Fear of cancer recurrence therapy (FORT): A randomized controlled trial.

Abstract

Objective: Most fear of cancer recurrence (FCR) interventions have small effects, and few target FCR. This randomized controlled trial (RCT) with breast and gynecological cancer survivors evaluated the efficacy of a cognitive-existential fear of recurrence therapy (FORT) compared to an attention placebo control group (living well with cancer [LWWC]) on FCR. Method: One hundred and sixty-four women with clinical levels of FCR and cancer distress were randomly assigned to 6-weekly, 120 min FORT (n = 80) or LWWC (n = 84) group sessions. They completed questionnaires at baseline (T1), posttreatment (T2; primary endpoint), 3 (T3), and 6 months (T4) posttreatment. Generalized linear models were used to compare group differences in the fear of cancer recurrence inventory (FCRI) total score and secondary outcomes. Results: FORT participants experienced greater reductions from T1 to T2 on FCRI total with a between-group difference of −9.48 points (p = .0393), resulting in a medium effect of −0.530, with a maintained effect at T3 (p = .0330) but not at T4. For the secondary outcomes, improvements were in favor of FORT, including FCRI triggers (p = .0208), FCRI coping (p = .0351), cognitive avoidance (p = .0155), need for reassurance from physicians (p = .0117), and quality of life (mental health; p = .0147). Conclusions: This RCT demonstrated that FORT, compared to an attention placebo control group, resulted in a greater reduction in FCR posttreatment and at 3 months posttreatment in women with breast and gynecological cancer, indicating its potential as a new treatment strategy. We recommend a booster session to sustain gains.

Acceptability, feasibility and preliminary effects of an online group psychotherapy intervention for adolescents and young adults with cancer

“…Improvements in QoL have been observed in other cognitive-existential group-based oncology interventions. 14,16 Improvements in other domains (e.g., fear of cancer recurrence, body image distress, general emotional distress, and post-traumatic growth) were also observed, however were not statistically significant in this small sample. Interestingly, social wellbeing as measured by the FACT-G, did not improve from pre-to postintervention.…”

“…These protocols, often referred to as "cognitive-existential" therapies, 13 have demonstrated efficacy in reducing emotional distress and improving QoL in adult oncology populations and are distinct from general peer support due to their focus on teaching skills and therapeutic facilitation of group discussion. [14][15][16] There is a compelling theoretical and empirical rationale for the utility of cognitive-existential group-based approaches to psychotherapy with AYAs with cancer, however currently, no such interventions exist.…”

“…The intervention was developed following an iterative, patientoriented process. First, potential session topics were identified based on existing protocols, 14,17 review of AYA psychosocial needs and clinical practice guidelines, [18][19][20] and clinical experience.…”

The development and preliminary implementation evaluation of the Fear Of Recurrence Therapy intervention virtual training workshop

“…3,4 One such intervention is the Fear Of Recurrence Therapy (FORT). 5 FORT consists of six consecutive weekly group sessions (90-120 min) facilitated by two trained psychosocial oncology professionals. It combines principles of cognitive-behavioral therapy and existential therapy.…”

“…Fortunately, two meta‐analyses provide evidence that brief (≤7 sessions) group or individual therapies can be efficacious and cost‐effective in decreasing FCR and improving quality of life 3,4 . One such intervention is the Fear Of Recurrence Therapy (FORT) 5 . FORT consists of six consecutive weekly group sessions (90–120 min) facilitated by two trained psychosocial oncology professionals.…”