Psychological intervention (ConquerFear) for treating fear of cancer recurrence: mediators and moderators of treatment efficacy

Abstract

Purpose: Many evidence-based interventions are not implemented into routine care, thus failing to impact patient outcomes. A critical area of research is to investigate factors influencing intervention sustainability. ConquerFear is an effective intervention for fear of cancer recurrence (FCR) which resulted in greater reductions in FCR immmediately and 6 months post treatment than a relaxation control intervention. This qualitative study aimed to determine the barriers and facilitators to sustainability of ConquerFear from the perspectives of study therapists. Methods: Twenty-six therapists who had delivered ConquerFear in the randomised controlled trial were invited to participate in a semi-structured phone interview. Theoretical saturation was reached after 14 interviews. Thematic analysis was used to identify themes which were then mapped to the PAHRiS implementation framework. Results: Participants comprised 13 males and 1 female, with on average 14 years of experience working in psycho-oncology. Nine over-arching themes falling into three domains were identified: Evidence (intervention credibility, experienced efficacy, perceived need for intervention); Context (attitude to and capacity for survivorship/ FCR care, therapist orientation and flexibility, limited referral) and Facilitation (intervention/service fit, intervention/patient fit, and training, support and provided resources). Conclusions: Results suggest that ConquerFear is a sustainable intervention in routine clinical practice. Facilitators included a sound evidence-base, a context where survivorship care is incorporated into service goals, and a good fit between the intervention and both therapist orientation and patient need. Flexibility of delivery and ability to adapt to patient need would assist sustainability. 4 Implications for cancer survivors: ConquerFear has the potential to sustainably reduce the impact of fear of cancer recurrence. It is important to establish the importance of survivorship care within cancer systems. While this study focused on ConquerFear, we believe these results have implications for other psycho-oncology intervention implementation efforts.

Sanhuang Decoction Controls Tumor Microenvironment by Ameliorating Chronic Stress in Breast Cancer: A Report of Ninety Cases

“…Our results achieved effects comparable to that of estrogen replacement treatment, with a decrease of 67%. Some clinical trials have reported that lifestyle and emotions, such as worry and fear, may have a positive influence on the prognosis of breast cancer (27,28). However, here, we report relief from chronic stress caused by long-term endocrine treatment with the use of oral SHD, which facilitates a positive change in the tumor microenvironment.…”

A psychological intervention (ConquerFear) for treating fear of cancer recurrence: Views of study therapists regarding sustainability

“…Similarly, therapists noted that ConquerFear might not be appropriate for all patients. Patients who used an avoidant coping style were thought to find the therapy more confronting, although this has not been born out in our mediator/moderator analysis, where avoidance was not found to be associated with ConquerFear uptake or outcome …”

“…This confusion in the literature is undoubtedly contributing to confusion in the clinic regarding who to refer to ConquerFear . Our recent analysis of mediators and moderators of ConquerFear outcomes showed that those with lower levels of FCR appeared to benefit equally from simple relaxation strategies, providing more support for a cut‐off of 22. More work is required to build consensus around assessment processes to guide clinicians in referral.…”

Towards a Stepped Care Model for Managing Fear of Cancer Recurrence or Progression in Cancer Survivors

“…There are few moderation studies of who benefits most, but we know that the relative benefit of ConquerFear was greater for those with higher baseline levels of FCR. 57 This would suggest that a matched approach to stepped care might be most useful. However, it would be important to demonstrate that those with higher FCR/P did not also benefit most from minimal interventions.…”

“…For example, changes in meta-cognitions and intrusions were found to moderate the relative efficacy of ConquerFear versus relaxation training. 57 Hence, focusing more on metacognitive therapy, 20 or interventions (such as the worst case scenario 58 ) may increase the efficacy of existing approaches. Secondly, it is possible that if both traditional and contemporary CBT approaches are both effective, that together they might be more efficacious.…”