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Conquer Fear

Posted 6/14/2013

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  Just a few days ago, I wrote about the new study from Lancet that suggests many women and couples experience persistent anxiety about recurrence for a very long time after cancer. This came as no surprise to most of us, but it surely raises the question about what might help. Since none of us are going to get  a promise from our doctors that we are cured, we have to find a way to live with the uncertainty and, sometimes, sharp fear. How long does it take before a backache is a sore muscle and not a possible sign of cancer spread? How long does it take before we head for an annual mammogram without a seething stomach?

  Having been thinking a lot about this over the past few days, I was especially delighted to see this study from Australia about a formal program, Conquer Fear (nice title even if it does seem a tad ambitious), that is designed to do exactly that. 260 cancer survivors will be assigned to a ten week program of either mindful meditation or this new program that includes meditation, but also a number of other stratagies to help reduce anxiety about possible recurrence.

  I suspect that, like everything else, this will turn out to be really helpful for some people and less so for others. As we all know, the only thing that really helps is the safe passage of time, and even that never completely extinguishes the fear. Here is the abstract and a link to read more:

Conquer fear: protocol of a randomised controlled trial of a psychological intervention to
reduce fear of cancer recurrence

Phyllis N Butow1*, Melanie L Bell1, Allan B Smith1, Joanna E Fardell1, Belinda Thewes1, Jane Turner2,
Jemma Gilchrist3, Jane Beith4, Afaf Girgis5, Louise Sharpe6, Sophy Shih7, Cathrine Mihalopoulos7
and members of the Conquer Fear Authorship Group

Background: Up to 70% of cancer survivors report clinically significant levels of fear of cancer recurrence (FCR).
Despite the known negative impact of FCR on psychological wellbeing and quality of life, little research has
investigated interventions for high FCR. Our team has developed and piloted a novel intervention (Conquer Fear) based on the Self-Regulatory Executive Function Model and Relational Frame Theory and is evaluating Conquer Fear in a randomised controlled trial (RCT). We aim to compare the efficacy and cost-efficacy of the Conquer Fear Intervention and relaxation training in reducing the impact of FCR.

Methods/design: This study is a multi-centre RCT with 260 participants randomised either to the Conquer Fear
Intervention or relaxation training. Both interventions will be delivered in five sessions over 10 weeks by trained
psychologists, psychiatrists and social workers with five or more years experience in oncology. Conquer Fear
sessions use attentional training, detached mindfulness, meta-cognitive therapy, values clarification and
psycho-education to help patients change the way they regulate and respond to thoughts about cancer
recurrence. Relaxation training includes training in progressive and passive muscle relaxation, meditative relaxation, visualisation and “quick relaxation” techniques. Relaxation was chosen to control for therapist time and attentio n and has good face-validity as an intervention. The primary outcome is fear of cancer recurrence. Secondary outcomes include distress, quality of life, unmet needs, and health care utilisation. Participants complete questionnaires prior to starting the intervention, immediately after completing the intervention, 3 and 6 months later. Eligible participants are early-stage breast or colorectal cancer survivors who have completed hospital-based  treatment between 2 months and 5 years prior to study entry and report a score in the clinical range on the Fear of Cancer Recurrence Inventory. The biostatistician is blinded to group allocation and participants are blinded to  which intervention is being evaluated. Randomisation is computer generated, stratified by therapist, and uses  sequentially numbered sealed envelopes.

Discussion: If successful, the study will provide an evidence-based intervention to reduce psychological morbidity in cancer survivors, and reduce overall health care costs due to more appropriate use of follow-up care and other health services in this very large population.


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