Cancer care

Online therapy allays patients’ fear of cancer recurrence


A self-guided online tool can help ease the often debilitating fear of cancer recurrence in cancer survivors, an Australian research team have shown.

The program, iConquerFear, is a digital intervention based on CBT techniques that targets and addresses a person’s unhelpful beliefs about worry of cancer recurrence, to reduce psychological distress.

The tool has been developed and tested by a national team led by Dr Ben Smith of the Cancer Institute NSW and Dr Adeola Bamgboje-Ayodele at the Ingham Institute for Applied Medical Research in Sydney.

They adapted it from the face-to-face ConquerFear program delivered by therapists, which was originally developed by the Psycho-Oncology Co-operative Research Group.

The goal of iConquerFear is to empower survivors with different strategies and techniques to manage the fear of recurrence and develop actions that align with their values. Throughout five bite-sized modules, participants complete interactive exercises about goal setting, attention training and mindfulness, giving them a range of practical tools to assist in reducing unhelpful thoughts about recurrence.

“Getting help to cope with a fear of cancer recurrence is a cancer survivor’s top unmet need, above pain, fatigue and other physical symptoms,” says Dr Smith.

“Worries about recurrence are rational and normal, and it’s important to understand that they can’t just be eliminated. The iConquerFear approach is about changing how people engage with their thoughts about recurrence. It’s about helping them to not get caught up in the negative thoughts that impact their wellbeing.”

The team have seen promising results with iConquerFear in a preliminary study (link) of the intervention in 54 breast cancer survivors.

Participants showed a decrease in fear of recurrence severity immediately and at at three months post-intervention. About a quarter of the participants also reported clinically significant improvements in their reduction of fear of recurrence.

“We saw strong initial uptake and engagement and promising reductions in fear recurrence – equivalent in size to what we saw in the face-to-face [therapy program],” Dr Smith says.

“It suggests that digital interventions can actually improve access to psychosocial support and facilitate self-management by survivors.”

The researchers say a digital intervention could potentially overcome some of the barriers to face-to-face therapy for fear of cancer recurrence, including distance and resourcing.

“Existing interventions, while effective, are inaccessible to many Australian cancer survivors, particularly those in rural and remote areas,” Dr Smith says. “The health system is also under a lot of strain to address the mental health burden with insufficient resourcing.”

In addition, face-to-face isn’t always a treatment model all patients like to, or are able to, engage in.

“Participants feel like they’re managing their fears and are being supported to do that as they go through these activities and get tailored feedback,” Dr Smith says. “The program is designed with relatable examples to engage users while supporting behaviours such as self-examination and follow-up that could help minimise the risk of their cancer coming back.”

In their next study, the team is partnering with Ovarian Cancer Australia to conduct a pilot randomised control trial to investigate iConquerFear’s effectiveness further before embarking on a full-scale rollout.

“We are open to exploring commercial models with partners that would maximise the accessibility and impact of iConquerFear in Australia and beyond,” Dr Smith said.

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