Efficacy of eye movement desensitization and reprocessing therapy for fear of cancer recurrence among cancer survivors: a randomized single-case experimental design

LBA10000 Background: Up to 70% of cancer survivors report clinically significant fear of cancer recurrence (FCR). This parallel RCT evaluated the impact of a psychological intervention, Conquer Fear (CF), on FCR in cancer survivors. Methods: Participants were disease-free stage I-III breast, colorectal or melanoma cancer survivors, 2 months to 5 years post-treatment, who scored above the clinical cut-off (≥13) on the FCR Inventory (FCRI) severity subscale. CF included 5 sessions incorporating attention training, detached mindfulness, challenging unhelpful metacognitions, values clarification and psycho-education. Participants were randomised to the intervention ( n= 121) or a relaxation training (RT) control arm ( n= 101) (target n= 260). The primary end-point was reduction in FCR (FCRI total) immediately after intervention completion. Follow-up assessments occurred immediately, 3- and 6-months post-treatment. Data analysis was by intention to treat. The differences in change in FCR from baseline between CF and RT and secondary outcomes were tested using independent t-tests. A difference of 14.5 points in FCR was considered clinically significant. Long-term changes in FCR and secondary outcomes were evaluated using linear regression models fitted with generalized estimating equations (GEE), adjusted for baseline FCR. Results: Reduction in FCR between baseline and immediately post-treatment was significantly more in CF participants compared to RT. (Difference in change (95% CI): -10.5 (-16.1, -4.9); p < 0.001). Greater FCR reductions were also observed amongst CF participants at 3 months (-7.6 (-13.9, -1.4), p = 0.02) and 6 months (-7.8 (-14.2, -1.4), p = 0.02) compared with RT. The pattern of change in outcomes over time was consistent between treatment groups as no significant linear trends in treatment effects over time were observed. Conclusions: Conquer Fear is a theoretically-grounded intervention to reduce FCR and its associated psychological morbidity which leads to significantly greater reductions in FCR in the first 6 months following treatment than relaxation training. Clinical trial information: ACTRN12612000404820.

PurposeAlthough long-term colorectal cancer (CRC) survivors generally report a good quality of life, fear of cancer recurrence (FCR) remains an important issue. This study investigated whether the Cancer Worry Scale (CWS) can detect high FCR, the prevalence, and characteristics of FCR in CRC survivors.MethodsTwo hundred and eleven patients who had undergone successful CRC surgery in the period 2003–2010 in the Radboud University Medical Center in the Netherlands were asked to participate. All patients were sent an information letter plus questionnaires for collecting information on demographic and medical variables, FCR, distress, and quality of life.ResultsSeventy-six patients (36 %; median age of 67.7 years range 41–88 years) completed the questionnaires a median of 5.1 years after surgery. A cut-off score of 14 or higher on the CWS was optimal to detect high FCR. Twenty-nine patients (38 %) experienced high levels of FCR, characterized by higher levels of distress, post-traumatic stress symptoms, and lower quality of life. These individuals particularly reacted to disease-related triggers, felt helpless, were worried, and experienced limitations in daily functioning. High FCR was not associated with demographic or medical variables.ConclusionLong after successful CRC surgery, FCR is a serious problem that impairs the quality of life for a substantial proportion of patients. With the CWS, it is possible to detect high FCR and thereby assist survivors in receiving appropriate care.

Fear of cancer recurrence (FCR) is one of the major existential unmet needs of cancer survivors. Due to growing availability of evidenced-based interventions for high FCR, valid and reliable brief measures of FCR are needed. This study aimed to validate the 6-item Cancer Worry Scale (CWS) and to establish a cut-off score for high FCR. Participants in this study were 1033 cancer survivors and patients recruited as part of 5 existing studies on FCR involving patients and survivors with gastro-intestinal stromal tumors, colorectal, breast, and prostate cancer. De-identified data of the CWS, Fear of Cancer Recurrence Inventory (FCRI), Impact of Event Scale, Hospital Anxiety and Depression Scale, and EORTC-QLQ-C30 were amalgamated for the analyses. Confirmatory factor analysis of the CWS was performed. Sensitivity and specificity were tested with the FCRI as gold standard. Results confirmed that the 6-item version of the CWS maintained good construct validity, convergent and divergent validity, and high internal consistency (α 0.90). The optimal cut-off for the 6-item CWS was 9 versus 10 using the 12 vs 13 FCRI-SF score (sensitivity 82%, specificity 83%) and the 15 vs 16 FCRI-SF score (sensitivity 88%, specificity 73%). Using the highest FCRI-SF cut-off (21 vs 22), the optimal CWS cut-off was 11 vs 12 (sensitivity 88%, specificity 81%). The present results provide researchers and clinicians with a brief valid and reliable measure of FCR which is suitable for measuring FCR in cancer patients and survivors.

Fear of cancer recurrence (FCR) among cancer survivors is a persistent and distressing psychosocial concern that affects recovery and quality of life. The prevalence of FCR in Singapore is unknown. This cross-sectional study was designed to examine FCR and identify factors associated with FCR in mixed-cancer survivors locally. Cancer survivors in remission (n = 404) were assessed for: FCR using the Fear of Cancer Recurrence Inventory (FCRI); emotional distress using the Hospital Anxiety and Depression Scale; and quality of life using the World Health Organization Quality of Life-BREF. Clinical and severe/pathological FCR was determined based on the severity scale of FCRI, known as FCRI-Short Form. Multivariate logistic regression was performed to examine factors associated with FCR. The mean score on the FCRI was 59.5 ± 30.4. 43.6% of cancer survivors had clinical FCR and 32.1% had severe/pathological FCR. Younger age (odds ratio [OR] 0.952, 95% confidence interval [CI] 0.911-0.995, p < 0.05), higher educational status (OR 2.55, 95% CI 1.15-5.65, p < 0.05) and higher levels of emotional distress (OR 1.17, 95% CI 1.10-1.24, p < 0.001) were significantly associated with severe/pathological levels of FCR. The present study is the first to determine levels of FCR among cancer survivors in Singapore. While the total FCR scores were similar to those of international studies, severe/pathological levels of FCR were found to be four times higher. These findings highlight a problem that is not widely recognised or acknowledged, but which deserves greater attention.

To test the hypothesis that patient-initiated follow up reduces the fear of cancer recurrence (FCR) and healthcare use when compared with traditional hospital-based follow up. Pragmatic, multicentre randomised trial. Four Danish departments of gynaecology between May 2013 and May 2016. One hundred and fifty-six women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I low-intermediate risk endometrial carcinoma. Women allocated to the control group attended hospital-based follow up consisting of regular outpatient visits for 3years after primary treatment. Women in the intervention group were instructed in patient-initiated follow up, which included careful instruction in alarm symptoms and options for self-referral rather than a schedule of examinations. The primary end point was FCR as measured by the Fear of Cancer Recurrence Inventory (FCRI) after 10months of follow up. Secondary end points included cancer-related use of primary and secondary health care during the first 10months after treatment. In the primary analysis, FCR decreased significantly more in the control group from baseline to 10months of follow up (difference -5.9, 95% CI -10.9 to -0.9). The majority of this improvement happened after only 3months of follow up. Women receiving the intervention had fewer examinations at the department compared with the control group (0 versus 2 median visits, P<0.01) and 58% of these examinations were scheduled because of vaginal bleeding. Hospital-based follow up alleviates FCR significantly more than patient-initiated follow up, though the estimated difference was small. Patient-initiated follow up is a feasible, potentially cost-reducing follow-up approach in a population of endometrial cancer survivors with low risk of recurrence. The decision to use patient-initiated follow up should balance these benefits and harms. Patient-initiated follow up reduces healthcareuse but maintains fear of recurrence in endometrial cancer. Why and how was the study carried out? Follow up of women with endometrial cancer is resource consuming and previous research suggests that it is not effective. Even though the women benefit from reassurance at follow up, routine examinations may also remind the women of the disease and induce fear of cancer recurrence. Furthermore, routine follow up may delay recurrence diagnosis, because the women do not report their symptoms until the next scheduled visit. In the research explained in this article, patient-initiated follow up was evaluated as an alternative to traditional follow up. The women were randomly assigned to one of two follow-up programmes: regular gynaecological examinations at the department of gynaecology or self-referral with careful instruction in alarm symptoms, that is, patient-initiated follow up. The level of fear of cancer recurrence in the two groups was obtained by questionnaires. Information on healthcare use was obtained by questionnaires and a chart review. What were the main findings? Regular examinations at the department of gynaecology reduced the fear of cancer recurrence significantly more than patient-initiated follow up, though the difference was small. Women who were instructed in alarm symptoms, under self-referral, were able to monitor their symptoms, and this approach significantly reduced the number of examinations at the department of gynaecology. What are the limitations of the work? Participants in the self-referral group knew that they were examined less than other women, and this may have induced fear of cancer recurrence. Similarly, the regular completion of questionnaires regarding fear of cancer recurrence may have reminded the women of the disease and diminished the difference between the two groups. What are the implications for patients Patient-initiated follow up reduced healthcare use but maintained fear of cancer recurrence in women who had survived early-stage endometrial cancer. Future analyses on quality of life and cost-effectiveness are needed to balance the benefits and harms of patient-initiated follow up.

Knowledge about fear of cancer recurrence (FCR) among recurrence-free long-term colorectal cancer survivors (CRCS) is limited. This national cross-sectional study aimed to (1) assess the prevalence and correlates of FCR among CRCS; (2) investigate associations between colorectal cancer-specific symptoms and FCR; and (3) identify predictors of interest in engaging in FCR treatment. We identified 9638 living Danish CRCS, age above 18years, diagnosed between 2014 and 2018 through the Danish Clinical Registries. Electronic surveys were distributed between May 2023 and May 2024. FCR was measured on the Fear of Cancer Recurrence Inventory - Short Form (FCRI-SF). Associations with colorectal cancer-specific physical symptoms and psychological symptoms were analyzed using logistic regression models. Of 5480 respondents (56.9%; mean age: 73, range (30-99; 42% female), 5.3% of survivors reported clinical FCR (cFCR). In multivariate analyses, having severe abdominal pain (OR 8.7 (95% CI 4.8-15.8)), abdominal bloating, tension, or heaviness (OR 10.0 (95% CI (6.1-16.3)) and tiredness (OR 7.1 (95% CI (4.1-12.1)) were associated with increased odds of cFCR, as were psychological symptoms (health anxiety; OR 19.7 (95% CI (13.5-28.6)), anxiety; OR 11.2 (95% CI (6.4-19.6)), depression; OR 5.5 (95% CI (2.6-11.9)) compared to no FCR. Among those with cFCR, 75% were interested in treatment, with higher interest among males and chemotherapy recipients. FCR severity is strongly associated with specific colorectal symptoms, tiredness, and psychological symptoms. Addressing cancer-specific physical symptoms may be a promising strategy for reducing FCR.

Purpose Fear of cancer recurrence (FCR) is a common problem experienced by cancer survivors. Approximately one third of survivors report high FCR. This study aimed to evaluate whether blended cognitive behavior therapy (bCBT) can reduce the severity of FCR in cancer survivors curatively treated for breast, prostate, or colorectal cancer. Patients and Methods This randomized controlled trial included 88 cancer survivors with high FCR (Cancer Worry Scale score ≥ 14) from 6 months to 5 years after cancer treatment. Participants were randomly allocated (ratio 1:1, stratified by cancer type) to receive bCBT, including five face-to face and three online sessions (n = 45) or care as usual (CAU; n = 43). Participants completed questionnaires at baseline (T0) and 3 months later (T1). The intervention group completed bCBT between T0 and T1. The primary outcome was FCR severity assessed with the Cancer Worry Scale. Secondary outcomes included other distress-related measures. Statistical (one-way between-group analyses of covariance) and clinical effects (clinically significant improvement) were analyzed by intention to treat. Results Participants who received bCBT reported significantly less FCR than those who received CAU (mean difference, -3.48; 95% CI, -4.69 to -2.28; P < .001) with a moderate-to-large effect size ( d = 0.76). Clinically significant improvement in FCR was significantly higher in the bCBT group than in the CAU group (13 [29%] of 45 compared with 0 [0%] of 43; P < .001); self-rated improvement was also higher in the bCBT group (30 [71%] of 42 compared with 12 [32%] of 38 in the CAU group; P < .001). Conclusion bCBT has a statistically and clinically significant effect on the severity of FCR in cancer survivors and is a promising new treatment approach.

With medical and psychosocial advances in treatment, cancer survivorship has increased, yet fear of cancer recurrence is a main concern negatively affecting the quality of life among cancer survivors. This pilot study examined the relationship between physical activity, locus of control (LOC), and fear of cancer recurrence among participants in a community cancer support program. Self-reported interviews were used to examine if physical activity and LOC have a modifying effect on the negative impact of fear of recurrence among a group of cancer survivors (N = 32). The variables were measured using the fear of cancer recurrence inventory (FCRI), metabolic equivalency tasks (METs), and Rotter’s locus of control questionnaire. The results indicated that higher education levels and higher internal LOC lead to better coping, and thus having a modifying impact on the fear of recurrence. For those undergoing surgery less physical impairment was observed, thereby effecting and lessening the fear of recurrence. Implications for clinical practice and further research are discussed. It becomes important for oncology clinicians and family members to further encourage participation in physical activities among cancer survivors as a means of buffering and lessening the fear of cancer recurrence and thus contributing to better quality of life.

PurposeThis study aims to determine the fear of recurrence and the unmet needs among cancer survivors. It also explores the associations between the fear of recurrence, unmet needs and sociodemographic factors.Patients and MethodsThis descriptive study was carried out with 147 cancer survivors. The study was conducted between September 2023 and December 2024 in the training and research hospital. The data were collected using the Participant Assessment Form, the Fear of Cancer Recurrence Inventory (FCRI), the Cancer Survivors’ Unmet Needs (CaSUN-TR) Scale.ResultsThe findings of this study indicates that the median age of the survivors was 56 years. It was found that the fear of recurrence significantly increased with family history of cancer (p=0.001) and total unmet needs were significantly higher among females and those receiving psychological support (p=0.016; p=0.017). The regression analysis was found having a family history of cancer (ß=9.878), and total unmet needs (ß=9.939) and psychosocial support (ß=0.433) predicted the fear of cancer recurrence. Gender (ß=−0.171), psychological support (ß=0.188), and quality of life (ß=0.485) were identified as predictors of the unmet needs of cancer survivors.ConclusionIt was determined that increased unmet needs and a family history of cancer influence on the fear of cancer recurrence in cancer survivors. Therefore, determining the needs of patients receiving cancer treatment and informing patients, particularly those with a family history of cancer, is clinically important.

BACKGROUNDCervical cancer, a prevalent gynecological malignancy, exhibits recurrence rates of 30%-50% post-treatment, with recurrent cases facing a dire 10%-20% long-term survival rate, severely impacting patients’ mental health and quality of life. Fear of cancer recurrence (FCR) emerges as a critical psychological challenge, often leading to anxiety, social avoidance, and even suicidal tendencies. Despite its high prevalence, structured, evidence-based interventions for FCR in cervical cancer remain scarce, with most studies focusing on general psychological support rather than targeted strategies. The fear of progression theory provides a theoretical framework, highlighting cognitive-emotional conflicts arising from perceived threats of disease recurrence. Addressing this gap, this study developed a specialized, phased psychological intervention program grounded in fear of progression theory, aiming to reduce FCR and enhance resilience in cervical cancer survivors through multi-disciplinary strategies.AIMTo establish a psychological intervention program to support the fear of cervical cancer recurrence and to alleviate the psychological pressure of patients after cervical cancer surgery.METHODSThirteen experts were selected to conduct two rounds of correspondence through literature review and group discussions to amend the psychological intervention draft and form the basis for the psychological intervention. The selected experts also performed two rounds of correspondence to revise the psychological intervention draft and outline the first draft, and pre-experiments were conducted for further improvement of the psychological intervention program. Experiments were performed in 80 patients with cervical cancer to further improve the psychological intervention program of relapse fear support.RESULTSThe expert authority coefficient of the first and second rounds was higher than 0.8, indicating high authority. The coordination coefficient > 0.8 indicated high consistency with high significance (all P < 0.05). The FCR Inventory, Kessler Psychological Distress Scale, Psychological Distress Thermometer, and General Hospital Anxiety and Depression Scale scores at 3 and 6 months in the study group were lower than those of the control group, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Perceived Social Support Scale scores were higher than those of the control group (P < 0.05).CONCLUSIONThe psychological intervention program of relapse fear support which considers the individual differences between patients and expert opinions, has a good scientific and practical basis, and can be used to enhance the quality of life of patients.

Despite the prevalence of fear of cancer recurrence (FCR), understanding of factors underlying clinically significant FCR is limited. This study examined factors associated with greater FCR morbidity, according to a cognitive processing model, in cancer survivors who screened positively for clinically significant FCR seeking psychological treatment through the ConquerFear trial. Participants had completed treatment for breast, colorectal or melanoma cancer 2months to 5years previously and scored ≥ 13/36 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Hierarchical regression analyses examined associations between demographic, medical and psychological variables, namely metacognitions (MCQ-30), post-traumatic stress symptoms (IES-R) and FCR (FCRI total score). Two hundred and ten (95%) of the 222 cancer survivors who consented to the ConquerFear trial completed the baseline questionnaire. Participants were predominantly (89%) breast cancer survivors. The final regression model accounted for 68% of the variance in FCR (demographic and medical variables 13%, metacognitions 26%, post-traumatic stress symptoms 28%). Negative metacognitive beliefs about worry and intrusive post-traumatic stress symptoms were significant individual correlates of FCR, but negative beliefs about worry did not significantly moderate the impact of intrusions on FCR morbidity. Results provide partial support for the cognitive processing model of FCR. Psychological factors were found to play an important role in FCR morbidity after controlling for demographic/medical factors. More intrusive thoughts and negative beliefs about worry were strong independent predictors of FCR morbidity. Cancer survivors with clinically significant FCR may benefit from assessment for intrusive thoughts and metacognitions and delivery of trauma- and/or metacognitive-based interventions accordingly.

To define the prevalence and severity of fear of cancer recurrence and identify factors associated with fear of cancer recurrence in breast cancer and colorectal cancer survivors attending the Sydney Cancer Survivorship Clinic. A cross-sectional study was performed using prospectively collected data. Survivors completed questionnaires assessing quality of life (Functional Assessment of Cancer Therapy-General and symptoms (Distress Thermometer, Patient's Disease and Treatment Assessment Form)). Survivors were assessed by a clinical psychologist for the presence of fear of cancer recurrence. Clinical and quality of life variables were evaluated for associations with fear of cancer recurrence. Overall, 315 survivors (181 breast cancer, 134 colorectal cancer) were included. In total, 201 survivors (64%) had fear of cancer recurrence according to psychology assessment, and of the 118 that had fear of cancer recurrence severity recorded, 64 (54%) were rated as moderate-severe. On univariate analysis, fear of cancer recurrence was associated with younger age (P<0.001), higher distress thermometer score (P=0.001) and poorer overall wellbeing (P<0.001). On multivariate analysis, younger age (P=0.043), being bothered by side effects of treatment (P=0.023), feeling sad (P=0.020) and greater worry that their condition will get worse (P=0.017) were independently associated with fear of cancer recurrence. Fear of cancer recurrence is common in breast and colorectal cancer survivors, and moderate-severe in over half. Fear of cancer recurrence was independently associated with younger age, feeling sad, being more bothered by side effects.

Although the fear of cancer recurrence (FCR) is to varying degrees almost universal in cancer survivors, few studies have been carried out specifically on this issue partly because of the complexity and the heterogeneity of the phenomenon. To explore the presence of specific profiles of FCR and to describe the nature of intrusive thoughts associated with FCR. A medical database was used to randomly select a large pool of French-Canadian patients who had been treated for breast, prostate, lung, or colorectal cancer within the past ten years. A sample of 1 984 participants completed, by mail, the Fear of Cancer Recurrence Inventory (FCRI) and the Cognition Intrusive Questionnaire (CIQ). Cluster analysis revealed four distinct groups of FCR patients: Mild FCR-Low Copers, Mild FCR-High Copers, Moderate FCR-High Copers and High FCR-High Copers. Percentages of endorsement obtained on CIQ items suggested that intrusive thoughts associated with FCR share many characteristics with worries (i.e., egosyntonic, verbal content). However, intrusive thoughts associated with High FCR presented more characteristics of obsessions. There are different profiles of FCR, which vary according to its severity and the type of coping strategies used. Characteristics of intrusive thoughts associated with FCR suggested different targets for FCR specific intervention.

Beyond the fear that lingers: The interaction between fear of cancer recurrence and rumination in relation to depression and anxiety symptoms

BackgroundUp to 70% of cancer survivors report clinically significant levels of fear of cancer recurrence (FCR). Despite the known negative impact of FCR on psychological wellbeing and quality of life, little research has investigated interventions for high FCR. Our team has developed and piloted a novel intervention (Conquer Fear) based on the Self-Regulatory Executive Function Model and Relational Frame Theory and is evaluating Conquer Fear in a randomised controlled trial (RCT). We aim to compare the efficacy and cost-efficacy of the Conquer Fear Intervention and relaxation training in reducing the impact of FCR.Methods/designThis study is a multi-centre RCT with 260 participants randomised either to the Conquer Fear Intervention or relaxation training. Both interventions will be delivered in five sessions over 10 weeks by trained psychologists, psychiatrists and social workers with five or more years experience in oncology. Conquer Fear sessions use attentional training, detached mindfulness, meta-cognitive therapy, values clarification and psycho-education to help patients change the way they regulate and respond to thoughts about cancer recurrence. Relaxation training includes training in progressive and passive muscle relaxation, meditative relaxation, visualisation and “quick relaxation” techniques. Relaxation was chosen to control for therapist time and attention and has good face-validity as an intervention. The primary outcome is fear of cancer recurrence. Secondary outcomes include distress, quality of life, unmet needs, and health care utilisation. Participants complete questionnaires prior to starting the intervention, immediately after completing the intervention, 3 and 6 months later. Eligible participants are early-stage breast or colorectal cancer survivors who have completed hospital-based treatment between 2 months and 5 years prior to study entry and report a score in the clinical range on the Fear of Cancer Recurrence Inventory. The biostatistician is blinded to group allocation and participants are blinded to which intervention is being evaluated. Randomisation is computer generated, stratified by therapist, and uses sequentially numbered sealed envelopes.DiscussionIf successful, the study will provide an evidence-based intervention to reduce psychological morbidity in cancer survivors, and reduce overall health care costs due to more appropriate use of follow-up care and other health services in this very large population.Trial registrationTrial registration:ACTRN12612000404820