Psychological intervention (ConquerFear) for treating fear of cancer recurrence: mediators and moderators of treatment efficacy
ConquerFear is an efficacious intervention for fear of cancer recurrence (FCR) that demonstrated greater improvements than an attention control (relaxation training) in a randomized controlled trial. This study aimed to determine mediators and moderators of the relative treatment efficacy of ConquerFear versus relaxation.
One hundred and fifty-two cancer survivors completed 5 therapy sessions and outcome measures before and after intervention and at 6 months’ follow-up. We examined theoretically relevant variables as potential mediators and moderators of treatment outcome. We hypothesized that metacognitions and intrusions would moderate and mediate the relationship between treatment group and FCR level at follow-up.
Only total FCR score at baseline moderated treatment outcome. Participants with higher levels of FCR benefited more from ConquerFear relative to relaxation on the primary outcome. Changes in metacognitions and intrusive thoughts about cancer during treatment partially mediated the relationship between treatment group and FCR.
These results show that ConquerFear is relatively more effective than relaxation for those with overall higher levels of FCR. The mediation analyses confirmed that the most likely mechanism of treatment efficacy was the reduction in unhelpful metacognitions and intrusive thoughts during treatment, consistent with the theoretical framework underpinning ConquerFear.
Implications for Cancer Survivors
ConquerFear is a brief, effective treatment for FCR in cancer survivors with early-stage disease. The treatment works by reducing intrusive thoughts about cancer and changing beliefs about worry and is particularly helpful for people with moderate to severe FCR.
KeywordsOncology Cancer Psychotherapy Fear of recurrence Metacognitive therapy Acceptance commitment therapy Metacognitions Intrusive thoughts
ConquerFear Authorship group includes Melanie Bell, Lisa Beatty, Barbara Bennett, Rachel Brebach, Christina Brock, Sue Butler, Donna Byrne, Justine Diggens, Amanda Fairclough, Therese Faulkner, Maria Ftanou, Maree Grier, Geraldine Hill, Tessa Jones, Laura Kirsten, Sue McConaghey, Sarah McKinnon, Catherine Mihalopoulos, Shab Mireskandari, Toni Musiello, James Penhale, Annabel Pollard, Anita Rangganadhan, Marita Scealy, Mary Scott, Sophy Shih, Mey Teoh, Kerry Tiller and Paula Watt.
The work presented in this paper was co-funded by BeyondBlue, the National Breast Cancer Foundation and Cancer Australia (CAPdCCRS 1022584).
Compliance with ethical standards
Conflict of interest
Author Jane Beith received travel, accommodation and expenses from Roche. The remaining authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 3.Thewes B, Butow P, Bell M, 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. 2012;20(11):2651–9.CrossRefPubMedGoogle Scholar
- 4.Koch L, Bertram H, Eberle A, Holleczek B, Schmid-Hopfner S, Waldmann A, et al. Fear of recurrence in long-term breast cancer survivors-still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the cancer survivorship-a multi-regional population-based study. Psychooncology. 2014;23(5):547–54.CrossRefPubMedGoogle Scholar
- 8.Dieng M, Butow PN, Costa DS, Morton RL, Menzies S, Mireskandari S, et al. Psychoeducational intervention to reduce fear of cancer recurrence in people at high risk of developing another primary melanoma: results of a randomized controlled trial. J Clin Oncol. 2016;34(36):4405–14.CrossRefPubMedGoogle Scholar
- 10.Butow P, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell J, et al. A randomized controlled trial (RCT) of a psychological intervention (ConquerFear) to reduce clinical levels of fear of cancer recurrence in breast, colorectal and melanoma cancer survivors. J Clin Oncol. 2017;35(36):4066–77.CrossRefPubMedGoogle Scholar
- 14.Nerenz DR, Leventhal H. Self-regulation theory in chronic illness. Coping with Chronic Disease: Research and Applications. 1983:13–38.Google Scholar
- 28.Hayes AF. PROCESS: a versatile computational tool for observed variable mediation, moderation, and conditional process modelling. 2012.Google Scholar
- 33.Smith AB, Sharpe L, Thewes B, Turner J, Gilchrist J, Fardell JE, et al. Demographic, medical and psychological factors associated with ‘clinical’ fear of cancer recurrence: a cross-sectional analysis. Support Care Cancer. 2018:1–10.Google Scholar