Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence

Abstract

Purpose Fear of cancer recurrence (FCR) is prevalent, distressing, and long lasting. This study evaluated the impact of a theoretically/empirically based intervention (ConquerFear) on FCR. Methods Eligible survivors had curable breast or colorectal cancer or melanoma, had completed treatment (not including endocrine therapy) 2 months to 5 years previously, were age > 18 years, and had scores above the clinical cutoff on the FCR Inventory (FCRI) severity subscale at screening. Participants were randomly assigned at a one-to-one ratio to either five face-to-face sessions of ConquerFear (attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting) or an attention control (Taking-it-Easy relaxation therapy). Participants completed questionnaires at baseline (T0), immediately post-therapy (T1), and 3 (T2) and 6 months (T3) later. The primary outcome was FCRI total score. Results Of 704 potentially eligible survivors from 17 sites and two online databases, 533 were contactable, of whom 222 (42%) consented; 121 were randomly assigned to intervention and 101 to control. Study arms were equivalent at baseline on all measured characteristics. ConquerFear participants had clinically and statistically greater improvements than control participants from T0 to T1 on FCRI total ( P < .001) and severity subscale scores ( P = .001), which were maintained at T2 ( P = .017 and P = .023, respectively) and, for FCRI total only, at T3 ( P = .018), and from T0 to T1 on three FCRI subscales (coping, psychological distress, and triggers) as well as in general anxiety, cancer-specific distress (total), and mental quality of life and metacognitions (total). Differences in FCRI psychological distress and cancer-specific distress (total) remained significantly different at T3. Conclusion This randomized trial demonstrated efficacy of ConquerFear compared with attention control (Taking-it-Easy) in reduction of FCRI total scores immediately post-therapy and 3 and 6 months later and in many secondary outcomes immediately post-therapy. Cancer-specific distress (total) remained more improved at 3- and 6-month follow-up.

The role of daily couple communication in the relationship between illness representation and fear of cancer recurrence in breast cancer survivors and their spouses

“…If replicated, the current results have important clinical implications. Prior studies showed some interventions such as cognitive and behavioral therapy, meta‐cognitive therapy, and acceptance and commitment therapy . The current study emphasized the importance of spouses in maintaining and relieving of FCR.…”

Fear of cancer recurrence among Chinese cancer survivors: Prevalence and associations with metacognition and neuroticism

“…Some indication of different mechanisms is present. Focusing on modifying metacognitive knowledge and experiences may be the basis for an adapted intervention in the Chinese cultural context benefitting this specific population with subclinical and clinically significant FCR.…”

Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3‐arm pilot randomized controlled trial

“…Unlike CBT, which aims to change unhelpful thoughts and feelings, ACT emphasizes acceptance while living mindfully according to one's values. Although research has suggested that ACT may improve distress symptoms and QOL in patients with cancer, to the best of our knowledge only 3 studies to date have applied ACT to FCR . Although effect sizes were promising (range, 0.33‐0.66), 2 studies were nonrandomized, 2 studies used a resource‐intensive individual format, and 1 study was an ACT‐metacognitive therapy hybrid .…”