June 06, 2023; Unhurry Expert Research Team
In This Article
About 50 percent of all cancer survivors and 70 percent of young breast cancer survivors report moderate to high fear of recurrence. A study published in the American Society of Clinical Oncology states a psychological intervention called Conquer Fear substantially lowered the fear of recurrence immediately after the intervention.
The fear can be so distressing that it negatively affects medical follow-up behaviour, mood, relationships, work, goal setting, and quality of life.
“The number of people surviving cancer is higher than ever before, but many survivors fear that cancer will return even long after they have finished treatment. The hope is that the positive results of this fear-reducing intervention will pave the way for making it more widely available to patients,” said Don S. Dizon, MD, FACP, ASCO Expert.
A psychological intervention called Conquer Fear substantially
Conquer Fear, a psychological treatment, significantly reduced fear of recurrence immediately following the intervention as well as three and six months later in a phase II randomized clinical trial. Immediate improvements in general anxiety, cancer-specific distress, and quality of life were seen in the psychological intervention group.
“The reduction in fear of recurrence in the psychological intervention group was large enough to improve survivors’ psychological and emotional well-being,” said lead study author Jane Beith, MD, PhD, a Medical Oncologist at the University of Sydney in Australia, who developed the Conquer Fear intervention with colleagues, including psycho-oncologist Phyllis Butow, BA(Hons)Dip Ed, MClinPsych, MPH, PhD.
“The majority of participants were young women with breast cancer, but we expect the intervention may be appropriate for other patients who have moderate to high fear of recurrence,” she added.
About the Conquer Fear Intervention
The Conquer Fear psychology intervention is based on a novel theoretical framework developed by the authors (the intervention was developed for research). Over the course of ten weeks, five individual, face-to-face sessions lasting 60 to 90 minutes each were conducted by trained study therapists.
Conquer Fear focuses on:
- accepting the inherent uncertainty of whether cancer would come back
- teaching strategies to control worry
- giving survivors more control over where they place their attention
- helping them focus on what they want to get out of life
- choosing a sensible level of cancer screening and sticking to it
About the Study
Researchers randomly assigned 222 survivors of stage I-III breast cancer, colorectal cancer, or melanoma who reported high fear of recurrence to either the Conquer Fear intervention or relaxation training (control group).
All survivors had completed cancer treatment two months to five years before enrolling in this study and were cancer-free at the time.
Five individual, face-to-face relaxation sessions lasting 60 minutes were given to survivors in the control group. The study therapists who gave the sessions over a period of ten weeks included rapid relaxation techniques, visualization, and muscle relaxation. Both groups were given directions for practice at home.
Researchers utilized total scores from a validated 42-item questionnaire known as the Fear of Cancer Recurrence Inventory, or FCRI, to gauge changes in patients’ fears of cancer recurrence. Higher ratings indicate worse fear of recurrence; the values range from 0 to 168. The questionnaire was filled out by survivors at enrolment, right after following the intervention, and three and six months later.
Key Findings of the Conquer fear intervention
In the intervention arm, the average FCRI score was 82.7 at baseline, compared to 85.7 in the control arm. The total fear-of-cancer-recurrence score, the study’s main finding, was significantly lower in the intervention group immediately following the intervention (18.1 points on average) than in the control group (7.6 points on average). This has a conventional effect size of 0.44, which falls within the range deemed clinically significant.
The average FCRI scores decreased with time, by 27.2 points in the intervention group and 17.8 points in the control group on average, with significant differences between the groups at six months.
The researchers also looked at other patient outcomes, such as quality of life (which includes independent living, physical pain, mental health, happiness, coping, relationships, and self-worth), cancer-specific distress (how much someone is troubled by thoughts about cancer), and general distress (anxiety, depression, and stress). Compared to relaxation training, the psychological intervention had a more favourable impact on these results.
Face-to-face intervention with those with severe fear of recurrence
The authors note that while Conquer Fear is effective in a face-to-face format, it is a time- and resource-intensive intervention. Other formats, such as delivery via the Internet, in a group, or by phone, may be possible. A stepped-care approach could also be considered, with only those with severe fear of recurrence receiving a face-to-face intervention.
“In this study, the interventions were delivered by experienced psycho-oncologists. It is possible that community psychologists or other professionals who have basic training in cognitive therapy could deliver the interventions, given appropriate training and supervision,” said Dr. Beith.
May 23, 2023; Unhurry Expert Research Team Cancer diagnoses can be extremely emotionally taxing for both patients and their families. This could continue for years
Materials provided by American Society of Clinical Oncology. Note: Content may be edited for style and length.
American Society of Clinical Oncology. “Psychological intervention lowers survivors’ fear of cancer recurrence.” ScienceDaily. ScienceDaily, 5 June 2017. <www.sciencedaily.com/releases/2017/06/170605092301.htm>.
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