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Hampton J, Alam A, Zdenkowski N, Rowe C, Fradgley E, O'Neill CJ. Fear of Cancer Recurrence in Differentiated Thyroid Cancer Survivors: A Systematic Review. Thyroid 2024; 34:541-558. [PMID: 38368547 DOI: 10.1089/thy.2023.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background: Despite excellent survival rates, health-related quality of life detriments are common in differentiated thyroid cancer survivors and can be driven by fear of cancer recurrence (FCR). This review aims to report the incidence of FCR in thyroid cancer survivors and synthesize evidence regarding contributing factors. An overview and appraisal of the range of tools used to measure FCR is presented. Methods: A systematic review of the English literature was performed. The search across six electronic databases generated 3414 studies. Two reviewers independently screened the citations and full-text articles, of which 31 were included. The data were extracted independently by two reviewers. Results: The incidence of FCR was reported in 27/31 studies and ranged from 15% to 91%. Direct comparisons regarding incidence and severity of FCR were not possible due to heterogeneity in cut-points used to define FCR. A total of eight validated tools were used to measure FCR across all studies, with five studies using self-developed nonvalidated items. There was minimal repetition of validated tools and no clear consensus as to a preferred survey tool. Factors influencing FCR were reported in 11 studies. There was minimal overlap of factors influencing FCR. Risk factors contributing to increased FCR reported in more than one study included young age and an upcoming clinical appointment. Male gender and higher education levels were reported in more than one article as protective. No literature evaluating interventions to address FCR in thyroid cancer survivors was found. Conclusion: FCR is common in thyroid cancer survivors, but significant heterogeneity in the current evidence base limits assessment of incidence, severity, or risk factors. There is a need to use validated tools to assess FCR in both research and clinical contexts. Reliable assessment of FCR may permit routine assessment of FCR in clinical practice and allow interventions to be prospectively evaluated to optimize the holistic well-being of thyroid cancer survivors.
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Affiliation(s)
- Jacob Hampton
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Ahmad Alam
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nicholas Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Christopher Rowe
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Department of Endocrinology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Elizabeth Fradgley
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christine J O'Neill
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Graham CD, Ellison R, Hall LH, Clark J, McNaught E, Green SMC, Wilkes H, Robson G, Lorentz I, Holmes L, Bould N, Hartley S, Naik J, Buckley S, Hirst C, Hartup S, Foy R, Neal RD, Velikova G, Farrin A, Collinson M, Smith SG. A pilot randomised controlled trial of acceptance and commitment therapy for medication decision-making and quality of life in women with breast cancer: The ACTION trial. Psychooncology 2024; 33:e6349. [PMID: 38752788 DOI: 10.1002/pon.6349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE Non-adherence to adjuvant endocrine therapy (AET) in women with breast cancer is common and associated with medication side-effects and distress. We co-designed an Acceptance and Commitment Therapy intervention (ACTION) to enhance medication decision-making and quality of life (QoL). We undertook a pilot trial of ACTION to inform the feasibility of a phase III trial, and to examine intervention acceptability. METHODS This was a multi-site, exploratory, two-arm, individually randomised external pilot trial. Women with early breast cancer prescribed AET were randomised (1:1) to receive usual care (UC) or UC + ACTION. The ACTION intervention comprised a remotely delivered one-to-one ACT session followed by three group sessions delivered by clinical psychologists, alongside a website containing ideas for the self-management of side effects. RESULTS Of the 480 women screened for eligibility, 260 (54.2%) were approached and 79 (30.4%) randomised. 71 (89.9%) women provided data at 3-month and 70 (88.6%) at 6-month 40 women were randomised to receive UC + ACTION and 32 (80.0%) completed the intervention. Most (75.0%) accessed the website at least once. ACTION was acceptable to participants (Borkovec & Nau Scale: mean = 7.8 [SD = 2.7] out of 10). Signals of effectiveness in favour of the UC + ACTION arm were observed for medication adherence (Adherence Starts with Knowledge questionnaire-12), QoL (work and social adjustment scale), health-related QoL (functional assessment of cancer therapy[FACT] general and FACT-ES-19/23), distress (generalised anxiety disorder -7, patient health questionnaire-9) and psychological flexibility (valuing questionnaire). CONCLUSIONS The ACTION intervention was acceptable to patients. There were promising signals for effectiveness on primary and secondary outcomes. A phase III randomised controlled trial is feasible. TRIAL REGISTRATION ISRCTN12027752.
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Affiliation(s)
- Christopher D Graham
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Rachel Ellison
- Department of Health Sciences, University of York, York, UK
| | - Louise H Hall
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Jane Clark
- Department of Clinical and Health Psychology, St James's University Hospital, Leeds, UK
| | - Emma McNaught
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sophie M C Green
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Hollie Wilkes
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Gita Robson
- Department of Clinical and Health Psychology, St James's University Hospital, Leeds, UK
| | - Ian Lorentz
- Department of Clinical and Health Psychology, St James's University Hospital, Leeds, UK
| | - Lucy Holmes
- Department of Clinical and Health Psychology, St James's University Hospital, Leeds, UK
| | - Nicky Bould
- Department of Clinical and Health Psychology, St James's University Hospital, Leeds, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jay Naik
- Department of Oncology, Harrogate & District Foundation Trust, Harrogate, UK
| | - Sarah Buckley
- Department of Clinical Research, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | | | - Sue Hartup
- St James's University Hospital, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - Richard D Neal
- APEx (Exeter Collaboration for Academic Primary Care), Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samuel G Smith
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
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Zhu X, Ren G, Wang J, Yan Y, Du X. A multiple linear regression analysis identifies factors associated with fear of cancer recurrence in postoperative patients with gastric cancer. Medicine (Baltimore) 2024; 103:e35110. [PMID: 38489733 PMCID: PMC10939660 DOI: 10.1097/md.0000000000035110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/11/2023] [Accepted: 08/16/2023] [Indexed: 03/17/2024] Open
Abstract
To investigate the risk factors of fear of cancer recurrence (FCR) in postoperative patients with gastric cancer (GC) and provide references for targeted nursing intervention development. A total of 84 patients who underwent GC surgery were included in this study. The fear of progression questionnaire-short form and social support rating scale were conducted, and multiple linear regression was performed to identify risk factors of FCR. The score of the fear of progression questionnaire-short form in patients with GC surgery was 39.1 ± 7.6. The results of multiple linear regression showed that age, education level, occupational status, course of the disease, Tumor node metastasis staging, and social support were the influencing factors of FCR in patients with GC (P < .05). The current situation of FCR in patients with GC surgery is not optimistic. The medical staff should pay more attention to patients with low age, low education level, unemployment, short course, high tumor node metastasis staging, low social support level, and other high-risk groups, and provide social support resources to reduce the level of FCR.
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Affiliation(s)
- Xuejuan Zhu
- Gastroenterology Department, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Guijun Ren
- Department of Hepatobiliary Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Junmin Wang
- Gastroenterology Department, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yajuan Yan
- Gastroenterology Department, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Xian Du
- Gastroenterology Department, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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Heathcote LC, Webster SN, Loecher N, Spunt SL, Simon P, Pradhan P, Coutts-Bain D, Sharpe L, Tutelman PR, Simons LE. The bodily threat monitoring scale: Development and preliminary validation in adult and childhood cancer survivors. Psychooncology 2023; 32:1885-1894. [PMID: 37916988 DOI: 10.1002/pon.6236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Bodily threat monitoring is a core clinical feature of Fear of cancer recurrence (FCR) and is targeted in psycho-oncology treatments, yet no comprehensive self-report measure exists. The aim of this study was the theory-informed development and initial validation of the Bodily Threat Monitoring Scale (BTMS). METHODS Adult survivors of breast and gynaecological cancers (Study 1: N = 306, age = 37-81 years) and childhood cancer survivors (Study 2: N = 126, age = 10-25 years) completed the BTMS, designed to assess how individuals monitor for and interpret uncertain symptoms as indicating that something is wrong with their body. Participants completed measures to assess construct and criterion validity of the BTMS, and childhood cancer survivors (Study 2) completed the BTMS again 2 weeks later to assess test-retest reliability. RESULTS The 19-item BTMS demonstrated excellent internal consistency across adult and childhood cancer samples (α = 0.90-0.96). Factor analyses indicated two subscales capturing 1. Monitoring of bodily sensations and 2. Threatening interpretations of bodily sensations. Two-week stability estimates were acceptable. For construct validity, the BTMS correlated with body vigilance and anxiety sensitivity. The BTMS also demonstrated criterion validity, yielding significant associations with FCR, intolerance of uncertainty, help-seeking behaviours, and quality of life. The BTMS was associated with FCR while controlling for body vigilance and anxiety sensitivity, indicating a unique contribution of this theory-informed measure. CONCLUSIONS The BTMS shows evidence of sound psychometric properties and could be used to elucidate the role of bodily threat monitoring in the maintenance and management of FCR.
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Affiliation(s)
- Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Sarah N Webster
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nele Loecher
- Department of Psychology and Behavioral Sciences, St Jude's Children's Research Hospital, Memphis, Tennessee, USA
| | - Sheri L Spunt
- Department of Pediatric Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Pamela Simon
- Department of Pediatric Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Poorva Pradhan
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Daelin Coutts-Bain
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- The School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Pereira L, Nguyen P, Benea A, Townsley C. A quality improvement project to optimize access to psychosocial care for cancer survivors who experience fear of recurrence. J Psychosoc Oncol 2023; 41:721-731. [PMID: 37702764 DOI: 10.1080/07347332.2023.2254755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND The prevalence of moderate to high levels of fear of cancer recurrence (FCR) in cancer survivors may vary from 22% to 87%, although most are not usually referred to psychosocial support. The After Cancer Treatment Transition (ACTT) clinic in Women's College Hospital (Toronto) provides follow-up care to cancer survivors but in a sample of 2893 patients seen April 2019 to March 2022, only 1.5% were referred to a social worker for psychosocial needs. A single-question screening tool is currently available to screen for FCR. OBJECTIVE To evaluate the use of the single-question screening tool for FCR among cancer survivors and its impact on social work referrals. RESULTS Between July and October 2022, 788 patients were seen in the ACTT clinic. Generally, most patients in ACTT are breast cancer survivors (75%), and the remaining survivors are a mix of other cancer types (colorectal cancer, ovarian cancer, thyroid cancer, melanoma). Three hundred thirty (41.9%) ACTT patients completed the single-question screening tool for FCR. Most screened patients were female (96%), the average age was 60 years, and most were diagnosed with breast cancer (90%). Among screened patients, 37 (11%) indicated a moderately severe to high level of FCR and efforts were made to refer these 37 patients to a social worker. In the end, 22 (59.5%) patients with moderately severe/high levels of FCR were offered and accepted referral to a social worker. In comparison to the 1.5% referred to social work (among 2893 patients) prior to FCR screening, referrals increased to 6.7% (among 330 screened). CONCLUSION Use of a single-question FCR screening tool improved identifying cancer survivors in need of psychosocial support and improved access to a social worker.
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Affiliation(s)
- Luana Pereira
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
| | - Patricia Nguyen
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
| | - Aronela Benea
- After Cancer Treatment Transition (ACTT) Program, Women's College Hospital, Toronto, ON, Canada
| | - Carol Townsley
- After Cancer Treatment Transition (ACTT) Program, Women's College Hospital, Toronto, ON, Canada
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Liu S, Zhang Y, Miao Q, Zhang X, Jiang X, Chang T, Li X. The Mediating Role of Self-Perceived Burden Between Social Support and Fear of Progression in Renal Transplant Recipients: A Multicenter Cross-Sectional Study. Psychol Res Behav Manag 2023; 16:3623-3633. [PMID: 37693331 PMCID: PMC10488562 DOI: 10.2147/prbm.s424844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose To explore the mechanism of social support and fear of progression (FoP) in renal transplant recipients (RTRs) and the self-perceived burden that acts as a mediator between social support and FoP. Patients and Methods Sociodemographic and clinical characteristics, the Social Support Rating Scale (SSRS), the Self-Perceived Burden Scale (SPBS), and the Fear of Progression-Questionnaire-Short Form (FoP-Q-SF) were used. Structural equation modeling (SEM) was used to examine the mediating role of self-perceived burden. Results Our results showed that social support was negatively related to the self-perceived burden (r = -0.28, p < 0.001) and FoP (r = -0.37, p < 0.001). Moreover, we determined that self-perceived burden was positively related to FoP (r = 0.58, p < 0.001) and that the indirect effect of social support on FoP via self-perceived burden was significant (β = -0.172, 95% CI: -0.253, -0.097), and with a mediating effect value of 36.9%. Conclusion The FoP in RTRs is a concern. Higher social support and lower self-perceived burden can reduce the risk of FoP. Healthcare professionals (HCPs) should assist RTRs in correctly evaluating an individual's social support system, helping them optimize social support to reduce the self-perceived burden and the development of FoP.
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Affiliation(s)
- Sainan Liu
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Ying Zhang
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Qi Miao
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Xu Zhang
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Xiaoyu Jiang
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Tiantian Chang
- The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Xiaofei Li
- Transplantation and Hepatobiliary Department, The First Affiliated Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
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Bae KR, Ahn Y, Park JW, Kim SJ. Exploring Fear of Cancer Recurrence (FCR) in cancer survivors from a medical social work perspective: A qualitative study of medical social workers in South Korea. PLoS One 2023; 18:e0288059. [PMID: 37410785 DOI: 10.1371/journal.pone.0288059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Fear of Cancer Recurrence (FCR) in cancer survivors has been insufficiently addressed despite its imperativeness in cancer journey. Although several studies have investigated healthcare professionals' experience with FCR in cancer survivors, a medical social work perspective has rarely been reflected. This study aimed to explore Korean medical social workers' experience with intervening FCR in cancer survivors. METHODS Snowball sampling recruited 12 experienced medical social workers intervening with cancer survivors at tertiary or university cancer hospitals in South Korea. Individual and focus-group interviews (FGI) were conducted with the medical social workers. The interviews were recorded, transcribed, and analyzed by using an inductive qualitative content analysis. RESULTS Content analysis of the interviews extracted the following major themes regarding FCR in cancer survivors. First, when and how FCR among cancer survivors emerged at the early stage of medical social work interventions was identified. Second, how medical social workers dealt with FCR in cancer survivors was illustrated. Third, the responses of cancer survivors to medical social work interventions for FCR were assessed. Finally, the internal and external issues underlying the medical social work interventions for FCR among cancer survivors were revealed and discussed. CONCLUSION Based on the results, this study suggested the implications on dealing with FCR in cancer survivors in the realm of medial social work profession. Furthermore, it expanded the discussion about FCR in cancer survivors from cancer hospitals to community.
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Affiliation(s)
- Ka Ryeong Bae
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Yeojin Ahn
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea
| | - Joung Won Park
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Division of Social Work, Samsung Medical Center, Seoul, South Korea
| | - Seok-Joo Kim
- Department of Social Welfare, College of Social Sciences, Daegu University, Gyeongbuk, South Korea
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Rose M, Graham CD, O'Connell N, Vari C, Edwards V, Taylor E, McCracken LM, Radunovic A, Rakowicz W, Norton S, Chalder T. A randomised controlled trial of acceptance and commitment therapy for improving quality of life in people with muscle diseases. Psychol Med 2023; 53:3511-3524. [PMID: 35192788 PMCID: PMC10277769 DOI: 10.1017/s0033291722000083] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/15/2021] [Accepted: 01/06/2022] [Indexed: 01/09/2023]
Abstract
UNLABELLED Abstract. BACKGROUND Chronic muscle diseases (MD) are progressive and cause wasting and weakness in muscles and are associated with reduced quality of life (QoL). The ACTMuS trial examined whether Acceptance and Commitment Therapy (ACT) as an adjunct to usual care improved QoL for such patients as compared to usual care alone. METHODS This two-arm, randomised, multicentre, parallel design recruited 155 patients with MD (Hospital and Depression Scale ⩾ 8 for depression or ⩾ 8 for anxiety and Montreal Cognitive Assessment ⩾ 21/30). Participants were randomised, using random block sizes, to one of two groups: standard medical care (SMC) (n = 78) or to ACT in addition to SMC (n = 77), and were followed up to 9 weeks. The primary outcome was QoL, assessed by the Individualised Neuromuscular Quality of Life Questionnaire (INQoL), the average of five subscales, at 9-weeks. Trial registration was NCT02810028. RESULTS 138 people (89.0%) were followed up at 9-weeks. At all three time points, the adjusted group difference favoured the intervention group and was significant with moderate to large effect sizes. Secondary outcomes (mood, functional impairment, aspects of psychological flexibility) also showed significant differences between groups at week 9. CONCLUSIONS ACT in addition to usual care was effective in improving QoL and other psychological and social outcomes in patients with MD. A 6 month follow up will determine the extent to which gains are maintained.
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Affiliation(s)
- Michael Rose
- Department of Neurology, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Christopher D. Graham
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast BT9 5BN, Northern Ireland
| | - Nicola O'Connell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Chiara Vari
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Victoria Edwards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Emma Taylor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Lance M. McCracken
- Department of Psychology, Uppsala University, Postal Box 1225, 751 42 Uppsala, Sweden
| | - Aleksander Radunovic
- Barts and the London MND Centre, Royal London Hospital, Whitechapel, London, EH1 1BB, UK
| | - Wojtek Rakowicz
- Wessex Neurological Service, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, Centre for Rheumatic Disease, King's College London, Weston Education Centre, London, SE5 8AF, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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Liu J, Serafimovska A, He S, Butow P, Shaw J, McHardy CJ, Harris G, Butt Z, Beith J. Protocol of an implementation study of a clinician intervention to reduce fear of recurrence in cancer survivors (CIFeR_2 implementation study). BMC MEDICAL EDUCATION 2023; 23:312. [PMID: 37147706 PMCID: PMC10161179 DOI: 10.1186/s12909-023-04279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Fear of cancer recurrence (FCR) affects 50-70% of cancer survivors with 30% reporting an unmet need for help with managing FCR. Patients indicate desire to discuss FCR with clinicians, however clinicians indicate discomfort with managing FCR and no formal educational interventions on how to discuss FCR or worry exists for oncology clinicians. Our team developed a novel clinician-driven brief education intervention to help patients manage FCR (the Clinician Intervention to Reduce Fear of Recurrence (CIFeR) intervention). In earlier work, we demonstrated the feasibility, acceptability, and efficacy of CIFeR in reducing FCR in breast cancer patients. We now aim to explore the barriers and facilitators to implementing this low-cost brief intervention within routine oncology practice in Australia. The primary objective is to assess the adoption of CIFeR in routine clinical practice. Secondary objectives are to identify the uptake and sustainability, perceived acceptability, feasibility, costs, barriers and facilitators of implementation of CIFeR in routine clinical practice, and to assess whether training in CIFeR increases clinicians' self-efficacy in managing FCR with their patients. METHODS This multicentre, single-arm Phase I/II implementation study will recruit medical and radiation oncologists and oncology surgeons who treat women with early breast cancer. Participants will complete online CIFeR training. They will then be asked to use CIFeR with suitable patients for the next 6 months. Participants will complete questionnaires prior to, immediately after and 3 and 6 months after training to assess confidence addressing FCR, and 3 and 6 months after training to assess Proctor Implementation outcomes. At 6 months, they will also be asked to participate in a semi-structured telephone interview to elicit their feedback about barriers and facilitators to using CIFeR in routine clinical practice. DISCUSSION This study will provide further data to support the routine use of an evidence-based, clinician-lead educational intervention to reduce FCR in breast cancer patients. Additionally, this study will identify any barriers and facilitators to implementing the CIFeR intervention in routine care and evidence for integration of FCR training into oncology communication skills education. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12621001697875. TRIAL SPONSOR Chris O'Brien Lifehouse. PROTOCOL VERSION 2.6, Dated 28th February 2023.
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Affiliation(s)
- Jia Liu
- Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia.
- School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia.
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia.
| | | | - Sharon He
- The Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Phyllis Butow
- School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia
| | - Joanne Shaw
- School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Zoe Butt
- The Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jane Beith
- The Chris O'Brien Lifehouse, Camperdown, NSW, Australia
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Blom M, Guicherit OR, Hoogwegt MT. Perfectionism, intolerance of uncertainty and coping in relation to fear of cancer recurrence in breast cancer patients. Psychooncology 2023; 32:581-588. [PMID: 36702980 DOI: 10.1002/pon.6102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Improved medical treatment has led to an increased cohort of cancer survivors. The prevalence of emotional problems in this group is high, with fear of cancer recurrence (FCR) being among the most prevalent and distressing conditions. In order to gain more insight in the psychological mechanisms playing a role in levels of FCR, this study examined the relationship between perfectionism and FCR in breast cancer patients, as well as the mediating role of intolerance of uncertainty (IU) and coping in this relationship. In order to contribute to a more comprehensive understanding of the mechanisms related to the experience of FCR in breast cancer patients, the purpose of the present study is to investigate the relationship between perfectionism and FCR, with IU and coping strategies as possible mediating factors. METHODS Validated Dutch versions of the FCR Inventory, the Multidimensional Perfectionism Scale, the Intolerance of Uncertainty Scale and the Utrechtse Coping List were filled out by 146 breast cancer patients, at least one year after (finishing) medical treatment. Correlation analyses were conducted to administer the associations between FCR, perfectionism, IU, coping and demographic/medical variables. PROCESS was used to examine mediation mechanisms. RESULTS A significant correlation was found between perfectionism and FCR (r = 0.19, p = 0.024). IU was found to mediate the relationship between perfectionism and FCR. In contrast, coping style did not emerge as a significant mediating factor. CONCLUSIONS This study shows that intolerance of uncertainty mediates the relationship between perfectionism and FCR. Psychological interventions targeting FCR may benefit from incorporating specific modules on dealing with uncertainty. Future research is necessary to further increase understanding of the mechanisms that play a role in FCR, in order to optimize and personalize psychological treatment for cancer patients with this type of emotional distress.
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Affiliation(s)
- Mariska Blom
- Department of Medical Psychology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Onno R Guicherit
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Madelein T Hoogwegt
- Department of Medical Psychology, Haaglanden Medical Center, The Hague, The Netherlands
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11
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Wright SR, Graham CD, Houghton R, Ghiglieri C, Berry E. Acceptance and commitment therapy (ACT) for caregivers of children with chronic conditions: A mixed methods systematic review (MMSR) of efficacy, process, and acceptance. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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12
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van Meurs J, Stommel W, Leget C, van de Geer J, Kuip E, Vissers K, Engels Y, Wichmann A. Oncologist responses to advanced cancer patients' lived illness experiences and effects: an applied conversation analysis study. BMC Palliat Care 2022; 21:37. [PMID: 35300674 PMCID: PMC8928655 DOI: 10.1186/s12904-022-00917-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background An advanced cancer patient’s life is often disturbed by fear of cancer recurrence, cancer progress, approaching suffering, and fear of dying. Consequently, the role of the medical oncologist is not only to provide best quality anti-cancer treatment, but also to address the impact of disease and treatment on a patient’s life, the lived illness experience. We aimed to gain insights into whether and how medical oncologists working at an outpatient clinic identify and explore lived illness experiences raised by patients with advanced cancer, and how this influences patients’ responses. Methods Conversation Analysis was applied to analyse 16 verbatim transcribed audio-recorded consultations. Results We identified 37 fragments in which patients expressed a lived experience from 11 of the 16 consultations. We found differing responses from different oncologists. Patients continued talking about their lived experiences if the listener produced a continuer such as humming or tried to capture the experience in their own words. In contrast, a response with optimistic talking or the presentation of medical evidence prevented patients from further unfolding the experience. In consultations in which the lived illness experience was most extensively unfolded, medical oncologists and patients could constantly see each other’s facial expressions. Conclusions When a patient with advanced cancer spontaneously introduces a lived illness experience, it helps to identify and explore it when the medical oncologist produces a continuer or tries to capture this experience in their own words. Our findings can be implemented in training sessions, followed by frequent reinforcement in daily care. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00917-4.
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Affiliation(s)
- Jacqueline van Meurs
- Department of Spiritual and Pastoral Care & Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, P.O. Box 9101 (714), Nijmegen, 6500 HB, Netherlands.
| | - Wyke Stommel
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Carlo Leget
- Department of Care and Welfare, University of Humanistic Studies, Utrecht, The Netherlands
| | - Joep van de Geer
- Academic Hospice Demeter, Bilthoven & Agora, De Bilt, the Netherlands
| | - Evelien Kuip
- Department of Medical Oncology & Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Anne Wichmann
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
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13
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Park SY, Lim JW. Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature. BMC Cancer 2022; 22:217. [PMID: 35227244 PMCID: PMC8883021 DOI: 10.1186/s12885-021-08909-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background Fear of cancer recurrence (FCR) has been addressed as a cause of emotional distress among breast cancer survivors (BCSs). This study aimed to systematically review the evidence on randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) designed to reduce FCR among BCSs. Methods A systematic review of published original research articles meeting the inclusion criteria was conducted. Five electronic databases, including the Cochrane Library, CINAHL, PubMed, PsycINFO, and Web of Science, were independently searched to identify relevant articles. The Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist was used to evaluate the quality of the eligible studies. Results Through a database search and a manual review process, seventeen quantitative studies with an RCT study design were included in the current systematic review. The interventions varied greatly in length and intensity, but the study designs and methodologies were similar. RCTs with face-to-face interventions of at least 1 month seemed to be more effective in reducing FCR outcomes and complying with than the CONSORT 2010 criteria than those with a brief online or telephone format of interventions; nevertheless, most RCT interventions appeared to be effective. Conclusions These findings highlight the importance of conducting well-designed CBT interventions to reduce FCR in BCSs with diverse populations at multiple sites, thereby improving the quality of research in this area. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08909-y.
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Affiliation(s)
- So-Young Park
- Ewha Institute for Age Integration Research, Ewha Womans University, 52 Ewhayeodae-gil, Sedaemun-gu, Seoul, 03760, Republic of Korea
| | - Jung-Won Lim
- College of Social Welfare, Kangnam University, 40 Kangnam-Ro, Giheung-Gu, Yongin-Si, Gyeonggi-Do, 16979, Republic of Korea.
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14
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Graham CD, McCracken LM, Harrison A, Walburn J, Weinman J. Outlining an Acceptance and Commitment Therapy approach to treatment non-adherence. Br J Health Psychol 2021; 27:1-12. [PMID: 34897907 DOI: 10.1111/bjhp.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/23/2021] [Indexed: 01/22/2023]
Affiliation(s)
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Sweden
| | - Anthony Harrison
- Department of Clinical and Health Psychology, Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Jess Walburn
- School of Cancer & Pharmaceutical Sciences, King's College London, UK
| | - John Weinman
- School of Cancer & Pharmaceutical Sciences, King's College London, UK
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15
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Pradhan P, Sharpe L, Menzies RE. Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors. Cancer Manag Res 2021; 13:8953-8965. [PMID: 34880676 PMCID: PMC8645945 DOI: 10.2147/cmar.s294114] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/07/2021] [Indexed: 01/08/2023] Open
Abstract
Background Fear of cancer recurrence or progression (FCR) is common amongst cancer survivors and an important minority develop clinically significant levels of FCR. However, it is unclear how current clinical services might best support the growing numbers of cancer survivors. Purpose The aim of this study is to develop recommendations for future research in the management of FCR and propose a model of care to help manage FCR in the growing population of cancer survivors. Methods This is a narrative review and synthesis of empirical research relevant to managing FCR. We reviewed meta-analyses, systematic reviews and individual studies that had investigated interventions for FCR. Results A recent, well-conducted meta-analysis confirmed a range of moderately effective treatments for FCR. However, many survivors continued to experience clinical levels of FCR after treatment, indicating a clear need to improve the gold standard treatments. Accessibility of interventions is arguably a greater concern. The majority of FCR treatments require face-to-face therapy, with highly skilled psycho-oncologists to produce moderate changes in FCR. With increasing numbers of cancer survivors, we need to consider how to meet the unmet need of cancer survivors in relation to FCR. Although there have been attempts to develop minimal interventions, these are not yet sufficiently well supported to warrant implementation. Attempts to help clinicians to provide information which might prevent the development of clinically significant FCR have shown some early promise, but research is needed to confirm efficacy. Conclusion The next decade of research needs to focus on developing preventative approaches for FCR, and minimal interventions for those with mild-to-moderate symptoms. When evidence-based approaches to prevent FCR or manage moderate levels of FCR are available, stepped care approaches that could meet the needs of survivors could be implemented. However, we also need to improve existing interventions for severe FCR.
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Affiliation(s)
- Poorva Pradhan
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, 2006, Australia
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16
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Hall LH, Clark J, Smith SG, Graham CD. Patient and health care professional co-development of an Acceptance and Commitment Therapy intervention to support hormone therapy decision-making and well-being in women with breast cancer. J Psychosoc Oncol 2021; 40:407-424. [PMID: 34825858 DOI: 10.1080/07347332.2021.1955318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this work was to co-develop an Acceptance and Commitment Therapy (ACT) intervention to support medication adherence and quality of life in breast cancer survivors (BCSs). The research approach was intervention co-development. METHODS The sample consisted of BCS focus groups (n = 24), health care provider (HCP) interviews (n = 10), and a co-development workshop (BCSs, n = 12; HCPs, n = 9).We conducted 6 BCS focus groups and 10 HCP interviews to understand the acceptability of ACT. We co-designed the intervention in a workshop. RESULTS Participants reported high acceptability of an ACT intervention. BCSs preferred ACT exercises focused on values and self-compassion. Both groups recommended face-to-face intervention delivery, by a clinical psychologist, with a mixture of individual and group sessions. BCSs requested advice on side-effect management. CONCLUSIONS We effectively used patient and HCP co-design to configure an ACT intervention to support medication adherence and quality of life for BCSs. If feasible and efficacious, this ACT-based intervention could support breast cancer survivorship.
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Affiliation(s)
| | - Jane Clark
- Department of Clinical and Health Psychology, St James's University Hospital, Leeds, UK
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17
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Serafimovska A, Liu J, Beith J, Butow P. Patients' and oncologists' perspectives on a novel Clinician-led Fear of Cancer Recurrence (CIFeR) Intervention. Support Care Cancer 2021; 29:7637-7646. [PMID: 34132882 DOI: 10.1007/s00520-021-06336-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite strong demand from breast cancer survivors, there is a dearth of flexibly delivered, accessible psychological interventions addressing fear of cancer recurrence (FCR). This study aimed to explore patients' and clinicians' perspectives concerning the experience, utility and barriers to a novel clinician-led FCR intervention (CIFeR). METHODS Twenty female participants (mean age, 59.8, SD = 11.43), diagnosed with early-stage breast cancer (mean years since diagnosis = 2.8, SD = 1.37 years) participated in telephone interviews, and their five oncologists completed a semi-structured electronic survey. Thematic qualitative analyses were performed on interview transcripts and survey responses. RESULTS Findings indicated both patients and clinicians were positive about CIFeR with perceived cognitive, behavioural and emotional benefits of CIFeR most pronounced for patients with clinically significant FCR. All patients, however, found that receiving CIFeR (especially the tailored prognostic information) from their oncologists with whom they had a long-standing relationship added a much-needed human element to addressing FCR. Similarly, clinicians valued CIFeR as a clear and consistent way to address unmet needs around FCR, with some barriers around time, language and cultural issues noted. CONCLUSION Overall, all participants perceived CIFeR as strongly beneficial in reducing FCR and related worries, thus warranting further evaluation of its utility in clinical practice.
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Affiliation(s)
- Anastasia Serafimovska
- Psycho-Oncology Co-Operative Group (PoCoG), University of Sydney, Sydney, NSW, Australia
| | - Jia Liu
- ProCan, The Children's Medical Research Institute, Faculty of Medicine and Health, The University of Sydney, Westmead, Sydney, NSW, Australia. .,Faculty of Medicine, University of Western Sydney, Campbelltown, NSW, Australia.
| | - Jane Beith
- Psycho-Oncology Co-Operative Group (PoCoG), University of Sydney, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-Operative Group (PoCoG), University of Sydney, Sydney, NSW, Australia
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18
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Uner FO, Korukcu O. A qualitative exploration of fear of cancer recurrence in Turkish cancer survivors who were referred for colposcopy. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:729-737. [PMID: 33662170 DOI: 10.1111/hsc.13326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/23/2021] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
We aimed to qualitatively explore factors related to fear of cancer recurrence in women who had a risk of cervical cancer relapse/metastasis and to identify the psychological effect of gynaecological examination and colposcopy in cancer survivors. We conducted the present descriptive study with a qualitative design based on the thematic analysis approach on ten women who under suspicion of new cancer and were admitted to the Gynaecological Oncology Polyclinic of Akdeniz University for colposcopy between July and October 2017 via in-depth interviews. As a result of the interviews, we identified three main themes: colposcopy-related fear, emotions associated with fear of cancer recurrence, and fear of being diagnosed with cancer. Moreover it was determined that women experienced a fear of death, fear of family being affected, fear of stigmatisation by society, and fear of not coping with the treatment process. We found that women with cancer history and undergoing colposcopy because of abnormal cervical cytology in routine oncology controls experienced a significant fear of cancer recurrence. We found that gynaecological examination and colposcopy caused anxiety in patients. Healthcare professions should be aware and help women to cope with the fear of cancer recurrence in the colposcopy process and should determine the social care needs of these patients.
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Affiliation(s)
- Fatma Ozlem Uner
- Department of Obstetrics and Gynecological Nursing, Faculty of Health, Alaaddin Keykubat University, Alanya, Turkey
| | - Oznur Korukcu
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
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19
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Rajah HDA, Chan CMH, Kong YC, Wong LP, Bustaman RS, Ho GF, Lai KMY, Yip CH, Bhoo-Pathy N. Insights on emotional distress following cancer, sources of support and the unmet needs in a setting with limited supportive care services for people living with cancer. Support Care Cancer 2021; 29:5811-5819. [PMID: 33742239 DOI: 10.1007/s00520-021-06148-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/08/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Delivery of supportive cancer care is often deemed a low priority in resource-limited settings. We aimed to explore the sources of emotional distress, the related support and the unmet needs of cancer survivors in Malaysia, where cancer survivorship services are presently limited. METHOD Twenty focus group discussions were conducted with 102 cancer patients from diverse ethnic and socioeconomic backgrounds. Thematic analyses were performed. RESULTS Patient narratives suggested that emotional distress arose from direct and indirect stressors. Direct stressors comprised physical and cognitive side effects of cancer surgery and therapies, and fear of recurrence. Indirect stressors included worry over dependent family members, financial distress following cancer, working with cancer and lack of practical support at home. Distress from altered physical appearances, fear of recurrence and lack of practical support were mainly raised by women, implying that men and women may have disproportionate emotional needs. Emotional support largely came from informal sources including self, family, friends and religion. While formal emotional support from professional counsellors and cancer support groups was acknowledged as important, it appeared to be largely lacking. Unmet needs in coping with fear of recurrence, financial distress, workplace discrimination and household chores were particularly highlighted. CONCLUSION The unmet needs revealed in this study provide insights to initiate actionable changes to improve the emotional wellbeing of people living with cancer in settings where cancer survivorship services are still in its infancy.
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Affiliation(s)
- Harenthri Devy Alagir Rajah
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Caryn Mei Hsien Chan
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yek-Ching Kong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Li-Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ros Suzanna Bustaman
- Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, 50586, Kuala Lumpur, Malaysia
| | - Gwo-Fuang Ho
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Cheng-Har Yip
- Subang Jaya Medical Centre, 47500, Subang Jaya, Malaysia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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20
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Salvetti MDG, Donato SCT, Machado CSP, de Almeida NG, Santos DVD, Kurita GP. Psychoeducational Nursing Intervention for Symptom Management in Cancer Patients: A Randomized Clinical Trial. Asia Pac J Oncol Nurs 2021; 8:156-163. [PMID: 33688564 PMCID: PMC7934602 DOI: 10.4103/apjon.apjon_56_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/20/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this study was to assess the effects of a psychoeducational intervention upon symptom control and quality of life (QoL) among cancer patients. Methods This was an open randomized clinical trial (RCT) conducted at the Cancer Institute of the State of São Paulo. The RCT comprised 107 outpatients in chemotherapy or radiation for malignant neoplasms. Participants were randomized to control group (usual treatment) or intervention group (IG) (psychoeducational intervention) with assessments at baseline and upon completion of the intervention. Sociodemographic information, clinical data, QoL, functionality, and symptoms were assessed. This trial is registered with the Brazilian Clinical Trials Registry number RBR-9337nv. A mixed-effects model was applied to compare the effects of the intervention between the groups. Results The most frequent symptoms were fatigue (76.6%), insomnia (47.7%), pain (42.1%), and loss of appetite (37.4%). The symptom intensity analysis suggests that insomnia was the strongest symptom, followed by fatigue, loss of appetite, and pain. The IG experienced a significant improvement in terms of loss of appetite (P = 0.002) and a tendency toward less insomnia (P = 0.053). Conclusions The intervention significantly reduced appetite loss in cancer patients. Despite no effects observed in global QoL or functionality, the intervention yielded a tendency to improve insomnia, and this outcome should be investigated in future studies.
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Affiliation(s)
- Marina de Góes Salvetti
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | | | - Natalia Gondim de Almeida
- Department of Medical-Surgical Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | - Geana Paula Kurita
- Department of Neuroanaesthesiology, Multidisciplinary Pain Centre, Neuroscience Centre and Palliative Research Group, Rigshospitalet Copenhagen University Hospital, São Paulo, Brazil
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21
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Kim JHJ, Drake BL, Accortt EE, Pollin IS, Bairey Merz CN, Stanton AL. Younger Women Living with Chronic Disease: Comparative Challenges, Resiliencies, and Needs in Heart Disease and Breast Cancer. J Womens Health (Larchmt) 2021; 30:1288-1302. [PMID: 33428530 DOI: 10.1089/jwh.2020.8506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Younger women with chronic disease (<60 years of age), especially women with stereotypically "men's" heart disease (HD), are understudied. Unique difficulties may occur with HD, which is less commonly associated with women, compared with breast cancer (BC). Similarities may also exist across younger women, as chronic disease is less normative in younger people. Intersections of gender, age, and the specific disease experience require greater attention for improving women's health. This exploratory qualitative study compared younger women's experiences of HD or BC. Methods: Semistructured interviews with 20 women (n = 10 per disease) were analyzed using applied thematic analysis. Results: Amidst building careers, intimate relationships, and families, women felt thwarted by disease-related functional problems. Cognitive-behavioral coping strategies spurred resilience, including integrating the illness experience with self-identity. Barriers arose when medical professionals used representativeness heuristics (e.g., chronic disease occurs in older age). Important experiences in HD included worsened self-image from disability, negative impact of illness invisibility, and persisting isolation from lacking peer availability. Initial medical care reported by women with HD may reflect gender biases (e.g., HD missed in emergency settings and initial diagnostics). New information provided by the younger women includes limited illness-related optimism in women with HD facing age and gender stereotypes, as well as the advantages and disadvantages of peer availability in BC. Conclusions: Greater public awareness of younger women with chronic disease, alongside structural support and connection with similarly challenged peers, is suggested. As advocacy for BC awareness and action has strengthened over past decades, similar efforts are needed for younger women with HD.
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Affiliation(s)
- Jacqueline H J Kim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Brittany L Drake
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Eynav E Accortt
- Department of Obstetrics and Gynecology and Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Irene S Pollin
- Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences and University of California, Los Angeles, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA
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22
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Reb AM, Borneman T, Economou D, Cangin MA, Cope DG, Ma H, Ruel N, Sharpe L, Patel SK, Cristea M, Koczywas M, Ferrell B. A nurse-led intervention for fear of cancer progression in advanced cancer: A pilot feasibility study. Eur J Oncol Nurs 2020; 49:101855. [PMID: 33120211 PMCID: PMC8493814 DOI: 10.1016/j.ejon.2020.101855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the feasibility, acceptability, and preliminary effects of a nurse-led intervention for managing fear of cancer progression in advanced cancer patients. METHODS A single group mixed methods study was conducted in patients with stage III or IV gynecologic or lung cancer (n = 31) with dysfunctional levels of fear of progression or distress. The intervention consisted of seven videoconferencing sessions with skills practice. Feasibility measures included enrollment rate, attendance, attrition, and home practice adherence. Acceptability was based on exit interview responses. Content analysis was used to analyze the qualitative data. Participants completed quantitative questionnaires assessing fear of progression and secondary outcomes at baseline, eight, and 12 weeks. Linear mixed model analysis was used to assess changes in outcome measures. RESULTS The average enrollment rate was seven participants/month over 4.5 months. Participants attended a mean of 5.3 of seven sessions. Attrition rate was 30%. The analysis showed improvements over time in fear of progression and exploratory outcomes. Participants reported feeling calmer and more focused. The skills practice helped to manage anxiety and fears. Themes included: Struggling with fears, Refocusing the fears, and Realizing/reaffirming what is important in life. The most beneficial components included the values clarification exercise, detached mindfulness and worry postponement practices. CONCLUSION The intervention was acceptable; most feasibility criteria were met. Preliminary data suggest that the intervention reduced fear of progression and improved secondary outcomes. The intervention required a significant time commitment by participants, which may have contributed to increased attrition. To decrease burden, we will shorten the intervention.
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Affiliation(s)
- Anne M Reb
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA.
| | - Tami Borneman
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA
| | - Denice Economou
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA
| | - Marissa A Cangin
- City of Hope, Department of Supportive Care Medicine, Duarte, CA, USA
| | - Diane G Cope
- Florida Cancer Specialists & Research Institute, Fort Myers, FL, USA
| | - Huiyan Ma
- City of Hope, Division of Biomarkers of Early Detection and Prevention, Department of Population Sciences, Duarte, CA, USA
| | - Nora Ruel
- City of Hope, Department of Computational and Quantitative Medicine, Duarte, CA, USA
| | - Louise Sharpe
- University of Sydney, School of Psychology, Sydney, Australia
| | - Sunita K Patel
- City of Hope, Divisions of Outcomes and Psychology, Departments of Population Sciences and Supportive Medicine, Duarte, CA, USA
| | - Mihaela Cristea
- City of Hope National Cancer Center, Department of Medical Oncology & Therapeutics Research, Duarte, CA, USA
| | - Marianna Koczywas
- City of Hope National Cancer Center, Department of Medical Oncology & Therapeutics Research, Duarte, CA, USA
| | - Betty Ferrell
- Beckman Research Institute of the City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA, USA
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23
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Uner FO, Korukcu O. A prevalence and psychometric study on fear of cancer in women with abnormal cervical cytology undergoing colposcopy. Psychooncology 2020; 29:1850-1855. [DOI: 10.1002/pon.5504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Fatma Ozlem Uner
- Department of Obstetrics and Gynaecology Alanya Alaaddin Keykubat University Alanya Turkey
| | - Oznur Korukcu
- Department of Obstetrics and Gynaecological Nursing Akdeniz University Faculty of Nursing Antalya Turkey
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24
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Reb AM, Borneman T, Economou D, Cangin MA, Patel SK, Sharpe L. Fear of Cancer Progression: Findings From Case Studies and a Nurse-Led Intervention. Clin J Oncol Nurs 2020; 24:400-408. [PMID: 32678373 PMCID: PMC8366305 DOI: 10.1188/20.cjon.400-408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fear of cancer recurrence or progression (FOP) is a significant concern for cancer survivors. With the advent of new targeted therapies and immunotherapy, many patients with advanced cancer are living longer while dealing with uncertainty and fears related to cancer progression. Although some level of FOP is normal and adaptive, high levels adversely affect quality of life and healthcare costs. OBJECTIVES This article describes a nurse-led intervention for managing FOP in two patients with advanced gynecologic cancer. The intervention teaches skills for managing worry, challenging unhelpful beliefs, and modifying unhelpful coping behaviors. METHODS Preliminary findings from the two case studies are presented, including a comparison of post-treatment FOP scores to baseline scores. FINDINGS The participants reported feeling more focused, less overwhelmed, and more in control of their worries. Both participants achieved statistically reliable improvements in FOP scores.
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25
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Omidi Z, Kheirkhah M, Abolghasemi J, Haghighat S. Effect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer: a randomized controlled clinical trial. Qual Life Res 2020; 29:1789-1800. [PMID: 32152817 PMCID: PMC7295820 DOI: 10.1007/s11136-020-02455-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) and its associated symptoms harm the quality of life (QoL) of cancer survivors and can stimulate fear of cancer recurrence (FCR). Self-management education for lymphedema has been introduced as an effective method in controlling FCR. This study investigates the effect of lymphedema group-based education compared to the social network-based and control group on QoL and FCR in breast cancer patients. METHODS This three-arm clinical trial studied 105 patients with breast cancer-related lymphedema referred to Seyed_Khandan rehabilitation center. Sampling was done by random allocation method in blocks of 3 with 35 subjects in each group. All subjects received routine lymphedema treatments. The group-based education (GE) and social network-based education (SNE) groups received self-management education in the clinic and Telegram™ messenger channel, respectively. Impairment in QoL and mean score of FCR were assessed before, immediately after, and three months after the intervention by using the Persian version of Lymphedema Life Impact Scale (LLIS) and Fear of Progression Questionnaire-Short Form (FoPQ-SF), respectively. Mixed-model ANOVA was applied for statistical analysis. RESULTS There was a significant time effect on total LLIS (P = 0.007), psychosocial (P = 0.038) and functional (P = 0.024) subscale changes in three groups of study. Interaction between the main effect of group and time on psychosocial subscale changes was statistically significant (P = 0.017). The multicomparison results illustrated that the main effect of time, the main effect of group, and interaction of them on the mean score of FCR were P = 0.084, P = 0.380, and P = 0.568, respectively. CONCLUSION Despite no significant reduction in the FCR score, results showed the improvement of most QoL aspects after three months of intervention. Although the social network-based education method was effective, the group-based education method was more beneficial. Applying these educational methods in lymphedema treatment protocols needs cost-effectiveness studies. TRIAL REGISTRATION This study was registered at the Iranian Registry of Clinical Trials (IRCT2017052834176N1).
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Affiliation(s)
- Zahra Omidi
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Kheirkhah
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Abolghasemi
- Department of Biostatistics, School of Public Health, Iran University of Medical Science, Tehran, Iran
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
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26
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Bae KR, Cho J. Research Trends for Nurse-led Interventions to Decrease Fear of Cancer Recurrence. ASIAN ONCOLOGY NURSING 2020. [DOI: 10.5388/aon.2020.20.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ka Ryeong Bae
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkynkwan University, Seoul, Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkynkwan University, Seoul, Korea
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27
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Bae KR, Ahn Y, Cho J. Healthcare Professionals' Experience of Fear of Cancer Recurrence among Cancer Survivors. ASIAN ONCOLOGY NURSING 2020. [DOI: 10.5388/aon.2020.20.4.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ka Ryeong Bae
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Yeojin Ahn
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
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28
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Luberto CM, Hall DL, Chad-Friedman E, Park ER. Theoretical Rationale and Case Illustration of Mindfulness-Based Cognitive Therapy for Fear of Cancer Recurrence. J Clin Psychol Med Settings 2019; 26:449-460. [PMID: 30756278 PMCID: PMC6689451 DOI: 10.1007/s10880-019-09610-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Fear of cancer recurrence (FCR) is a common problem among cancer survivors and evidence-based interventions grounded in theoretical models are needed. Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based intervention for reducing health anxiety that could be useful to apply to FCR. However, there has only been one study of MBCT for FCR to date, and the theoretical rationale and practical application of MBCT for FCR has not been described. The purpose of this paper is to offer an evidence-based rationale for MBCT to treat FCR based on a health anxiety model; describe the process of adapting MBCT to target FCR; and present a case study of the adapted protocol for treating FCR in a young adult breast cancer survivor to illustrate its delivery, feasibility, acceptability, and associated changes in outcomes. Clinical implications and directions for future research are discussed.
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Affiliation(s)
- Christina M Luberto
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 15th floor, Boston, MA, 02114, USA.
| | - Daniel L Hall
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Outcomes Research, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 15th floor, Boston, MA, 02114, USA
| | - Emma Chad-Friedman
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cancer Outcomes Research, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 15th floor, Boston, MA, 02114, USA
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29
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Sharpe L, Turner J, Fardell JE, Thewes B, Smith AB, Gilchrist J, Beith J, Girgis A, Tesson S, Day S, Grunewald K, Butow P. Psychological intervention (ConquerFear) for treating fear of cancer recurrence: mediators and moderators of treatment efficacy. J Cancer Surviv 2019; 13:695-702. [PMID: 31347010 DOI: 10.1007/s11764-019-00788-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/05/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE ConquerFear is an efficacious intervention for fear of cancer recurrence (FCR) that demonstrated greater improvements than an attention control (relaxation training) in a randomized controlled trial. This study aimed to determine mediators and moderators of the relative treatment efficacy of ConquerFear versus relaxation. METHODS One hundred and fifty-two cancer survivors completed 5 therapy sessions and outcome measures before and after intervention and at 6 months' follow-up. We examined theoretically relevant variables as potential mediators and moderators of treatment outcome. We hypothesized that metacognitions and intrusions would moderate and mediate the relationship between treatment group and FCR level at follow-up. RESULTS Only total FCR score at baseline moderated treatment outcome. Participants with higher levels of FCR benefited more from ConquerFear relative to relaxation on the primary outcome. Changes in metacognitions and intrusive thoughts about cancer during treatment partially mediated the relationship between treatment group and FCR. CONCLUSIONS These results show that ConquerFear is relatively more effective than relaxation for those with overall higher levels of FCR. The mediation analyses confirmed that the most likely mechanism of treatment efficacy was the reduction in unhelpful metacognitions and intrusive thoughts during treatment, consistent with the theoretical framework underpinning ConquerFear. IMPLICATIONS FOR CANCER SURVIVORS ConquerFear is a brief, effective treatment for FCR in cancer survivors with early-stage disease. The treatment works by reducing intrusive thoughts about cancer and changing beliefs about worry and is particularly helpful for people with moderate to severe FCR.
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Affiliation(s)
- Louise Sharpe
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.
| | - J Turner
- Mental Health Centre, Faculty of Medicine, University of Queensland, Saint Lucia, Australia
| | - J E Fardell
- Kids Cancer Centre, Sydney Children's Hospital and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Saint Lucia, Australia
| | - B Thewes
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.,Department Medical Psychology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - A B Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - J Gilchrist
- Crown Princess Mary Cancer Centre, Breast Cancer Institute, Westmead Hospital, Westmead, Australia
| | - J Beith
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Camperdown, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Missenden Rd., Camperdown, Australia
| | - A Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - S Tesson
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia
| | - S Day
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia
| | - K Grunewald
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia
| | - P Butow
- School of Psychology, University of Sydney, Brennan MacCallum (A18), Camperdown, NSW, 2006, Australia.,Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Camperdown, Australia
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30
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Systematic review of interventions by non-mental health specialists for managing fear of cancer recurrence in adult cancer survivors. Support Care Cancer 2019; 27:4055-4067. [DOI: 10.1007/s00520-019-04979-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
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31
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Maheu C, Hébert M, Louli J, Yao TR, Lambert S, Cooke A, Black A, Kyriacou J. Revision of the fear of cancer recurrence cognitive and emotional model by Lee-Jones et al with women with breast cancer. Cancer Rep (Hoboken) 2019; 2:e1172. [PMID: 32721129 DOI: 10.1002/cnr2.1172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is among the top unmet concerns reported by breast cancer survivors. Despite the sizable literature on FCR, few theoretical models have been empirically tested. One of the most cited is the FCR model. AIM This study seeks to understand the nature of women's cognitive and emotional issues from FCR using specific guidance from the model by Lee-Jones and to provide suggestions for modifications to the model based on empirical results from the reported experiences of women living with breast cancer. METHODS AND RESULTS A qualitative descriptive study using semi-structured interviews was conducted at an urban hospital. Recruited by convenience sampling, 12 breast cancer survivors concerned with FCR and who had recently completed active treatment participated in the study. Seven thematic categories emerged from the women's descriptions of their cognitive and emotional experiences with FCR: (a) FCR is always there; (b) beliefs about risk of recurrence; (c) beliefs about eradication of cancer; (d) preferences not to seek information about recurrence; (e) derailment of normal life; (f) worries related to recurrence; and (g) need for support. Adjustments to the model by Lee-Jones et al1 specifically to women living with breast cancer include the addition of new variables-the fear is always present, a preference not to seek information, and the need for support beyond treatment-and the merging of two variables, anxiety and worry, as participants viewed these concepts as interchangeable and experienced in similar ways. Lastly, participants did not report any remorse related to not opting for more aggressive treatments. CONCLUSION The refinement of a more comprehensive FCR theoretical model, such as through the modifications derived from this study, provides a deeper understanding of breast cancer survivors' experiences with FCR and can more effectively guide health care professionals to develop appropriately tailored interventions aimed at decreasing FCR levels.
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Affiliation(s)
- Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Maude Hébert
- Department of Nursing, University of Quebec at Trois-Rivières, Trois-Rivières, Quebec, Canada.,Post-doctoral fellow Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Julie Louli
- Jewish General Hospital, Montreal, Quebec, Canada
| | - Tian-Ran Yao
- Jewish General Hospital, Montreal, Quebec, Canada
| | - Sylvie Lambert
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,St. Mary's Research Centre, McGill University, Montreal, Quebec, Canada
| | - Andrea Cooke
- Jewish General Hospital, Montreal, Quebec, Canada
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32
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Shih ST, Butow P, Bowe SJ, Thewes B, Turner J, Gilchrist J, Mihalopoulos C. Cost‐effectiveness of an intervention to reduce fear of cancer recurrence:
The ConquerFear
randomized controlled trial. Psychooncology 2019; 28:1071-1079. [DOI: 10.1002/pon.5056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Sophy Ting‐Fang Shih
- Deakin Health Economics, School of Health and Social DevelopmentDeakin University Burwood Victoria
| | - Phyllis Butow
- Psycho‐Oncology Co‐operative Research Group, School of PsychologyUniversity of Sydney Sydney New South Wales
| | - Steven J. Bowe
- Biostatistics Unit, Faculty of HealthDeakin University Burwood Victoria
| | - Belinda Thewes
- Psycho‐Oncology Co‐operative Research Group, School of PsychologyUniversity of Sydney Sydney New South Wales
| | - Jane Turner
- Faculty of MedicineUniversity of Queensland Brisbane Queensland
| | - Jemma Gilchrist
- Crown Princess Mary Cancer CentreWestmead Hospital Westmead New South Wales
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social DevelopmentDeakin University Burwood Victoria
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33
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Fisher PL, Byrne A, Fairburn L, Ullmer H, Abbey G, Salmon P. Brief Metacognitive Therapy for Emotional Distress in Adult Cancer Survivors. Front Psychol 2019; 10:162. [PMID: 30766505 PMCID: PMC6365419 DOI: 10.3389/fpsyg.2019.00162] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/17/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Adult cancer survivors often experience substantial psychological morbidity following the completion of acute cancer treatment. Unfortunately, current psychological interventions are of limited efficacy. This study explored if metacognitive therapy (MCT); a brief transdiagnostic psychological intervention was potentially efficacious and could be delivered effectively to adult cancer survivors with psychological morbidity. Methods: An open trial with 3- and 6-month follow-up evaluated the treatment effects of MCT in 27 consecutively referred individuals to a clinical psychology health service specializing in psycho-oncology. Each participant received a maximum of six 1-hour sessions of MCT. Levels of anxiety, depression, fear of cancer recurrence, post-traumatic stress symptoms, health related quality of life, and metacognitive beliefs and processes were assessed using self-report questionnaires. Results: MCT was associated with statistically significant reductions across all outcome measures which were maintained through to 6-month follow-up. In the ITT sample on the primary treatment outcome measure, the Hospital Anxiety and Depression Scale-Total, 59% of participants met recovery criteria at post-treatment and 52% at 6-month follow-up, respectively. No participants significantly deteriorated. In the completer sample (N = 20), 80% recovered at post-treatment and 70% at 6-month follow-up. MCT was acceptable to patients with approximately 75% of patients completing all treatment sessions. Conclusion: MCT, a brief transdiagnostic psychological intervention can be delivered effectively to a heterogenous group of cancer survivors with promising treatment effects. Examining the efficacy of brief MCT against the current gold standard psychological intervention would be a valuable advance toward improving the quality of life of cancer survivors.
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Affiliation(s)
- Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Clinical Health, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom.,Psychology Service, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom
| | - Angela Byrne
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Clinical Health, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom.,Psychology Service, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom
| | - Louise Fairburn
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Clinical Health, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom.,Psychology Service, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom
| | - Helen Ullmer
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Clinical Health, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom.,Psychology Service, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom
| | - Gareth Abbey
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.,Liverpool Clinical Health, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom.,Psychology Service, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom
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34
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Almeida SN, Elliott R, Silva ER, Sales CMD. Fear of cancer recurrence: A qualitative systematic review and meta-synthesis of patients' experiences. Clin Psychol Rev 2018; 68:13-24. [PMID: 30617013 DOI: 10.1016/j.cpr.2018.12.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 12/10/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022]
Abstract
Fear of cancer recurrence (FCR) is a significant issue for most cancer survivors, with nearly half of cancer survivors reporting it at moderate to high levels of intensity. We aimed to further explore the experience of having FCR from the point of view of patients by systematically reviewing qualitative studies. Following PRISMA guidelines, 87 qualitative studies were selected. All participants' quotes about FRC were extracted, then analysed using a conceptual framework based on the emotion-focused therapy theory of emotion schemes, which consist of experienced/implicit emotions, along with perceptual-situational, bodily-expressive, symbolic-conceptual and motivational-behavioral elements. According to participant descriptions, FCR was found to be an intense, difficult, multi-dimensional experience. Considering the diversity of experiences identified, it is useful to look at FCR as an emotional experience that extends along a continuum of adaptive and maladaptive responses. For some participants, FCR was described in trauma-like terms, including forms of re-experiencing, avoidance, negative thoughts and feelings, and arousal or reactivity related to cancer-related triggers or memories. Vivid metaphors expressing vulnerability and conflict also reflect the strong impact of FCR in patients' lives and can help therapists empathize with their clients.
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Affiliation(s)
- Susana N Almeida
- Portuguese Institute of Oncology of Porto FG, EPE, ISMAI - University Institute of Maia, Maia, Portugal.
| | - Robert Elliott
- Counselling Unit, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Eunice R Silva
- Portuguese Institute of Oncology of Porto FG, EPE, Porto, Portugal
| | - Célia M D Sales
- Centre for Psychology at the University of Porto, Porto, Portugal
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35
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van de Wal M, Servaes P, Berry R, Thewes B, Prins J. Cognitive Behavior Therapy for Fear of Cancer Recurrence: A Case Study. J Clin Psychol Med Settings 2018; 25:390-407. [PMID: 29468568 PMCID: PMC6209054 DOI: 10.1007/s10880-018-9545-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This case study describes the course and content of cognitive behavior therapy (CBT) for clinical fear of cancer recurrence (FCR) in a breast cancer survivor. The CBT for clinical FCR consisted of seven face-to-face therapy sessions and one telephone session. The primary treatment goal was to reduce FCR severity by modifying cognitive processes and dysfunctional behavior. Assessments of FCR and quality of life were completed by the breast cancer survivor pre-therapy, post-therapy, and at 6 and 12 months of post-therapy. In each treatment session, perceived control over FCR was assessed. A clinical nurse specialist participated in evaluation interviews. The patient's perceived control over FCR increased during the therapy, and FCR severity declined to a non-clinical level. This improvement was still evident at the 6- and 12-month follow-up assessments and was supported by results for secondary and exploratory outcomes measures. FCR offers a great challenge for health care professionals due to the lack of effective treatment options. This case study shows how clinical FCR can be addressed with CBT and can contribute to the improvement of care for cancer survivors.
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Affiliation(s)
- Marieke van de Wal
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Department of Medical Psychology, Maxima Medical Center, Eindhoven/Veldhoven, The Netherlands.
| | - Petra Servaes
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rebecca Berry
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Belinda Thewes
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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36
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Development and Feasibility of a Group Cognitive-Behavioral Therapy for Fear of Cancer Recurrence. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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Gonzalez-Hernandez E, Romero R, Campos D, Burychka D, Diego-Pedro R, Baños R, Negi LT, Cebolla A. Cognitively-Based Compassion Training (CBCT ®) in Breast Cancer Survivors: A Randomized Clinical Trial Study. Integr Cancer Ther 2018; 17:684-696. [PMID: 29681185 PMCID: PMC6142100 DOI: 10.1177/1534735418772095] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context. Breast cancer (BC) requires a significant psychological
adaptation once treatment is finished. There is growing evidence of how
compassion training enhances psychological and physical well-being, however,
there are very few studies analyzing the efficacy of compassion-based
Interventions on BC survivors. Objective. To study the efficacy
of the Cognitively-Based Compassion Training (CBCT) protocol in a BC survivor
sample on quality of life, psychological well-being, fear of cancer recurrence,
self-compassion, and compassion domains and mindfulness facets. Furthermore,
enrollment, adherence, and satisfaction with the intervention were also
analyzed. Methods. A randomized clinical trial was designed.
Participants (n = 56) were randomly assigned to CBCT (n = 28) or a
treatment-as-usual control group (TAU; n = 28). Pre-post intervention and
6-month follow-up measures took place to evaluate health-related quality of
life, psychological well-being; psychological stress, coping strategies, and
triggering cognitions; self-compassion and compassion; and mindfulness in both
intervention and wait-list groups. Results. Accrual of eligible
participants was high (77%), and the drop-out rate was 16%. Attendance to CBCT
sessions was high and practice off sessions exceeded expectations). CBCT was
effective in diminishing stress caused by FCR, fostering self-kindness and
common humanity, and increasing overall self-compassion scores, mindful
observation, and acting with awareness skillsets. Conclusion.
CBCT could be considered a promising and potentially useful intervention to
diminish stress caused by FCR and enhance self-kindness, common humanity,
overall self-compassion, mindful observation, and acting with awareness
skillsets. Nevertheless, future randomized trials are needed and a process of
deeper cultural adaptation required.
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Affiliation(s)
| | - Rocio Romero
- 2 Fundación Instituto Valenciano de Oncología, València, Spain
| | | | | | | | - Rosa Baños
- 1 Universitat de València, València, Spain.,4 CIBERObn Ciber Fisiopatologia de la obesidad y la nutrición, Madrid, Spain
| | | | - Ausiàs Cebolla
- 1 Universitat de València, València, Spain.,4 CIBERObn Ciber Fisiopatologia de la obesidad y la nutrición, Madrid, Spain
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Tomei C, Lebel S, Maheu C, Lefebvre M, Harris C. Examining the preliminary efficacy of an intervention for fear of cancer recurrence in female cancer survivors: a randomized controlled clinical trial pilot study. Support Care Cancer 2018; 26:2751-2762. [PMID: 29500582 DOI: 10.1007/s00520-018-4097-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 02/07/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Among cancer survivors, fear of cancer recurrence (FCR) is the most frequently reported unmet need. Despite this, research on psychosocial interventions that target FCR is limited. To address this gap, an individual cognitive-existential psychotherapy intervention for FCR was pilot tested via small-scale RCT. METHODS Participants were recruited via study posters, healthcare professionals' referrals, and an electronic hospital database. Twenty-five female cancer survivors were randomized to experimental or wait-list control groups. Sessions included cognitive restructuring techniques, behavioral experiments, discussion of existential concerns, and relaxation exercises. Nineteen women completed the 6-week intervention and completed questionnaire packages at various time points. All participants completed self-administered questionnaires at pre-intervention (T1), post-intervention (T2), and at 3-month follow-up (T3). Participants in the control group also completed the same questionnaires, including at baseline (T0). RESULTS Statistically significant results of between-within ANOVAs included time by condition interactions in the primary outcome measure of FCR and, for the experimental group participants, time by condition interactions in the secondary outcome measures of cancer-specific distress and uncertainty in illness. Statistically significant results of repeated measures ANOVAs included reductions in FCR, cancer-specific distress, uncertainty in illness, reassurance seeking, cognitive avoidance, and intolerance of uncertainty, as well as improvements in positive reinterpretation and growth, emotional coping, and quality of life (improved mental health), when compared to the control group. Most changes were maintained at 3-month follow-up. CONCLUSIONS This intervention responds to a need for evidence-based individual modality interventions targeting quality of life in cancer survivors. Our results demonstrate preliminary promising results in addressing FCR in female cancer survivors. Future research could seek to replicate results with a larger sample. Further research is needed to test this intervention with patients of mixed cancer sites.
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Affiliation(s)
- Christina Tomei
- School of Psychology, University of Ottawa, 136 Jean-Jacques-Lussier Private, Vanier Hall, Ottawa, ON, K1N 6N5, Canada.
| | - Sophie Lebel
- School of Psychology, University of Ottawa, 136 Jean-Jacques-Lussier Private, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | | | - Cheryl Harris
- Psychology Department, The Ottawa Hospital, Ottawa, ON, Canada
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Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, Tesson S, O’Connell R, Girgis A, Gebski VJ, Asher R, Mihalopoulos C, Bell ML, Zola KG, Beith J, Thewes B. Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence. J Clin Oncol 2017; 35:4066-4077. [DOI: 10.1200/jco.2017.73.1257] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose Fear of cancer recurrence (FCR) is prevalent, distressing, and long lasting. This study evaluated the impact of a theoretically/empirically based intervention (ConquerFear) on FCR. Methods Eligible survivors had curable breast or colorectal cancer or melanoma, had completed treatment (not including endocrine therapy) 2 months to 5 years previously, were age > 18 years, and had scores above the clinical cutoff on the FCR Inventory (FCRI) severity subscale at screening. Participants were randomly assigned at a one-to-one ratio to either five face-to-face sessions of ConquerFear (attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting) or an attention control (Taking-it-Easy relaxation therapy). Participants completed questionnaires at baseline (T0), immediately post-therapy (T1), and 3 (T2) and 6 months (T3) later. The primary outcome was FCRI total score. Results Of 704 potentially eligible survivors from 17 sites and two online databases, 533 were contactable, of whom 222 (42%) consented; 121 were randomly assigned to intervention and 101 to control. Study arms were equivalent at baseline on all measured characteristics. ConquerFear participants had clinically and statistically greater improvements than control participants from T0 to T1 on FCRI total ( P < .001) and severity subscale scores ( P = .001), which were maintained at T2 ( P = .017 and P = .023, respectively) and, for FCRI total only, at T3 ( P = .018), and from T0 to T1 on three FCRI subscales (coping, psychological distress, and triggers) as well as in general anxiety, cancer-specific distress (total), and mental quality of life and metacognitions (total). Differences in FCRI psychological distress and cancer-specific distress (total) remained significantly different at T3. Conclusion This randomized trial demonstrated efficacy of ConquerFear compared with attention control (Taking-it-Easy) in reduction of FCRI total scores immediately post-therapy and 3 and 6 months later and in many secondary outcomes immediately post-therapy. Cancer-specific distress (total) remained more improved at 3- and 6-month follow-up.
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Affiliation(s)
- Phyllis N. Butow
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Jane Turner
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Jemma Gilchrist
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Louise Sharpe
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Allan Ben Smith
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Joanna E. Fardell
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Stephanie Tesson
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Rachel O’Connell
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Afaf Girgis
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Val J. Gebski
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Rebecca Asher
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Cathrine Mihalopoulos
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Melanie L. Bell
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Karina Grunewald Zola
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Jane Beith
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
| | - Belinda Thewes
- Phyllis N. Butow, Louise Sharpe, Allan Ben Smith, Joanna E. Fardell, Stephanie Tesson, Rachel O’Connell, Val J. Gebski, Rebecca Asher, Melanie L. Bell, Karina Grunewald Zola, and Belinda Thewes, University of Sydney; Jemma Gilchrist, Westmead Hospital; Allan Ben Smith, Joanna E. Fardell, and Afaf Girgis, University of New South Wales, Sydney; Jane Beith, Chris O’Brien Lifehouse, Camperdown, New South Wales; Jane Turner, University of Queensland, Brisbane, Queensland; Cathrine Mihalopoulos, Deakin
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Ozakinci G, Swash B, Humphris G, Rogers SN, Hulbert-Williams NJ. Fear of cancer recurrence in oral and oropharyngeal cancer patients: An investigation of the clinical encounter. Eur J Cancer Care (Engl) 2017; 27. [PMID: 29024186 DOI: 10.1111/ecc.12785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 01/15/2023]
Abstract
Fear of cancer recurrence (FCR) is common among individuals treated for cancer. Explorations of how this fear is expressed within an oncology setting and responded to are currently lacking. The aim was to investigate how head and neck cancer survivors in follow-up consultations express FCR, investigate how a healthcare professional addresses recurrence fears, and examine how survivors experience this interaction. We recorded the follow-up consultations of those participants who have reported FCR as a concern on the Patient Concerns Inventory. We also conducted a follow-up phone interview with the participants. We analysed the transcripts using thematic analysis. Five men and six women were recruited, aged 55-87 (mean age = 64). Follow-up consultation analyses revealed that the consultant used "normalising FCR," "reassurance," and "offer of referral to a counsellor." Interviews revealed themes around how they coped with FCR, relevance of personal history on FCR, and the impact of feeling gratitude towards the consultant on expression of FCR. Analyses indicate that patients may feel reluctant to raise their FCR with their clinician for fear of appearing "ungrateful" or of damaging a relationship that is held in high esteem. Findings indicate the initiation of FCR with patients can be beneficial for patient support.
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Affiliation(s)
- G Ozakinci
- School of Medicine, University of St Andrews, St Andrews, UK
| | - B Swash
- Department of Psychology, University of Chester, Chester, UK.,Palliative and End of Life Care Group, University of Cambridge, UK
| | - G Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - S N Rogers
- Faculty of Health and Social Care, Evidence-Based Practice Research Centre (EPRC), Edge Hill University, Ormskirk, UK.,Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
| | - N J Hulbert-Williams
- Chester Research Unit for the Psychology of Health, Department of Psychology, University of Chester, Chester, UK
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Worry in Head and Neck Cancer Caregivers: The Role of Survivor Factors, Care-Related Stressors, and Loneliness in Predicting Fear of Recurrence. Nurs Res 2017; 66:295-303. [PMID: 28654567 DOI: 10.1097/nnr.0000000000000223] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fear of recurrence (FOR) is a primary concern for both cancer survivors and their caregivers, yet little is known about what care-related factors exacerbate this worry. OBJECTIVES This study aimed to establish the role of care-related stressors-as distinct from survivor characteristics-in predicting FOR in head and neck cancer caregivers. METHODS HNC survivor-caregiver dyads took part in a mailed survey. Survivors provided information on health and quality of life (using the Functional Assessment of Cancer Therapy Questionnaire). Caregivers provided sociodemographic information, impact of caring on their time and finances, as well as their level of social support (Oslo Support Scale), loneliness (3-point loneliness scale), and completed the Worry of Cancer Scale (to measure FOR). RESULTS Data from 180 dyads were available for analysis. Multiple regression analysis was used to examine the role of caregiver stressors, social support, and loneliness while controlling for caregiver and survivor characteristics. The model explained 28% of the variance in Worry of Cancer scores (FOR). Caregivers who reported more loneliness, spent more time caring, and had greater financial stress from caring had higher scores on Worry of Cancer (FOR). Female caregivers, those caring for younger survivors, and those with survivors who had undergone less extensive forms of surgery also reported higher FOR. DISCUSSION A combination of factors place caregivers at greater risk of cancer-related worry, paving the way for designing interventions aimed at reducing FOR in caregivers of patients with head and neck cancers.
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van de Wal M, Thewes B, Gielissen M, Speckens A, Prins J. Efficacy of Blended Cognitive Behavior Therapy for High Fear of Recurrence in Breast, Prostate, and Colorectal Cancer Survivors: The SWORD Study, a Randomized Controlled Trial. J Clin Oncol 2017; 35:2173-2183. [PMID: 28471726 DOI: 10.1200/jco.2016.70.5301] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose Fear of cancer recurrence (FCR) is a common problem experienced by cancer survivors. Approximately one third of survivors report high FCR. This study aimed to evaluate whether blended cognitive behavior therapy (bCBT) can reduce the severity of FCR in cancer survivors curatively treated for breast, prostate, or colorectal cancer. Patients and Methods This randomized controlled trial included 88 cancer survivors with high FCR (Cancer Worry Scale score ≥ 14) from 6 months to 5 years after cancer treatment. Participants were randomly allocated (ratio 1:1, stratified by cancer type) to receive bCBT, including five face-to face and three online sessions (n = 45) or care as usual (CAU; n = 43). Participants completed questionnaires at baseline (T0) and 3 months later (T1). The intervention group completed bCBT between T0 and T1. The primary outcome was FCR severity assessed with the Cancer Worry Scale. Secondary outcomes included other distress-related measures. Statistical (one-way between-group analyses of covariance) and clinical effects (clinically significant improvement) were analyzed by intention to treat. Results Participants who received bCBT reported significantly less FCR than those who received CAU (mean difference, -3.48; 95% CI, -4.69 to -2.28; P < .001) with a moderate-to-large effect size ( d = 0.76). Clinically significant improvement in FCR was significantly higher in the bCBT group than in the CAU group (13 [29%] of 45 compared with 0 [0%] of 43; P < .001); self-rated improvement was also higher in the bCBT group (30 [71%] of 42 compared with 12 [32%] of 38 in the CAU group; P < .001). Conclusion bCBT has a statistically and clinically significant effect on the severity of FCR in cancer survivors and is a promising new treatment approach.
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Affiliation(s)
- Marieke van de Wal
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Belinda Thewes
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marieke Gielissen
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anne Speckens
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Judith Prins
- Marieke van de Wal, Belinda Thewes, Anne Speckens, and Judith Prins, Radboud University Medical Center, Nijmegen; and Marieke Gielissen, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Manne SL, Virtue SM, Ozga M, Kashy D, Heckman C, Kissane D, Rosenblum N, Morgan M, Rodriquez L. A comparison of two psychological interventions for newly-diagnosed gynecological cancer patients. Gynecol Oncol 2017; 144:354-362. [PMID: 27887806 PMCID: PMC5239741 DOI: 10.1016/j.ygyno.2016.11.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/07/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study compared the efficacy of two psychological interventions, a coping and communication-enhancing intervention (CCI) and supportive counseling (SC), in reducing depressive symptoms, cancer-specific distress, fear of recurrence, and emotional well-being of women diagnosed with gynecological cancer. Demographic, medical, and psychological moderators of intervention effects were evaluated. METHODS Three hundred fifty-two women with gynecological cancer were randomly assigned to eight sessions of CCI, eight sessions of SC, or usual care (UC). Participants completed measures of distress and wellbeing at six time points over an 18month period of time. RESULTS CCI had a beneficial impact on depressive symptoms and cancer specific distress over the first six months as compared with UC and SC and had a beneficial impact on emotional well-being. The greater coping skill development in CCI has made it a more effective intervention than traditional SC across a broader range of key psychological outcomes. Declines among women in the SC condition were not significantly different from UC. CONCLUSIONS The CCI intervention had significant effect on patients' depression, cancer-specific distress, and emotional well-being during a time when the majority of newly diagnosed patients experience elevated levels of distress. Ameliorating such distress post-diagnosis merits its incorporation into clinical care. A brief 8-session structured intervention can be readily applied to this distressed population in need. Brief supportive counseling did not evidence treatment effects, suggesting that more structured approaches are crucial to truly deliver benefits.
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
| | - Shannon Myers Virtue
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
| | - Melissa Ozga
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Deborah Kashy
- Michigan State University, Department of Psychology, 316 Physics Rm 262, East Lansing, MI 48824, USA.
| | - Carolyn Heckman
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
| | - David Kissane
- Monash University, Department of Psychiatry, Wellington Rd & Blackburn Rd, Clayton, VIC 380, Australia.
| | - Norman Rosenblum
- Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Mark Morgan
- University of Pennsylvania, 800 Walnut Street, Philadelphia, PA 19107, USA
| | - Lorna Rodriquez
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
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Ander M, Wikman A, Ljótsson B, Grönqvist H, Ljungman G, Woodford J, Lindahl Norberg A, von Essen L. Guided internet-administered self-help to reduce symptoms of anxiety and depression among adolescents and young adults diagnosed with cancer during adolescence (U-CARE: YoungCan): a study protocol for a feasibility trial. BMJ Open 2017; 7:e013906. [PMID: 28132011 PMCID: PMC5278290 DOI: 10.1136/bmjopen-2016-013906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A subgroup of adolescents and young adults diagnosed with cancer during adolescence reports elevated levels of anxiety and depressive symptoms and unmet needs for psychological support. Evidence-based psychological treatments tailored for this population are lacking. This protocol describes a feasibility study of a guided-internet-administered self-help programme (YoungCan) primarily targeting symptoms of anxiety and depression among young persons diagnosed with cancer during adolescence and of the planned study procedures for a future controlled trial. METHODS/ANALYSIS The study is an uncontrolled feasibility trial with a pre-post and 3-month follow-up design. Potential participants aged 15-25 years, diagnosed with cancer during adolescence, will be identified via the Swedish Childhood Cancer Registry. 30 participants will be included. Participants will receive YoungCan, a 12-week therapist-guided, internet-administered self-help programme consisting primarily of cognitive-behavioural therapy organised into individually assigned modules targeting depressive symptoms, worry and anxiety, body dissatisfaction and post-traumatic stress. Interactive peer support and psychoeducative functions are also available. Feasibility outcomes include: recruitment and eligibility criteria; data collection; attrition; resources needed to complete the study and programme; safety procedures; participants' and therapists' adherence to the programme; and participants' acceptability of the programme and study methodology. Additionally, mechanisms of impact will be explored and data regarding symptoms of anxiety, depression, post-traumatic stress, body dissatisfaction, reactions to social interactions, quality of life, axis I diagnoses according to the Mini International Neuropsychiatric Interview and healthcare service use will be collected. Exploratory analyses of changes in targeted outcomes will be conducted. ETHICS/DISSEMINATION This feasibility protocol was approved by the Regional Ethical Review Board in Uppsala, Sweden (ref: 2016/210). Findings will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals and presentations at scientific and clinical conferences. TRIAL REGISTRATION NUMBER ISRCTN97835363.
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Affiliation(s)
- Malin Ander
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Wikman
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Helena Grönqvist
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Clinical Education Development and Research (CEDAR), Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Annika Lindahl Norberg
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Hefner J, Berberich S, Lanvers E, Sanning M, Steimer AK, Kunzmann V. New insights into frequency and contents of fear of cancer progression/recurrence (FOP/FCR) in outpatients with colorectal carcinoma (CRC) receiving oral capecitabine: a pilot study at a comprehensive cancer center. Patient Prefer Adherence 2017; 11:1907-1914. [PMID: 29180853 PMCID: PMC5694194 DOI: 10.2147/ppa.s142784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fear of cancer progression/recurrence (FOP/FCR) is considered one of the most prevalent sources of distress in cancer survivors and associated with lower quality of life and functional impairment. Detailed measures of FOP/FCR are needed because little is known about the knowledge of FOP/FCR, its associations with the patient-doctor relationship, and the rate of adequate therapy. Colorectal cancer (CRC) is one of the most prevalent cancer entities, and oral capecitabine is widely prescribed as treatment. Therefore, we initiated a pilot study to expand the literature on FOP/FCR in CRC outpatients receiving capecitabine and to generate hypotheses for future investigations. METHODS This study included 58 patients treated at a comprehensive cancer center. FOP/FCR was assessed with the Fear of Progression Questionnaire (FOP-Q-SF). Satisfaction with the relationships with doctors was assessed with the Patient-Doctor Relationship Questionnaire-9 (PRDQ-9). Levels of side effects were rated by the patients on a visual analog scale. Clinical data were extracted from the charts. RESULTS A total of 19 out of 58 patients (36%) suffered from FOP/FCR according to our assessment. Levels of FOP/FCR seemed to be mostly moderate to high. Only four out of the 19 distressed patients (21%) were treated accordingly. Typical side effects of oncological treatment were associated with higher FOP/FCR. Satisfaction with doctor-patient relationships was not associated with FOP/FCR. Regarding single items of FOP/FCR, three out of the five most prevalent fears were associated with close relatives. DISCUSSION FOP/FCR occurred frequently in more than one in three patients, but was mostly untreated in this sample of consecutive outpatients with CRC receiving oral capecitabine. In detail, most fears were related to family and friends. In addition to an unmet need of patients, our data indicate sources of distress not considered thus far. If replicated in larger studies, results may help to inform intervention development and improve patient care.
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Affiliation(s)
- Jochen Hefner
- Section of Psychosomatic Medicine, Department of Internal Medicine II, University of Wuerzburg
- Correspondence: Jochen Hefner, Section of Psychosomatic Medicine, Department of Internal Medicine II, University of Wuerzburg, Oberdürrbacher Str 6, 97080 Wuerzburg, Germany, Tel +49 931 40160, Fax +49 931 640160, Email
| | | | - Elena Lanvers
- Children’s Hospital of the City of Cologne, North Rhine-Westphalia
| | - Maria Sanning
- Faculty of Medicine, University of Wuerzburg, Bavaria
| | | | - Volker Kunzmann
- Section of Clinical Oncology, Department of Internal Medicine II, University of Wuerzburg, Bavaria, Germany
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Graham CD, Gouick J, Krahé C, Gillanders D. A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clin Psychol Rev 2016; 46:46-58. [DOI: 10.1016/j.cpr.2016.04.009] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 03/07/2016] [Accepted: 04/07/2016] [Indexed: 12/21/2022]
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Freeman-Gibb LA, Janz NK, Katapodi MC, Zikmund-Fisher BJ, Northouse L. The relationship between illness representations, risk perception and fear of cancer recurrence in breast cancer survivors. Psychooncology 2016; 26:1270-1277. [PMID: 27146965 DOI: 10.1002/pon.4143] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 01/18/2016] [Accepted: 03/20/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Fear of cancer recurrence, although distinct from distress continues to be under-evaluated, captured, or treated when standard distress scales are used to assess concerns of cancer survivors. We tested a model assessing the association of demographic and clinical factors, illness representations, and perceived risk with fear of cancer recurrence in breast cancer survivors. METHODS We recruited 117 breast cancer survivors at least one year after completing breast cancer treatment from Internet discussion boards for this cross-sectional, descriptive, correlational study. Participants completed a survey that assessed their level of fear of cancer recurrence as well as their illness representations, perceived risk of recurrence, and demographic and medical characteristics. RESULTS Our model explained 62% of the variance in fear of cancer recurrence. Emotional representations (β = .46, p < .01), symptom attribution (β = .21, p < .01), timeline (β = .23, p < .01), and consequences (β = .16, p < .03) were significantly related to fear of recurrence. By contrast, the majority of clinical and demographic variables were not significant contributors to fear of recurrence. CONCLUSIONS Upon completion of cancer treatment, survivors with more emotional representations of the experience and those who attribute unrelated symptoms to their breast cancer have a higher level of fear of recurrence. Evaluation of these factors during treatment may help mitigate fear of recurrence in the survivorship phase of the breast cancer trajectory. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Nancy K Janz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Maria C Katapodi
- Institute of Nursing Science/Faculty of Medicine, University of Basel, Basel, Switzerland
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Lebel S, Ozakinci G, Humphris G, Thewes B, Prins J, Dinkel A, Butow P. Current state and future prospects of research on fear of cancer recurrence. Psychooncology 2016; 26:424-427. [DOI: 10.1002/pon.4103] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/25/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Belinda Thewes
- Radboud University Medical Centre; Nijmegen The Netherlands
| | - Judith Prins
- Radboud University Medical Centre; Nijmegen The Netherlands
| | | | - Phyllis Butow
- University of Sydney; Sydney New South Wales Australia
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49
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Tomei C, Lebel S, Maheu C, Mutsaers B. Addressing fear of recurrence: improving psychological care in cancer survivors. Support Care Cancer 2016; 24:2815-8. [PMID: 26838024 DOI: 10.1007/s00520-016-3103-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/24/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is defined as "the fear or worry that the cancer will return or progress in the same area or another part of the body." FCR is associated with impaired functioning and lower quality of life in cancer patients. A cognitive-existential (CE) manualized group intervention for women with FCR showed a moderate effect size in reducing FCR, cancer-specific distress, and maladaptive coping. However, it appears that no individual intervention for FCR exists for both men and women. Therefore, the group intervention was adapted to an individual format. METHODS This study was conducted to determine the feasibility, acceptability, and satisfaction of the individual intervention. The intervention was pilot-tested on n = 3 cancer survivors. The 6-week sessions included cognitive restructuring, structured exercises, and relaxation techniques. Participants completed questionnaire packages during a 4-week baseline period and throughout the 6-week intervention. Participants completed exit interviews following the intervention. RESULTS General trends in baseline and intervention stages were compared. Based on the line graphs, the individual intervention appears to help survivors lower their elevated FCR and cancer-specific distress. Qualitative exit interviews conducted with the study participants demonstrated that the intervention was acceptable and satisfactory. CONCLUSIONS This clinical intervention allows researchers to systematically focus on evidence-based treatments for managing FCR, and displays the availability of treatment options in different therapeutic modalities. However, further research is needed to identify the active therapeutic ingredients and mechanisms of change in the intervention. Overall, intervention studies suggest it is possible to help cancer survivors manage their FCR.
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Affiliation(s)
- Christina Tomei
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, Room 4016, Ottawa, ON, K1N 6N5, Canada.
| | - Sophie Lebel
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, Room 4016, Ottawa, ON, K1N 6N5, Canada
| | - Christine Maheu
- Ingram School of Nursing, McGill University, 3506 University Street, Room 401-A, Wilson Hall, Montreal, QC, H3A 2A7, Canada
| | - Brittany Mutsaers
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, Room 4016, Ottawa, ON, K1N 6N5, Canada
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50
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Fear of cancer recurrence: a theoretical review and novel cognitive processing formulation. J Cancer Surviv 2016; 10:663-73. [PMID: 26782171 DOI: 10.1007/s11764-015-0512-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/25/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is prevalent among survivors. However, a comprehensive and universally accepted theoretical framework of FCR to guide intervention is lacking. This paper reviews theoretical frameworks previously used to explain FCR and describes the formulation of a novel theoretical framework for FCR. METHODS A systematic review of the literature was undertaken to identify conceptual frameworks or theories applied to FCR. MEDLINE, PubMED, CINAHL, AMED, PsycINFO and Web of Science were searched. Identified conceptual frameworks were reviewed for strength of evidence supporting their validity. RESULTS Of 558 papers initially identified, 16 made reference to six different conceptual frameworks relating to FCR. The most comprehensive and evidence-based theoretical approach is the Common Sense Model (CSM). Other approaches have limited evidence supporting their application to FCR. Two theoretical approaches developed in the context of emotional disorders that appear to be highly relevant to FCR: the Self-Regulatory Executive Function (S-REF) model and Relational Frame Theory were combined with the CSM to produce a novel cognitive processing account of FCR. CONCLUSIONS Few conceptual frameworks have been used consistently to guide FCR research, and not all frameworks are empirically well supported, suggesting that further discussion regarding the conceptualisation of FCR is needed. The novel theoretical framework for FCR presented highlights the multidimensional nature of FCR and the importance of cognitive processing and metacognitions in the development and maintenance of FCR. IMPLICATIONS FOR CANCER SURVIVORS The novel theoretical formulation of FCR outlined here provides a much-needed comprehensive framework to further investigate and address FCR in cancer survivors.
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