Benefits of a Brief Psychological Intervention Targeting Fear of Cancer Recurrence in People at High Risk of Developing Another Melanoma

12-month Follow-up Results of a Randomized Controlled Trial

M. Dieng; R.L. Morton; D.S.J. Costa; P.N. Butow; S.W. Menzies; S. Lo; G.J. Mann; A.E. Cust; N.A. Kasparian

Disclosures

The British Journal of Dermatology. 2020;182(4):860-868. 

In This Article

Abstract and Introduction

Abstract

Background: People with melanoma want and need effective interventions for living with fear of cancer recurrence (FCR).

Objectives: This study reports the 12-month outcomes of a brief, psychological intervention designed to reduce FCR in people at high risk of developing another primary melanoma compared with usual care.

Methods: In this two-arm randomized controlled trial, adults previously diagnosed with stage 0, I or II melanoma were randomly allocated to the intervention (n = 80) or control (usual care) arm (n = 84). The trial was registered with the Australian and New Zealand Clinical Trials Registry on 19 March 2013 (registration: ACTRN12613000304730). The intervention comprised a 76-page psychoeducational resource and three individually tailored, telephone-based sessions with a psychologist, scheduled at specific time points around participants' dermatological appointments. The primary outcome was the level of self-reported fear of new or recurrent melanoma assessed at 12 months postintervention using the severity subscale of the Fear of Cancer Recurrence Inventory.

Results: Compared with the control arm, the intervention group reported significantly lower FCR at 12 months postintervention; the between-group mean difference was −1·41 for FCR severity [95% confidence interval (CI) −2·6 to −0·2; P = 0·02] and −1·32 for FCR triggers (95% CI −2·6 to −0·02; P = 0·04). The odds ratio for FCR severity scores ≥13 (54% intervention, 63% control) was 0·59 (95% CI 0·30–1·14, P = 0·12). There were no differences between groups in secondary outcomes, such as anxiety, depression or health-related quality of life.

Conclusions: The previously reported 6-month benefits of this brief, patient-centred psychological intervention in reducing FCR were found to continue 12 months postintervention, with no known adverse effects, supporting implementation as part of routine melanoma care.

Introduction

People treated for early-stage melanoma are at 5–10 times greater risk of developing new primary disease relative to people without a history of melanoma.[1,2] As a consequence, many people who have had melanoma often experience fear of cancer recurrence (FCR) or progression. Recent studies have shown that over 70% of people with a history of melanoma report levels of fear of melanoma recurrence indicative of a need for clinical intervention;[3–5] a proportion higher than those documented for other cancers.[6]

Interventions specifically designed to address FCR are limited (Table S1; see Supporting Information).[7,8] Only six studies have tested the efficacy of psychological interventions in reducing FCR, with FCR as the primary outcome.[4,9–13] These studies include a total of 913 participants, the majority of whom had a history of breast or gynaecological cancer. Overall, results demonstrate the efficacy of psychological interventions in assisting people to cope with and reduce FCR. Four additional studies included FCR as a secondary outcome and these also found psychological intervention to be effective in reducing FCR.[14–17] Although these results are promising, all of the studies cited above provide 6-month follow-up data outcomes only. FCR is an enduring concern for many people who have had cancer and remains relatively stable over time;[6,18,19] thus, effective, long-lasting treatment strategies are needed to support people in managing cancer-related fear.[3]

To address this gap in clinical care we have conducted previous work to inform the design of this psychological intervention to reduce FCR. In our previous research we firstly developed and piloted a psychoeducational resource, delivered in booklet format, which was judged positively by patients and healthcare providers in terms of the quality and quantity of information, its value and capacity to address unmet needs. We then piloted and evaluated in a randomized controlled trial the 1-month and 6-month efficacy of a new psychological intervention to reduce FCR and improve psychological adjustment and found the intervention to be effective.[4] We now report, for the first time, the longer-term effects of this brief, tailored psychological intervention for people with a history of early-stage melanoma. The trial was registered with the Australian and New Zealand Clinical Trials Registry on 19 March 2013: registration number: ACTRN12613000304730.

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