July 2021

ONCOLOGY

VIRTUAL INTERVENTION REDUCES FEAR OF BREAST CANCER RECURRENCE

Featuring: David Cella, PhD

​A targeted virtual health intervention was effective for reducing fear of recurrence among breast cancer survivors, according to a clinical trial published in the Journal of the National Cancer Institute.

Fear of recurrence can cause anxiety and related symptoms, so implementing effective and convenient strategies can improve quality of life for survivors of cancer, according to David Cella, PhD, the Ralph Seal Paffenbarger Professor and chair of Medical Social Sciences and a co-author of the study.

“Most often, honest reassurance is the most effective first line of support,” said Cella, who is also director of the Institute for Public Health and Medicine’s (IPHAM) Center for Patient-Centered Outcomes and associate director of the Cancer Prevention and Control Research Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “In cases where that fails and anxiety persists, there are very effective pharmacologic and behavioral approaches to treat fear of recurrence.”

Fear of recurrence is a common experience for breast cancer survivors; one study found 48 percent of survivors experienced intrusive thoughts related to it.
“These effects include distress, cognitive symptoms, interference with work productivity, reduced enjoyment of life, and in more extreme cases, stress responses such as startle response, flashbacks to painful treatment memories and disturbed sleep,” Cella said.

Current strategies for managing fear of recurrence include cognitive behavioral therapy (CBT) and mind-body interventions, but a lack of providers, cost and logistical challenges limit access. According to the authors, there is an unmet need for convenient and effective fear of recurrence management.

Enter, “FoRtitude.” The virtual cognitive behavioral therapy teaches a variety of strategies to manage fear of recurrence. In the study, investigators evaluated three different CBT strategies combined with telecoaching, which was hypothesized to increase adherence to the CBT therapy. A control group received online health management content.

In a group of nearly 200 breast cancer survivors, both CBT and health management content were associated with decreased scores on a survey measuring fear of recurrence. However, telecoaching proved to be the difference-maker: It was associated with lower attrition and greater engagement with the virtual interventions.

“Telecoaching is a safe and convenient way to reach out to people, help normalize their fears, and provide strategies to minimize their effects,” Cella said.

Further study of the optimal integration of CBT and health management content, along with the most effective features of virtual delivery, could help improve these interventions. In the era of COVID-19 and increased usage of telehealth, virtual interventions like these could prove a useful tool to reduce fear of cancer recurrence, the authors said.
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This work was supported by the National Cancer Institute grants CA173193 and 1UG1CA189828, and by the ECOG-ACRIN Medical Research Foundation.
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This article was originally published in the Feinberg School of Medicine News Center on July 23, 2021. ​
David Cella, PhD, the Ralph Seal Paffenbarger Professor and chair of the Department of Medical Social Sciences, was a co-author of the study published in the Journal of the National Cancer Institute.

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