Advertisement

Journal of Cancer Survivorship

, Volume 8, Issue 3, pp 485–496 | Cite as

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

  • Sophie LebelEmail author
  • Christine Maheu
  • Monique Lefebvre
  • Scott Secord
  • Christine Courbasson
  • Mina Singh
  • Lynne Jolicoeur
  • Aronela Benea
  • Cheryl Harris
  • Michael Fung Kee Fung
  • Zeev Rosberger
  • Pamela Catton
Article

Abstract

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.

Keywords

Fear of cancer recurrence Pilot study Cognitive-existential intervention Breast cancer Ovarian cancer 

Notes

Acknowledgments

This research was supported in by the Canadian Institutes of Health Research through a Catalyst grant to Sophie Lebel (PI) and Christine Maheu (co-PI) and from a matching fund from the Canadian Nurses Foundation, Nursing Care Partnership Program to Christine Maheu (PI) and Sophie Lebel (co-PI). We appreciate the efforts of our research assistants on this project: Megan McCallum, Christina Tomei, and Ai Tinamizu.

Conflict of interest

I, Sophie Lebel, declare that myself or my institution (University of Ottawa) or my co-authors have no relationship, financial or otherwise, with individuals or organizations that could influence the authors’ work inappropriately.

References

  1. 1.
    Baker F, Denniston M, Smith T, West MM. Adult cancer survivors: how are they faring? Cancer Causes Control CCC. 2005;104(S11):2565–76.Google Scholar
  2. 2.
    Muzzin LJ, Anderson NJ, Figueredo AT, Gudelis SO. The experience of cancer. Soc Sci Med. 1994;38(9):1201–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Vickberg S. The concerns about recurrence scale CARS: a systematic measure of women’s fears about the possibility of breast cancer recurrence. Ann Behav Med. 2003;25(1):16–24.CrossRefPubMedGoogle Scholar
  4. 4.
    Simard S, Savard J. Fear of cancer recurrence inventory: development and initial validation of a multidimensional measure of fear of recurrence. Support Care Cancer. 2009;17(3):241–51.CrossRefPubMedGoogle Scholar
  5. 5.
    Fitch M, Gray RE, Franssen E. Perspectives on living with ovarian cancer: young women’s views. Rev Can Nurs Oncol. 2000;10(3):101–8.Google Scholar
  6. 6.
    Mehnert A, Berg P, Henrich G, Herschbach P. Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors. Psycho-Oncology. 2009;18(12):1273–80. doi: 10.1002/pon.1481.CrossRefPubMedGoogle Scholar
  7. 7.
    Herschbach P, Keller M, Knight L, Brandl T, Huber B, Henrich G, et al. Psychological problems of cancer patients: a cancer distress screening with a cancer-specific questionnaire. Br J Cancer. 2004;91(3):504–11. doi: 10.1038/sj.bjc.6601986.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Llewellyn CD, Weinman J, Mcguk M, Humphris G. Can we predict which head and neck cancer survivors develop fears of recurrence. J Psychosom Res. 2008;65:525–32.CrossRefPubMedGoogle Scholar
  9. 9.
    van den Beuken-van Everdingen MHJ, Peters ML, de Rijke JM, Schouten HC, van Kleef M, Patijn J. Concerns of former breast cancer patients about disease recurrence: a validation and prevalence study. Psycho-Oncology. 2008;17(11):1137–45.CrossRefPubMedGoogle Scholar
  10. 10.
    Crist JV, Grunfeld EA. Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psycho-Oncology. 2012;22(5):978–86. doi: 10.1002/pon.3114.CrossRefPubMedGoogle Scholar
  11. 11.
    Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Survivorship. 2013;7(3):300–22. doi: 10.1007/s11764-013-0272-z.CrossRefGoogle Scholar
  12. 12.
    Koch L, Jansen L, Brenner H, Arndt V. Fear of recurrence and disease progression in long-term (>/=5 years) cancer survivors—a systematic review of quantitative studies. Psycho-Oncology. 2012. doi: 10.1002/pon.3022.Google Scholar
  13. 13.
    Humphris GM, Rogers S, McNally D, Lee-Jones C, Brown J, Vaughan D. Fear of recurrence and possible cases of anxiety and depression in orofacial cancer patients. Int J Oral Maxillofac Surg. 2003;32(5):486–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Mellon S, Northouse LL, Weiss LK. A population-based study of the quality of life of cancer survivors and their family caregivers. Cancer Nurs. 2006;29(2):120–31. quiz 32–3.CrossRefPubMedGoogle Scholar
  15. 15.
    Phillips KA, Osborne RH, Giles GG, Dite GS, Apicella C, Hopper JL, et al. Psychosocial factors and survival of young women with breast cancer: a population-based prospective cohort study. J Clin Oncol. 2008;26(28):4666–71.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Lebel S, Tomei C, Feldstain A, Beattie S, McCallum M. Does fear of cancer recurrence predict cancer survivors’ health care use? Support Care Cancer. 2013;21(3):901–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Dow KH, Ferrell BR, Leigh S, Ly J, Gulasekaram P. An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Res Treat. 1996;39(3):261–73.CrossRefPubMedGoogle Scholar
  18. 18.
    Thewes B, Butow P, Bell ML, Beith J, Stuart-Harris R, Grossi M, et al. Fear of cancer recurrence in young women with a history of early-stage breast cancer: a cross-sectional study of prevalence and association with health behaviours. Support Care Cancer Off J Multl Assoc Support Care Cancer. 2012;20(11):2651–9. doi: 10.1007/s00520-011-1371-x.CrossRefGoogle Scholar
  19. 19.
    Herschbach P, Berg P, Waadt S, Duran G, Engst-Hastreiter U, Henrich G, et al. Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychother Psychosom. 2010;79(1):31–8. doi: 10.1159/000254903.CrossRefPubMedGoogle Scholar
  20. 20.
    Humphris G, Ozakinci G. The AFTER intervention: a structured psychological approach to reduce fears of recurrence in patients with head and neck cancer. Br J Health Psychol. 2008;13(Pt 2):223–30. doi: 10.1348/135910708X283751.CrossRefPubMedGoogle Scholar
  21. 21.
    Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology. 2009;18(12):1261–72. doi: 10.1002/pon.1529.CrossRefPubMedGoogle Scholar
  22. 22.
    Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107–17. doi: 10.1177/0898010110385938.CrossRefPubMedGoogle Scholar
  23. 23.
    Cameron LD, Booth RJ, Schlatter M, Ziginskas D, Harman JE. Changes in emotion regulation and psychological adjustment following use of a group psychosocial support program for women recently diagnosed with breast cancer. Psycho-Oncology. 2007;16(3):171–80. doi: 10.1002/pon.1050.CrossRefPubMedGoogle Scholar
  24. 24.
    Shields CG, Ziner KW, Bourff SA, Schilling K, Zhao Q, Monahan P, et al. An intervention to improve communication between breast cancer survivors and their physicians. J Psychosoc Oncol. 2010;28(6):610–29. doi: 10.1080/07347332.2010.516811.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Lee-Jones C, Humphris G, Dixon R, Hatcher MB. Fear of cancer recurrence—a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psycho-Oncology. 1997;6(2):95–105.CrossRefPubMedGoogle Scholar
  26. 26.
    Mishel MH. Uncertainty in illness. Image J Nurs Scholarsh. 1988;20(4):225–32.CrossRefGoogle Scholar
  27. 27.
    Ladouceur R, Dugas MJ, Freeston MH, Leger E, Gagnon F, Thibodeau N. Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. J Consult Clin Psychol. 2000;68(6):957–64.CrossRefPubMedGoogle Scholar
  28. 28.
    Kissane DW, Bloch S, Miach P, Smith GC, Seddon A, Keks N. Cognitive-existential group therapy for patients with primary breast cancer—techniques and themes. Psycho-Oncology. 1997;6(1):25–33. doi: 10.1002/(SICI)1099-1611(199703)6:1<25::AID-PON240>3.0.CO;2-N.CrossRefPubMedGoogle Scholar
  29. 29.
    Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, et al. Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Psycho-Oncology. 2003;12(6):532–46. doi: 10.1002/pon.683.CrossRefPubMedGoogle Scholar
  30. 30.
    Kissane DW, Love A, Hatton A, Bloch S, Smith G, Clarke DM, et al. Effect of cognitive-existential group therapy on survival in early-stage breast cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2004;22(21):4255–60. doi: 10.1200/JCO.2004.12.129.CrossRefGoogle Scholar
  31. 31.
    Mishel MH, Germino BB, Gil KM, Belyea M, Laney IC, Stewart J, et al. Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psycho-Oncology. 2005;14(11):962–78. doi: 10.1002/pon.909.CrossRefPubMedGoogle Scholar
  32. 32.
    Edelman S, Kidman AD. Description of a group cognitive behaviour therapy programme with cancer patients. Psycho-Oncology. 1999;8(4):306–14. doi: 10.1002/(SICI)1099-1611(199907/08)8:4<306::AID-PON387>3.0.CO;2-Y.CrossRefPubMedGoogle Scholar
  33. 33.
    Spiegel D, Morrow GR, Classen C, Raubertas R, Stott PB, Mudaliar N, et al. Group psychotherapy for recently diagnosed breast cancer patients: a multicenter feasibility study. Psycho-Oncology. 1999;8(6):482–93.CrossRefPubMedGoogle Scholar
  34. 34.
    Northouse LL. The impact of cancer in women on the family. Cancer Pract. 1995;3(3):134–42.PubMedGoogle Scholar
  35. 35.
    Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41(3):209–18.CrossRefPubMedGoogle Scholar
  36. 36.
    Stanton AL. Psychosocial concerns and interventions for cancer survivors. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(32):5132–7. doi: 10.1200/JCO.2006.06.8775.CrossRefGoogle Scholar
  37. 37.
    Faller H, Schuler M, Richard M, Heckl U, Weis J, Kuffner R. Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(6):782–93. doi: 10.1200/JCO.2011.40.8922.CrossRefGoogle Scholar
  38. 38.
    Lerman C, Schwartz MD, Miller SM, Daly M, Sands C, Rimer BK. A randomized trial of breast cancer risk counseling: interacting effects of counseling, educational level, and coping style. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 1996;15(2):75–83.Google Scholar
  39. 39.
    Lee-Jones C, Humphris G, Dixon R, Hatcher MB. Fear of cancer recurrence—a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears. Psycho-Oncology. 1997;6(2):95–105. doi: 10.1002/(SICI)1099-1611(199706)6:2<95::AID-PON250>3.0.CO;2-B.CrossRefPubMedGoogle Scholar
  40. 40.
    Simard S, Savard J, Ivers H. Fear of cancer recurrence: specific profiles and nature of intrusive thoughts. J Cancer Survivorship. 2010;4(4):361–71. doi: 10.1007/s11764-010-0136-8.CrossRefGoogle Scholar
  41. 41.
    Easterling DV, Leventhal H. Contribution of concrete cognition to emotion: neutral symptoms as elicitors of worry about cancer. J Appl Psychol. 1989;74(5):787–96.CrossRefPubMedGoogle Scholar
  42. 42.
    Asmundson GJ, Taylor S, Cox BJ, editors. Health anxiety: clinical and research perspectives on hypochondriasis and related conditions. New York: Wiley; 2001.Google Scholar
  43. 43.
    Humphris G, Ozakinci G. The AFTER intervention: a structured psychological approach to reduce fears of recurrence in patients with head and neck cancer. Br J Health Psychol. 2008;13:223–30.CrossRefPubMedGoogle Scholar
  44. 44.
    Miedema B, Tatemichi S, MacDonald I. Cancer follow-up care in New Brunswick: cancer surveillance, support issues and fear of recurrence. Can J Rural Med. 2004;9(2):101–7.Google Scholar
  45. 45.
    Mishel MH. The measurement of uncertainty in illness. Nurs Res. 1981;30(5):258–63.CrossRefPubMedGoogle Scholar
  46. 46.
    Langlois F, Ladouceur R. Treatment for hypochondriasis. Cogn Behav Pract. 2004;11:393–404.CrossRefGoogle Scholar
  47. 47.
    Furer P, Walker JR, Freeston MH. Approach to integrated cognitive-behavior therapy for intense illness worry. In: Asmundson GJ, Taylor A, Cox BJ, editors. Health anxiety: clinical and research perspectives on hypochondrias and related conditions. New York: John Wiley & Sons Ltd.; 2001. p. 161–92.Google Scholar
  48. 48.
    Zebrack BJ, Ganz PA, Bernaards CA, Petersen L, Abraham L. Assessing the impact of cancer: development of a new instrument for long-term survivors. Psycho-Oncology. 2006;15(5):407–21.PubMedCentralCrossRefPubMedGoogle Scholar
  49. 49.
    Carver CS. You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92–100. doi: 10.1207/s15327558ijbm0401_6.CrossRefPubMedGoogle Scholar
  50. 50.
    Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Olfson M, Mojtabai R, Sampson NA, Hwang I, Druss B, Wang PS, et al. Dropout from outpatient mental health care in the United States. Psychiatr Serv. 2009;60(7):898–907. doi: 10.1176/appi.ps.60.7.898.PubMedCentralCrossRefPubMedGoogle Scholar
  53. 53.
    Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull. 1986;99(1):20–35.CrossRefPubMedGoogle Scholar
  54. 54.
    Kendall PC, Panichelli-Mindel SM. Cognitive-behavioral treatments. J Abnorm Child Psychol. 1995;23(1):107–24.CrossRefPubMedGoogle Scholar
  55. 55.
    Deacon BJ, Abramowitz JS. Cognitive and behavioral treatments for anxiety disorders: a review of meta-analytic findings. J Clin Psychol. 2004;60(4):429–41. doi: 10.1002/jclp.10255.CrossRefPubMedGoogle Scholar
  56. 56.
    Simard S, Savard J. Fear of cancer recurrence inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2009;17(3):241–51. doi: 10.1007/s00520-008-0444-y.Google Scholar
  57. 57.
    Herschbach P, Berg P, Dankert A, Duran G, Engst-Hastreiter U, Waadt S, et al. Fear of progression in chronic diseases: psychometric properties of the fear of progression questionnaire. J Psychosom Res. 2005;58(6):505–11. doi: 10.1016/j.jpsychores.2005.02.007.CrossRefPubMedGoogle Scholar
  58. 58.
    Jacobsen PB, Donovan KA, Trask PC, Fleishman SB, Zabora J, Baker F, et al. Screening for psychologic distress in ambulatory cancer patients. Cancer. 2005;103(7):1494–502. doi: 10.1002/cncr.20940.CrossRefPubMedGoogle Scholar
  59. 59.
    Gottlieb BH, Wachala ED. Cancer support groups: a critical review of empirical studies. Psycho-Oncology. 2007;16(5):379–400. doi: 10.1002/pon.1078.CrossRefPubMedGoogle Scholar
  60. 60.
    Herschbach P, Book K, Dinkel A, Berg P, Waadt S, Duran G, et al. Evaluation of two group therapies to reduce fear of progression in cancer patients. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2010;18(4):471–9. doi: 10.1007/s00520-009-0696-1.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sophie Lebel
    • 1
    Email author
  • Christine Maheu
    • 2
    • 3
  • Monique Lefebvre
    • 4
  • Scott Secord
    • 5
  • Christine Courbasson
    • 6
  • Mina Singh
    • 7
  • Lynne Jolicoeur
    • 4
  • Aronela Benea
    • 3
  • Cheryl Harris
    • 8
    • 9
  • Michael Fung Kee Fung
    • 4
  • Zeev Rosberger
    • 10
  • Pamela Catton
    • 3
    • 11
  1. 1.School of PsychologyUniversity of OttawaOttawaCanada
  2. 2.Ingram School of NursingMcGill UniversityMontréalCanada
  3. 3.Cancer Survivorship Program, Princess Margaret HospitalUniversity Health NetworkTorontoCanada
  4. 4.Gynecologic OncologyThe Ottawa HospitalOttawaCanada
  5. 5.Canadian Partnership Against CancerTorontoCanada
  6. 6.Cognitive Behavioural Therapy CentreTorontoCanada
  7. 7.School of NursingYork UniversityTorontoCanada
  8. 8.Department of Psychology and Psychosocial Oncology ProgramThe Ottawa Hospital Cancer CentreOttawaCanada
  9. 9.Ottawa Hospital Research InstituteOttawaCanada
  10. 10.Louise Granofsky-Psychosocial Oncology ProgramJewish General HospitalMontréalCanada
  11. 11.Radiation Oncology, Princess Margaret HospitalUniversity Health NetworkTorontoCanada

Personalised recommendations