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Project Overview

Approximately 49% of cancer survivors overall and up to 70% of vulnerable groups experience moderate to high levels of fear of cancer progression or recurrence (FOP). Recent data suggest that FOP is an even more pressing concern in advanced cancer. Patients with FOP have intrusive thoughts about cancer, unhelpful coping behaviors, and difficulty making future plans. Although some degree of FOP is normal, excessive levels adversely affect quality of life and health care costs. The purpose of this study was to assess the feasibility, acceptability, and preliminary effects of a nurse-led intervention for managing FOP in patients with advanced gynecologic or lung cancer. The intervention was adapted from an intervention called “Conquer Fear,” which has shown to have efficacy in a large RCT of patients with breast, colorectal, and melanoma cancer treated with curative intent.

Data Overview

A single group mixed methods study was conducted in patients with stage III or IV gynecologic or lung cancer (n=31) with dysfunctional levels of fear of progression or distress. The intervention consisted of seven videoconferencing sessions with skills practice. Feasibility measures included enrollment rate, attendance, attrition, and home practice adherence. Participants completed quantitative questionnaires assessing fear of progression and secondary outcomes at baseline, eight, and 12 weeks. Linear mixed model analysis was used to assess changes in outcome measures. Acceptability was based on exit interview responses. Conventional content analysis was used to analyze the qualitative data (Hsieh and Shannon, 2005). The quantitative and qualitative data were analyzed separately and compared and integrated in the discussion section.

Data Analysis

Twenty-one participants (n=11 GYN; n=10 lung) completed exit interviews, which were used for the thematic analysis and program evaluation. Two team members independently analyzed the qualitative data using content analysis with an inductive approach (Elo and Kyngas, 2008). Responses to open-ended questions were transcribed into a table and categorized according to themes. The researchers used N-Vivo 12 software (QSR International) to identify preliminary categories with supporting quotes. To help identify themes, the number of participants contributing to each response category was tabulated for frequency and response patterns (Sandelowski, 2000). Team members met several times to refine the themes. To address credibility/confirmability, an outside investigator reviewed themes against transcript excerpts. Participants reported feeling calmer and more focused. The skills practice helped to manage anxiety and fears. Three themes were identified: Struggling with fears, Refocusing the fears, and Realizing/reaffirming what is important in life. The most beneficial components included the values clarification exercise, detached mindfulness and worry postponement practices.

Reb, A., Borneman, T., Economou, D., Cangin, M., Cope, D., Huiyan, M., Ruel, M., Sharpe, L., Patel, S., Cristea, M., Koczywas, M. & Ferrell, B. 2020. A nurse-led intervention for fear of cancer progression in advanced cancer: A pilot feasibility study. European Journal of Oncology Nursing.

Reb, A.M., Borneman, T., Economou, D., Cangin, M.A., Patel, S.K., Sharpe, L., 2020. Fear of Cancer Progression: Findings from case studies and a nurse-led intervention. Clin. J. Oncol. Nurs. 24, 400-408. https://doi.org/10.1188/20.CJON.400-408.