A Guided Online Cognitive Behavioral Intervention to Prevent Persistent Pain After Breast Cancer Surgery: A Randomized Feasibility and Acceptability Study

Persistent pain after breast cancer treatment (PPBCT) is highly prevalent. Psychological factors such as anxiety and pain worry are associated with increased prevalence of PPBCT. Perioperative psychological interventions may mitigate the risk for PPBCT. This study evaluates the feasibility and acceptability of a guided online cognitive behavioral intervention (eCBT) for women scheduled for breast cancer surgery. Additionally, the efficacy of the intervention to decrease anxiety and pain worry was compared to that of a guided online active control intervention. The current study is part of a larger RCT on the effectiveness of perioperative eCBT to decrease the prevalence of PPBCT. Patients were randomized to receive five sessions of eCBT or five sessions of health education, both accompanied by three video calls with a therapist. Feasibility was determined by participation and retention rate, attendance and treatment fidelity. Acceptability was assessed with evaluation forms completed by patients and therapists. Changes in anxiety and pain worry after the intervention were compared between the eCBT and control group. The intervention appeared feasible. Although only 40% of eligible patients participated, most of those randomized to eCBT followed the program and completed all sessions. Quantitative and qualitative data showed that participants appreciated the intervention and experienced benefits from it. Nevertheless, patients also indicated experiencing problems to fully engage in the intervention because of treatment and disease burden or private circumstances. Anxiety and pain worry significantly decreased after the intervention, but not more than after the control intervention. Effectiveness for reducing PPBCT remains to be determined.