Blended Cognitive Behavior Therapy and Fear of Recurrence in Cancer Survivors


Key Points

  • Blended CBT was associated with a higher rate of clinically significant improvement in the fear of recurrence among survivors of breast, prostate, and colorectal cancers.
  • The rate of patient self-reported improvement in the fear of recurrence was higher with blended CBT than usual care.

A Dutch study (SWORD) has shown that blended cognitive behavioral therapy (CBT)—mixing face-to-face and online sessions—reduced the fear of recurrence among survivors of breast, prostate, and colorectal cancers. These results were reported by van de Wal et al in the Journal of Clinical Oncology.

Study Details

In the study, 88 cancer survivors (36 breast cancer, 30 prostate cancer, 22 colorectal cancer) with a high fear of cancer recurrence (Cancer Worry Scale [CWS] score ≥ 14) at 6 months to 5 years after cancer treatment were randomized to receive blended CBT (n = 45) or usual care (n = 43). Participants completed CWS questionnaires at baseline (T0) and 3 months later (T1).

The intervention was delivered over 3 months (T0 to T1), consisting of five individual 1-hour face-to-face sessions (sessions 1–3, 5, and 8) combined with three 15-minute e-consultations (chat application, no video) with access to a website (sessions 4, 6, and 7). The usual-care group had no restrictions regarding the use of psychosocial support during the study period.

The CWS score range is 8 to 32. A significant change was defined as a minimum of 4.48 points; a clinically significant improvement was defined as both at least a minimum significant change and reduction to a CWS score of 14.

Reduced Fear

Patients receiving blended CBT reported significantly less fear of recurrence than did those receiving usual care (mean difference = –3.48, P < .001), with a moderate-to-large effect size (d = 0.76). Clinically significant improvement in fear of recurrence was significantly higher in the blended CBT group (29% vs 0%, P < .001). Rates of self-rated improvement were 71% vs 32% (P < .001), respectively.

The investigators concluded: “[Blended] CBT has a statistically and clinically significant effect on the severity of [fear of cancer recurrence] in cancer survivors and is a promising new treatment approach.”

The study was supported by the Dutch Cancer Society.

Marieke van de Wal, MSc, of Radboud University Medical Centre, Nijmegen, the Netherlands, is the corresponding author of the Journal of Clinical Oncology article.

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®.