Psychoeducational Intervention to Reduce Fear of Cancer Recurrence in People at High Risk of Developing Another Primary Melanoma: Results of a Randomized Controlled Trial

Abstract

Purpose People with a history of melanoma commonly report a fear of cancer recurrence (FCR), yet psychologic support is not routinely offered as part of ongoing melanoma care. This randomized controlled trial examined the efficacy of a psychoeducational intervention to reduce FCR and improve psychologic adjustment in this patient group compared with usual care. Methods The intervention comprised a newly developed psychoeducational resource and three telephone-based psychotherapeutic sessions over a 1-month period timed in accordance with dermatologic appointments. Participants were randomly assigned to intervention (n = 80) or usual care (n = 84). Assessments were completed at baseline, 1 month, and 6 months after dermatologic appointments. Linear mixed models were used to examine differences between treatment and control groups for patient-reported outcomes, including FCR, anxiety, stress, depression, melanoma-related knowledge, health behaviors, satisfaction with melanoma care, unmet needs, and health-related quality of life. Results At 6 months, the intervention group reported lower FCR severity, trigger, and distress scores than the control group in the baseline-adjusted models; the between-group mean difference was -1.9 for FCR severity (95% CI, -3.1 to -0.7; P = .002), -2.0 for FCR triggers (95% CI, -3.3 to -0.7; P = .003), and -0.7 for FCR distress (95% CI, -1.3 to -0.1; P = .03). The decrease in FCR severity (but not triggers or distress) remained statistically significant after adjustment for other covariates ( P = .04). At 6 months, the intervention group also reported lower stress (-1.6; 95% CI, -3.1 to -0.2; P = .03) and improved melanoma-related knowledge (1.7; 95% CI, 0.8 to 2.6; P < .001) compared with the control group. No differences were found between groups for other secondary outcomes. Conclusion This newly developed evidence-based psychoeducational intervention was effective in reducing FCR and stress and increasing melanoma-related knowledge in people at high risk for another melanoma.

Self‐management interventions for cancer survivors: A systematic review and evaluation of intervention content and theories

“…After removal of duplicates, 5738 titles and abstracts were screened, and 406 full‐text articles were reviewed. From this, we included 41 studies (n = 6038 participants) . The selection of articles, including reasons for exclusion, is outlined in Data S4.…”

Benefits of a brief psychological intervention targeting fear of cancer recurrence in people at high risk of developing another melanoma: 12‐month follow‐up results of a randomized controlled trial

“…In our previous research we firstly developed and piloted a psychoeducational resource, delivered in booklet format, which was judged positively by patients and healthcare providers in terms of the quality and quantity of information, its value and capacity to address unmet needs. We then piloted and evaluated in a randomized controlled trial the 1‐month and 6‐month efficacy of a new psychological intervention to reduce FCR and improve psychological adjustment and found the intervention to be effective . We now report, for the first time, the longer‐term effects of this brief, tailored psychological intervention for people with a history of early‐stage melanoma.…”

“…As a consequence, many people who have had melanoma often experience fear of cancer recurrence (FCR) or progression. Recent studies have shown that over 70% of people with a history of melanoma report levels of fear of melanoma recurrence indicative of a need for clinical intervention; a proportion higher than those documented for other cancers …”

“…Interventions specifically designed to address FCR are limited (Table S1; see Supporting Information) . Only six studies have tested the efficacy of psychological interventions in reducing FCR, with FCR as the primary outcome . These studies include a total of 913 participants, the majority of whom had a history of breast or gynaecological cancer.…”

ECCO essential requirements for quality cancer care for melanoma: Defining how to organise care

“…Common reactions include excessive worry and rumination, difficulty concentrating, insomnia, increased use of alcohol and other drugs, social withdrawal and somatic complaints (Kasparian, 2013). There is strong evidence that psychological intervention can improve psychological outcomes (Boesen et al, 2005;Dieng et al, 2016).…”