It's time to address fear of cancer recurrence in family caregivers: usability study of an virtual version of the Family Caregiver-Fear Of Recurrence Therapy (FC-FORT)

Fear of Cancer Recurrence and Associated Factors in Lymphoma Survivors and Their Family Caregivers: A Cross-Sectional Study

BACKGROUND

Fear of cancer recurrence (FCR) is a pervasive concern among lymphoma survivors and their family caregivers, influencing psychological and physical health. Given the substantial burden of FCR, identifying its predictors is crucial for targeted interventions that could enhance palliative care. We aimed to evaluate the prevalence of FCR in lymphoma survivors and their caregivers, as well as associated factors METHODS: A total of 118 patients with lymphoma, along with their family caregivers, were recruited from Hacettepe University Cancer Institute between March 2024 and May 2024. Psychological assessments were conducted using the Depression Anxiety Stress Scales (DASS-21), the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) and the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) RESULTS: High levels of FCR were experienced by 50.8% (n = 60) of lymphoma survivors and 57.6% (n = 68) of their caregivers. There was a positive correlation between the FCR of the survivors and caregivers (r = 0.349, p < 0.001). Poor overall quality of life (QoL) (aOR: 4.279, 95% CI: 1.738-10.531, p = 0.002), recent diagnosis (< 3 year) (aOR: 5.135, 95% CI: 1.852-14.238, p = 0.002), survivors' anxiety (aOR: 2.540, 95% CI: 1.014-6.363, p = 0.002) and caregivers' FCR (aOR: 2.970, 95% CI: 1.119-7.879, p = 0.029) were associated with high levels of FCR in lymphoma survivors.

CONCLUSION

We observed high FCR levels in over half the survivors with lymphoma and a higher FCR risk in patients with anxiety, poor QoL and caregiver FCR. These findings highlight the critical need for developing comprehensive care plans and interventions targeting FCR in patients with lymphoma.

The Relational Experience of Fear of Cancer Recurrence in Family Caregivers: A Reflexive Thematic Analysis Study

Fear of cancer recurrence (FCR) affects approximately 50% of family caregivers. While FCR in cancer patients has been well-documented, less is known about the experience of FCR in family caregivers. This study aimed to qualitatively explore the distinct characteristics of FCR in family caregivers. A focus group and semi-structured interviews were conducted via videoconferencing with family caregivers of cancer survivors (stages I-III, finished treatment, no recurrence). Participants were recruited through Canadian hospitals, community partners, and social media. The focus group and qualitative interviews explored family caregivers' experiences of FCR, including its content, frequency, impact, and management. A reflexive thematic analysis was used. In total, twenty family caregivers participated. Six participated in the focus group. Sixteen participated in the interviews. Two participated in both. Family caregivers described their experience of FCR as all-consuming, constant, and marked by a sense of helplessness. Qualitative analysis revealed a major theme of relational aspects of FCR in family caregivers, with the following four inter-related themes: patient-centric hypervigilance, self-silencing, FCR as isolating, and finding support. This qualitative study examined the experiences of family caregivers living with FCR. Our findings highlight that relational factors shape how family caregivers experience and manage their FCR. High-quality survivorship care should be redefined to include FCR interventions tailored to family caregivers.

Adapting a Self-Guided eHealth Intervention Into a Tailored Therapist-Guided eHealth Intervention for Survivors of Colorectal Cancer

Unlabelled

Therapist-guided eHealth interventions have been shown to engage users more effectively and achieve better outcomes than self-guided interventions when addressing psychological symptoms. Building on this evidence, this viewpoint aimed to describe the adaptation of iConquerFear, a self-guided eHealth intervention targeting fear of cancer recurrence, into a therapist-guided version (TG-iConquerFear) tailored specifically for survivors of colorectal cancer (CRC). The goal was to optimize patient outcomes while minimizing the need for extensive resources. The adaptation process followed the Information System research framework, which facilitated a systematic integration of knowledge and iterative testing. Drawing on insights from the original iConquerFear development, as well as feedback from end users, oncologists, and therapists, we began by identifying areas for improvement. These insights formed the foundation for the first design cycle. Initial internal testing revealed the need for several adjustments to enhance the intervention. While the core concept of iConquerFear remained unchanged, we made significant modifications to improve access by optimizing the platform for mobile devices, to support adherence by expanding the exercises, and to equip therapists with tools such as reflective questions and a monitoring control panel. External field testing with 5 survivors of CRC provided further validation. Participants reported a high level of acceptability, and their feedback guided additional minor points to consider incorporating in future versions. This study illustrates how a self-guided eHealth intervention can be successfully adapted into a therapist-guided format for fear of cancer recurrence, tailored to meet the needs of survivors of CRC. The described approach serves as a valuable framework for integrating therapist guidance into similar interventions, ensuring their relevance and effectiveness for targeted populations.

It is Time to Address Fear of Cancer Recurrence in Family Caregivers: Feasibility and Acceptability of a Randomized Pilot Study of the Family Caregiver Version of the Fear of Recurrence Therapy (FC-FORT)

OBJECTIVE

Fear of cancer recurrence (FCR) is common, persistent, and associated with lower quality of life, impaired functioning, and psychological distress in family caregivers (FC) of individuals with a cancer diagnosis. Interventions are needed to specifically target FCR in FC. This study aimed to pilot test the adapted Family Caregiver-Fear Of Recurrence Therapy (FC-FORT) to establish its feasibility, acceptability, and clinical significance.

METHODS

This pilot study used a mixed-method, parallel, two-group randomized control trial (FC-FORT vs. waitlist control group) design. Women FC were recruited through Canadian hospitals, community partners, and social media. FC in the intervention group completed 7 weekly sessions of virtual group therapy (FC-FORT) and an exit interview. All participants completed questionnaires at baseline, post-intervention, and 3-month follow-up. Feasibility (e.g., recruitment, allocation, fidelity), acceptability (e.g., dropout, completion, satisfaction) and clinical significance of secondary outcomes were evaluated. Descriptive statistics, mixed ANOVAs, and conventional content analyses were used.

RESULTS

Regarding feasibility, 22 FC were recruited, 18 were randomized and therapist fidelity was 87%. As to acceptability, 67% of participants completed≥ ${\ge} $ 5 sessions (33% dropout). Questionnaire completion rate was 92%. FC satisfaction was 80%. Analyses did not reveal any significant differences on the secondary outcomes between groups. Qualitative analyses revealed high importance, helpfulness, satisfaction, and group cohesion. Suggestions were made by FC for improvements.

CONCLUSIONS

This is one of the first interventions to address FCR in FC. While acceptability of FC-FORT was good, important feasibility issues need to be addressed before moving forward with a larger randomized control trial.

TRIAL REGISTRATION

NCT, NCT05441384. Registered July 1st, 2022, https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05441384.

Navigating the emotional landscape: exploring caregivers' journey alongside breast cancer survivors with chronic pain

PURPOSE

Caregiving is a crucial but frequently overlooked part of cancer care, as well as the main emotions experienced by caregivers during that journey. This qualitative study aimed to explore the emotional landscape of informal caregivers in supporting breast cancer survivors (BCs) living with chronic pain (CP).

METHODS

We conducted 3 focus groups with informal caregivers of BCs with CP. For the sentiment analysis, we used R Software and the NRC Emotion Lexicon following Plutchik's theoretical framework of emotions. The emotion spectrum was visualized using the "PyPlutchik" package in Python.

RESULTS

Caregivers (Mage = 43.17, SD = 10.97) predominantly experienced negative emotions (n = 65; M = 0.06, SD = 0.25) compared to positive ones (n = 37; M = 0.10, SD = 0.31), with sadness (n = 46), fear (n = 43), and disgust (n = 37) being most common, alongside feelings of remorse (n = 37), despair (n = 41), and shame (n = 37). The COVID-19 pandemic, as reported by caregivers, also intensified feelings of shame, frozenness, and ambivalence. Despite more frequent negative sentiments, trust (n = 53) and hope (n = 24) were consistently expressed, indicating a complex emotional landscape where positive and negative feelings coexist.

DISCUSSION

This study identifies the broad spectrum of emotions experienced by caregivers in the context of BCs with CP, ranging from individualistic feelings (e.g., fear, despair) to social emotions (e.g., shame, frozenness), and even includes instances of positive emotions (e.g., trust, hope). While our study highlights the emotional toll on caregivers, we suggest that future research and interventions focus more on providing effective support frameworks to manage these emotional challenges. Any discussion regarding the specific impacts of these emotional experiences on clinical outcomes (e.g., quality of life, fear of cancer recurrence) should be approached with caution.

Exploring the Caregiver Experiences of Symptom Management in Children With Cancer: A Qualitative Systematic Review

Although caregivers of children with cancer play an instrumental role in managing their child's symptoms, the impact of their own experiences or perspectives is under-explored. Understanding these factors is essential as they influence caregiving behaviors and overall well-being. This qualitative systematic review addresses this knowledge gap by synthesizing existing research on caregiver's experiences. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers utilized Rayyan to screen titles and abstracts retrieved from comprehensive keyword searches of five databases including CINAHL, APA PsycINFO, Embase, and MEDLINE. Databases and bibliographies were hand-searched for additional articles. One reviewer completed full text assessment and data were extracted into an Excel spreadsheet. The Quality Assessment with Diverse Studies tool was used to appraise included studies. Thematic content analysis was used to synthesize findings, which are presented narratively. Twelve articles are included, representing the experiences of 597 caregivers, most of which (83%) were undertaken in high-income nations. Quality appraisal scores indicated all studies were of moderate to robust quality. Three main themes were identified including: (1) caregivers as protectors in their role, (2) normalization of symptoms yet they remain disrupting, and (3) communication between the caregiver and child. Findings emphasize the importance of formalized information provision and education to better support caregivers in managing their child's cancer-related symptoms. Nurses are uniquely positioned to provide this essential support thereby improving the quality of life for both caregivers and children.

It is time to address fear of cancer recurrence in family caregivers: protocol for the feasibility and acceptability of a randomized pilot study of the online version of the Family Caregiver-Fear Of Recurrence Therapy (FC-FORT)

BACKGROUND

Fear of cancer recurrence (FCR) is common, persistent, and is associated with lower quality of life, impaired functioning, and psychological distress in cancer patients. Studies suggest that family caregivers of cancer patients experience equal or greater levels of FCR than patients themselves. In the past 5 years, several interventions have demonstrated their ability to reduce FCR among cancer patients and in patient-caregiver dyads. However, to date, no intervention exists to individually target family caregiver's FCR. The aims of the proposed pilot study are to (1) assess the feasibility and acceptability of the newly adapted Family Caregiver-Fear Of Recurrence Therapy (FC-FORT) intervention to inform a larger randomized control trial study, and (2) estimate the clinical significance of FC-FORT. Initial evaluation of FC-FORT revealed high user satisfaction and usability.

METHODS

A parallel, two-group, pilot randomized controlled trial comparing FC-FORT to a waitlist control (care as usual) will be conducted. Participant inclusion criteria are (a) women family caregivers taking care of adult cancer patients (no recurrence), (b) experiencing clinical levels of FCR, (c) access to a computer/internet connection, and (d) living in Canada. Participants (n = 36) will be recruited at Ottawa and Toronto hospitals, previous study participant pools, through social media and community partners across Canada. Participants in the intervention group will complete the FC-FORT intervention (7 consecutive weeks of virtual group therapy and homework). Participants in the control group will be offered the intervention after their participation in the study. All participants will be asked to complete questionnaire packages at baseline (T0), immediately post-intervention (7 weeks; T1) and at 3-months post-intervention (T2). Feasibility (e.g., recruitment, allocation, fidelity), acceptability (e.g., dropout, completion, satisfaction) and clinical significance of secondary outcomes will be evaluated (i.e., FCR illness uncertainty). Participants in the intervention group will be asked to complete measures of group cohesion and therapeutic alliance and take part in a semi-structured exit interview exploring their overall experience with FC-FORT.

DISCUSSION

This project will evaluate the acceptability and feasibility of the newly adapted FC-FORT to inform a larger trial.

TRIAL REGISTRATION

NCT, NCT05441384. Registered July 1st, 2022, https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05441384.

Fear of cancer recurrence and associated factors in family caregivers of patients with hematologic malignancy receiving chemotherapy: A latent profile analysis

Objective

This study identified the potential subgroups of fear of cancer recurrence (FCR) in family caregivers (FCs) of patients with hematologic malignancies receiving chemotherapy, as well as exploring factors associated with subgroups.

Methods

This was a cross-sectional study involving 206 pairs of participating patients with hematologic malignancies receiving chemotherapy and their FCs. Using Mplus 8.3 to perform the latent profile analysis of FCs' FCR, the FCs' burden, quality of life, psychological resilience, and anxiety as well as their demographic characteristics were compared between the subgroups, with a logistic regression analysis being applied to examine the factors associated with the FCR subgroups.

Results

A total of 206 FCs were classified into two subgroups: "a low level of FCR" (Class 1, 65.4%) and "a high level of FCR" (Class 2, 34.6%). Quality of life, anxiety, and frequency of chemotherapy were significantly associated with the two subgroups.

Conclusions

FCs of patients with hematologic malignancy receiving chemotherapy had two FCR subgroups, "a low level of FCR" and "a high level of FCR", in association with quality of life, anxiety, and frequency of chemotherapy. These findings provide the theoretical foundations for screening the FCR factor of FCs and conducting interventions for them.