Psychological Intervention Reduced Fear of Cancer Recurrence

CHICAGO-Use of a psychological intervention-Conquer Fear-significantly reduced fear of cancer recurrence in cancer survivors in the first 6 months after treatment, compared with the use of relaxation training, according to the results of a phase II randomized controlled trial (abstract LBA10000) presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2–6.

Fear of cancer recurrence is associated with poorer quality of life, greater distress, lack of planning for the future, avoidance of or excessive screening, and greater healthcare utilization. About 50% of all cancer survivors and 70% of young breast cancer survivors report moderate to high fear of recurrence, according to researcher Jane Beith, MD, PhD, a medical oncologist at the University of Sydney in Australia, who developed the Conquer Fear intervention with colleagues. Despite the prevalence of fear of recurrence, interventions to alleviate this fear are lacking.

“Fear of cancer recurrence is a real issue,” Beith said. “This is one of the first studies to show benefit from psychological intervention.”

In the study, Conquer Fear sessions focused on helping survivors accept the inherent uncertainty of whether their 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, and helping them choose a sensible level of cancer screening and stick to it. Participants worked with trained therapists in five 60- to 90-minute individual, face-to-face sessions over 10 weeks. Conquer Fear is not yet being used in clinical practice.

In the study, 222 survivors of stage I to III breast cancer, colorectal cancer, or melanoma, with high fear of recurrence were randomly assigned to the Conquer Fear intervention (n = 121) or to relaxation training (n = 101). The primary endpoint was reduction in fear of cancer recurrence immediately after intervention completion. The researchers conducted follow-up assessment with patients immediately and at 3 and 6 months post-treatment.

Change in fear of recurrence was measured using total scores from a validated 42-item questionnaire called the Fear of Cancer Recurrence Inventory (FCRI). A difference of 14.5 points in fear of recurrence was considered clinically significant.

The average FCRI score at baseline was 82.7 for the Conquer Fear group and 85.7 for the control arm. Participants in both groups improved in all outcome measures, according to Beith. However, the Conquer Fear arm performed better than the group that used relaxation techniques with regard to total fear of cancer recurrence scores at all time points.

Immediately after the intervention, patients in the intervention group had a mean reduction in the fear of recurrence score of 18.1 points, compared with 7.6 points in the control group (difference in change, -10.5; P < .001). Greater improvement in fear of recurrence was also seen in patients assigned to Conquer Fear at both 3 months (-7.6; P = .02) and 6 months (-7.8; P = .02) after the intervention, compared with those assigned to relaxation training. Assignment to Conquer Fear also improved the severity of fear of recurrence immediately after the intervention and at 3 months.

In the future, Beith and colleagues will explore the cost of implementing this intervention, as well as more accessible and more affordable formats.

Commenting on the study, ASCO Expert Don S. Dizon, MD, FACP, said, “We as oncologists only have about 15 minutes with patients, and assessment of patients in follow-up, for the most part, concentrates on cancer outcomes. When they leave the room, we assume that there is a level of fear of recurrence. What Dr. Beith is showing is that fear of recurrence is a real entity in patients treated for cancer and can last out to 6 years. If we can’t do an intervention like Conquer Fear, we can at least tell our folks now, based on these data, that something as simple as recommending relaxation techniques can improve their lives.”