Australian researchers have developed an oncologist-led intervention to address their patients’ common fear of cancer recurrence.
When tested in breast cancer survivors, the intervention led to a gradual reduction in the proportion of people with clinically significant fear of cancer recurrence – from 64% at baseline to 52% at one -week and 40% at three months.
The components of the intervention were:
- Reassurance that fear of cancer recurrence is common and normal,
- Provision of accurate prognostic information,
- Education on red-flag symptoms of recurrence,
- Brief advice on managing worry using techniques such as distraction, meditation, mindfulness,
- Referral to a psychologist if fear of cancer recurrence is high.
The study, published in JCO Oncology Practice, found most patients (97%) reported the intervention was useful, most (98%) would recommend it to other breast cancer survivors, and most (90%) found it reassuring.
“Participants most valued normalisation, and the fact that their usual oncologist addressed their fears as it provided a “human,” personalised experience and validated their worries about the possibility of recurrence,” the study said.
The intervention, delivered in about 8 minutes by the oncologist during a routine face-to-face consultation, was also deemed to be “feasible”.
Participating oncologists said the intervention was useful to them and was “just right” in terms of length and complexity.
One of the investigators, Professor Phyllis Butow told the limbic the intervention was designed to be delivered by oncologists but many of its components could also be delivered by other health professionals.
“I think the one aspect that might be more difficult for a nurse [to deliver] is the provision of prognostic information. We did design it to ensure that patients should understand their prognosis because many patients overestimate the likelihood that their cancer will come back.”
Professor Butow, from the Psycho-Oncology Co-operative Research Group at the University of Sydney, said the intervention made patients feel like they were being treated holistically.
“They really appreciated the sense of connection with their oncologists that they were able to talk about these additional issues.
“It should be something that happens anyway but it doesn’t necessarily happen. Doctors and patients can go down the path of focussing just on treatment. Traditionally follow-up care has focussed on scans and signs of recurrence. It hasn’t focussed on the worry that goes along with a fear of cancer recurrence.”
She said there was evidence that fear of cancer recurrence doesn’t decline without an intervention.
“Some people started worrying about the cancer coming back as soon as they were diagnosed.”
However the intervention was timed to be delivered after people had survived the overwhelm associated with active treatment.
She said the time required to administer the intervention was a perceived barrier to implementation.
“Doctors worry about the time it will take but it didn’t take very long at all – about 8 minutes – and we suspect that it will result in less need for conversations after this so that time will not be lost,” she said.
She said the intervention should give oncologists the skills to feel confident addressing their patients’ fear of cancer recurrence.
“Fear of cancer recurrent is the most common issue for patients after the treatment. It’s the thing that they struggle with the most moving on.”