Journal of Cancer Survivorship

, Volume 7, Issue 1, pp 63-73

First online:

Evaluation of the efficacy and usability of NCI’s Facing Forward booklet in the cancer community setting

  • Joanne S. BuzagloAffiliated withResearch & Training Institute, Cancer Support Community
  • , Suzanne M. MillerAffiliated withPsychosocial and Biobehavioral Medicine Department, Fox Chase Cancer Center Email author 
  • , Jeffery KendallAffiliated withPsychosocial Oncology Program, UT Southwestern Simmons Cancer Center
  • , Annette L. StantonAffiliated withDepartments of Psychology and Psychiatry/Biobehavioral Sciences, Division of Cancer Prevention and Control Research, University of California Los Angeles
  • , Kuang-Yi WenAffiliated withPsychosocial and Biobehavioral Medicine Department, Fox Chase Cancer Center, Robert C. Young Pavilion
  • , John ScarpatoAffiliated withPsychosocial and Biobehavioral Medicine Department, Fox Chase Cancer Center, Robert C. Young Pavilion
  • , Fang ZhuAffiliated withBiostatistics and Bioinformatics Facility, Fox Chase Cancer Center
  • , Jennifer LyleAffiliated withNational Comprehensive Cancer Network
  • , Julia RowlandAffiliated withOffice of Cancer Survivorship, National Cancer Institute, National Institutes of Health, NIH/DHHS

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The NCI developed the print-based educational brochure, Facing Forward, to fill a gap in helping cancer patients meet the challenges of transitioning from active treatment to survivorship; however, little research has been conducted on its efficacy.


The aims of this study were to evaluate the efficacy of Facing Forward in promoting the uptake of recommended behaviors (e.g., ways to manage physical changes) and to explore its usability.


At the last treatment appointment, early-stage breast, prostate, colorectal, and thoracic cancer patients (N = 340) recruited from community clinical oncology practices and an academic medical center completed a baseline assessment and were randomized to receive either Facing Forward (n = 175) or an attention control booklet about the NCI’s Cancer Information Service (n = 165). Patients completed follow-up assessments at 8 weeks and 6 months post-baseline.


The reported uptake of recommended stress management behaviors was greater among intervention than control participants at both 8 weeks post-baseline (p = 0.016) and 6 months post-baseline (p = 0.017). At 8 weeks post-baseline, the intervention control group difference was greater among African-American than Caucasian participants (p < 0.03) and significant only among the former (p < 0.003); attendance at a cancer support group was also greater among the intervention than control group participants (p < 0.02). There were no significant intervention control group differences in the reported uptake of recommended behaviors in three other categories (p > 0.025). Intervention participants rated Facing Forward as understandable and helpful and indicated a high level of intention to try the behaviors recommended.


Facing Forward can enhance early-stage survivors’ reported ability to manage stress and increase support group use during the reentry period.

Implications for Cancer Survivors

Facing Forward can help survivors meet the challenges of the reentry period.


Survivorship Cancer control Psychosocial interventions Facing Forward