Citation: Tack L, Lefebvre T, Lycke M, Langenaeken C, Fontaine C, Borms M, Hanssens M, Knops C, Meryck K, Boterberg T, Pottel H, Schofield P, Debruyne PR. A randomised wait-list controlled trial to evaluate Emotional Freedom Techniques for self-reported cancer-related cognitive impairment in cancer survivors (EMOTICON). EClinicalMedicine. 2021 Aug 19;39:101081. doi: 10.1016/j.eclinm.2021.101081. PMID: 34466793; PMCID: PMC8385168.
Open Access Link to Full Text: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00361-8/fulltext
ABSTRACT:
Background
Cancer-related cognitive impairment (CRCI) is a prevalent source of comprised quality of life in cancer survivors. This study evaluated the efficacy of Emotional Freedom Techniques (EFT) on self-reported CRCI (sr-CRCI).
Methods
In this prospective multicentre randomised wait-list controlled study (ClinicalTrials.gov Identifier: NCT02771028), eligible cancer survivors had completed curative treatment, were 18 years or older and screened positive for sr-CRCI with ≥ 43 on the Cognitive Failures Questionnaire (CFQ). Participants were randomised to the immediate treatment group (ITG) or wait-list control (WLC) group, based on age (< or ≥ 65 years), gender, treatment (chemotherapy or not), and centre. The ITG started to apply EFT after inclusion and performed this for 16 weeks. The WLC group could only start the application of EFT after 8 weeks of waiting. Evaluations took place at baseline (T0), 8 weeks (T1) and 16 weeks (T2). The primary outcome was the proportion of patients with sr-CRCI according to the CFQ score.
Findings
Between October 2016 and March 2020, 121 patients were recruited with CFQ ≥ 43 indicating sr-CRCI. At T1, the number of patients scoring positive on the CFQ was significantly reduced in the ITG compared to the WLC group (40.8% vs. 87.3% respectively; p<0.01). For the WLC group, a reduction in CFQ scores was observed at T2, comparable to the effect of the ITG at T1. Linear mixed model analyses indicated a statistically significant reduction in the CFQ score, distress, depressive symptoms, fatigue and also an improvement in quality of life.
Interpretation
This study provides evidence for the application of EFT for sr-CRCI in cancer survivors and suggests that EFT may be useful for other symptoms in cancer survivors.
Funding
Stand up to Cancer (Kom op tegen Kanker), the King Baudouin Foundation (J1121310) and the AZ Groeninge clinical trials fund.
Keywords
Subjective cognitive complaints
Emotional freedom techniques
Cancer-related cognitive impairment
Cancer survivorship
Craig’s Notes:
This is research done with the highest rigor, published by one of the most respected journals and is one of only 2-3 research papers showing the efficacy of EFT to help cancer patients.It is of significant importance that this study is published in EClinicalMedicine which is published by the Lancet, one of THE most respected medical journals in the world. You do not even have to read beyond the study abstract to find these powerful statements about EFT:
- “Clinical EFT is an evidence-based method that combines elements of cognitive and somatic therapies with acupressure.”
- “This approach has been validated in more than 100 clinical trials that have shown that EFT is an efficacious and safe self-help tool to improve both physiological and psychological symptoms in non-cancer patients.”
- “This is the first study to acknowledge EFT as an active treatment for sr-CRCI and highlights the potential of EFT to improve quality of life, distress levels, depressive symptoms, and fatigue in cancer survivors.”
- “Implication of all the available evidence: As a safe and reliable self-help method, EFT demonstrates clinical utility as a low-cost non-drug treatment for sr-CRCI in cancer survivors, easy to implement in clinical practice.”
This study (referred to as an EMOTICON trial) explores the effectivenes of EFT for Cancer-related cognitive impairment (CRCI) also referred to as brain fog or “chemo-brain” or “chemo-fog” though the latter does not include the brain fog that can appear pre-chemotherapy treatment as well. It is discussed that cognitive difficulties can have a detrimental effect on a patient’s sense of autonomy, return to work, social relationships, and self-confidence in the context of long-term cancer care. They discuss recent explorations of psychosocial interventions, such as cognitive behaviour therapy (CBT) and mindfulness to help patients cope with emotional stress, anxiety and depression during and after cancer. The researchers decided to see the results of using EFT for this condition, clinically examined for the first time, stating: ” EFT utilizes established techniques including cognitive restructuring, exposure, and systematic desensitization, but it adds the novel component of stimulating acupuncture points (acupoints) whilst disturbing memories or triggers are mentally activated.”
According to the researchers: This prospective multicentre randomised wait-list controlled study was coordinated by AZ Groeninge Kortrijk (Belgium) and took place in three Belgian centers. The study period was from 2016-2020 and the final reporting number of participants was 121, with 93% being feamle, an average age of 53%, with breast cancer being the most predominant diagnosis.
Patients eligible for this study were diagnosed with a solid tumour or haematologic malignancy and had completed curative cancer treatment including chemotherapy, radiotherapy, surgery or targeted therapy. Eligible patients were randomised into one of two groups: an immediate treatment group (ITG) or wait-list control (WLC) group. The first group began using EFT for 16 weeks: the first eight weeks they applied the technique under supervision of the EFT instructor (until time point T1), while the next eight weeks they were asked to continue the application of EFT without intervention (‘observation 8 weeks’ until T2). The WLC group could only start the application of EFT at T1, after eight weeks of waiting. Thereafter, they cross over to the intervention arm and applied EFT for 8 weeks under supervision of the EFT instructor, until T2.
A first session “how to apply EFT” took place with the local EFT International EFT practitioner. This first session lasted between 40 and 90 min. A second follow-up session usually took place one week later and lasted about 10 to 20 min. Assessments were done at baseline (before randomisation) (time point 0 (T0)), after eight weeks (T1), and after 16 weeks (T2). Participants could continue the application of EFT after the period of eight or 16 weeks. Follow-up evaluation six and 12 months after study participation consisted of the EuroQol EQ-5D-3 L and the question if patients continued the application of EFT.
So what did the results show? The data showed that EFT reduced cognitive complaints reduced by 46.5% when comparing the between the EFT treatment group compared to the waitlist group at 8 weeks (p<0.01), almost twice the assumed difference…which according to the authors their expectation had been a 25% improvement using EFT. When the waitlist group then began EFT, after 8 weeks any difference was no longer statistically significant as their use of EFT resulted in a similar reduction of cognitive complaints in the Waitlist group, catching up with the same effect in the 16 week EFT treatment group.
In summary according to the authors: This multicentre randomised wait-list controlled trial demonstrated that EFT is an effective strategy for patients suffering from sr-CRCI. Furthermore, EFT is associated with multidimensional improvements in mental well-being and quality of life. These data highlight the importance of monitoring for sr-CRCI and to implement strategies to manage sr-CRCI. This trial highlights EFT as a safe, effective, low cost and low threshold intervention, easy to implement in clinical practice.
