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Tauber NM, O'Toole MS, Jensen AB, Butow PN, Thewes B, Elkjaer E, Knutzen S, von Heymann A, Johansen C, Zachariae R. ConquerFear-Group: A randomized controlled trial of an online-delivered group-based psychological intervention for fear of cancer recurrence in breast cancer survivors. Psychooncology 2023; 32:1424-1432. [PMID: 37489745 DOI: 10.1002/pon.6193] [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] [Received: 04/13/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a distressing concern among cancer survivors. Interventions to address FCR need to be effective but also accessible and low cost. This randomized controlled trial evaluated the efficacy of an online group-based psychological intervention for FCR (ConquerFear-Group). METHODS Eligible breast cancer (BC) survivors had completed primary treatment 3 months-5 years previously, were ≥18 years, and scored ≥22 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Participants were randomized to online ConquerFear-Group (focusing on metacognitive strategies, values-clarification, and education about follow-up behavior) or online group-based relaxation training (active control). Questionnaires were completed at baseline (T1), 1 week post-intervention (T2), three (T3) and six (T4) months later. The primary outcome was FCR (FCRI total). A number of secondary and process outcomes were also collected. Treatment effects were evaluated with mixed linear models. RESULTS Of 866 eligible BC survivors, 475 (55%) completed the FCR screening, and 85 (18%) were randomized to ConquerFear-Group or relaxation training (2 × 6 groups). Compared with control participants, ConquerFear-Group participants experienced larger reductions in FCR (Cohen's d = 0.47, p = 0.001) and FCR severity (d = 0.57, p < 0.001), as well as mindfulness and decentering from baseline through follow-up, and improvements in emotion regulation (T2), worry (T2, T3) and rumination (T2) at some time points. CONCLUSIONS The results demonstrated statistically significant and stable effects of ConquerFear-Group on FCR that were maintained over a 6-month period. It is suggested to investigate the program in a real-life setting, where a pragmatic trial can further demonstrate feasibility and effectiveness.
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Affiliation(s)
- Nina M Tauber
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Mia S O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Anders B Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus, Denmark
| | - Phyllis N Butow
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Belinda Thewes
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Emma Elkjaer
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Sofie Knutzen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center for Late Effects (DCCL), Aarhus, Denmark
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Ng DWL, Fielding R, Tsang C, Ng C, Chan J, Or A, Kong IWM, Tang JWC, Li WWY, Chang ATY, Foo CC, Kwong A, Ng SSM, Suen D, Chan M, Chun OK, Chan KKL, Butow PN, Lam WWT. Study protocol of ConquerFear-HK: a randomised controlled trial of a metacognition-based, manualised intervention for fear of cancer recurrence among Chinese cancer survivors. BMJ Open 2023; 13:e065075. [PMID: 36669845 PMCID: PMC9872480 DOI: 10.1136/bmjopen-2022-065075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/30/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Fear of cancer recurrence (FCR) is a prevalent and frequently debilitating response to a cancer diagnosis, affecting a substantial proportion of cancer survivors. Approximately 30% of local Hong Kong Chinese cancer survivors in a recent survey reportedly experienced persistent high FCR over the first-year post-surgery. This was associated with lower levels of psychological well-being and quality of life. A manualised intervention (ConquerFear) developed primarily based on the Self-Regulatory Executive Function Model and the Rational Frame Theory, has been found to reduce FCR effectively among Caucasian cancer survivors. The intervention now has been adapted to a Chinese context; ConquerFear-HK. The primary aim of this study is to evaluate its efficacy vs a standard-survivorship-care control (BasicCancerCare) in FCR improvement in a randomised control trial (RCT). METHODS AND ANALYSIS In this RCT, using the sealed envelope method, 174 eligible Chinese cancer survivors will be randomised to either the ConquerFear-HK or BasicCancerCare intervention. Both interventions include six sessions over 10 weeks, which will be delivered via face to face or online by trained therapists. The ConquerFear-HK intervention incorporates value classification, metacognitive therapy, attentional training, detached mindfulness and psychoeducation; BasicCancerCare includes relaxation training, dietary and physical activity consultations. Participants will be assessed at prior randomisation (baseline; T0), immediately postintervention (T1), 3 months (T2) and 6 months postintervention (T3) on the measures of FCR (Fear of Cancer Recurrence Inventory) as a primary outcome; metacognition (30-item Metacognitions Quesionnaire) and cognitive attentional syndrome (Cognitive-attentional Syndrome Questionnaire) as process outcomes; psychological distress (Hospital Anxiety and Depression Scale), cancer-related distress (Chinese Impact of Events Scale), quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire) and treatment satisfaction are secondary outcomes. ETHICS AND DISSEMINATION Ethics approval has been obtained from HKU/HA HKW Institutional Review Board (ref: UW19-183). The patients/participants provide their written informed consent to participate in this study. The study results will be disseminated through international peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04568226.
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Affiliation(s)
- Danielle Wing Lam Ng
- Centre for Psycho-Oncological Research and Training, Division of Behavioural Sciences, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Richard Fielding
- Centre for Psycho-Oncological Research and Training, Division of Behavioural Sciences, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Catherine Tsang
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Carmen Ng
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Joyce Chan
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Amy Or
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Izy Wing Man Kong
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Julia Wei Chun Tang
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wylie Wai Yee Li
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Amy Tien Yee Chang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chi Choo Foo
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ava Kwong
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong
| | - Simon Siu-Man Ng
- Department of Surgery, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Dacita Suen
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong
| | - Miranda Chan
- Department of Surgery, Kwong Wah Hospital, Hong Kong Hospital Authority, Hong Kong, Hong Kong
| | - Oi-Kwan Chun
- Department of Surgery, Kwong Wah Hospital, Hong Kong Hospital Authority, Hong Kong, Hong Kong
| | - Karen Kar Loen Chan
- Department of Obstetric and Gynaecology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Phyllis N Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Wing Tak Lam
- Centre for Psycho-Oncological Research and Training, Division of Behavioural Sciences, School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
- HKU Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Pang L, Yao S, Li W, Jing Y, Yin X, Cheng H. Impact of the CALM intervention on breast cancer patients during the COVID-19 pandemic. Support Care Cancer 2023; 31:121. [PMID: 36648574 PMCID: PMC9843115 DOI: 10.1007/s00520-023-07582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The COVID-19 outbreak has adversely affected breast cancer patients both physically and mentally. Managing Cancer and Living Meaningfully (CALM) is a psychological intervention that is easy to implement. It also decreases the possibility of virus transmission because it can be administered online. Therefore, this study investigated the effects of CALM on the sleep quality, memory, psychological distress, and quality of life (QoL) of breast cancer patients during the ongoing COVID-19 pandemic. METHODS Sixty breast cancer patients were recruited and randomly assigned to a CALM group and a Care as Usual (CAU) group. They filled in questionnaires before and after the CALM intervention and CAU. These included the Sleep Quality Scale (SQS), Prospective Memory Scale (PM), Retrospective Memory Scale (RM), Psychological Distress Thermometer (DT), and Quality of life (QoL) Scale. RESULTS The scores of all the aforementioned scales after the CALM intervention (ACM) were significantly lower compared to the said scores before the CALM intervention (BCM) and after Care as Usual (ACU) (t = 12.369/8.013, t = 8.632/4.583, t = 7.500/6.900, t = 12.479/9.780, t = 12.224/6.729 respectively, P < 0.05) There was a linear correlation between the QoL, DT, and SQS scores. CONCLUSION CALM is an effective psychotherapy for breast cancer patients, especially during the COVID-19 pandemic, for improving the QoL because it relieves psychological distress and enhances sleep quality.
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Affiliation(s)
- Lulian Pang
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, 230601 Anhui China
| | - Senbang Yao
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, 230601 Anhui China
| | - Wen Li
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, 230601 Anhui China
| | - Yanyan Jing
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, 230601 Anhui China
| | - Xiangxiang Yin
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, 230601 Anhui China
| | - Huaidong Cheng
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, 230601, Anhui, China. .,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, 510500, China. .,Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, 518000, Guangdong, China.
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Tran MJ, Jefford M, Smith B, Lynch F, Dhillon HM, Shaw J, McDowell L, White A, Halloran C, Wiesenfeld D, Ftanou M. Study protocol for the evaluation of Fear-Less: a stepped-care program for fear of cancer recurrence in survivors with early-stage disease. Pilot Feasibility Stud 2022; 8:177. [PMID: 35948952 PMCID: PMC9364569 DOI: 10.1186/s40814-022-01123-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is a significant unmet need amongst cancer survivors and is consistently associated with psychological distress and impaired quality of life. Psychological interventions for FCR, such as ConquerFear, have demonstrated efficacy in reducing FCR and improving emotional wellbeing. Unfortunately, there are barriers to the uptake of evidence-based FCR treatments in clinical practice. A stepped-care FCR treatment model may overcome these barriers and has demonstrated potential in people with advanced melanoma. This study aims to evaluate the acceptability, feasibility, and impact of a stepped-care FCR treatment model (Fear-Less) in people with other cancer types, who have completed treatment with curative intent. METHODS Sixty people with early-stage cancer (defined as individuals who have received treatment with curative intent and with no metastatic disease) will be screened for FCR using the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Individuals reporting moderate FCR (FCRI-SF between 13 and 21) will be offered a clinician-guided self-management resource; those reporting high FCR (FCRI-SF ≥ 22) will be offered individual therapy according to the ConquerFear protocol. Participants will complete purpose-built evaluation surveys assessing their FCR screening and intervention experiences. Clinicians will also complete a survey regarding their experiences of the treatment model. Fear-Less will be evaluated in terms of (1) acceptability (i.e., patient and clinician experience), (2) feasibility (i.e., referral uptake, treatment adherence, and time taken to screen and deliver interventions), and (3) impact (i.e., pre- to post-intervention FCR changes). DISCUSSION The Fear-Less stepped-care model is a novel framework for screening FCR and stratifying survivors to the appropriate level of treatment. Our study will provide an indication of whether Fear-Less is a feasible and acceptable FCR model of care amongst survivors with early-stage disease and inform further investigations of this model. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR); ACTRN12622000818730 .
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Affiliation(s)
- Mei Jun Tran
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Ben Smith
- Ingham Institute for Applied Medical Research and South West Sydney Clinical Campuses, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Lynch
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia
| | - Haryana M Dhillon
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia.,Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Camperdown, NSW, Australia
| | - Joanne Shaw
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan White
- Consumer Representative, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Consumer Representative, Continence Foundation of Australia, Melbourne, Victoria, Australia
| | - Clare Halloran
- Consumer Representative, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Wiesenfeld
- Director Head and Neck Tumour Stream, Melbourne Health and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Lead in Research and Education Head and Neck, VCCC Alliance, Melbourne, Victoria, Australia.,Honorary Clinical Professor, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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