Development and Feasibility of a Group Cognitive-Behavioral Therapy for Fear of Cancer Recurrence

Abstract Background Fear of cancer recurrence, depressive symptoms, and cancer-related fatigue are prevalent symptoms among cancer survivors, adversely affecting patients’ quality of life and daily functioning. Effect sizes of interventions targeting these symptoms are mostly small to medium. Personalizing treatment is assumed to improve efficacy. However, thus far the empirical support for this approach is lacking. The aim of this study is to investigate if systematically personalized cognitive behavioral therapy is more efficacious than standard cognitive behavioral therapy in cancer survivors with moderate to severe fear of cancer recurrence, depressive symptoms, and/or cancer-related fatigue. Methods The study is designed as a non-blinded, multicenter randomized controlled trial with two treatment arms (ratio 1:1): (a) systematically personalized cognitive behavioral therapy and (b) standard cognitive behavioral therapy. In the standard treatment arm, patients receive an evidence-based diagnosis-specific treatment protocol for fear of cancer recurrence, depressive symptoms, or cancer-related fatigue. In the second arm, treatment is personalized on four dimensions: (a) the allocation of treatment modules based on ecological momentary assessments, (b) treatment delivery, (c) patients’ needs regarding the symptom for which they want to receive treatment, and (d) treatment duration. In total, 190 cancer survivors who experience one or more of the targeted symptoms and ended their medical treatment with curative intent at least 6 months to a maximum of 5 years ago will be included. Primary outcome is limitations in daily functioning. Secondary outcomes are level of fear of cancer recurrence, depressive symptoms, fatigue severity, quality of life, goal attainment, therapist time, and drop-out rates. Participants are assessed at baseline (T0), and after 6 months (T1) and 12 months (T2). Discussion To our knowledge, this is the first randomized controlled trial comparing the efficacy of personalized cognitive behavioral therapy to standard cognitive behavioral therapy in cancer survivors. The study has several innovative characteristics, among which is the personalization of interventions on several dimensions. If proven effective, the results of this study provide a first step in developing an evidence-based framework for personalizing therapies in a systematic and replicable way. Trial registration The Dutch Trial Register (NTR) NL7481 (NTR7723). Registered on 24 January 2019.

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Fear of Cancer Recurrence

Psycho-Oncology ◽

10.1093/med/9780190097653.003.0094 ◽

2021 ◽

pp. 755-759

Author(s):

Allan B. Smith ◽

Joanna E. Fardell ◽

Phyllis N. Butow

Keyword(s):

Cancer Survivors ◽

Behavioral Therapy ◽

Unmet Need ◽

Cancer Recurrence ◽

Symptom Burden ◽

Fear Of Cancer Recurrence ◽

Future Research ◽

After Cancer ◽

Fear Of Cancer ◽

High Level

Fear of cancer recurrence (FCR) is broadly defined as “fear, worry or concern relating to the possibility that cancer will come back or progress.” Some degree of FCR is almost universal among cancer survivors, and management of FCR is frequently reported as an unmet need. Conceptualization and measurement of FCR remain challenging, as consensus regarding its multidimensional nature and clinical presentation is yet to be established. Accordingly, estimated prevalence rates of “clinical FCR” vary widely. Research suggests that if left untreated FCR remains stable over time, and that those who are younger, have greater symptom burden, and experience greater psychological distress are likely to experience more FCR. In contrast, medical (diagnosis staging, treatment, etc.) and other demographic variables do not appear to be strongly associated with FCR levels, making identification of FCR in clinical practice difficult. Brief FCR screening measures have been developed, but further work validating clinical cut-offs is needed. Those who experience a high level of FCR have poorer quality of life and experience difficulties moving on with their life after cancer diagnosis and treatment. A growing number of interventions have demonstrated efficacy in addressing FCR in recent years, with those using contemporary cognitive-behavioral therapy approaches focused on how patients relate to their thoughts, rather than on changing the contents of thoughts, shown to be most effective. Priorities for future research include development of treatment models, such as stepped care, that address the varying levels of FCR in cancer survivors and use interventions of varying intensity to efficiently address FCR.

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