With improved survival from cancer there has been more focus on survivorship and in particular, in more recent years, on fear of cancer relapse. Fear of cancer relapse is associated with a poorer quality of life, greater distress, lack of planning for the future, avoidance of or excessive screening and greater healthcare utilisation. We know that 50% of cancer survivors will have moderate to high or clinically significant fear of cancer relapse. We know that this can persist over the whole trajectory of their illness and out over six years since diagnosis.

Our group developed a novel theoretical model on why fear of recurrence can be heightened and that the average patient goes through a cancer experience, has distress and then comes out with a normal new when some patients who have unhelpful worry, beliefs or focus too much on the cancer have heightened fear of cancer recurrence. We then developed a novel intervention to try and address some of these issues in trying to modify their fear of recurrence. This was a lot based on metacognition.

So what is metacognition? Metacognition is worrying about worrying. So, for instance, a cancer survivor will worry if they don’t worry about the cancer coming back that it won’t be caught early and they’ll have a worse survival.

We started a randomised trial where patients were randomised to the Conquer Fear, is what we called our intervention, or taking it easy. Therapists were recruited from around Australia and trained in a one day course. Participants who were early breast and colon cancer or melanoma survivors from two months to five years post-diagnosis, breast cancer patients could still be on hormone treatment, were recruited. Participants had a baseline survey and had to have clinical significant fear of recurrence on that survey. We had 222 patients who were randomised to intervention or control. Follow-up was done after the intervention at three and six months.

The treatment arms with Conquer Fear, what they did was address their values clarification so trying to get people to work out what was important to their life and to plan for the future; also to focus on the moment; also to control over their attention focus and the main thing with metacognition – what to worry about and what not to worry about and how to modify unhelpful thoughts about worry. It was also developing an appropriate follow-up that they actually didn’t avoid follow up and they actually had appropriate follow-up as well. The taking it easy arm we decided that we would have an actual active intervention because relaxation techniques have been shown in previous studies to have an effect on cancer patients in anxiety and depression. Each received five 60-90 minute sessions over ten weeks and therapists delivered both sessions.

The results showed participants in both groups improved on all outcomes. Conquer Fear was better than taking it easy on the primary outcome of fear of cancer recurrence in the inventory at all time points, at post, three and six months. The severity of fear of cancer recurrence was significantly better immediately after and at three months but not at six months.  Our secondary outcomes included anxiety, cancer anxiety, quality of life and metacognition. Conquer Fear improved all these secondary endpoints compared to taking it easy immediately after treatment, but these were not significant at three and six months, so potentially did not have a clinically significant effect on these outcomes.

So new treatments are increasing survival from cancer. Fear of cancer recurrence is a real issue. This is one of the first studies to show a new benefit from a new psychological intervention. In the future we will do an economic evaluation and also explore more accessible and less costly formats such as online, group or community interventions.