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Cancer-Related Distress

There are about 18 million cancer patients and survivors in the United States today. Nearly half of all cancer patients experience psychosocial distress, anxiety, or depression.


Fewer than half of patients who experience cancer-related distress are referred to mental health care specialists.

If left untreated, these feelings can lower a cancer survivors' quality of life and may negatively affect survival. The National Comprehensive Cancer Network (NCCN) has proposed guidelines for the delivery of mental health care services in oncology, which include screening patients for signs of distress and implementing a treatment plan to address these needs with a mental health care specialist.

Unfortunately, fewer than half of patients who experience cancer-related distress are referred to mental health care specialists. Prescription digital therapeutics that help to treat cancer-related distress have the potential to help close this cancer treatment gap. These may incorporate cognitive behavioral stress management (CBSM), which has been tailored to cancer patients and shown in numerous clinical studies to improve emotional well-being, physical health, and overall survival.

About Cognitive Behavioral Stress Management

Cognitive Behavioral Stress Management (CBSM) is an evidence-based protocol adapted from Cognitive Behavioral Therapy (CBT) and relaxation stress management, designed specifically for patients with cancer. CBSM was originally developed by a clinical psychologist, Michael Antoni, Ph.D. CBSM has been studied since the early ’90s, and has been published in multiple clinical studies.

Key Research

Reduction of Cancer-Specific Thought Intrusions and Anxiety Symptoms With a Stress Management Intervention Among Women Undergoing Treatment for Breast Cancer.
Antoni MH, Wimberly SR, Lechner SC, et al.
Am J Psychiatry. 2006 Oct;163(10):1791-7.

Cognitive Behavioral Stress Management Improves Stress-Management Skills and Quality of Life in Men Recovering From Treatment of Prostate Carcinoma.
Penedo FJ, Dahn JR, Molton I, et al.
Cancer. 2004;100(1):192-200.

Long-term Psychological Benefits of Cognitive-Behavioral Stress Management for Women With Breast Cancer: 11-year Follow-Up of a Randomized Controlled Trial.
Stagl JM, Bouchard LC, Lechner SC, et al.
Cancer. 2015 Jun 1;121(11):1873-81.


CBSM provides long-term benefits

A Randomized Controlled Trial of Cognitive-Behavioral Stress Management in Breast Cancer: Survival and Recurrence at 11-year Follow-Up.
Stagl JM, Lechner SC, Carver CS, et al.
Breast Cancer Res Treat. 2015 Nov;154(2):319-28.

Randomized Controlled Trial of Cognitive Behavioral Stress Management in Breast Cancer: A Brief Report of Effects on 5-year Depressive Symptoms.
Stagl JM, Antoni MH, Lechner SC, et al.
Health Psychol. 2015 Feb;34(2):176-80.


CBSM helps patients with prostate cancer

Identifying How and for Whom Cognitive-Behavioral Stress Management Improves Emotional Well-Being Among Recent Prostate Cancer Survivors.
Traeger L, Penedo FJ, Benedict C, et al.
Psychooncology. 2013 Feb;22(2):250-9.

Feasibility, Acceptability, and Preliminary Efficacy of a Technology Assisted Psychosocial Intervention for Racially Diverse Men With Advanced Prostate Cancer.
Yanez B, McGinty HL, Mohr DC, et al.
Cancer. 2015 Dec 15;121(24):4407-15.

Technology Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men With Advanced Prostate Cancer: Results From a Randomized Controlled Trial.
Penedo FJ, Fox RS, Oswald LB, et al.
Int J Behav Med. 2020 Jan 2.


CBSM improves physiological markers of stress

Cognitive Behavioral Stress Management Reduces Serum Cortisol by Enhancing Benefit Finding Among Women Being Treated for Early Stage Breast Cancer.
Cruess DG, Antoni MH, McGregor BA, et al.
Psychosom Med. May-Jun 2000;62(3):304-8.

Stress Management Intervention Reduces Serum Cortisol and Increases Relaxation During Treatment for Nonmetastatic Breast Cancer.
Philips KM, Antoni MH, Lechner SC, et al.
Psychosom Med. 2008 Nov;70(9):1044-9.

Cognitive-behavioral Stress Management Reverses Anxiety-Related Leukocyte Transcriptional Dynamics.
Antoni MH, Lutgendorf SK, Blomberg B, et al.
Biol Psychiatry. 2012 Feb 15;71(4):366-72.

The Effects of a Randomized Trial of Brief Forms of Stress Management on RAGE-associated S100A8/A9 in Patients With Breast Cancer Undergoing Primary Treatment.
Taub CJ, Lippman ME, Hudson BI, et al.
Cancer. 2019 May 15;125(10):1717-1725.


CBSM helps patients with breast cancer

Cognitive-behavioral Stress Management Intervention Decreases the Prevalence of Depression and Enhances Benefit Finding Among Women Under Treatment for Early Stage Breast Cancer.
Antoni MH, Lehman JM, Kilbourn KM, et al.
Health Psychol. 2001 Jan;20(1):20-32.

How Stress Management Improves Quality of Life After Treatment for Breast Cancer.
Antoni MH, Lechner SC, Kazi A, et al.
J Consult Clin Psychol. 2006 Dec;74(6):1143-52.

Cognitive Behavioral Stress Management Effects on Psychosocial and Physiological Adaptation in Women Undergoing Treatment for Breast Cancer.
Antoni MH, Lechner S, Diaz A, et al.
Brain Behav Immun. 2009 Jul;23(5):580-91.

Brief Cognitive-Behavioral and Relaxation Training Interventions for Breast Cancer: A Randomized Controlled Trial.
Gudenkauf LM, Antoni MH, Stagl JM, et al.
J Consult Clin Psychol. 2015 Aug;83(4):677-688.

Cognitive Behavioral Stress Management Increases Benefit Finding and Immune Function Among Women With Early-Stage Breast Cancer.
McGregor, BA, Antoni MH, Boyers A, et al.
J Psychosom Res. 2004 Jan;56(1):1-8.


CBSM works in diverse populations

Stress Management Effects on Perceived Stress and Cervical Neoplasia in Low-Income HIV-infected Women. Antoni MH, Pereira DB, Marion I, et al.
Psychosom Res. 2008 Oct;65(4):389-401.

Cognitive Behavioral Stress Management and Psychological Well-Being in HIV+ Racial/Ethnic Minority Women With Human Papillomavirus.
Jensen SE, Pereira DB, Whitehead N, et al.
Health Psychol. 2013 Feb;32(2):227-230.