The psychological intervention Conquer Fear lowered fear of cancer recurrence by a clinically meaningful amount among cancer survivors, most of whom were young breast cancer survivors. The results from the phase II randomized clinical trial evaluating Conquer Fear were presented at the 2017 ASCO Annual Meeting (Abstract LBA10000).
“With improved survival from cancer, there's been more focus on survivorship, and in particular in more recent years on fear of cancer relapse,” said lead study author Jane Beith, MD, PhD, a medical oncologist at the University of Sydney in Australia.
Most young breast cancer patients, about 70 percent, report moderate to high fear of recurrence. Fear of recurrence among all cancer survivors is common too, affecting about half.
“Fear of cancer relapse is associated with a poorer quality of life, greater distress, lack of planning for the future, avoidance of, or excessive, screening, and greater health care utilization,” Beith said. “We know that this can persist over the whole trajectory of their illness and now over 6 years since diagnosis.”
When asked about the study, Kelly Trevino, PhD, of the Center for Research on End-of-Life Care at Weill Cornell Medicine, New York, N.Y., said this is an “important study” and similarly “important area of research.”
“Fear of cancer recurrence is a real issue,” Beith said. “This is one of the first studies to show new benefit from new psychological intervention.”
The researchers enrolled 222 cancer survivors who had stage I-III breast cancer, colorectal cancer, or melanoma and reported high fear of cancer recurrence; most were young women who were breast cancer survivors. All participants had finished cancer therapy between 2 months and 5 years before the study.
Participants were then randomly assigned to either the control group or the intervention group. Those in the control group received, over a span of 10 weeks, five 60-minute in-person sessions during which trained study therapists used relaxation techniques.
Previous studies have found relaxation techniques to improve anxiety and depression among cancer patients, Beith said.
Currently, there is no standard therapy for fear of recurrence.
Those in the intervention group received, over a span of 10 weeks, five 60- to 90-minute in-person sessions during which trained study therapists used Conquer Fear. Instructions for at-home exercises were provided to both groups.
Conquer Fear focused on a few key items, including helping patients determine what was of value in their life and how to plan for their future, guiding patients on how to manage their concerns and worries, and teaching patients the appropriate amount of screening follow-up needed.
All participants filled out Fear of Cancer Recurrence Inventory (FCRI), a 42-item questionnaire, before the study to establish their baseline fear of recurrence. The questionnaire produced a score on scale of 0 to 168; a higher score indicated a greater fear of recurrence.
To measure an effect, the questionnaire was given again at three time points: immediately after the five sessions, 3 months after, and 6 months after.
“This study appears to have used a really robust design by randomizing patients to the intervention and also to a more active control condition,” Trevino said. “The fact that they compared Conquer Fear to relaxation training is a much stronger test of the intervention than if they had done treatment as usual or a more passive control group.”
Researchers found baseline FCRI scores to be on average 82.7 points for those in the intervention group and 85.7 for those in the control group. On average, immediately after therapy, those in the intervention group had a score 18.1 points lower than baseline and those in the control group had 7.6 points lower. The effect size for this outcome was 0.44, meaning the finding was statistically and clinically significant.
“The people receiving the intervention had a change that may impact their life and their well-being,” Trevino said regarding the meaningful effect size.
The scores continued to decrease at 3 months and 6 months after therapy for the intervention group as compared to the control; however, the outcome was statistically significant only at 3 months, not 6 months.
The study also evaluated a set of secondary outcomes, including general anxiety, cancer-related anxiety, and quality of life. Participants in the Conquer Fear group had better secondary outcomes than those of the control group immediately after treatment, but the difference between groups was not significant at 3 or 6 months.
Although the study showed Conquer Fear to be a successful intervention, the authors recognized it was labor-intensive and, therefore, may not be feasible for all settings.
“If we can't do an intervention like Conquer Fear, we can at least tell our folks now, based on this data, that something as simple as recommending relaxation techniques can improve their lives now,” commented Don S. Dizon, MD, FACP, ASCO Expert. “We need more interventions, and we need to recognize that there are things that our patients go through after cancer that are real, that are significant, and that cannot only impact their lives but also the lives of their families.”
Christina Bennett is a contributing writer.