Pilot of a theoretically grounded psychologist‐delivered intervention for fear of cancer recurrence (Conquer Fear)

Dear Editor,IntroductionFear of cancer recurrence (FCR), defined as the fear orworry that cancer could return or progress in the sameplace or another part of the body [1], is a commonand debilitating problem among cancer survivors. A re-cent systematic review found that across different cancersites and assessment strategies, the following on aver-age: 73% of cancer survivors report some degree ofFCR (range=39–97%); 49% report moderate to highFCR (range=22–87%); and 7% report high FCR(range=0–15%) [2]. FCR is stable over time and hasbeen shown to impact negatively on quality of life(QOL), psychological adjustment, emotional distressand anxiety, ability to establish future plans and carerQOL [2]. High FCR has also been associated withgreater medical service usage and costs [2]. Despitethe high prevalence, morbidity and potential cost ofFCR, survivors commonly report strong unmet needsfor help managing FCR [2]. This suggests many cancerservices are currently providing inadequate care in thisarea. Indeed, clinicians in psycho-oncology report diffi-culties dealing with high FCR [3]. There is a clear needfor interventions specifically targeting FCR, but veryfew have been developed and evaluated to date [4–6].This paper reports on the pilot testing of a novel, theo-retically based intervention for FCR.MethodsInterventionThe manualised intervention (Conquer Fear) aims to re-duce the impact of FCR and is based on the common-sense model (CSM) of illness [7], self-regulatory execu-tive function (S-REF) model [8] and Relational FrameTheory (RFT) [9]. Key intervention objectives includethe following: (a) teaching strategies for controllingworry and excessive threat monitoring (S-REF), (b)modifying unhelpful beliefs about worry (S-REF), (c)developing appropriate monitoring and screeningbehaviours (CSM), (d) providing information aboutfollow-up care and empirically supported behaviouralchange (e.g. weight loss and exercise) to reduce riskof recurrence (CSM), (e) addressing cancer-related exis-tential changes (RFT), and (f) promoting values-basedgoal-setting (RFT). The intervention comprises five60–90 min, individual face-to-face sessions with atrained psychologist/psychiatrist (therapist). Home-basedpractice and reading (≈2 h/week) is encouraged to con-solidate skills. See Table 1 for an overview of sessioncontent. More details are provided in Butow et al. [10].Study designThe feasibility, acceptability and likely efficacy ofConquer Fear were evaluated in a small longitudinalsingle-arm pilot study approved by relevant local ethicscommittees.