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

Abstract

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 1week 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. 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. 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. 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.