Psychological intervention (ConquerFear) for treating fear of cancer recurrence: mediators and moderators of treatment efficacy

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. 1.

    Lebel S, Ozakinci G, Humphris G, Mutsaers B, Thewes B, Prins J, et al. From normal response to clinical problem: definition and clinical features of fear of cancer recurrence. Support Care Cancer. 2016;24(8):3265–8.

    Article  Google Scholar 

  2. 2.

    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 Surviv. 2013;7(3):300–22.

    Article  Google Scholar 

  3. 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.

    CAS  Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 5.

    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.

    Article  Google Scholar 

  6. 6.

    Otto AK, Szczesny EC, Soriano EC, Laurenceau JP, Siegel SD. Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors. Health Psychol. 2016;35(12):1320–8.

    Article  Google Scholar 

  7. 7.

    Lichtenthal WG, Corner GW, Slivjak ET, Roberts KE, Li Y, Breitbart W, et al. A pilot randomized controlled trial of cognitive bias modification to reduce fear of breast cancer recurrence. Cancer. 2017;123(8):1424–33.

    Article  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 9.

    van de Wal M, Thewes B, Gielissen M, Speckens A, Prins J. Efficacy of a blended cognitive behaviour therapy for high fear of recurrence in breast, prostate and colorectal cancer survivors: the SWORD study, a randomized controlled trial. J Clin Oncol. 2017;35(19):2173–83.

    Article  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 11.

    Fardell JE, Thewes B, Turner J, Gilchrist J, Sharpe L, Girgis A, et al. Fear of cancer recurrence: a theoretical review and novel cognitive processing formulation. J Cancer Surviv. 2016;10(4):663–73.

    Article  Google Scholar 

  12. 12.

    Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2016;44(1):1–25.

    Article  Google Scholar 

  13. 13.

    Wells A. A metacognitive model and therapy for generalized anxiety disorder. Clin Psychol Psychother. 1996;6(2):86–95.

    Article  Google Scholar 

  14. 14.

    Nerenz DR, Leventhal H. Self-regulation theory in chronic illness. Coping with Chronic Disease: Research and Applications. 1983:13–38.

  15. 15.

    Herschbach P, Book K, Dinkel A, Berg P, Waadt S, Duran G, et al. Evaluation of two group therapies to reduce fear of cancer progression in cancer patients. Support Care Cancer. 2010;18(4):471–9.

    Article  Google Scholar 

  16. 16.

    Simonelli LE, Siegel SD, Duffy NM. Fear of cancer recurrence: a theoretical review and its relevance for clinical presentation and management. Psycho-Oncology. 2017;26(10):1444–54.

    Article  Google Scholar 

  17. 17.

    Curran L, Sharpe L, Butow P. Anxiety in the context of cancer: a systematic review and development of an integrated model. Clin Psychol Rev. 2017;56:40–54.

    Article  Google Scholar 

  18. 18.

    Butow PN, Bell ML, Smith AB, Fardell JE, Thewes B, Turner J, et al. Conquer fear: protocol of a randomised controlled trial of a psychological intervention to reduce fear of cancer recurrence. BMC Cancer. 2013;13(1):201.

    Article  Google Scholar 

  19. 19.

    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. 2009;17(3):241–51.

    Article  Google Scholar 

  20. 20.

    Devilly GJ, Borkovec TD. Psychometric properties of the credibility/ expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86.

    CAS  Article  Google Scholar 

  21. 21.

    Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335–43.

    CAS  Article  Google Scholar 

  22. 22.

    Richardson J, Iezzi A, Khan MA, Maxwell A. Validity and reliability of the Assessment of Quality of Life (AQoL)-8D multi-attribute utility instrument. The Patient-Patient-Centered Outcomes Research. 2014;7(1):85–96.

    Article  Google Scholar 

  23. 23.

    Thewes B, Zachariae R, Christensen S, Nielsen T, Butow P. The concerns about recurrence questionnaire: validation of a brief measure of fear of cancer recurrence amongst Danish and Australian breast cancer survivors. J Cancer Surviv. 2015;9:68–79.

    Article  Google Scholar 

  24. 24.

    Weiss DS. The impact of event scale: revised. In: Cross-cultural Assessment of Psychological Trauma and PTSD. Boston: Springer; 2007. p. 219–38.

    Google Scholar 

  25. 25.

    Wells A, Cartwright-Hatton SA. Short form of the metacognitions questionnaire: properties of the MCQ-30. Behav Res Ther. 2004;42(4):385–96.

    Article  Google Scholar 

  26. 26.

    Hatcher RL, Gillaspy JA. Development and validation of a revised short version of the working alliance inventory. Psychother Res. 2006;16(1):12–25.

    Article  Google Scholar 

  27. 27.

    Hayes AF, Preacher KJ. Statistical mediation analysis with a multicategorical independent variable. Br J Math Stat Psychol. 2014;67(3):451–70.

    Article  Google Scholar 

  28. 28.

    Hayes AF. PROCESS: a versatile computational tool for observed variable mediation, moderation, and conditional process modelling. 2012.

  29. 29.

    Thewes B, Butow P, Zachariae R, Christensen S, Simard S, Gotay C. Fear of cancer recurrence: a systematic literature review of self-report measures. Psycho-Oncology. 2012;21(6):571–87.

    Article  Google Scholar 

  30. 30.

    Simard S, Savard J. Screening and comorbidity of clinical levels of fear of cancer recurrence. J Cancer Surviv. 2015;9(3):481–91.

    Article  Google Scholar 

  31. 31.

    Costa DS, Smith AB, Fardell JE. The sum of all fears: conceptual challenges with measuring fear of cancer recurrence. Support Care Cancer. 2016;24(1):1–3.

    Article  Google Scholar 

  32. 32.

    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.

    Article  Google Scholar 

  33. 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.

  34. 34.

    Cusack K, Jonas DE, Forneris CA, Wines C, Sonis J, Cook J, et al. Psychological treatments for adults with posttraumatic stress disorder: a systematic review and meta-analysis. Clin Psychol Rev. 2016;1(43):128–41.

    Article  Google Scholar 

  35. 35.

    Moran C, Tomei C, Lefebvre M, Harris C, Maheu C, Lebel S. An exploratory study of the worst-case scenario exercise as an exposure treatment for fear of cancer recurrence. Support Care Cancer. 2017;25(5):1373–5.

    Article  Google Scholar 

  36. 36.

    Wampold BE. How important are the common factors in psychotherapy? An update. World Psychiatry. 2015;14(3):270–7.

    Article  Google Scholar 

  37. 37.

    Brebach R, Sharpe L, Costa DS, Rhodes P, Butow P. Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. Psycho-Oncology. 2016;25(8):882–90.

    Article  Google Scholar 

  38. 38.

    Thewes B, Brebach R, Dzidowska M, Rhodes P, Sharpe L, Butow P. Current approaches to managing fear of cancer recurrence; a descriptive survey of psychosocial and clinical health professionals. Psycho-Oncology. 2014;23(4):390–6.

    CAS  Article  Google Scholar 

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Acknowledgements

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.

Funding

The work presented in this paper was co-funded by BeyondBlue, the National Breast Cancer Foundation and Cancer Australia (CAPdCCRS 1022584).

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Correspondence to Louise Sharpe.

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Author Jane Beith received travel, accommodation and expenses from Roche. The remaining authors declare that they have no conflicts of interest.

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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.

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Sharpe, L., Turner, J., Fardell, J.E. et al. Psychological intervention (ConquerFear) for treating fear of cancer recurrence: mediators and moderators of treatment efficacy. J Cancer Surviv 13, 695–702 (2019). https://doi.org/10.1007/s11764-019-00788-4

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Keywords

  • Oncology
  • Cancer
  • Psychotherapy
  • Fear of recurrence
  • Metacognitive therapy
  • Acceptance commitment therapy
  • Metacognitions
  • Intrusive thoughts