Psychologist-supported digital intervention can reduce fear of cancer recurrence
Research from the University of Southern Denmark and Lillebaelt Hospital shows that a digital treatment intervention combined with written support from a psychologist can reduce the fear of cancer recurrence and improve the quality of life for people who have had colorectal cancer.
Fear of cancer recurrence is a common late effect among former cancer patients. For around one in five, this fear is so persistent that it interferes with everyday life and reduces quality of life.
Researchers from the University of Southern Denmark and Lillebaelt Hospital have now tested a treatment combining a digital intervention with written support from a psychologist. The treatment was trialled on a group of former cancer patients who had been treated for colorectal cancer five to ten years earlier.
– Our previous research has shown that fear of cancer recurrence can persist for up to ten years after treatment for colorectal cancer. We know that face-to-face therapy works, and that self-help doesn’t. So now we’ve tested how “little” psychological support is needed to make a difference, explains Johanne Dam Lyhne, PhD student at the Department of Regional Health Research and Lillebaelt Hospital.
Three questions for the researcher about the study:
What are you investigating in the study?
Our study investigates whether we can support people managing severe fear of cancer recurrence in a way that better suits their needs.
What is the key finding?
The key finding is that written support from a psychologist is ‘enough’ to achieve a significant effect.
How might the results be applied?
The results may help ensure that more people with severe fear of recurrence are offered support in a format that fits into their lives and daily routines.
She and her fellow researchers found that more than 80% of the 42 participants in the study who received the new treatment fell below the level that has been defined as the threshold for what is defined as ‘highly distressing’ fear of recurrence.
- We can see from the results that a decrease in the severity of fear of recurrence is associated with an increase in quality of life, explains Johanne Dam Lyhne:
- So it seems that this form of treatment, which is very flexible for the recipients, works as intended.
A flexible approach
A total of 95 people participated in the randomised controlled clinical trial. Of these, 42 received the psychologist-supported digital offer, while 53 received a purely digital intervention. The participants’ fear of cancer recurrence was measured using questionnaires both before and after the course of treatment.
Randomised clinical trial:
A randomised clinical or controlled trial is a scientific method of testing whether a treatment works.
‘Clinical’ refers to the fact that the trial takes place in a clinical context, i.e. with patients and treatment, while ‘randomisation’ refers to ‘random distribution’ – typically drawing lots. This makes it possible to follow two similar groups of patients who are offered two different treatments, such as a new treatment and a standard treatment, and compare the results.
Randomised clinical trials are considered the most reliable method to determine whether a drug, treatment or intervention is actually making a difference.
- We tested a model where participants access a programme on a website and have written contact with a psychologist. This provides great flexibility for the participants because they can work with the programme whenever they have the time and energy. There are no fixed appointments, no visits to the hospital, and the participants decide for themselves how much they want to involve the psychologist, Johanne Dam Lyhne explains.
In addition to a significant reduction in the severity of fear of recurrence, the participants also reported relief from symptoms of anxiety and depression.
More research needed
Although the treatment has so far only been tested on a group of former colorectal cancer patients, Johanne Dam Lyhne believes that the approach could also be relevant for people who have had other types of cancer.
- We believe this could be relevant for anyone who fears a cancer recurrence, says Johanne Dam Lyhne.
- However, findings from a pilot study conducted in Australia indicate that ensuring the content is relevant for the individual is crucial, so some adaptation of the material will be necessary.
Johanne Dam Lyhne emphasises that the new treatment should be regarded as an addition to existing services.
- Effective treatment is already available for people who fear cancer recurrence, for example, in the Late-Effects Clinics and the Danish Cancer Society’s Counselling Centres. This offer should be seen as a supplement and is likely to appeal to a slightly different patient group due to the flexible format, says Johanne Lyhne:
- My hope is that the treatment will eventually be made freely available, so that healthcare professionals already working with this patient group can also offer flexible support in a written digital format. But we’re not quite there yet, says Johanne Lyhne
About the study:
Method and size: The study is a randomised controlled clinical trial. 95 people with former colorectal cancer participated in the study. Forty-two participants received treatment with the TG-iConquerFear method. Fifty-three participants were in the control group and were offered support in the form of a self-help programme.
The digital offer used in the trial is called TG-iConquerFear (in Danish: LivEFTERkræft). Patients work through the web-based programme with written support from a psychologist. The offer originates from a therapy programme (ConquerFear) that has been transformed into a digital intervention (iConquerFear). In the new programme type, ‘TG’ stands for Therapy Guided – which means that a psychologist is involved to support and guide participants as needed.
Fear of cancer recurrence was measured in both groups using a Danish version of the international ‘Fear of Cancer Recurrence Inventory’, in which participants self-report their degree of fear of recurrence.
Funding: The study has received funding from the following Danish foundations: The Danish Cancer Society, TrygFonden, Dagmar Marshalls fond, Fabrikant Einar Willumsens Mindelegat, Overlæge Jørgen Werner Schous og hustru Else Marie Schou, født Wanges Fond, Tømrermester Jørgen Holm og hustru Elisa f. Hansens Mindelegat, the Region of Southern Denmark and Lillebaelt Hospital.
Link to the study: Name of study: E-health intervention for fear of cancer recurrence: A Randomised Controlled Trial is published in JAMA Open
Meet the researcher
Johanne Dam Lyhne’s research focuses on psychological late effects after cancer. She is a PhD student at the Department of Regional Health Research and Lillebaelt Hospital, Research Unit for Oncology.