The Ottawa clinical fear of recurrence instruments: A screener, self-report, and clinical interview.

OBJECTIVE: Clinical fear of cancer recurrence (FCR) was recently defined by a group of experts during a Delphi study. Five criteria were agreed upon, namely: (a) high levels of preoccupation, (b) high levels of worry, (c) that are persistent, (d) hypervigilance and hypersensitivity to physical sensations that e) may result in functional impairment. No existing instruments comprehensively capture all these criteria for clinical FCR. METHODS: To remedy this gap, a set of three patient-reported outcome instruments including a one-item screener, self-report questionnaire, and semi-structured clinical interview, named the Ottawa Clinical Fear of Recurrence instruments, were developed. To do so, the research team first conducted a literature review of potential items. Additional FCR experts discussed the content of the screener and interview. The self-report's items were assessed for content validity by the same expert panel using Likert ratings and the Content Validity Index to narrow down the number of items. The three instruments were piloted with a group of cancer survivors to assess face validity following the European Organization for Research and Treatment of Cancer recommendations. RESULTS: The literature review and content validity assessment led to a final draft pre-pilot of 23 potential items for the self-report questionnaire. The instruments were piloted. Pilot study participants suggested changing wording and response options (particularly for the self-report) for greater clarity. CONCLUSIONS: Based on the feedback received, minor modifications were made, mostly for the self-report. In general, content and face validity for the three instruments were good for both experts and cancer survivors.

Fear of cancer recurrence in adolescent patients with malignant bone tumors: a cross-section survey.

BACKGROUND: Adolescent malignant-bone tumor patients' fear of cancer recurrence is a significant psychological issue, and exploring the influencing factors associated with fear of cancer recurrence in this population is important for developing effective interventions. This study is to investigate the current status and factors influencing fear of cancer recurrence (FCR) related to malignant bone-tumors in adolescent patients, providing evidence for future targeted mental health support and interventions. DESIGN: A cross-sectional survey. METHODS: In total, 269 adolescent malignant-bone tumor cases were treated at two hospitals in Zhejiang Province, China from January 2023 to December 2023. Patients completed a General Information Questionnaire, Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Family Hardiness Index (FHI), and a Simple Coping Style Questionnaire (SCSQ). Univariate and multivariable logistic regressions analysis were used to assess fear of cancer recurrence. RESULTS: A total of 122 (45.4%) patients experienced FCR (FoP-Q-SF ≥ 34). Logistic regression analysis analyses showed that per capita-monthly family income, tumor stage, communication between the treating physician and the patient, patient's family relationships, family hardiness a positive coping score, and a negative coping score were the main factors influencing FCR in these patients (P < 0.05). CONCLUSIONS: FCR in malignant-bone tumor adolescent patients is profound. Healthcare professionals should develop targeted interventional strategies based on the identified factors, which affect these patients; helping patients increase family hardiness, helping patients to positively adapt, and avoid negative coping styles.

Lung cancer-specific symptoms and fear of cancer recurrence among recurrence-free non-small cell lung cancer survivors.

PURPOSE: Lung cancer survivors have more psychosocial problems, including depression and anxiety disorder, than other cancer survivors. Lung cancer-specific symptoms, such as cough, dyspnea, or pain in chest, might increase FCR among survivors. We aimed to evaluate the association between lung cancer-specific symptoms and FCR among recurrence-free non-small cell lung cancer (NSCLC) survivors. METHODS: This is a cross-sectional study. Recurrence-free NSCLC survivors were recruited from January to October 2020 at a tertiary hospital in Seoul, Korea. We measured FCR using the Korean version of FCRI-SF and categorized them into three groups: non-clinical FCR (nFCR, < 13), subclinical FCR (sFCR, 13 to 21), and clinical FCR (cFCR, ≥ 22). Lung cancer-specific symptoms were measured using the Korean version of EORTC QLQ-LC13 and EORTC QLQ-C30. RESULTS: A total of 727 survivors were enrolled. One-third (30.8%) of survivors reported sFCR, and 19.7% had cFCR. In a multivariate analysis, survivors with severe pain in chest were 4.7 times (95% CI: 2.4-9.0) more likely to experience cFCR compared to those without it. Mild dyspnea (OR 1.7, 95% CI: 1.1-2.7) and mild dysphagia (OR 2.4, 95% CI: 1.3-4.4) were associated with cFCR. Survivors with sFCR (Coef. - 6.3, 95% CI: - 9.8, - 2.8) and cFCR (Coef. - 11.3, 95% CI: - 15.5, - 7.2) had poorer quality of life compared to survivors with nFCR. CONCLUSION: NSCLC survivors were experiencing lung cancer-specific symptoms even a few years after treatment, which were associated with cFCR, resulting in poor HRQoL. It is necessary to develop a lung cancer-specific symptom checklist and use it during even long-term surveillance.

Relationship Between Fear of Cancer Recurrence and Quality of Life in Patients Undergoing Active Cancer Treatment: The Mediating Role of Social Support.

INTRODUCTION: Socio-psychological factors such as fear of recurrence and presence of social support may affect quality of life (QOL) of cancer patients. Identifying mediating factors that impact QOL are crucial for targeting vulnerability in patients undergoing cancer treatments. The study purpose was therefore to determine relationships between presence of fear of cancer recurrence and QOL of patients, with the mediating role of social support. METHODS: A predictive correlational design was used to conduct the study with 300 patients with cancer who were undergoing chemotherapy, radiotherapy, or surgery at two medical centers in Tehran. Measures included a demographic information form, the Fear of Cancer Recurrence Inventory (FCRI), the European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30), and the Multidimensional Scale of Perceived Social Support (MSPSS). Data analyses included descriptives, and path analysis analyses. RESULTS: Higher fear of cancer recurrence predicted lower QOL (ß = -0.60, p < 0.001). Moreover, individuals with lower fear of cancer recurrence also perceived higher social support (ß = 0.32, p < 0.001). Additionally, individuals with higher perceived social support also reported better QOL (ß = 0.30, p < 0.001). CONCLUSION: Perceived social support plays a significant mediating role in the relationship between the fear of cancer recurrence and QOL in patients undergoing active cancer treatment. Enhancing social support among cancer patients may contribute to enhanced QOL, and as does reducing fears associated with disease recurrence.

[Post-Cancer Treatment-Related Symptom Distress and Fear of Cancer Recurrence in Colorectal Cancer Survivors].

BACKGROUND: Colorectal cancer (CRC) is a primary cause of cancer-related mortality, and, after treatment, cancer survivors often worry that disease recurrence may worsen their health. Nevertheless, limited research on fear of cancer recurrence (FCR) and treatment-related symptoms has been conducted on survivors of CRC. PURPOSE: This study was designed to explore (1) symptom distress severity and post-treatment FCR in CRC survivors and (2) the predictors of FCR. METHODS: A cross-sectional correlational research design and convenience sampling approach were used to recruit patients at the colorectal surgery outpatient department of a medical center in central Taiwan. Basic demographic data, the Symptom Distress Scale - Chinese Modified Form, and Fear of Progression Questionnaire - Short Form were used as monitoring tools. Pearson's product-moment correlation analysis, independent t-tests, one-way ANOVA, and stepwise linear regression analysis were used for statistical analysis. RESULTS: One hundred fourteen survivors of CRC with an average age of 63.44 were enrolled as participants. The top five symptoms of distress were numbness, bowel patterns, fatigue, insomnia, and dry mouth, and the average FCR score was 18.09. Gender, educational level, monthly disposable income, and symptom distress were identified as significant predictors of FCR, with an overall explanatory power of 41.4%. CONCLUSIONS: Level of post-treatment FCR in survivors of CRC is influenced by symptom distress severity. Early intervention by healthcare providers to control or alleviate physical symptoms can help prevent the emergence of negative emotions and improve quality of life in this patient group.

Marital Self-Disclosure Intervention for the Fear of Cancer Recurrence in Chinese Patients With Gastric Cancer: Protocol for a Quasiexperimental Study.

BACKGROUND: Patients with gastric cancer experience different degrees of fear of cancer recurrence. The fear of cancer recurrence can cause and worsen many physical and psychological problems. We considered the "intimacy and relationship processes in couples' psychosocial adaptation" model. OBJECTIVE: The study aims to examine the effectiveness of a marital self-disclosure intervention for improving the level of fear of cancer recurrence and the dyadic coping ability among gastric cancer survivors and their spouses. METHODS: This is a quasiexperimental study with a nonequivalent (pretest-posttest) control group design. The study will be conducted at 2 tertiary hospitals in Taizhou City, Jiangsu Province, China. A total of 42 patients with gastric cancer undergoing chemotherapy and their spouses will be recruited from each hospital. Participants from Jingjiang People's Hospital will be assigned to an experimental group, while participants from Taizhou People's Hospital will be assigned to a control group. The participants in the experimental group will be involved in 4 phases of the marital self-disclosure (different topics, face-to-face) intervention. Patients will be evaluated at baseline after a diagnosis of gastric cancer and reassessed 2 to 4 months after baseline. The primary outcome is the score of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for patients. The secondary outcomes are the scores of the FoP-Q-SF for partners and the Dyadic Coping Inventory. RESULTS: Research activities began in October 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 12 months. The primary results of this study are anticipated to be announced in June 2024. CONCLUSIONS: This study aims to assess a marital self-disclosure intervention for improving the fear of cancer recurrence in Chinese patients with gastric cancer and their spouses. The study is likely to yield desirable positive outcomes as marital self-disclosure is formulated based on evidence and inputs obtained through stakeholder interviews and expert consultation. The study process will be carried out by nurses who have received psychological training, and the quality of the intervention will be strictly controlled. TRIAL REGISTRATION: ClinicalTrials.gov NCT05606549; https://clinicaltrials.gov/study/NCT05606549. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55102.

The effects of lifestyle and behavioural interventions on cancer recurrence, overall survival and quality of life in breast cancer survivors: A systematic review and network meta-analysis.

Lifestyle/behavioural interventions may improve breast cancer outcomes and quality of life (QoL); however, uncertainty remains about the most effective interventions due to limited evidence. This study aimed to assess and compare the effects of lifestyle/behavioural interventions on cancer recurrence, survival and QoL in breast cancer survivors. Electronic databases including Medline, EMBASE, PsycINFO, CINAHL and EBM Reviews were searched for relevant literature. Randomized controlled trials (RCTs) and quasi-RCTs comparing a lifestyle/behavioural intervention with a control condition in breast cancer survivors were included. Outcomes included cancer recurrence, overall survival and QoL. A network meta-analysis synthesized intervention effect. Studies not included in the analysis were reported narratively. Of 6251 identified articles, 38 studies met the selection criteria. Limited evidence exists on the impacts of lifestyle/behavioural interventions on breast cancer recurrence/survival. Exercise was identified as the most effective intervention in improving overall survival (HR 0.50, 95 % CI 0.36, 0.68). Lifestyle/behavioural interventions may improve QoL; psychosocial interventions (SMD 1.28, 95 % CI 0.80, 1.77) and aerobic-resistance exercise (SMD 0.33, 95 % CI -0.03, 0.69) were the most effective interventions to enhance QoL. This review highlights potential post-breast cancer benefits from lifestyle/behavioural interventions, notably exercise and psychosocial support for QoL and exercise for overall survival. Thus, encouraging active lifestyle, stress management and coping skills programs during and after cancer treatment may enhance physical wellbeing and QoL. However, the findings should be interpreted with caution due to the small number and sample sizes of studies. Future longer-term RCTs are required for conclusive recommendations.

Health-related quality of life and neurocognitive functioning in patients with recurrent glioblastoma treated with intracerebral immune checkpoint inhibition.

PURPOSE: After glioblastoma (GB) recurrence, prognosis is very cumbersome. Therefore, health-related quality of life (HRQoL) and neurocognitive functioning (NCF) have become important endpoints in clinical trials when evaluating novel treatments. We aimed to evaluate the HRQoL and NCF in patients with recurrent glioblastoma (rGB) treated with a combination of surgical intervention (reoperation or biopsy) and intracerebral immune checkpoint inhibition. METHODS: Patients who participated in the trial (N = 23), at a single-center university hospital were included. Data were collected using 3 patient-reported outcome measures (EORTC-QLQ-C30, EORTC-QLQ-BN20, and HADS) and computerized NCF testing. In the responder group, baseline values were compared to results at a 6-month follow-up. Additionally, exploratory analyses compared baseline HRQoL and NCF between responders and non-responders. RESULTS: There were five responders and 18 non-responders. When comparing the mean and individual baseline with follow-up results for the responders, we observed overall a stable to slight clinically relevant improvement of HRQoL in multiple subsets of the questionnaires while maintaining a stable NCF. One patient deteriorated on anxiety and depression symptoms from baseline to follow-up. CONCLUSIONS: In patients that responded to intracerebral immunotherapy in our institutional trial, HRQoL and NCF remained stable over time, suggesting that no detrimental effect on cognitive function or quality of life may be expected with this treatment approach. Furthermore, there seems to be an overall tendency for responders to score better on HRQoL and NCF than non-responders at baseline.

Lived Experiences and Fear of Cancer Recurrence Among Survivors of Localized Cutaneous Melanoma.

Importance: Most of the rapid increase in cutaneous melanoma incidence in the US has been localized disease that is treated surgically and is associated with high survival rates. However, little is known about the psychological well-being of survivors in the US. Objective: To explore the lived experiences and fear of cancer recurrence among survivors of localized cutaneous melanoma. Design, Setting, and Participants: This was a qualitative and survey-based study that used semistructured interviews and the Fear of Cancer Recurrence Inventory short form (FCRI-SF) survey tool with participants recruited from an academic dermatology practice affiliated with the University of Texas, Austin. Interviews were completed via telephone or in person from August 2021 to September 2022. Each of the 9 items in the FCRI-SF was rated on a 5-point Likert scale, scored from 0 to 4, with a maximum possible score of 36 points. Data analyses were performed from February 2022 to June 2023. Main Outcomes and Measures: Semistructured interviews were analyzed for themes and subthemes associated with the lived experiences of survivors of cutaneous melanoma. The FCRI-SF scores were tabulated, with scores of 13 or greater identifying potential cases of clinically significant fear of cancer recurrence. Results: In all, 51 participants (mean [SD] age, 49.5 [11.7] years; 34 [67%] female and 17 [33%] male) with a history of localized melanoma (stage 0-IIA) completed the interview and survey. Among them, 17 (33%) had survived a diagnosis of stage 0 melanoma, and the remainder, at least 1 invasive melanoma diagnosis (stage I-IIA). Semistructured interviews revealed several themes: (1) emotions surrounding follow-up appointments, (2) intensity of melanoma surveillance, (3) lifestyle changes regarding sun exposure, and (4) thoughts about life and death. Thirty-eight of 51 participants had an FCRI-SF score above the threshold for clinical fear of cancer recurrence. Conclusions and Relevance: This qualitative and survey-based study found that despite having an excellent prognosis, some survivors of localized melanoma, even those who had stage 0, have high rates of fear of cancer recurrence and intense survivorship experiences that affect their psychological well-being.

Fear of Cancer Recurrence in Differentiated Thyroid Cancer Survivors: A Systematic Review.

Background: Despite excellent survival rates, health-related quality of life detriments are common in differentiated thyroid cancer survivors and can be driven by fear of cancer recurrence (FCR). This review aims to report the incidence of FCR in thyroid cancer survivors and synthesize evidence regarding contributing factors. An overview and appraisal of the range of tools used to measure FCR is presented. Methods: A systematic review of the English literature was performed. The search across six electronic databases generated 3414 studies. Two reviewers independently screened the citations and full-text articles, of which 31 were included. The data were extracted independently by two reviewers. Results: The incidence of FCR was reported in 27/31 studies and ranged from 15% to 91%. Direct comparisons regarding incidence and severity of FCR were not possible due to heterogeneity in cut-points used to define FCR. A total of eight validated tools were used to measure FCR across all studies, with five studies using self-developed nonvalidated items. There was minimal repetition of validated tools and no clear consensus as to a preferred survey tool. Factors influencing FCR were reported in 11 studies. There was minimal overlap of factors influencing FCR. Risk factors contributing to increased FCR reported in more than one study included young age and an upcoming clinical appointment. Male gender and higher education levels were reported in more than one article as protective. No literature evaluating interventions to address FCR in thyroid cancer survivors was found. Conclusion: FCR is common in thyroid cancer survivors, but significant heterogeneity in the current evidence base limits assessment of incidence, severity, or risk factors. There is a need to use validated tools to assess FCR in both research and clinical contexts. Reliable assessment of FCR may permit routine assessment of FCR in clinical practice and allow interventions to be prospectively evaluated to optimize the holistic well-being of thyroid cancer survivors.

Investigating fear of cancer recurrence among female breast cancer survivors and their spouses in southwest China: a cross-sectional study.

OBJECTIVES: Examining fear of cancer recurrence (FCR) among breast cancer survivors and their spouses, and the protective effect of family resilience on FCR among couples affected by breast cancer. DESIGN: Cross-sectional survey design. SETTING: Ten general grade IIIa (>500 beds) hospitals in southwest China. PARTICIPANTS: Overall, 392 early breast cancer survivors and their spousal caregivers (N=392) were recruited from cancer centres in hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES: Spouses' and survivors' FCR were the primary outcome measures. Family resilience and perceived stress were the secondary outcome measures. Using a convenience sampling method, we collected data on-site using paper questionnaires. The Chinese version of the Family Resilience Assessment Scale, Perceived Stress Scale, Fear of Progression Questionnaire Short Form and Fear of Progression Questionnaire-Short Form for spouses were used to evaluate the outcomes. RESULTS: The model accounted for 66.3% and 53.6% of the variance in spouses' FCR and survivors' FCR, respectively. Family resilience directly negatively affected perceived stress and spouses' and survivors' FCR (ß=-0.22; ß=-0.13; ß=-0.19). Perceived stress was a partial mediator of the association between family resilience and survivors' FCR (ß=-0.070; 95% CI :-0.151 to -0.022). Spouses' FCR partially mediated the association between family resilience and survivors' FCR (ß=-0.048; 95% CI= -0.092 to -0.015). Perceived stress and spouses' FCR played a significant chain-mediated role between family resilience and survivors' FCR (ß=-0.061; 95% CI: -0.119 to -0.022). CONCLUSIONS: Family-centred approaches to reducing survivors' perceived stress can improve the psychological well-being of couples affected by breast cancer and ultimately reduce FCR. Medical staff should consider the psychological feelings of survivors and their spousal caregivers when devising the intervention plan, which should address the families' potential and mobilise family and community resources for increasing family resilience.

Trajectories of fear of cancer recurrence and its influence factors: A longitudinal study on Chinese newly diagnosed cancer patients.

OBJECTIVE: The fear of cancer recurrence (FCR) is an ongoing and common psychological problem faced by cancer patients. The objective of this study was to explore the variation trend of FCR and its influencing factors in Chinese newly diagnosed cancer patients from admission to 2 months after discharge. Demographic and tumor characteristics, as well as experiential avoidance (EA), were used as predictors. METHOD: A longitudinal design and a consecutive sampling method were used to select 266 newly diagnosed cancer patients admitted to a tertiary cancer hospital in China from July to December 2022. Measurements of FCR and EA were obtained at admission (T1), 1 month after discharge (T2), and 2 months post-discharge (T3). Generalized estimating equations were used to identify factors associated with FCR for longitudinal data analysis. RESULTS: A total of 266 participants completed the follow-up. Both FCR and EA scores of patients with newly diagnosed cancer showed a significant trend of first increasing and then decreasing at baseline and follow-up (p < 0.001). The junior secondary and less education level, rural residence, advanced tumor and high EA level were risk factors for higher FCR. CONCLUSIONS: Our findings suggest that the FCR levels of most newly diagnosed cancer patients in China are different at the three time points and affected by different factors, with the highest level at 1 month after discharge. These results have significant implications for future identifying populations in need of targeted intervention based on their FCR trajectories.

The association between metacognition, coping style and fear of cancer recurrence among postmastectomy patients: A cross sectional study.

PURPOSE: To investigate the incidence of fear of cancer recurrence (FCR) in Chinese postmastectomy patients and explore the relationships between metacognition, coping style, and FCR on the basis of the self-regulating executive function model. METHODS: A total of 480 postmastectomy patients from two tertiary comprehensive hospitals in Xi'an were enrolled from March 2021 to November 2021. The participants completed demographic information, the Metacognitions Questionnaire-30 (MCQ-30), Positive Metacognitions and Positive Meta-Emotions Questionnaire (PMCEQ), Simplified Copying Style Questionnaire (SCSQ), and Fear of Cancer Recurrence Inventory Short Form (FCRI-SF). RESULTS: 34.2% of the respondents had scores indicating a clinical level of FCR (FCRI-SF≥13). FCR had a positive correlation with maladaptive metacognition and negative coping style (P < 0.01), while adaptive metacognition and positive coping style were negatively correlated (P < 0.01). Besides, maladaptive metacognition had both direct and indirect effects on FCR, with the indirect effect primarily mediated by negative coping style (total effect, 0.430). Adaptive metacognition had both direct and indirect effects on FCR, with the indirect effect primarily mediated by positive coping style (total effect,ï¹£0.302). CONCLUSION: FCR was a common phenomenon in postmastectomy patients and moderate in most patients. In addition, both metacognition and coping style had a direct and indirect association with the occurrence and development of FCR. Moreover, adaptive metacognition and maladaptive metacognition had different mechanisms on FCR in patients with breast cancer.

Validity and screening capacity of the FCR-1r for fear of cancer recurrence in long-term colorectal cancer survivors.

PURPOSE: Existing fear of cancer recurrence (FCR) screening measures is being shortened to facilitate clinical use. This study aimed to evaluate the validity and screening capacity of a single-item FCR screening measure (FCR-1r) in long-term colorectal cancer (CRC) survivors with no recurrence and assess whether it performs as well in older as in younger survivors. METHODS: All Danish CRC survivors above 18, diagnosed and treated with curative intent between 2014 and 2018, were located through a national patient registry. A questionnaire including the FCR-1r, which measures FCR on a 0-10 visual analog scale, alongside the validated Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) as a reference standard was distributed between November 2021 and May 2023. Screening capacity and cut-offs were evaluated with a receiver-operating characteristic analysis (ROC) in older (≥ 65 years) compared to younger (< 65 years) CRC survivors. Hypotheses regarding associations with other psychological variables were tested as indicators of convergent and divergent validity. RESULTS: Of the CRC survivors, 2,128/4,483 (47.5%) responded; 1,654 (36.9%) questionnaires were eligible for analyses (median age 76 (range 38-98), 47% female). Of the responders, 85.2% were aged ≥ 65. Ninety-two participants (5.6%) reported FCRI-SF scores ≥ 22 indicating clinically significant FCR. A FCR-1r cut-off ≥ 5/10 had 93.5% sensitivity and 80.4% specificity for detecting clinically significant FCR (AUC = 0.93, 95% CI 0.91-0.94) in the overall sample. The discrimination ability was significantly better in older (AUC = 0.93, 95% CI 0.91-0.95) compared to younger (0.87, 95% (0.82-0.92), p = 0.04) CRC survivors. The FCR-1r demonstrated concurrent validity against the FCRI-SF (r = 0.71, p < 0.0001) and convergent validity against the short-versions of the Symptom Checklist-90-R subscales for anxiety (r = 0.38, p < 0.0001), depression (r = 0.27, p < 0.0001), and emotional distress (r = 0.37, p < 0.0001). The FCR-1r correlated weakly with employment status (r = - 0.09, p < 0.0001) and not with marital status (r = 0.01, p = 0.66) indicating divergent validity. CONCLUSIONS: The FCR-1r is a valid tool for FCR screening in CRC survivors with excellent ability to discriminate between clinical and non-clinical FCR, particularly in older CRC survivors.

Effectiveness of a guided online primary care intervention for fear of cancer recurrence: A randomised controlled trial.

OBJECTIVE: Fear of Cancer Recurrence (FCR) is highly prevalent among cancer survivors and leads to decreased quality of life and increased healthcare costs. We assessed the effectiveness of a guided online primary care intervention for FCR, compared to waiting list. METHODS: In this RCT, participants were recruited online and randomised 1:1. All adults who finished successful curative cancer treatment between 3 months and 10 years ago, wanted support for FCR, and had sufficient Dutch skills were eligible. The intervention consisted of a 10-week online programme and three to five video calling sessions with a trained mental health worker. After 6 months, the control group received the same intervention. The primary outcome was the difference between the groups in the change in FCR severity from baseline (T0) to 6 months (T2), measured online with the short form of the Fear of Cancer Recurrence Inventory. RESULTS: One hundred and seventy-three participants were enroled and randomised to the intervention (n = 86) or control group (n = 87). FCR severity dropped 2.1 points more in the intervention group than in the control group (2.7 points (SD = 3.9) versus 0.6 points (SD = 3.6), t(154) = 3.4, p = 0.0007). General mental well-being also improved significantly in the intervention group and remained stable in the control group. These improvements remained at 10 months follow up. CONCLUSIONS: This easily accessible and relatively inexpensive intervention effectively reduces FCR and has potential to replace or precede existing more intensive psychological treatments, improving patients' access to care. TRIAL REGISTRATION: The trial was prospectively registered in the Netherlands Trial Register on 25-02-2019 with number NL7573.

Eficacia de los tratamientos psicológicos para el miedo a la recurrencia del cáncer de mama / Efficacy of psychological treatments for fear of breast cancer recurrence

Introducción: El miedo a la recurrencia del cáncer es una de las consecuencias más frecuentes en los supervivientes del cáncer. El cáncer de mama fue el tipo de cáncer más diagnosticado en el 2020 en todo el mundo, aunque se ha evidenciado una baja tasa de mortalidad de este tipo de cáncer en España, lo que favorece una mayor prevalencia de miedo a la recurrencia en el cáncer de mama. Objetivo: Realizar una revisión sistemática sobre las intervenciones utilizadas para reducir el miedo a la recurrencia del cáncer en supervivientes de cáncer de mama. Metodología: Se realizó la búsqueda en las bases de datos SCOPUS, APA PsycInfo, APA PsycArticles, MEDLINE y E-Journals, limitando los resultados a los estudios controlados aleatorizados de los últimos siete años. Resultados: Se incluyeron finalmente 18 estudios. Las intervenciones que se centran en los sesgos atencionales y en las preocupaciones y las rumiaciones resultaron ser las más eficaces. Se discuten los resultados en base al modelo de Miedo a la Recurrencia del Cáncer desarrollado por Lee-Jones et al. (1997) y se proponen futuras líneas de investigación. Conclusiones: Existen varias intervenciones eficaces sobre el miedo a la recurrencia del cáncer, destacando el programa ConquerFear por sus resultados y su bajo coste (AU)

Introduction: Fear of cancer recurrence is one of the most frequent consequences in cancer survivors. Breast cancer was the most diagnosed type of cancer in 2020 worldwide, although a low mortality rate of this type of cancer has been evidenced in Spain, which favors a higher prevalence of fear of recurrence in breast cancer. Objective: To conduct a systematic review of the interventions used to reduce the fear of cancer recurrence in breast cancer survivors. Methodology: We searched the SCOPUS, APA PsycInfo, APA PsycArticles, MEDLINE, and E-Journals databases, limiting the results to randomized controlled studies from the last seven years. Results: Eighteen studies were finally included. Interventions targeting attentional biases and worries, and ruminations were found to be the most effective. Results are discussed based on the Fear of Cancer Recurrence model developed by Lee-Jones et al. (1997) and future lines of research are proposed. Conclusions: There are several effective interventions on fear of cancer recurrence, with the ConquerFear program standing out for its results and low cost (AU)

Validación ecológica del programa FORT (Fear of Cancer Recurrence Therapy): una adaptación del español mexicano al español castellano: reporte preliminar / Ecological validation of Fear of Cancer Recurrence Therapy from Mexican to european Spanish for breast cancer patients: Preliminary repor

Introducción: El miedo a la recaída es uno de los problemas psicológicos en los pacientes con cáncer, más específicos. El aumento en la esperanza de vida en el paciente oncológico, y la supervivencia, hace que cada vez más conozcamos las consecuencias emocionales, y vivir con el llamado Síndrome de la Espada de Damocles es sin duda una de las más importantes. Este miedo a la recaída puede llegar a ser invalidante y por ello cada vez más se elaboran programas terapéuticos para poderlo combatir. Uno de los más conocidos es el FORT (Fear of Recurrence Therapy) elaborado por Maheu y Lebel y que en este momento está siendo adaptado a otros lenguajes y culturas. Una de ellas es la adaptación de Gálvez en México. Objetivo: Nuestro objetivo en el presente trabajo preliminar es presentar los primeros datos de adaptación de esta terapia del español mexicano al europeo. Método: El procedimiento seguido es la validación ecológica propuesta por Bernal en base al consenso de dos psicooncólogas expertas. Resultados: Después de valorar el cambio de diferentes conceptos y terminologías, se han valorado de forma independiente por parte de ambas psicooncólogas, las 8 dimensiones de Bernal con un alto índice Kappa (de 0,8 a 1). Conclusiones: Este es un estudio preliminar al que le va a seguir los mismos pasos para el manual de la paciente por parte de profesionales y de pacientes con cáncer de mama (AU)

Introduction: Fear of recurrence is one of the most specific psychological problems faced by cancer patients. Their increase in life expectancy, and survival, makes them increasingly aware of the emotional consequences, and living with the so-called Sword of Damocles Syndrome is undoubtedly one of the most important. Fear of recurrence can become disabling and affect their emotional well-being, leading to the development of therapeutic programs like FORT (Fear of Recurrence Therapy) developed by Maheu and Lebel. This therapy is being adapted to different languages and cultures, including Mexican Spanish by Gálvez. Objective: In this preliminary work, we aim to present the first data on adapting FORT from Mexican Spanish to European Spanish. Methods: The procedure used was to follow the ecological validation method proposed by Bernal, by two skilled psychooncologists. Results: The assessment of different concepts and terminologies by the two psychooncologists in an independent way, the analysis yielded a high Kappa index (from 0.8 to 1) for the 8 dimensions of Bernal. Conclusions: This preliminary study will be followed by a similar process for the patient manual by professionals and breast cancer patients (AU)

A quality improvement project to optimize access to psychosocial care for cancer survivors who experience fear of recurrence.

BACKGROUND: The prevalence of moderate to high levels of fear of cancer recurrence (FCR) in cancer survivors may vary from 22% to 87%, although most are not usually referred to psychosocial support. The After Cancer Treatment Transition (ACTT) clinic in Women's College Hospital (Toronto) provides follow-up care to cancer survivors but in a sample of 2893 patients seen April 2019 to March 2022, only 1.5% were referred to a social worker for psychosocial needs. A single-question screening tool is currently available to screen for FCR. OBJECTIVE: To evaluate the use of the single-question screening tool for FCR among cancer survivors and its impact on social work referrals. RESULTS: Between July and October 2022, 788 patients were seen in the ACTT clinic. Generally, most patients in ACTT are breast cancer survivors (75%), and the remaining survivors are a mix of other cancer types (colorectal cancer, ovarian cancer, thyroid cancer, melanoma). Three hundred thirty (41.9%) ACTT patients completed the single-question screening tool for FCR. Most screened patients were female (96%), the average age was 60 years, and most were diagnosed with breast cancer (90%). Among screened patients, 37 (11%) indicated a moderately severe to high level of FCR and efforts were made to refer these 37 patients to a social worker. In the end, 22 (59.5%) patients with moderately severe/high levels of FCR were offered and accepted referral to a social worker. In comparison to the 1.5% referred to social work (among 2893 patients) prior to FCR screening, referrals increased to 6.7% (among 330 screened). CONCLUSION: Use of a single-question FCR screening tool improved identifying cancer survivors in need of psychosocial support and improved access to a social worker.

Effects of CALM intervention on neutrophil-to-lymphocyte ratio (NLR), fear of cancer recurrence and quality of life in patients with lung cancer.

PURPOSE: To evaluate the feasibility and practicability of Managing Cancer and Living Meaningfully (CALM) as a psychological intervention to reduce neutrophil to lymphocyte ratio (NLR), fear of cancer recurrence, general distress, and improve quality of life in lung cancer survivors. METHODS: Eighty lung cancer patients with FCRI severity subscale (≥13 points) were recruited and randomly assigned to CALM or usual care (UC). NLR was recorded before and after treatment. The Fear of Cancer Recurrence Inventory (FCRI), Quality of Life Questionnaire Core 30 (QLQ-C30) and Depression-Anxiety-Stress Scale (DASS-21) were used to evaluate patients at baseline (T0), immediately after treatment (T1), and at 2 (T2) and 4 (T3) months. RESULTS: Compared with UC, NLR was significantly different before and after CALM intervention (z=-5.498; P=0.000). There were significant differences in the scores of QLQ, FCR and general distress before and after the T1, T2 and T3 interventions (F=220.30, F=315.20, F=290.10, respectively; P<0.001). NLR was negatively correlated with QOL both before (r=-0.763; P<0.0001) and after the intervention (r=-0.810, P<0.0001). FCR and general distress were negatively correlated with QOL in CALM (T0: r=-0.726, r=-0.776, respectively; P<0.0001; T1: r=-0.664, r=-0.647, respectively; P<0.0001; T2: r=-0.678, r=-0.695, respectively; P<0.0001; T3: r=-0.511, P = 0.0008; r=-0.650, P<0.0001). CONCLUSION: CALM intervention can effectively reduce the NLR, alleviate the recurrence fear and general distress and improve the quality of life in patients. This study suggests that CALM may be an effective psychological intervention for reducing symptoms associated with lung cancer survivors.

Fear of Cancer Recurrence and Coping Strategies among Prostate Cancer Survivors: A Qualitative Study.

BACKGROUND: Fear of cancer recurrence (FCR), as a commonly reported problem among prostate cancer survivors, has not been fully understood. This study aimed to explore the experience of FCR and relevant coping strategies among Iranian prostate cancer survivors. METHODS: Qualitative research was conducted on 13 men who completed treatments for prostate cancer in the last 24 months. The participants were selected through purposeful sampling, and in-depth semi-structured interviews were used for data collection. Conventional content analysis was used for data analysis. RESULTS: Data analysis led to the emergence of three themes. "Living with insecurity" describes the participants' experiences regarding what triggers FCR with two categories, including "fear of incomplete cure" and "fear of cancer return." In addition, "struggling to cope" with two categories, including "psychological strategies" and "spiritual coping," presents coping strategies used by the participants for reducing FCR. Furthermore, "trying to prevent cancer recurrence" with two categories, "seeking health" and "lifestyle modification," indicates coping strategies used by the participants to prevent cancer recurrence. CONCLUSIONS: Healthcare providers need to consider the cultural characteristics of prostate cancer survivors when assessing their FCR, encourage them to disclose their concerns and fears, and provide tailored interventions in order to reduce FCR among them.