Cognitive-Behavioral Group Therapy Addressing Fear of Progression in Cancer Out-Patients

Abstract

Fear of progression (FoP) is an appropriate, rational response to the real threat of cancer and its treatments. However, patients experiencing elevated, dysfunctional levels of FoP often feel severely distressed and are in need of treatment. We previously conducted a (partly-)randomized controlled study with cancer patients undergoing in-patient rehabilitation and showed that a brief, four-session cognitive-behavioral group therapy significantly reduced dysfunctional FoP. In this report, we describe the adaption of the cognitive-behavioral group therapy program for use with cancer out-patients. This group therapy program was conducted in the psycho-oncological out-patient department of a large university hospital. It comprises 6 group sessions lasting 90 min each. Because of the larger number of sessions there is more room for the use of exposure-based techniques. Imaginal exposure is used to confront the patient's cancer-related fears and worries. Patients are asked to vividly recount their worries and to think of what would be the worst that can happen (worst-case scenario exercise). In addition, interventions that focus the patient's ressources are applied. The completion of 3 group therapies in the pilot phase supported the feasibility of the program. Pre-post evaluation (n=10) revealed a significant decline of FoP (Fear of Progression Questionnaire, FoP-Q) from M=12,0 (SD=2,0) to M=10,3 (SD=1,7), p=0.029. This represents a large effect (Cohen's d=0.9). Three out of 14 participants (21%) quit treatment after 2 sessions. In sum, the results and our experiences show that this out-patient group therapy program is feasible and probably effective. However, it also shows that some patients regard confronting their cancer-related fears and worries as too stressful. High ambivalence with regard to exposure seems to increase the risk for premature termination. Thus, cancer patients should be thoroughly educated before starting exposure-based treatment of dysfunctional FoP.