Blended Cognitive Behavior Therapy May Reduce Fear of Cancer Recurrence

Blended cognitive behavior therapy (bCBT) can help reduce the severity of fear of cancer recurrence in survivors, according to a new randomized study.

“Fear of cancer recurrence (FCR), defined as ‘fear, worry, or concern about cancer returning or progressing,’ is one of the most commonly cited concerns of cancer survivors,” wrote study authors led by Marieke van de Wal, a PhD candidate at Radboud University Medical Center in Nijmegen, the Netherlands. “[H]igh levels of FCR are associated with intrusive thoughts and re-experiencing the event, avoidance of reminders of cancer, hypervigilance, difficulty in making future plans, and increased emotional distress.”

Previous research has shown that high FCR can affect more than 30% of survivors of common cancer types, long after completion of treatments. The new study assessed whether bCBT could overcome this barrier. With blended therapy, part of the therapy is delivered in person, and part is offered via web-based consultation or with other formats.

This study randomized 88 cancer survivors with high FCR based on a Cancer Worry Scale score of 14 or higher, who were between 6 months and 5 years from treatment; patients either underwent bCBT (45 patients), including five face-to-face and three online sessions, or care as usual (43 patients). The results were published online ahead of print on May 4 in the Journal of Clinical Oncology.

Patients completed questionnaires assessing FCR at baseline and at 3 months; the bCBT sessions occurred between those points. The decrease in FCR over that period was significantly greater with bCBT than with usual care, with a mean difference of -3.48 (P < .001) and a “moderate-to-large” effect size (d = 0.76). Those receiving bCBT had better improvement on four of seven subscales of the Fear of Cancer Recurrence Inventory, as well as on global quality of life, emotional functioning, and cognitive functioning.

There were no increases in FCR reported in either group. Thirteen of 45 bCBT patients experienced a clinically significant improvement in FCR (29%), compared with none of the 43 usual care patients (P < .001).

In terms of implementation of bCBT, there were some obstacles. Seven of 42 patients were unable to use the web site because of a lack of internet skills, so instead requested a workbook version. The therapy lasted a mean of 10.9 weeks, and 66% of patients completed all the sessions; those who completed the sessions had significantly better FCR scores at the end of the study period than those who did not (P = .008).

“To the best of our knowledge, this is the first randomized controlled trial to demonstrate effects of a psychological intervention on FCR reduction in a mixed group of cancer survivors,” the authors wrote. “Given that some FCR is normal, many health professionals find it difficult to identify patients with high FCR. Developing educational programs for healthcare professionals regarding the prevalence of FCR and its characteristics, consequences, and treatments is therefore a priority.”