Blended cognitive therapy reduces fear of cancer recurrence

Blended cognitive behavior therapy improved fear of recurrence in breast, prostate and colorectal cancer survivors, according to results of the SWORD clinical study

One-third of participants showed clinically significant improvement after therapy compared with no participants in a control group.

“To the best of our knowledge, this is the first randomized controlled trial to demonstrate effects of a psychological intervention on fear of cancer recurrence reduction in a mixed group of cancer survivors,” Marieke A. van de Wal, from the department of medical psychology at Radbound University Medical Center in Nijmegen, Netherlands, and colleagues wrote. “Our findings are in line with a feasibility study, a pilot study and two trials that reported beneficial effects of individual and group face-to-face therapies for fear of cancer recurrence.”

Fear of cancer recurrence is one of the most common concerns of survivors. However, it is often poorly addressed in clinical settings because health care providers are unaware of best practices.

Researchers aimed to determine whether blended cognitive therapy would decrease the severity of fear of cancer recurrence among patients who received curative treatment for breast, prostate or colorectal cancers.

The analysis included 88 cancer survivors with high fear of cancer recurrence — indicated by a Cancer Worry Scale score higher than 14 — randomly allocated to receive blended cognitive behavior therapy (n = 45) or usual care (n = 43).

Participants were 6 months to 5 years beyond treatment and were not already receiving psychological or psychiatric treatment.

Blended cognitive behavior therapy consisted of five face-to-face and three online therapy sessions and involved intervention techniques such as psycho-education, cognitive restructuring and behavioral modification.

Fear of cancer recurrence severity — assessed with the Cancer Worry Scale — served as the primary measure. Secondary outcomes included other distress-related measures and multidimensional aspects of the Fear of Cancer Recurrence Inventory (FCRI). Participants completed questionnaires at baseline and 3 months.

Participants who received blended cognitive behavioral therapy reported significantly less fear of cancer recurrence than participants who received care as usual (mean difference, –3.48; 95% CI, –4.69 to –2.28) with a moderate-to-large effect size (d = 0.76).

Clinically significant improvement in fear of cancer recurrence occurred in more participants assigned therapy than usual care (n = 13 vs. 0; P < .001).

More participants in the blended therapy group also showed higher self-rated improvement (n = 30 vs. 12; P < .001).

Researchers observed a weak-to-moderate correlation between the number of completed therapy sessions (0-8) and fear of cancer recurrence severity at 3 months (r = –0.371; P = .012).

Participants who received blended therapy experienced greater improvement on the FCRI total score and four of seven FCRI subscales — severity, triggers, distress and functioning impairments —with moderate-to-large effect size (d = 0.45-0.72). Participants who received therapy also showed improvements in global quality of life, emotional functioning and cognitive functioning (d = 0.47-0.74).

“Screening for high fear of cancer recurrence and making referrals to psychological services is an important role for health care professionals,” the researchers wrote. “Developing educational programs for health care professionals regarding the prevalence of fear of cancer recurrence and its characteristics, consequences and treatments is therefore a priority.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.