Easing Patients’ Minds
Any oncology appointment has the potential to be a high-stress environment for a patient in remission who is already struggling with FOCR, particularly if an imaging scan or other type of test is involved, Dr Hall said. So, physicians should keep in mind that a patient might already be more emotional than usual at that point, he said.
But it’s still a good time to screen for FOCR, starting with letting patients know that these feelings are common, Dr Hall told Cancer Therapy Advisor.
“My recommendation is just to ask patients if they have worries or concerns about their future health, and if they’re interested in learning some techniques for reducing how upsetting those worries can be,” he said.
The recent review in Psycho-Oncology of the 19 mind-body interventions for FOCR found some broad patterns in the approaches the trials used.3 The typical total duration per intervention was 720 minutes stretched across a series of sessions. Most interventions primarily focused on cognitive behavioral techniques to better cope with uncertainty and focus on the present moment. Less frequently, they incorporated relaxation techniques such as meditation or yoga.
One psychological intervention that’s being studied, called ConquerFear, was developed by Australian researchers and involves a series of five 60-minute to 90-minute sessions over the course of 10 weeks. Through the protocol, therapists work with survivors on strategies to better accept uncertainty, limit worry, help them develop personal goals, and choose an appropriate screening strategy.
When tested in a randomized study, involving 222 cancer survivors with no detectable cancer, the approach reduced FOCR up to 6 months after the counseling ended when compared with a control group in which participants trained in various meditation and relaxation techniques, according to findings published in 2017 in the Journal of Clinical Oncology.6
Dr Schapira said that the type of help she seeks out for her patients depends on their circumstances, including their finances and the severity of their symptoms. In some cases, she suggests a cancer support group so the patient “can be with peers or buddies who have walked the walk.” In others, where the symptoms have become more debilitating, she’ll recommend that the patient work with a mental health professional.
Given the recent surge in research, Dr Schapira predicted that there will one day be a validated way to incorporate FOCR into part of a routine psychological assessment of survivors. Until then, oncologists should look for signs of these fears as they talk to patients and evaluate their emotional resilience, she said.
Otherwise, Dr Schapira said, there’s a risk that a patient’s angst will impede that individual’s long-term recovery in other ways.
“Living with fear of recurrence puts patients in a state of being vigilant of physical symptoms to the point of being hypervigilant,” she said, which can lead to unnecessary testing.
After all, it’s rational to worry about cancer coming back, as it sometimes does, Dr Schapira said.
“The doctor needs to make a statement of partnership — that they are there with that person, and that they’re with that person to face an uncertain future,” she said.
- Simard S, Thewes B, Humphris G, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7:300–322.
- Lebel S, Ozakinci G, Humphris G, et al. Current state and future prospects of research on fear of cancer recurrence. Psychooncology. 2017;26(4):424–427.
- Hall DL, Luberto CM, Philpotts LL, Song R, Park ER, Yeh GY. Mind-body interventions for fear of cancer recurrence: a systematic review and meta-analysis. Psychooncology. 2018;27(11):2546–2558.
- Jimenez RB, Perez GK, Rabin J, et al. Fear of recurrence among cancer survivors [abstract 10053]. J Clin Oncol. 2017:10053-10053. doi: 10.1200/JCO.2017.35.15_suppl.10053
- Hall DL, Lennes IT, Pirl WF, Friedman ER, Park ER. Fear of recurrence or progression as a link between somatic symptoms and perceived stress among cancer survivors. Support Care Cancer. 2017;25(5):1401-1407. doi: 10.1007/s00520-016-3533-3
- Butow PN, Turner J, Gilchrist J, et al. Randomized trial of ConquerFear: a novel, theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol. 2017;35(36):4066-4077. doi: 10.1200/JCO.2017.73.1257