Department of Psychology and Behavioural Sciences

Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis

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  • Nina M Tauber
  • Mia S. O'Toole
  • Andreas Dinkel, Department of Nuclear Medicine, Technical University Munich, Munich, Germany, Germany
  • Jacqueline Galica, 1 Queen's University, Kingston, Ontario, Canada.
  • ,
  • Gerry Humphris, School of Computer Science, University of St. Andrews, St. Andrews, United Kingdom.
  • ,
  • Sophie Lebel, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
  • ,
  • Christine Maheu, McGill University, Canada
  • Gozde Ozakinci, School of Computer Science, University of St. Andrews, St. Andrews, United Kingdom., United Kingdom
  • Judith Prins, Radboud University Medical Centre, Nijmegen, The Netherlands, Netherlands
  • Louise Sharpe, University of Sydney, Australia
  • Allan Ben Smith, Ingham Institute for Applied Medical Research and University of New South Wales, Sydney, NSW, Australia.
  • ,
  • Belinda Thewes, Radiation Physics Laboratory, Sydney Medical School, University of Sydney, NSW 2006, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; and School of Physics, University of Sydney, NSW 2006, Australia., Australia
  • Sébastien Simard, Département des sciences fondamentales, Université du Québec à Chicoutimi (UQAC), Saguenay, Canada G7H 2B1., Canada
  • Robert Zachariae

PURPOSE: Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis.

METHODS: We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514).

RESULTS: A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges's g) were found both at postintervention (g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up (g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs (g = 0.24; β = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = -.01; 95% CI, -.01 to -.00; P = .027) and group-based formats (β = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR.

CONCLUSION: Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition-for example, worry, rumination, and attentional bias-rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients' FCR presentation.

Original languageEnglish
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Pages (from-to)2899-2915
Number of pages17
Publication statusPublished - 2019

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