to the Text4Hope-Cancer Care program. CONCLUSIONS: Text4Hope-Cancer Care has the potential to provide key information regarding prevalence rates of anxiety and depressive symptoms in patients diagnosed or receiving care for cancer and their caregivers. The study will generate demographic correlates of anxiety and depression, and outcome data related to this scalable, population-level intervention. Information from this study will be valuable for healthcare practitioners working in cancer care and may help inform policy and decision-making regarding psychological interventions for cancer care. CLINICALTRIAL: Ethics approval has been granted by the University of Alberta Health Research Ethics Board (Pro00086163).