Cancer diagnosis constitutes a life-altering event, imposing not only physical challenges but also profound psychological effects on individuals. Patients grappling with cancer often exhibit elevated rates of psychiatric disorders, with depression being a predominant manifestation alongside anxiety, adjustment disorders, delirium, and substance-related disorders [1]. Recognizing the urgent need for diagnosis and intervention, particularly in the realm of psychiatric distress, becomes imperative. Distress, in the context of cancer, is characterized as a multifactorial and unpleasant emotional experience that spans cognitive, behavioral, emotional, social, and spiritual dimensions, potentially hindering coping mechanisms throughout the cancer trajectory [2]. Studies indicate that a significant proportion, ranging from 30% to 50%, of cancer patients experience distress across various phases of their illness [3, 4]. The management of the adverse impact of cancer on mental health has ascended in priority, given its undeniable influence on both psychological well- being and physical health [5].

Addressing this burgeoning concern, psycho-oncology intervention (PI) emerges as a pivotal strategy not only for enhancing well-being but also as a potential safeguard against relapse and symptom exacerbation [5]. Recent findings underscore the efficacy of PI in diminishing emotional distress among cancer patients, shedding light on its role in improving overall quality of life [6]. However, the integration of routine distress screening, often constrained by manpower limitations and a surge in patient loads, remains challenging in traditional clinical settings [7, 8].

In response to these challenges, this study explores the adoption of digital approaches, specifically Online Psycho-Oncology Counseling (OPC), as a complementary strategy to bolster existing psycho-oncological support for cancer patients. The advantages of cost-efficiency, high accessibility, and flexibility inherent in digital interventions hold promise for overcoming existing barriers and reaching underserved populations [5]. This investigation aims to analyze the impact of OPC on distress levels among cancer patients, considering its potential to address the unique needs of this population and contribute to an enhanced quality of life throughout their cancer journey. Additionally, the study includes the evaluation of the feasibility and satisfaction of the OPC program.

This interventional study involved experimental pre-post design to understand the OPC on the cancer patients to reduce the distress among the cancer patients Assessment of feasibility and satisfaction of online Psycho-oncology intervention counseling among cancer patients conducted between November, 2023 – January, 2024.

The study was conducted at 4baseCare, an Illumina Accelerator Company specializing in precision oncology, utilizing advanced genomics to personalize patient care, offering services like Genetic Counseling and Onco Diet consultations through the innovative Oncobuddy platform. The study is conducted through Oncobuddy, a 360-degree digital healthcare platform developed by 4baseCare oncosolutions private limited. This platform serves as a unified and patient-centric ecosystem, providing comprehensive support to patients in their battle against cancer. Through Oncobuddy, patients can avail consultations with Psycho-Oncologists, Oncologists, and other supportive care services through both video and audio calls.

The referral process commences after the collection of blood samples for genetic analysis. Care companions or coordinators, acting as liaisons between patients and services, contact patients to explain the available supportive care services, including Psycho-Oncology, Diet Counseling, and Genetic Counseling. Patients opting for these services are seamlessly referred to either Psycho- Oncology, Diet Counseling, or Genetic Counseling based on their preferences.

Care companions schedule psycho-oncology sessions based on patient and psycho-oncologist availability through Oncobuddy or Google Meet. Sessions are scheduled based on patient language preferences, with the lead consultant, proficient in Bengali, English, and Hindi. The documentation of interventions and psycho-social concerns for each patient is maintained by the psycho-oncologist. Patient medical reports are uploaded to Google Drive, enabling psycho-oncologists to review medical summaries and reports before counseling sessions. Psycho-Oncology interventions are based on existing publications on the cancer population, ensuring evidence-based and patient-tailored strategies.

The first online session, lasting 45 to 60 minutes, involve rapport establishment, self-introduction, discussion of current health, distress assessment, problem list assessment, and verbal psychological recommendations. Interventions are uploaded on Oncobuddy, allowing patients to access and download recommendations at any time. The importance of following psychological recommendations is explained, and patients are informed about the next follow-up call scheduled after one month. Care companions provide the first follow-up date after one month based on patients’ availability, with reminder calls two days and one day prior to the session. A brief follow-up session assesses distress levels, patient adherence to interventions, and satisfaction with the initial psycho-oncology counseling.

The study included 30 patients diagnosed with solid tumors undergoing cancer treatment, aged between 30 – 59 years, who have enrolled with 4basecare for support services between November 2023 and December 2023. The Online Psycho-Oncology Counseling (OPC) was administered to patients with a distress score equal to or greater than 4. The intervention, encompassing counselling on four key themes, addressed prevalent issues among participants. Patients on psychiatric medications and in hospice care were excluded from the study.

Patients’ gender, marital status, employment and hobbies were documented.

Data about the diagnosis and treatment of the initial cancer was obtained from 4baseCare patient master sheet which contained detailed information about diagnosis and treatment.

Distress was measured using the Distress Thermometer (DT) [6]. DT is a screening tool, on which cancer patients can indicate their overall distress (physical, emotional, social, as well as practical). Higher scores indicate more distress. The DT is a quick screening tool that accurately identifies distress in cancer patients [6]. Another measure was the Problem Checklist (PL) of the patient was documented. Both DT and PL are well-validated and mandated screening tools. Patients are requested to rate their distress on a scale ranging between 0 -10 (0 - no distress; 10 - extreme distress). Patients scored below 4 were excluded from the study. Cancer patients enrolled for the program were requested to fill an DT and PL questionnaire. Patients were included based on the distress score; patients scored below 4 were excluded from the study.

Psycho oncology counseling sessions for all participants were conducted online. It included a generic approach to improve coping with current or future challenges of illness and preventing or reducing psychosocial problems, e.g. (health) anxiety or difficulties in relationships (family, friends and colleagues). The intervention process is given in Figure 1.

After the PI, an evaluation questionnaire was used to assess Feasibility and satisfaction with the OPC in post – OPC intervention. Patients were asked to give the OPC an overall grade on a 5-point Likert-scale (1-5). They were asked to indicate their level of comfort with the duration of the session on a 3-point Likert-scale (1-3). The extent of PI followed by the patients were assessed on a 3-point Likert-scale (1-3). The reasons for following and not following PI were explored using one open-ended question. Furthermore, patients’ willingness to recommend PI to other cancer patients were assessed using a 3-point Likert-scale (1-3).

Questions regarding feasibility and satisfaction included are as: “Were you able to follow PI in the last one month”? and “Would you recommend OPC to other cancer patients”? Likert scale was used to obtain the response from participants at post – OPC intervention.

Two Open-ended questions were also included. Thematic analysis was followed to analyze the data. Qualitative responses were recoded and transferred into quantitative variables into frequencies. The reasons for the same were also explored using an open-ended question.

The statistical analyses were conducted using IBM SPSS Statistics Version 26 (IBM Corporation, NY). Descriptive statistics were employed to provide a comprehensive overview of participants’ socio-demographic and medical characteristics. The feasibility and satisfaction of the Online Psycho-Oncology Intervention (OPC) were assessed using descriptive statistics. Additionally, a thematic analysis was applied to qualitative data gathered from the feasibility and satisfaction scale. To explore the preliminary effectiveness of the intervention, differences in distress scores between pre and post-intervention were examined using parametric tests, specifically the Paired T-Test. Statistical significance was set at p < 0.05 to determine the presence of meaningful differences.

The study, encompassing 30 cancer patients, revealed a predominantly female and married cohort (70% and 96.67%, respectively), with a mean age of 47.73 ± 9.30 years. Employment distribution highlighted 43.33% engaged in paid occupations (Table 2).

Understanding and addressing the distress experienced by cancer patients is pivotal in developing effective interventions within the realm of psycho-oncology. This study aimed to evaluate the impact of Online Psycho-Oncology (OPC) as an intervention in alleviating distress among cancer patients.

In a study, cancer patients’ distress was assessed using the Distress Thermometer (DT) and Problem List (PL) by NCCN, revealing prevalent concerns such as fears, worry, and fatigue. Our study aligns with these findings, highlighting “fatigue,” “anxiety,” and “changes in appearance” as predominant concerns among the cohort [11].

Focusing on individuals aged 30-59, this study revealed a high distress level of 73.3% even after the intervention, emphasizing a significant prevalence of distress within this age group. This aligns with existing literature reporting distress rates ranging from 30% to 60% [7, 8]. Early diagnosis of distress, coupled with interventions, has shown positive outcomes in improving the quality of life and treatment results for cancer patients [9, 10].

Noteworthy is the decline in distress scores observed post-implementation of the OPC intervention. This ground breaking aspect of our study, being the first to conduct online sessions for cancer patients and report a significant reduction in distress levels, underscores the potential of online interventions in enhancing the psychological well-being of cancer patients, marking a significant advancement in psycho-oncology.

Studies involving advanced cancer patients, have demonstrated positive outcomes with psychosocial interventions, including cognitive-behavioral therapy, in reducing fatigue and enhancing quality of life.

Mindfulness-based cognitive therapy has also shown sustained improvements in psychological distress, fatigue, spiritual well-being, and overall quality of life [11-16].

The virtual format of our psycho-oncology counseling program may have contributed to the success of our study by overcoming logistical barriers, providing a sense of anonymity and privacy, and offering greater flexibility in scheduling. These advantages likely played a significant role in minimizing dropout rates and ensuring consistent participation in follow-up sessions.

Despite these contributions, certain limitations must be acknowledged, including the absence of a control group and the measurement of effects within a one-month post-intervention timeframe with a limited sample size. Future research will address these limitations by employing larger cohorts to enhance statistical measures. The promise demonstrated by OPC for patients suggests the need for ongoing development and continuous follow-up at specific intervals to optimize the efficacy and alignment of psycho-oncology interventions with evolving patient needs. Comprehensive follow-up procedures will provide a more in-depth understanding of the long-term outcomes and effectiveness of psycho-oncology interventions.

In conclusion, the study highlights the transformative potential of digital interventions in the field of psycho- oncology, offering new avenues for providing accessible and effective support to individuals navigating the challenges of cancer diagnosis and treatment.

The authors thank all the Cancer patients for their participation in the study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for- profit sectors.

The authors have no conflict of interest to declare. The contents of this paper do not necessarily reflect the views of the organization (s) the authors are affiliated to.

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