Digest Commentator: Sophie Lebel, PhD, C.Psych, School of Psychology, University of Ottawa
Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto
Fear of cancer recurrence is a growing area of research, now with its own IPOS Special Interest Group called FORWARDS. As a researcher and clinician working on fear of cancer recurrence, I frequently get asked this question: “Fear of cancer recurrence is present in almost all of my patients but how can I help them deal with this fear? I am not sure it is something that can be changed”. Until recently, this feeling was warranted as there was only one published trial of an intervention to address fear of cancer recurrence (Herschbach et al, 2009), which showed that both group Cognitive Behavioral Therapy and group supportive expressive therapy were efficacious in reducing this fear. In November 2017, Butow and colleagues published the results of their trial of an individual therapy to address fear of cancer recurrence in cancer survivors in the Journal of Clinical Oncology. The intervention is called ConquerFear and consists of five face-to face individual sessions that cover attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting. Specifically, the intervention teaches strategies for controlling worry and excessive threat monitoring, modifying unhelpful beliefs about worry, and developing appropriate monitoring and screening behaviors, educates about follow-up and strategies (e.g., exercise) to reduce risk of recurrence, addresses existential issues, and promotes goal setting. One of the interesting features of this trial is that the intervention was compared to a nonspecific attention control intervention (five sessions of face-to-face relaxation training). The effects of the therapy were also assessed at 3- and 6-months post therapy. Participants (95% female) were 222 stage 0 to III breast, Dukes’ stage A to C colorectal, and Stage IA to IIB melanoma survivors who were disease-free and who displayed elevated levels of fear of cancer recurrence before being enrolled in the trial (as defined as a score of ≥ 13 on the Fear of Cancer Recurrence Inventory). Participants had completed adjuvant treatment 2 months to 5 years previously. They were randomly assigned to either ConquerFear or the control group. Twenty-six therapists from 17 sites across Australia participated and delivered both interventions. ConquerFear participants had clinically and statistically greater improvements than control participants from baseline to completion of the intervention on their fear of cancer recurrence score and these differences were still statistically significant at 3- and 6-month post-intervention. There were also significantly greater improvements reported by ConquerFear participants in general anxiety, cancer-specific distress, and mental quality of life and metacognitions from baseline to end of the intervention, however few of these differences were significant at the subsequent follow-ups. Interestingly, ConquerFear was effective regardless of baseline fear of cancer recurrence levels, stage of disease, age, education, and country of birth.
Why I liked the article: In conclusion, yes, it is possible to help patients deal with their fear of cancer recurrence. A next step will be to see how these interventions fare when implemented in clinical settings.
Citation: Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, Tesson S,O’Connell R, Girgis A, Gebski VJ, Asher R, Mihalopoulos C, Bell ML, Zola KG, Beith J, Thewes B. Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence. J Clin Oncol. 2017 Nov 2:JCO2017731257. doi: 10.1200/JCO.2017.73.1257.Journal website: http://ascopubs.org/doi/full/10.1200/JCO.2017.73.1257