The use of emotional freedom techniques to reduce fear of cancer recurrence
Dr. Philip Debruyne (AZ Groeninge) has been awarded with the 2020 Pfizer Oncology Award for his project which aims to examine the efficacy of Emotional Freedom Techniques (EFT) to reduce the fear of cancer recurrence.
Emotional freedom techniques and fear of cancer recurrence
Although there are over a quarter of a million cancer survivors in Belgium, the mental wellbeing and quality of life of patients after their cancer diagnosis and treatment is often poorly addressed. As a result, many cancer survivors live with a fear of cancer recurrence (FCR) and approximately one third of cancer survivors indicate they would need professional help to cope with the fear, worry or concern that their cancer may return or progress. Although cognitive behaviour therapy, mindfulness and yoga might be valuable in relieving stress, anxiety and depression in these patients, these techniques usually require an intensive program. Emotional freedom techniques (EFT) is an easy to learn self-help tool that might be a suitable alternative. EFT was originally developed to manage anxieties and phobias and is comprised of a somatic and a cognitive component. The somatic component includes acupressure (specific points on the head, face, collarbone and under the arm) while the cognitive component refers to a psychological tool in which one addresses a problem, complaint, worry or concern out loud. With these techniques, a conditioned response helps to induce tolerance to the stimulus that causes anxiety. Dr. Debruyne further explains: “The trial will be conducted on behalf of the BSMO Cancer Survivorship Task Force and builds on our previous research trial examining the effect of EFT as an intervention strategy to reduce patient-reported cognitive complaints in cancer survivors (EMOTICON: NCT02771028). In this trial, we observed positive effects of EFT on secondary endpoints such as psychological distress and emotional wellbeing. As FCR is a major problem in cancer survivors and there is no widely implemented evidence-based strategy to address FCR, it is definitely worthwhile to try these emotional freedom techniques now also for this group of patients.”
Before participation, cancer patients who were previously treated with surgery, chemotherapy, radiotherapy, anti-hormonal or targeted therapy, need to complete the Cancer Worry Scale (CWS). In total, eight items are rated on a 4-point scale ranging from 1 (never) to 4 (almost always) with lower scores indicating less FCR. When scoring 14 or more, patients are diagnosed with FCR and can participate to the trial. Subsequently, they will be randomised to either the intervention or wait-list control group. In total, 43 patients in each study cohort are required. Patients in the intervention group take off with 8 weeks of practicing EFT, at least once a day, while the wait-list control group will only start their 8 weeks of EFT practice, after a waiting period of 8 weeks. Importantly, the trial is designed as a remote multicentre randomised trial and EFT training will thus be offered by an internet-based approach that allows the investigators to perform the trial with one instructor/coordinator only. This instructor is formally trained and acquired the AAMET Emotional Freedom Techniques level 1 certificate. Patients can make use of remotely organised personal contact sessions with the instructor as well as background information and instruction videos made available on an online EFT platform. Two sessions are foreseen to introduce and follow-up on the EFT practice but additional contact sessions (although virtual) with the instructor/coordinator of the trial, can be made by patients who are in need of extra support. At study entry, at week 8 (primary outcome) and at week 16, patients will be asked to complete the CWS and other questionnaires to measure the efficacy of EFT on the reduction of psychological distress, fatigue, emotional wellbeing, quality of life, health status and patients’ professional lives. “We aim to start recruiting patients in 2021 and thus far, six centres have already indicated their willingness to participate in the trial; AZ Groeninge Kortrijk, UZ Brussel (Dr. C. Fontaine), AZ Klina Brasschaat (Dr. C. Langenaeken), Jessa Ziekenhuis Hasselt (Pr. J. Mebis), AZ Glorieux Ronse (Dr. F. Vanryckegem) and UZ Gent (Pr. T. Boterberg). Nevertheless, other centres that would put themselves forward will also be offered the opportunity to participate. Depending on how fast patients will be recruited, results can be expected after roughly two years. We are, of course, very grateful to win the Pfizer Oncology Award and will spend this budget mainly on personnel costs for the responsible project coordinator for writing the protocol, obtaining approval from ethic committees, data collection and analysis, etc. The rest of the budget will be used for the development of the EFT online platform.”
Pfizer Oncology Award
During the 13th BSMO-Bordet meeting on November 22-23th 2019, professor Yves Van Nieuwenhove and Mrs. Eva Pape (University Hospital Ghent) have been awarded with the yearly Pfizer Oncology Award. This award supports, recognises and encourages one innovative project in Belgium or Luxembourg that improves the quality and/or availability of patient care in oncology and is worth 25,000 euro. Projects addressing the clinical, surgical, medical or technical aspects of patient care as well as the different ways of collaboration and organisation between various health care providers or different levels of care during the course of the disease are eligible. The winning project was selected out of nineteen submissions by an independent scientific committee, chaired by professor Sylvie Rottey and composed of medical oncologists, haematologists and onco-nurse representatives. The winning project from the group of professor Van Nieuwenhove aims at developing a LARS-clinic to improve care for rectal cancer survivors in order to manage the struggle of patients dealing with the low anterior resection syndrome .
Mrs Eva Pape (center) and prof. Yves Van Nieuwenhove receive the Pfizer Oncology Award from prof. Sylvie Rottey (Chairman of the Scientific Committee) and Pfizer delegates.
The 2018 winner of the Pfizer Oncology Award is Dr Lore Lapeire (University Hospital Ghent) for her project “The development, implementation and evaluation of a multidisciplinary oncologic consultation for adolescents and young adults with cancer in Belgium, the AYA-MOC.”
Adolescents and young adults with cancer (AYAs) struggle with finding their place within a hospital. They are too old for the paediatric department, but also the adult department fails to adequately cover all their needs. Overall, AYAs are satisfied with the medical care they receive, but this type of patients is in a phase of their lives where they have to deal with a lot of other aspects. They worry about specific subjects, like education, finding a job, sports, hobbies, sexuality, fertility, etc. All these aspects need special attention and this is often lacking in the current practice. Dr.Lapeire confirms these unmet needs from her own experience. “We still hear from patients that the risk of losing your fertility due to specific treatments has never been addressed before the start of treatment. Afterwards it is often too late.”
Due to the complexity of this patient group, Care4AYA - a multidisciplinary workgroup which aims to improve the care for AYAs - was initiated at Ghent University Hospital. So far, the workgroup has developed some helpful tools, including cards to enhance the communication between AYAs and their caregivers, and a brochure that helps parents of AYAs to better cope with their young child suffering from cancer. However, there is still a lot of room for further improvement according to dr. Lapeire. “We are in continuous dialogue with AYAs and their parents about how we can make things better for them. We also want to rejuvenate some hospital rooms to better fit the needs of AYAs. Things like internet and gaming are important in their lives, but the current hospital setting does not support this yet.”
In the upcoming year, Care4AYA will use the Pfizer Oncology Award to develop and implement an AYA multidisciplinary oncology consult (AYA-MOC). The standard MOC has a pure medical focus with specialists from different departments, but the AYA-MOC also takes into consideration physical, financial, and emotional aspects. Therefore, not only doctors, but also nurses, social workers, physical therapists, occupational therapists, and other specialists participate in the AYA-MOC. “We are still examining how we can implement the AYA-MOC in the most optimal way,” dr. Lapeire explains. “I believe that it may be especially useful in the aftercare phase, which can be difficult for patients. During their treatment, patients frequently come to the hospital and have the opportunity to talk to their caregiver more often. When they are dismissed and the number of check-ups decreases, they tend to feel lost.”
Dr. Lapeire also looks across the borders at international AYA initiatives. In France, for example, former patients don’t have to mention their previous disease state to the insurance company after a couple of disease-free years. They call it ‘the right to be forgotten’ and it increases their chances on the house and job market. Currently, the Belgian minister is trying to accomplish the same thing. In the Netherlands there are specialized reference centres, where all AYAs are discussed.Dr. Lapeire hopes to reach something similar in Belgium. “For the future it would be great if the AYA-MOC would be acknowledged and perhaps even reimbursed by the government. Then this project would be extremely successful.” At the moment, 4 hospitals in Ghent are collaborating to improve AYA care. If the AYA-MOC proves to be successful, it can be implemented in other hospitals. “It is not our goal to make all the AYAs come to our hospital,” dr. Lapeire emphasizes. “It is our goal to optimize the treatment and care of every AYA, regardless of where he or she is being treated. We are connecting all specialists that have experience with AYAs and stimulate them to share their knowledge. As such, we hope to progressively improve the AYA care together.”
Dr. Lore Lapeire (2nd from left) receives the Pfizer Oncology Award from Prof. Sylvie Rottey (Chairman of the Scientific Committee) and Pfizer delegates.
During the BSMO/Bordet meeting in Brussels, Dr. Jean-Francois Daisne (CHU-UCL Namur) was presented as the 2017 Pfizer Oncology Award winner for his project entitled: ‘Self-administration of LLLT in oropharyngeal and buccal mucositis induced by (chemo) radiotherapy of the head and neck area’.
Treatment of head and neck squamous cell carcinoma with (chemo)radiotherapy leads to severe mucositis in 25 to >50% of the patients. It is more frequent in oropharyngeal and oral cavity locations. This debilitating side effect results in pain, loss of quality of life, diet modification and subsequent weight loss and denutrition. These effects can be treated by low level laser therapy (LLLT) or photobiomodulation. This results in enhanced wound repair and tissue regeneration by influencing different phases of injury resolution including the inflammatory, proliferative, and remodelling phase. It stimulates ATP synthesis, increased tissue oxygenation and has analgesic effects. In a phase III trial it was shown that LLLT resulted in a reduction of acute mucositis compared to placebo treatment. A six-fold decrease in the incidence of grades 3–4 oral mucositis was detected in the LLLT group compared to the placebo. As a result there was also a significant reduction in pain, an increased quality of life and a reduction in parenteral nutrition use. The improvements were seen both during and after the chemoradiotherapy. LLLT did not show a detrimental effect on the chemoradiotherapy. Progression-free survival and overall survival in patients treated with LLLT was not affected in a negative way.
However, the LLLT treatment has several practical issues. The administration is performed by a radiotherapy nurse, it is time consuming and it requires the entire staff to be trained adequately. The availability of radiotherapy nurses for LLLT is limited, whereas the treatment is required daily or every other day until symptoms are resolved. To address these issues, Dr. Daisne proposed to investigate a portable device, recently developed in the Netherlands. The device consists of a small medical laser device and two laser clips that can be put in the mouth. This can be done by patients themselves in the home situation. “This is about patient empowerment”, says Dr. Daisne, “It allows them to be independent of the availability of a nurse, they don’t have to travel to the hospital to get treatment for their symptoms and they can apply it at a time of their own choice”. Dr. Daisne had the opportunity to test the device already with two patients. In both cases it resulted in pain control and limited weight loss.
In the proposed study design Dr. Daisne and his team will recruit 50 patients with painful mucositis (VAS>2). “We will be able to start around February 2018 and recruit all patients within 12 or 18 months” says Dr. Daisne. There will be a weekly recording during radiotherapy and in addition 10 and 30 days post-treatment. Data will be collected, including VAS pain scale, total time LLLT use, analgesics doses, diet consistency, parenteral nutrition and weight evolution. Quality of life will be determined using the C30 and HN35 questionnaires. Dr. Daisne: “With the support of the Pfizer Oncology Award we will be able to buy a sufficient amount of portable laser devices, and cover the costs of the data collection and insurance.” Besides the clinical results, the study will also shed light on the financial impact on healthcare costs. “Currently the use of a portable laser device is not reimbursed by health insurance, I expect however, that with this study we can demonstrate that it is feasible and cost-effective”, says Dr. Daisne. The project of dr. Daisne and his team aims to evaluate an innovative treatment modality for patients suffering from debilitating adverse events. This will help to make such innovations available nationwide and consequently improve the quality of patient care in oncology.
Dr Daisne receives the 2017 Pfizer Oncology Award from Prof Sylvie Rottey (Chairman of the Scientific Committee) and Ludwig Van den Hove (Senior Medical Manager Pfizer)
The 2016 Pfizer Oncology Award has been won by the CTCU (Clinical Trial Conduct Unit) of the Jules Bordet Institute in Brussels represented by Dr Samuel Gwed for their project: Dynamic perspective for patient information: “How improving informed consent (IC) process/understanding using 3D film or cartoon material.”
Before patients can enter a clinical trial they need to read, understand and agree with the Informed Consent Form content. This mandatory ethical and legal step often presents hurdles to many patients because it is a lengthy document which requires a lot of explanation by the staff. Its complexity can also be a reason for patients to finally not take part in a clinical trial.
Therefore, Dr Gwed explains, we propose to use multimedia as a complementary and supporting tool to the classical approach of explaining IC. We want to develop a didactic, dynamic and accessible tool which will complete the standard paper consent. The better the patient will be informed about his rights, but also about the benefits and potential risks, the better he or she will be able to decide to take part in a clinical trial.
The tool will be developed in the weeks ahead which will then be approved by an independent bioethical committee allowing for testing the tool in 2 groups of patients : one group of patients only having access to the paper version of the IC and the other group having the paper version and the didactical tool.
Picture: PRISM Prod.