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

Fear of cancer recurrence among adolescent and young adult cancer survivors: a mixed-methods systematic review

PURPOSE

Fear of cancer recurrence (FCR) is common and burdensome in adolescent and young adult (AYA) cancer survivors. This systematic review examines FCR assessment, prevalence, severity, progression, related factors, consequences, and interventions in AYA cancer survivors.

METHODS

Electronic databases including PubMed, CINAHL, PsycINFO, Cochrane, and Embase were searched from their inception to October 2024. Two reviewers identified eligible peer-reviewed empirical studies, including both qualitative and quantitative ones on FCR in AYA survivors. The risk of bias was assessed using the Mixed-Methods Appraisal Tool. Quantitative studies were synthesized narratively, while qualitative studies underwent thematic synthesis.

RESULTS

Among the 5340 studies identified, 34 studies were included finally. 21.4 to 93.3% of AYA cancer survivors experienced FCR. About one-third of survivors with moderate or high FCR improved over time. Female survivors, those with advanced cancer stages, and individuals with negative illness perceptions or higher anxiety reported higher FCR. Persistent FCR was associated with increased psychological problems and lower quality of life. Two studies on behavioral interventions, particularly internet-based cognitive-behavioral therapy (CBT), were acceptable but had limited evidence of efficacy.

CONCLUSION

FCR is prevalent among AYA cancer survivors, particularly in female survivors, those with advanced cancer stages, and those with negative perceptions or higher anxiety. A significant proportion experience persistent, but variability in current evidence limits a comprehensive understanding of its severity, progression, and intervention efficacy. To enhance FCR management, the use of validated assessment tools is essential in both research and clinical contexts. Addressing the physical and psychological aspects of survivorship through comprehensive care is crucial for alleviating FCR and improving overall well-being.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying the key factors of FCR will stimulate the research and the development of targeted interventions for AYA cancer survivors.

Are digital psychological interventions for psychological distress and quality of life in cancer patients effective? A systematic review and network meta-analysis

BACKGROUND

Many cancer patients experience psychological distress and/or poor quality of life during or after their cancer treatment, yet they face multiple barriers to accessing psychological support. Digital psychological interventions represent a promising approach for addressing these barriers, however their comparative effectiveness remains uncertain.

METHODS

Nine databases were searched for randomized controlled trials (RCTs) from inception to July 2024. The primary outcomes were psychological distress and quality of life, and the secondary outcomes were measures of depression, anxiety, insomnia, fatigue, and fear of cancer recurrence in this study.

RESULTS

One hundred and thirty-six RCTs with 23,154 participants were identified. Of these interventions, three types-digitally-delivered cognitive behavioral therapy (CBT), health education, and virtual reality therapy (VRT)-demonstrated significant reductions in psychological distress compared to non-active controls. Digital CBT, narrative interventions, and VRT significantly improved quality of life compared to non-active controls. For depression, both digital CBT and VRT were superior to the non-active control group. Regarding anxiety, CBT, psychoeducation, and VRT outperformed the non-active control group. In terms of fatigue, CBT, psychoeducation, VRT, and multi-component interventions all showed enhanced efficacy compared to the non-active control group. However, only CBT exhibited significantly superior effectiveness in alleviating insomnia compared to non-active controls. Similarly, only mindfulness-based interventions significantly reduced fear of cancer recurrence compared to the non-active control condition.

CONCLUSIONS

Our results suggest that digital CBT and VRT are highly promising options for reducing psychological distress and enhancing the quality of life among cancer patients; further high-quality randomized controlled trials involving diverse populations are essential to validate these findings.

The Prevalence and Associated Factors of Cancer-Related Worries in Adult Survivors of Childhood Cancer: A Systematic Review

BACKGROUND

Many childhood cancer survivors (CCS) experience cancer-related worries (CRW), for example about late effects and cancer recurrence. CRW are associated with lower quality of life (QoL) and maladaptive health care use. We examined the prevalence, severity, and factors associated with CRW in adult CCS.

METHODS

We included quantitative studies of ≥ 100 participants reporting on prevalence, severity, mean scores and/or associated factors of CRW among CCS aged ≥ 18 years, diagnosed at ≤ 21 years, and ≥ 2 years post-diagnosis. We searched MEDLINE/PubMed and APA PsycINFO, hand-searched reference lists, and consulted experts. Risk of bias was assessed using the Cochrane Childhood Cancer Risk of Bias Criteria. Results were synthesized descriptively.

RESULTS

The 17 included studies with a total of 26,306 CCS identified three main themes of CRW: health-related, financial, and interpersonal. Most prevalent were health-related worries regarding future health (88%-92%), late effects (83%), cancer recurrence (25%-88%), second cancers (50%-91%), and infertility (34%-68%). Factors associated with increased CRW varied depending on the specific CRW. These included female sex, more pain, anxiety, depression, chronic conditions (e.g., neurologic, being overweight), and treatment history (chemotherapy, radiotherapy).

DISCUSSION AND IMPLICATIONS

Although most included studies used single items to assess CRW, this review underscores that health-related worries are particularly prevalent among CCS. Effectively identifying CCS at high risk, for example through using validated measures, and addressing severe CRW can facilitate adaptive healthcare use and improve QoL among CCS. Potential interventions can be providing information about late effects, psycho-education, discussions during follow-up care, and targeted psychosocial support for those with severe CRW.

Non-pharmacologic interventions for treating fear of cancer recurrence in patients with cancer: A network meta-analysis of randomized controlled trials

OBJECTIVE

This study aimed to evaluate the impact of non-pharmacological interventions on fear of cancer recurrence in patients with cancer by synthesizing evidence from various studies using the net meta-analysis (NMA) approach. Additionally, the study sought to rank the efficacy of these interventions.

METHODS

Two investigators independently searched the PubMed, Cochrane Library, Embase, and Web of Science databases to identify randomized controlled trials(RCTs) that met the inclusion criteria. The search encompassed the period from the inception of the database to December 2023. The included studies were then subjected to a quality assessment, and a network meta-analysis was performed to evaluate and compare the effectiveness of the interventions.

RESULTS

This study included 27 RCTs involving 3009 patients and examined seven types of non-pharmacological interventions. The NMA results indicated that, based on the Surface Under the Cumulative Ranking curve, Cancer and Living Meaningfully (CALM) was the most effective intervention (100 %), followed by Mindfulness Therapy (MT) at 76.5 % and Couples' Skills Training (CST) at 60.6 %. However, the league table results showed that, compared to the waitlist group, the effects of CALM [SMD = -4.83, 95 % CI (-5.93, -3.73)] and CST [SMD = -0.86, 95 % CI (-1.65, -0.07)] were significant, while MT [SMD = -1.52, 95 % CI (-3.46, 0.43)] did not reach statistical significance. Furthermore, CST was more effective than Cognitive Behavioral Therapy [SMD = -2.98, 95 % CI (-5.40, -0.56)].

CONCLUSION

The results of this study indicate that CALM is the most effective intervention for addressing mental health issues.

Web-based interventions for fear of cancer recurrence: A scoping review with a focus on suggestions for the development and evaluation of future interventions

PURPOSE

The objective of this scoping review is to provide an overview of the available evidence on the effectiveness of web-based interventions for fear of cancer recurrence (FCR) and a discussion of drawbacks and possible improvements for web-based interventions identified in the reviewed studies. These steps fulfil the aim of this review, which is to offer suggestions for developing future web-based interventions based on the reviewed studies.

METHODS

Five databases (PubMed, MEDLINE, EMBASE, SCOPUS and Web of Science) were searched. Original peer-reviewed articles, written in English, on web-based interventions for FCR were included for review. The data from the included studies was synthesised thematically.

RESULTS

We included 34 papers reporting on 28 interventions. Most of the studies in the papers were quantitative and mixed quantitative studies with a qualitative element, e.g. an interview post-intervention. Interventions were most commonly trialled with women breast cancer patients. Top three countries where studies were conducted were USA, Australia and the Netherlands. The most common theoretical framework for interventions is cognitive behavioural therapy (CBT), followed by mindfulness-based and mixed CBT, mindfulness, acceptance and commitment therapy (ACT), relaxation approaches. FCR was the primary focus/measure in 19 Studies, in 9 studies FCR was a secondary/related outcome/measure. Overall, the evidence of efficacy of web-based interventions on FCR is mixed.

CONCLUSIONS

The existing research suggests several key points for producing more robust evidence about the effectiveness of web-based interventions for FCR. First, the studies suggest that it is a priority to better define eligibility criteria to proactively include people with higher levels of FCR. Second, there is a need for longer-term follow-up and outcome measuring period. Third, research examining the reasons for dropout from web-based interventions for FCR is critical to improve the effectiveness of web-based interventions. Fourth, while web-based interventions do not involve the costs of transportation, traveling time, space, equipment, cleaning, and other expenses, further cost utility analyses should be performed. Finally, future studies should assess how intervention accessibility, adherence, and effectiveness can be improved across different intervention designs, varying from intensive synchronous individual therapist-assisted web-based programme to blended designs combining the advantages of face-to-face and internet-based elements, to entirely self-managed programmes.

IMPLICATIONS FOR CANCER SURVIVORS

Developing and evaluating more accessible FCR treatments have been identified among top international FCR research priorities (Shaw et al. 2021). While there is some evidence that web-based interventions can be as effective as face-to-face interventions, currently there is a dearth of systematic data about the ways in which the web-based modality specifically can enhance supportive care for FCR. Developing knowledge about effective web-based interventions has implications for cancer survivors as they can be presented with more accessible, low-cost and low-burden options for managing fear of cancer recurrence.