Novel Clinician-Lead Intervention to Address Fear of Cancer Recurrence in Breast Cancer Survivors

Abstract

PURPOSE: Fear of cancer recurrence (FCR) affects 50%-70% of cancer survivors. This multicenter, single-arm study sought to determine the participant-rated usefulness of an oncologist-delivered FCR intervention. METHODS: Women who completed treatment for early breast cancer (could be receiving endocrine therapy) with baseline FCR > 0 were invited to participate. FCR was measured using a validated 42-item FCR Inventory. The brief oncologist-delivered intervention entailed (1) FCR normalization; (2) provision of personalized prognostic information; (3) recurrence symptoms education, (4) advice on managing worry, and (5) referral to psycho-oncologist if FCR was high. FCR, depression, and anxiety were assessed preintervention (T0), at 1 week (T1), and 3 months (T2) postintervention. The primary outcome was participant-rated usefulness. Secondary outcomes included feasibility and efficacy. RESULTS: Five oncologists delivered the intervention to 61/255 women invited. Mean age was 58 ± 12 years. Mean time since breast cancer diagnosis was 2.5 ± 1.3 years. Forty-three women (71%) were on adjuvant endocrine therapy. Of 58 women who completed T1 assessment, 56 (97%) found the intervention to be useful. FCR severity decreased significantly at T1 (F = 18.5, effect size = 0.39, P < .0001) and T2 (F = 24, effect size = 0.68, P < .0001) compared with baseline. There were no changes in unmet need or depression or anxiety. Mean consultation length was 22 minutes (range, 7-47 minutes), and mean intervention length was 8 minutes (range, 2-20 minutes). The intervention was perceived as useful and feasible by oncologists. CONCLUSION: A brief oncologist-delivered intervention to address FCR is useful and feasible, and has preliminary efficacy in reducing FCR. Plans for a cluster randomized trial are underway.

Patients’ and Oncologists’ Perspectives On A Novel Clinician Led Fear of Cancer Recurrence (CIFeR) Intervention

“…Recently, the CIFeR single-arm Phase I-II study demonstrated that oncologists could deliver CIFeR in eightminutes at a follow up consultation; CIFeR was acceptable, feasible and reduced FCR severity 3-months post-intervention [13][14]. The current qualitative sub-study complements the quantitative CIFeR data, by exploring patients' and clinicians' experiences of receiving and delivering the CIFER intervention.…”

“…Participants Female, early stage (I-III inclusive) breast cancer survivors who had participated in the CIFeR study were eligible [13][14][15]. Inclusion criteria were women: ≥18 years old, at least 6 months to 5 years post-treatment (i.e.…”

“…Inclusion criteria were women: ≥18 years old, at least 6 months to 5 years post-treatment (i.e. surgery, adjuvant chemotherapy and/or radiotherapy) and pro cient in English, with a Fear of Cancer Recurrence Inventory (FCRI) [13][14][15] Severity subscale score > 0.…”

“…Clinicians' perceived the delivery of CIFeR to take 0 -5 mins (n = 2) to 6 -10 minutes (n = 3), which matched objective measures indicating CIFeR delivery took 8 minutes on average. 14 All clinicians indicated they had used CIFeR with patients outside the study and would very likely continue using it in future: "Some women were reporting FCR many years later, and discussion was bene cial. Reminds us of the importance of discussing this topic with every patient during recovery from their treatment phase."…”

Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors

“…of Arms Delivery Mode Intervention Outcomes Effect Size Cohen’s d (Time of Assessment) I.Psychoeducation and preventative interventions Pradhan et al (2021) 38 62 Ovarian Cancer Single-arm Online: Psychoeducational booklet Psychoeducation: Online PDF booklet. No effect on fear of progression 0.17 1 week Liu et al (2021) 32 61 Breast Cancer Single-arm Face-to-face Oncologist delivered preventative intervention FCR reduced 0.39 (1 month) 0.68 (3 months) Dieng et al (2016) 40 164 Melanoma Two Psychoeducational booklet Psychoeducation plus psychodynamic-based psychotherapy FCR reduced 0.5 (1 month) 0.3 (6 months) 3 Telephone sessions Sterba et al (2015) 83 92 Breast Cancer Two Mixed In-person video sessions and educational booklets No effect on cancer-related worries −0.22 II.Self-help and internet-delivered interventions Otto et al (2017) 42 67 Breast Cancer Two Online Positive psychology: Gratitude intervention No effect on FCR ...…”