ASCO 2017: Conquer Fear Intervention Lowers Young Breast Cancer Survivors’ Fear of Cancer Recurrence

Key Points

  • The average FCRI score at baseline was 82.7 in the intervention arm and 85.7 in the control arm. The primary outcome of the study—total fear-of-cancer-recurrence score—was reduced significantly more in the intervention group (by 18.1 points on average) than in the control group (by 7.6 points on average) immediately after the intervention.
  • FCRI scores continued to decrease over time, with a significant difference between groups at 6 months, decreasing by 27.2 points on average in the intervention group and 17.8 points on average in the control group.
  • The researchers also explored other patient outcomes, including cancer-specific distress, general distress, and quality of life. The psychological intervention had a greater positive effect on these outcomes than relaxation training. 

About 50% of all cancer survivors and 70% of young breast cancer survivors report a moderate to high fear of recurrence. The fear can be so distressing that it negatively affects medical follow-up behavior, mood, relationships, work, goal setting, and quality of life. Yet interventions to alleviate this fear are lacking. In a phase II randomized clinical trial, a psychological intervention called Conquer Fear substantially reduced the fear of recurrence immediately after the intervention as well as 3 and 6 months later. General anxiety, cancer-specific distress, and quality of life were better in the psychological intervention group immediately after therapy.

The study was presented today by Beith et al at the 2017 ASCO Annual Meeting (Abstract LBA10000).

“The reduction in fear of recurrence in the psychological intervention group was large enough to improve survivors’ psychological and emotional well-being,” said lead study author Jane Beith, MD, PhD, a medical oncologist at the University of Sydney in Australia, who developed the Conquer Fear intervention with colleagues including psycho-oncologist Phyllis Butow, BA(Hons)Dip Ed, MClinPsych, MPH, PhD. “The majority of participants were young women with breast cancer, but we expect the intervention may be appropriate for other patients who have moderate to high fear of recurrence.”

About the Intervention

The Conquer Fear psychology intervention is based on a novel theoretical framework developed by the authors (the intervention was developed for research and is not yet used in clinical practice). Trained study therapists delivered the intervention in five 60- to 90-minute individual, face-to-face sessions over 10 weeks. Conquer Fear focuses on:

  • Accepting the inherent uncertainty of whether the cancer would come back
  • Teaching strategies to control worry
  • Giving survivors more control over where they place their attention
  • Helping them focus on what they want to get out of life
  • Choosing a sensible level of cancer screening and sticking to it.

About the Study

Researchers randomly assigned 222 survivors of stage I­­–III breast cancer, colorectal cancer, or melanoma who reported high fear of recurrence to either the Conquer Fear intervention or relaxation training (control group). All survivors had completed cancer treatment 2 months to 5 years before enrolling in this study and were cancer-free at the time.

Survivors in the control group received five 60-minute, individual, face-to-face relaxation sessions. The sessions were delivered over 10 weeks by trained study therapists and incorporated muscle relaxation, meditative relaxation, and visualization and quick relaxation techniques. Both groups received instructions for home-based practice.

To measure change in fear of cancer recurrence, researchers used total scores from a validated 42-item questionnaire called Fear of Cancer Recurrence Inventory (FCRI). The scores range from 0 to 168, with higher scores indicating a worse fear of recurrence. Survivors completed the questionnaire at enrollment, immediately after the intervention, and 3 and 6 months later.

Key Findings

The average FCRI score at baseline was 82.7 in the intervention arm and 85.7 in the control arm. The primary outcome of the study—total fear-of-cancer-recurrence score—was reduced significantly more in the intervention group (by 18.1 points on average) than in the control group (by 7.6 points on average) immediately after the intervention. This represents a standardized effect size of 0.44, within the range considered clinically important.

FCRI scores continued to decrease over time, with a significant difference between groups at 6 months, decreasing by 27.2 points on average in the intervention group and 17.8 points on average in the control group.

The researchers also explored other patient outcomes, including cancer-specific distress (how much someone is plagued with thoughts about cancer), general distress (anxiety, depression, and stress), and quality of life (covers independent living, physical pain, mental health, happiness, coping, relationships, and self-worth). The psychological intervention had a greater positive effect on these outcomes than relaxation training.

Commentary

“The number of people surviving cancer is higher than ever before, but many survivors fear the cancer will return even long after they have finished treatment. The hope is that the positive results of this fear-reducing intervention will pave the way for making it more widely available to patients,” said Don S. Dizon, MD, FACP, an ASCO expert.

This study was funded by Cancer Australia, beyondblue, and National Breast Cancer Foundation.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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