Fear of cancer recurrence therapy (FORT): A randomized controlled trial.

OBJECTIVE: Most fear of cancer recurrence (FCR) interventions have small effects, and few target FCR. This randomized controlled trial (RCT) with breast and gynecological cancer survivors evaluated the efficacy of a cognitive-existential fear of recurrence therapy (FORT) compared to an attention placebo control group (living well with cancer [LWWC]) on FCR. METHOD: One hundred and sixty-four women with clinical levels of FCR and cancer distress were randomly assigned to 6-weekly, 120 min FORT (n = 80) or LWWC (n = 84) group sessions. They completed questionnaires at baseline (T1), posttreatment (T2; primary endpoint), 3 (T3), and 6 months (T4) posttreatment. Generalized linear models were used to compare group differences in the fear of cancer recurrence inventory (FCRI) total score and secondary outcomes. RESULTS: FORT participants experienced greater reductions from T1 to T2 on FCRI total with a between-group difference of -9.48 points (p = .0393), resulting in a medium effect of -0.530, with a maintained effect at T3 (p = .0330) but not at T4. For the secondary outcomes, improvements were in favor of FORT, including FCRI triggers (p = .0208), FCRI coping (p = .0351), cognitive avoidance (p = .0155), need for reassurance from physicians (p = .0117), and quality of life (mental health; p = .0147). CONCLUSIONS: This RCT demonstrated that FORT, compared to an attention placebo control group, resulted in a greater reduction in FCR posttreatment and at 3 months posttreatment in women with breast and gynecological cancer, indicating its potential as a new treatment strategy. We recommend a booster session to sustain gains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre.

Adapting to chronic illness or disability is accompanied by acute and ongoing illness stressors. Psychological factors such as emotional distress and low self-efficacy are common experiences in chronic illness and disability and interfere with adaptation and psychosocial outcomes such as health-related quality of life. Transdiagnostic group psychotherapy may provide a parsimonious approach to psychological treatment in rehabilitation care by targeting shared illness stressors across mixed chronic illnesses and disabilities, and shared processes that maintain psychological symptoms. Attachment theory may explain individual differences in outcomes and help identify individuals at risk of poor health-related quality of life trajectories. Adults (N=109) participated in an 8-week process-based ACT-CBT psychotherapy group at a tertiary care physical rehabilitation centre between 2016 and 2020. Participants completed measures of emotional distress, self-efficacy, health-related quality of life, and attachment at pre- and post-treatment. Multilevel analyses indicated that patients improved on most outcomes at post-treatment. Attachment anxiety at pre-treatment was associated with more positive outcomes. Reliable change indices suggest clinically meaningful change for the majority of participants, but most were not recovered. Results provide proof-of-concept for the transdiagnostic group intervention and suggest that a longer course of treatment may be clinically indicated. Results warrant replication with larger and more diverse samples, and more robust designs.

Attachment avoidance and health-related quality of life: Mediating effects of avoidant coping and health self-efficacy in a rehabilitation sample.

PURPOSE/OBJECTIVE: The onset of chronic illness or disability (CID) can be conceptualized as a threat that activates the attachment system. Moreover, the waxing-and-waning nature of CID-related symptoms and management of acute and chronic illness stressors means that the attachment system may be repeatedly activated. Contending with repeated threats to health (i.e., security) can complicate psychosocial adjustment to CID and can negatively impact health-related quality of life (HRQoL). Adjustment to CID requires intrapersonal resources, such as adaptive coping and self-efficacy. In spite of attachment theory's relevance to conceptualizing adaptation to CID, no models of psychosocial adaptation to CID account for individual differences in coping behaviors and health self-efficacy through an attachment lens. This limits future theory-driven research. Thus, the present study proposes and tests an integrated model of psychosocial adaptation to CID using an attachment framework. Research Method/Design: Participants in this study included adults referred for psychological services at a tertiary care physical rehabilitation center between 2016 and 2020. Ninety adults completed measures of attachment anxiety and attachment avoidance, coping, health self-efficacy, and HRQoL at one time point. RESULTS: Path analysis indicated that the proposed model fits the data well. Higher attachment avoidance was significantly related to lower HRQoL, as mediated by higher avoidant coping and lower health self-efficacy. CONCLUSIONS/IMPLICATIONS: Results suggest that individuals high on attachment avoidance may require additional support to move toward psychosocial adaptation. Further research examining the role of attachment insecurity dimensions in adaptation to CID is warranted and should include longitudinal designs to replicate these findings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Towards the validation of a new, blended theoretical model of fear of cancer recurrence.

OBJECTIVE: Fear of cancer recurrence (FCR) is defined as "fear, worry, or concern about cancer returning or progressing". To date, only the seminal model proposed by Lee-Jones and colleagues has been partially validated, so additional model testing is critical to inform intervention efforts. The purpose of this study is to examine the validity of a blended model of FCR that integrates Leventhal's Common Sense Model, Mishel's Uncertainty in Illness Theory, and cognitive theories of worry. METHODS: Participants (n = 106) were women diagnosed with stage I to III breast or gynecological cancer who were enrolled in a Randomized Controlled Trial of a group cognitive-existential intervention for FCR. We report data from standardized questionnaires (Fear of Cancer Recurrence Inventory-Severity and Triggers subscales; Illness Uncertainty Scale; perceived risk of recurrence; Intolerance of Uncertainty Scale; Why do people Worry about Health questionnaire; Reassurance-seeking Behaviors subscale of the Health Anxiety Questionnaire, and the Reassurance Questionnaire) that participants completed before randomization. Path analyses were used to test the model. RESULTS: Following the addition of four paths, the model showed an excellent fit (χ2 = 13.39, P = 0.20; comparative fit index = 0.99; root mean square error of approximation = 0.06). Triggers, perceived risk of recurrence, and illness uncertainty predicted FCR. FCR was associated with maladaptive coping. Positive beliefs about worrying and intolerance of uncertainty did not predict FCR but led to more maladaptive coping. CONCLUSIONS: These results provide support for a blended FCR model.

Examining the preliminary efficacy of an intervention for fear of cancer recurrence in female cancer survivors: a randomized controlled clinical trial pilot study.

PURPOSE: Among cancer survivors, fear of cancer recurrence (FCR) is the most frequently reported unmet need. Despite this, research on psychosocial interventions that target FCR is limited. To address this gap, an individual cognitive-existential psychotherapy intervention for FCR was pilot tested via small-scale RCT. METHODS: Participants were recruited via study posters, healthcare professionals' referrals, and an electronic hospital database. Twenty-five female cancer survivors were randomized to experimental or wait-list control groups. Sessions included cognitive restructuring techniques, behavioral experiments, discussion of existential concerns, and relaxation exercises. Nineteen women completed the 6-week intervention and completed questionnaire packages at various time points. All participants completed self-administered questionnaires at pre-intervention (T1), post-intervention (T2), and at 3-month follow-up (T3). Participants in the control group also completed the same questionnaires, including at baseline (T0). RESULTS: Statistically significant results of between-within ANOVAs included time by condition interactions in the primary outcome measure of FCR and, for the experimental group participants, time by condition interactions in the secondary outcome measures of cancer-specific distress and uncertainty in illness. Statistically significant results of repeated measures ANOVAs included reductions in FCR, cancer-specific distress, uncertainty in illness, reassurance seeking, cognitive avoidance, and intolerance of uncertainty, as well as improvements in positive reinterpretation and growth, emotional coping, and quality of life (improved mental health), when compared to the control group. Most changes were maintained at 3-month follow-up. CONCLUSIONS: This intervention responds to a need for evidence-based individual modality interventions targeting quality of life in cancer survivors. Our results demonstrate preliminary promising results in addressing FCR in female cancer survivors. Future research could seek to replicate results with a larger sample. Further research is needed to test this intervention with patients of mixed cancer sites.

An exploratory study of the worst-case scenario exercise as an exposure treatment for fear of cancer recurrence.

PURPOSE: The worst-case scenario (WCS) exercise is part of a manualized cognitive-existential group intervention for fear of cancer recurrence (FCR). It requires cancer survivors to describe the scenario they most fear when they think about the possibility of their cancer returning and to re-read the scenario daily for 1 week as homework. The purpose of this study was to present this novel clinical treatment for FCR and to examine whether at-home repeated exposure to the WCS was related to pre- and post-therapy FCR levels. METHODS: Women with breast and gynaecological cancers who received care at The Ottawa Hospital Cancer Centre were recruited to participate in this follow-up study. Consenting participants provided copies of their WCS exercises. RESULTS: The WCS of ten female cancer survivors were collected to examine the homework portion of the exercise. Higher adherence to homework was significantly related to lower post-therapy FCR but not to pre-therapy scores. CONCLUSIONS: Baseline levels of FCR may not be a factor influencing inter-session homework adherence to the WCS, while exposure to the WCS resulting from adherence to the homework exercise may influence post-therapy FCR outcomes. These effects remain to be differentiated from the overall therapeutic effect of the 6-week cognitive-existential intervention for FCR, using a larger sample. This study presents preliminary evidence for an upcoming multi-centre trial in which the WCS exercise will be re-examined with larger sample sizes.

Filling in the gaps: Sociodemographic and medical predictors of sexual health and other supportive care needs, and desire for help in gynecological cancer survivors.

PURPOSE: The goal of the present study was to evaluate predictors of unmet supportive care needs and readiness for help among gynecological cancer patients. METHODS: A sample of 113 gynecological cancer survivors completed a measure of needs and desire for help. Regression analyses identified sociodemographic and medical predictors of patient needs and desire for help. RESULTS: Younger age and shorter time since treatment were the strongest predictors of many unmet needs. Younger age and chemotherapy predicted greater unmet sexual health needs. Shorter time since treatment predicted readiness for help with informational needs. CONCLUSIONS: Post-treatment unmet needs are diverse and may be greater in younger and recently treated survivors. Chemotherapy treatment may contribute to greater sexual health needs.

An implementation evaluation of a wellness beyond cancer program survivorship class: Who is attending?

Breast and endometrial cancer survivors referred to the Wellness Beyond Cancer Program were invited to a survivorship education class. As not all survivors attended the class, this study aimed to identify socio-demographic and medical characteristics, and survivorship needs that predict attendance. A chart review was conducted on survivors who completed a needs assessment survey between 2012 and 2014 (n=144 endometrial; n=170 breast). Class attendees' characteristics were compared to those of non-attendees using t-tests, chi-square analyses, and regression analysis. Univariate analyses showed that age, distance from hospital, emotional and physical needs, and receiving chemotherapy and/or radiation therapy were associated with class attendance. Distance from hospital and physical needs were identified as multivariate predictors. The results of this study will help inform class content, improve class attendance, and identify attendees' characteristics.

Protocol of a randomized controlled trial of the fear of recurrence therapy (FORT) intervention for women with breast or gynecological cancer.

BACKGROUND: Clinically significant levels of fear of cancer recurrence (FCR) affect up to 49% of cancer survivors and are more prevalent among women. FCR is associated with psychological distress, lower quality of life, and increased use of medical resources. Despite its prevalence, FCR is poorly addressed in clinical care. To address this problem, we first developed, and pilot tested a 6-week, 2 h, Cognitive-existential group intervention therapy that targeted FCR in survivors of breast or gynecological cancer. Following the positive outcome of the pilot, we are now testing this approach in a randomized clinical trial (RCT). Goal and hypotheses: This multicenter, prospective RCT aims to test the efficacy of the intervention. The study hypotheses are that, compared to a control group, cancer survivors participating in the intervention (1) will have less FCR, (2) will show more favorable outcomes on the following measures: cancer-specific distress, quality of life, illness uncertainty, intolerance of uncertainty, perceived risk of cancer recurrence, and coping skills. We further postulate that the between-group differences will persist three and 6 months post-intervention. METHODS: Sixteen groups of seven to nine women are being allocated to the intervention or the control group. The control group receives a 6-week, 2 h, structurally equivalent support group. We are recruiting 144 cancer survivors from four hospital sites in three Canadian cities. The sample size was based on the moderate pre/post-test changes found in our pilot study and adjusted to the drop-out rates. MEASUREMENTS: The primary outcome, FCR, is measured by the Fear of Cancer Recurrence Inventory. Secondary outcomes measured include cancer-specific distress, perceived risk of cancer recurrence, illness uncertainty, intolerance of uncertainty, coping, and quality of life. We use reliable and recognized valid scales. Participants are to complete the questionnaire package at four times: before the first group session (baseline), immediately after the sixth session, and 3 and 6 months post-intervention. ANALYSIS: In the descriptive analysis, comparison of group equivalent baseline variables, identification of confounding/intermediate variables and univariate analysis are planned. Each participant's trajectory is calculated using Generalized Estimating Equation models to determine the time and group effects, after considering the correlation structures of the groups. An intent-to-treat analysis approach may be adopted. DISCUSSION: Our Fear of Recurrence Therapy (FORT) intervention has direct implications for clinical service development to improve the quality of life for patients with breast (BC) and gynecological cancer (GC). Based on our pilot data, we are confident that the FORT intervention can guide the development of effective psychosocial cancer survivorship interventions to reduce FCR and improve psychological functioning among women with BC or GC. TRIAL REGISTRATION: Dr. Christine Maheu registered the trial with ISRCTN registry (Registration number: ISRCTN83539618, date assigned 03/09/2014).

Empirical validation of the English version of the Fear of Cancer Recurrence Inventory.

PURPOSE: Cancer patients report that help in managing fear of cancer recurrence (FCR) is one of their greatest unmet needs. Research on FCR has been limited by the very few validated, multi-dimensional measures of this construct. One exception is the Fear of Cancer Recurrence Inventory (FCRI), originally developed and empirically validated in French. The present study validated the English version of the FCRI. METHODS: The FCRI was translated into English using a forward-backward translation procedure and pilot-tested with 17 English-speaking cancer patients. Cross-cultural equivalency of the French and English versions was established by administering both forms to 42 bilingual cancer patients. Last, 350 English-speaking breast, colon, prostate, or lung cancer patients were asked to complete the FCRI. A subsample (n = 135) was mailed the FCRI again one month later to evaluate test-retest reliability. RESULTS: The English translation of the FCRI was well accepted by participants. There was no item-bias when comparing bilingual participants' answers on both versions. A confirmatory factor analysis supported the hypothesized seven-factor structure. The English version has high internal consistency (α = .96 for the total scale and .71-.94 for the subscales) and test-retest reliability (r = .88 for the total scale and 56-.87 for the subscales). CONCLUSIONS: The English version of the FCRI is a reliable and valid measure of FCR applicable to breast, colon, prostate, and lung cancer patients. Its multi-dimensional nature makes it an attractive research and clinical tool to further our knowledge of FCR.

Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study.

BACKGROUND: Evidence suggests that fear of cancer recurrence (FCR) is one of the most frequently cited unmet needs among cancer survivors and is associated with psychological distress, stress-response symptoms, and lower quality of life, as well as increased use of health care resources. Despite these factors, few manualized interventions exist to address FCR among cancer survivors. PURPOSE: To develop, manualize, and pilot test the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address FCR in women with breast or ovarian cancer. METHODS: This study was a single-arm multi-site study with pre-, post-, and 3-month follow-up measurement occasions. RESULTS: A total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group intervention. Following the intervention, women experienced a reduction in the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. They also reported improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore, almost all changes were sustained at 3-month follow-up. CONCLUSION: This brief intervention appears feasible and has shown promising results in addressing FCR and related secondary outcomes of cancer-specific distress, uncertainty, quality of life, and coping; however, it should be further tested using a randomized controlled study design to more definitively assess its efficacy. IMPLICATIONS FOR CANCER SURVIVORS: FCR is a near-universal worry for cancer survivors that, when left unaddressed, tends to remain stable over time. This study has important implications for all cancer survivors as it is the first published intervention that provides preliminary evidence of its efficacy in decreasing fear of cancer recurrence.

Supportive care needs after gynecologic cancer: where does sexual health fit in?

DESIGN: Descriptive, cross-sectional study. SETTING: Follow-up clinic of a gynecologic oncology program in a regional cancer center. SAMPLE: 113 women treated for gynecologic cancer. METHODS: Data were collected using standardized instruments and analyzed through descriptive and correlation statistics. MAIN RESEARCH VARIABLES: Supportive care needs, sexual health needs, vaginal changes, desire for help, and socio-demographic and medical factors. FINDINGS: Forty percent of the sample was worried about the status of their sex life and many wished to meet one-on-one with a health professional or to receive written information. Younger age, premenopausal status at diagnosis, and lower sexual satisfaction and more vaginal changes after treatment were associated with greater sexual health needs and desire for help. CONCLUSIONS: Several sexual health needs were among the highest reported supportive care needs. Certain subgroups may report higher needs and desire for help; this domain merits additional research. Needs were extremely diverse, reflecting the use of an individual approach to screening for and meeting survivor needs. IMPLICATIONS FOR NURSING: Personal perceptions of the implications and meaning of sexual health and vaginal changes create the subjective experience of a need. Discussions of the women's perceptions of their needs and their views of healthy sexuality will help develop effective treatment plans.

Sexual health and gynecological cancer: conceptualizing patient needs and overcoming barriers to seeking and accessing services.

OBJECTIVE: The current study explored the subjective experiences of women treated for a gynecological cancer, with a focus on filling gaps in the current literature. Topics explored were: (1) women's own definitions of healthy sexuality; (2) services desired to meet needs; and (3) barriers to participation in sexual health-related services. METHODS: Fifteen women participated in a one-on-one, semistructured interview. Data collection and analysis were based on guidelines of interpretive description. RESULTS: Definitions of healthy sexuality included emotional intimacy, body image, sexual self-schema, and sexual response. Unmet sexual needs were reported when women's current sexual experiences did not correspond with their subjective perceptions of healthy sexuality. Most women desired informational services, delivered one-on-one or through written material. Younger women often did not utilize services due to practical barriers and emotional avoidance, while older women reported that shyness and stigma discouraged them from discussing sexuality with their health care team. CONCLUSIONS: In order to understand patient needs and desire for help, health care providers should assess current sexual health and patient perceptions of healthy sexuality. To increase effectiveness of distress screening and treatment interventions, potential barriers must be evaluated and addressed.