Is digital intervention for fear of cancer recurrence beneficial to cancer patients?: A systematic review and meta‐analysis

Abstract

ObjectiveThis study aimed to compare the effectiveness of digital and face‐to‐face interventions in reducing fear of cancer recurrence (FCR) among individuals with cancer.MethodsThis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines for evaluating the efficacy of psychological interventions for FCR published between July 2018 and December 2021. We searched for research papers using PubMed, Embase, and Cochrane and assessed their quality using the Revised Cochrane risk‐of‐bias tool for randomized trials.ResultsOf the 2113 identified studies, we analyzed 17 samples (N = 1482) from 14 studies, of which 13 were RCTs. The overall sample showed a moderate effect size (Hedges' g = 0.607; 0.356 to 0.858; p < 0.001; I2 = 81.29%) in FCR reduction. The overall effect size was 0.621 (95% CI, 0.276 to 0.966; p < 0.001; I2 = 81.78%) for face‐to‐face interventions and 0.517 (95% CI, 0.093 to 0.941; p = 0.017; I2 = 83.19%) for digital interventions. The difference between the two effect sizes was not statistically significant.ConclusionOur meta‐analysis suggests that digital interventions are moderately effective in reducing FCR, similar to face‐to‐face interventions. However, given the high degree of heterogeneity, this conclusion should be interpreted with caution. Further studies are required to identify the most effective digital interventions and the populations that may benefit from them.

Guidelines needed for the management of fear of cancer recurrence in adult survivors of cancer in the United States: A consensus statement

“…Metaanalyses of psychotherapy and mind-body interventions for FCR have demonstrated the effectiveness of targeted treatments. [12][13][14] FCR may require a more nuanced intervention approach than standard CBT treatment, which typically focuses on reframing irrational fears, exposure therapy, or behavioral activation. Although these coping strategies are evidence-based for certain anxiety and mood disorders, such as generalized anxiety disorder and major depressive disorder, they have the potential to be ineffective and invalidating for survivors faced with ongoing uncertainty.…”

“…Both treatment pathways, although well intentioned, are not empirically supported compared with FCR-targeted treatments. 12,13 For example, a recent trial testing the effect of behavioral activation 2740 -GUIDELINES FOR MANAGEMENT OF FEAR OF CANCER RECURRENCE on FCR found small effects, 15 whereas pooled effect sizes from FCR interventions are generally more robust (pooled Hedges g values of −0.36, −0.33, and −0.61, respectively [12][13][14] ).…”

“…5 Implementation of digital delivery can be helpful for targeting subpopulations at highest risk and may be noninferior to in-persondelivered FCR treatment. 14 For transparency, one of the authors (Allan "Ben" Smith) has developed an e-health FCR intervention that is being commercialized. In addition to addressing logistical challenges of in-person attendance and overcoming health-related social needs that may impede access to care, implementation of digital delivery may be optimal for cancer survivors who may feel that accessing FCR treatment in a setting that reminds them of cancer diagnosis or treatment (i.e., a hospital) is emotionally challenging.…”

The Evaluation of the Suitability, Quality, and Readability of Publicly Available Online Resources for the Self-Management of Fear of Cancer Recurrence

“…Low-intensity interventions, such as online self-management resources that provide psychoeducation about FCR, and strategies for managing FCR, may help make FCR support more widely available to survivors experiencing minimal or moderate FCR. Online psychological interventions for FCR have demonstrated moderate, but variable, effects in reducing FCR [20]. While these online interventions may increase access to effective FCR treatment, many still require a substantial time investment (e.g., about 5 h for iConquerFear [14]), which may make them unappealing for some cancer survivors with mild-moderate FCR.…”