A Multi-step Approach to Adapting a Mind-Body Resiliency Intervention for Fear of Cancer Recurrence and Uncertainty in Survivorship (IN FOCUS)

Abstract

Background: For cancer survivors, there is a paucity of fear of recurrence (FOR) interventions that integrate empirically supported mind-body and psychological skills for managing FOR and are delivered in scalable formats. 

Objective: To adapt an evidence-based resiliency intervention to address FOR among cancer survivors.

Methods: A multidisciplinary team of researchers, clinicians, and patient stakeholders followed an iterative intervention adaptation process (ORBIT). In Step 1, we sought to define key FOR management skills through a literature review and feedback from stakeholders. In Step 2, we integrated findings into a treatment manual and refined procedures for in-person delivery to groups of cancer survivors. In Step 3, we conducted a single arm trial to assess initial acceptability and change in FOR severity with 23 cancer survivors (N=4 intervention groups). In Step 4, we conducted additional qualitative interviews with 28 cancer survivors (N=6 focus groups stratified by FOR severity, N=15 individual interviews) to define adaptive and maladaptive strategies for coping with FOR and to identify preferences for delivery. In Step 5, we refined the treatment manual and procedures for testing in a future pilot randomized feasibility trial.

Results: We identified critical feedback using a combination of qualitative and quantitative methods. The single arm trial suggested preliminary feasibility and sustained reductions in FOR severity, yet need for refinement (i.e., eligibility, delivery modality), prompting additional qualitative interviews for further targeting. The resulting intervention (IN FOCUS) is comprised of virtual, synchronous, group-delivered sessions that offer an integrated approach to FOR management by teaching cognitive-behavioral techniques, meditation, relaxation training, adaptive health behaviors, and positive psychology skills. Sessions are targeted by applying skills to FOR and associated healthcare engagement.

Conclusions: IN FOCUS is a targeted intervention for teaching mind-body resiliency skills to groups of cancer survivors with elevated FOR. Next steps are testing feasibility in a pilot randomized trial.

A spotlight on avoidance coping to manage fear of recurrence among breast cancer survivors in an eHealth intervention

“…BCS who cope with FoR by avoidance were more likely to report severe post-traumatic anxiety symptoms and worse global mental health as compared to BCS without avoidance coping. The importance of avoidance coping in perpetuating FoR and exacerbating negative outcomes associated with FoR is supported by prevailing theoretical models of FoR (Lee-Jones et al, 1997;Leventhal et al, 1998) and resiliency through FoR management (Hall et al, 2022) but, prior to this study, there has been surprisingly little empirical investigation on FoR, avoidance coping, and intervention engagement. Collectively, this study is the first to characterize avoidance coping among BCS enrolled in an intervention targeting FoR and has several implications for the treatment of these prevalent fears in cancer survivors who cope by avoidance.…”

“…Cognitive techniques could also target maladaptive beliefs underlying avoidance (e.g., "thinking about my cancer might make it recur" or "I can't cope with anxiety, so I'll avoid thinking about cancer altogether"). Moreover, eHealth FoR interventions that incorporate synchronous sessions could offer real-time tailoring of skills to address avoidance coping (Hall et al, 2022). In non-cancer populations, avoidance coping has been associated with lower utilization of potentially life-saving healthcare (Wolf & Mori, 2009), including mental health services (Adams et al, 2018).…”

“…For instance, Lee-Jones et al's adapted model of Leventhal's Self-Regulation Model of Illness (Lee-Jones et al, 1997;Leventhal, Diefenbach, & Leventhal, 1992;Leventhal et al, 1998) posits that adaptive coping strategies enhance BCSs' confidence in their ability to manage cancer or recurrence, whereas avoidance coping strategies lower BCSs' confidence in their ability to cope, leading to poorer emotional health (e.g., distress, anxiety, depression, body image concerns), unhealthy behaviors (e.g., increased alcohol use and sedentary behavior), and avoidance of potentially lifesaving medical tests and procedures. More recently, cancer survivors' coping has been implicated as a key process underlying greater resiliency through FoR management (Hall et al, 2022). Few studies have examined these associations empirically (Cohee et al, 2021;Guimond et al, 2019;Yamani Ardakani et al, 2020).…”

Survivorship Experiences of Chinese Hematopoietic Stem Cell Transplantation Survivors

“…Psychological problems, including "disturbed by survivorship uncertainty" and "feeling worthless," deserve more attention. Related strategies such as "mind-body resiliency intervention," 49 "self-management intervention," 16 and "value achieving interventions" 47,48 might be feasible for reducing uncertainty across the survivorship, promoting meaning, finding value, and improving psychological well-being but still need to be examined in Chinese HSCT survivors. In addition, healthcare providers should disseminate accurate knowledge and information about hematological cancers and HSCT to the public to reduce disease and HSCT-related discrimination.…”