Limitations
VULVAR CANCER
This trial has several limitations. We only recruited patients with 3 types of GCs, while those with other GCs (eg, vulvar cancer) were excluded. Patients with GC recruited from the 2 participating university-affiliated hospitals may not represent those in the hospitals located in rural or remote areas. Implementing the intervention may exclude patients who were unfamiliar with technology and not comfortable with technology, which might further hinder generalizability. The evaluation data are more likely to reflect only those patients with a strong interest in psychosocial interventions, which may lead to positive bias. Additionally, the information on patients' treatment regimen changes during the trial were not collected, and its impacts on the outcomes could not be known. We only followed up patients with GC until the completion of our intervention at 24 weeks. Some researchers have shown that web-based cognitive behavioral therapy interventions have a positive effect on the improvement of QoL and decrease of symptoms at 1-year and 3-year follow-ups [