Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study
Abstract
Background Evidence suggests that fear of cancer recurrence (FCR) is one of the most frequently cited unmet needs among cancer survivors and is associated with psychological distress, stress-response symptoms, and lower quality of life, as well as increased use of health care resources. Despite these factors, few manualized interventions exist to address FCR among cancer survivors.Purpose To develop, manualize, and pilot test the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address FCR in women with breast or ovarian cancer.Methods This study was a single-arm multi-site study with pre-, post-, and 3-month follow-up measurement occasions.Results A total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group intervention. Following the intervention, women experienced a reduction in the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. They also reported improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore, almost all changes were sustained at 3-month follow-up.Conclusion This brief intervention appears feasible and has shown promising results in addressing FCR and related secondary outcomes of cancer-specific distress, uncertainty, quality of life, and coping; however, it should be further tested using a randomized controlled study design to more definitively assess its efficacy.Implications for cancer survivors FCR is a near-universal worry for cancer survivors that, when left unaddressed, tends to remain stable over time. This study has important implications for all cancer survivors as it is the first published intervention that provides preliminary evidence of its efficacy in decreasing fear of cancer recurrence.
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FORT is a standardized and manualized intervention that consists of six consecutive weekly sessions.
“The Fear Of Recurrence Therapy (FORT) is a standardized and manualized intervention that consists of six consecutive weekly sessions [43–45].”
The pilot study of FORT showed reductions of FCR and other secondary outcomes with medium effect sizes of pre to post change sustained at 3 months follow-up.
“Results of the pilot study showed reductions of FCR and other secondary outcomes, such as cancer-specific distress, perceived risk of cancer recurrence, illness uncertainty, intolerance of uncertainty, positive beliefs about worrying, coping, and QoL, which resulted in medium effect sizes of pre to post (within group) change that were sustained at a 3 months follow-up [43].”
FORT was first pilot tested as a group intervention using a single-arm pre-post study design with 56 breast or ovarian cancer survivors.
“It was first pilot tested as a group intervention using a single-arm pre-post study design and 56 breast or ovarian cancer survivors.”
FORT's pilot and RCT studies demonstrated good questionnaire completion rates.
“FORT’s pilot [43] and RCT [44, 46] studies demonstrated good questionnaire completion rates.”
This approach to maximizing attendance was successfully tested in previous FORT studies.
“This approach was successfully tested in previous FORT studies [43, 46].”
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Dawson, G., Madsen, L. T., & Dains, J. E. (2016) · Clinical journal of oncology nursing · doi:10.1188/16.cjon.e155-e161 · Cited by 48 · see citing works
Smith, A. ‘., Thewes, B., Turner, J., Gilchrist, J., Fardell, J., Sharpe, L., Bell, M. L., Girgis, A., Grier, M., Byrne, D., et al. (2015) · Psycho-Oncology · doi:10.1002/pon.3775 · Cited by 47 · see citing works
“There is a clear need for interventions specifically targeting FCR, but very few have been developed and evaluated to date [4–6].”
BackgroundPujade-Lauraine, É., & Combe, P. (2016) · Annals of Oncology · doi:10.1093/annonc/mdw079 · Cited by 47 · see citing works
“The most frequent are insomnia, fatigue and gastrointestinal symptoms such as bloating, abdominal pain, constipation or dyspepsia [22].”
Backgroundvan de Wal, M., Gielissen, M. F. M., Servaes, P., Knoop, H., Speckens, A. E. M., & Prins, J. B. (2015) · BMC Psychology · doi:10.1186/s40359-015-0068-1 · Cited by 43 · see citing works
“%) benefitted most from the interventions (Lebel et al. 2014).”
BackgroundInfluentialthe ConquerFear Authorship Group, Smith, A. B., Sharpe, L., Thewes, B., Turner, J., Gilchrist, J., Fardell, J. E., Girgis, A., Tesson, S., Descallar, J., et al. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4294-y · Cited by 45 · see citing works
Galica, J., Giroux, J., Francis, J., & Maheu, C. (2019) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2019.101705 · Cited by 39 · see citing works
Self-citationLengacher, C. A., Gruss, L. F., Kip, K. E., Reich, R. R., Chauca, K. G., Moscoso, M. S., Joshi, A., Tinsley, S., Shani, B., Cousin, L., et al. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-021-00214-0 · Cited by 40 · see citing works
Kang, D., Kim, N., Choi, E., Yoon, J. H., Lee, S., Lee, J. E., Nam, S. J., Han, W., Noh, D., & Cho, J. (2017) · Psycho-Oncology · doi:10.1002/pon.4408 · Cited by 38 · see citing works
“They might conclude that they are not recovering properly or that the cancer remains.(36) Individuals with a low tolerance for uncertaintymay feel particularly distressed when faced with a highly uncertain situation.”
BackgroundFear of cancer recurrence: a significant concern among partners of prostate cancer survivors
van de Wal, M., Langenberg, S., Gielissen, M., Thewes, B., van Oort, I., & Prins, J. (2017) · Psycho-Oncology · doi:10.1002/pon.4423 · Cited by 37 · see citing works
Tomei, C., Lebel, S., Maheu, C., Lefebvre, M., & Harris, C. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4097-1 · Cited by 36 · see citing works
“[16] piloted the group intervention with breast and ovarian cancer participants (n = 54), and results demonstrated significant patient improvement, with moderate time effects [16].”
BackgroundMethodInfluentialSelf-citationCho, D., & Park, C. L. (2016) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2016.1247408 · Cited by 36 · see citing works
“Also, a recent study conducted among female cancer survivors showed that a theory-based cognitive-existential intervention targeted to decrease FCR did not appeal to all survivors (Lebel et al., 2014); survivors may drop out of the intervention because dealing with FCR can, paradoxically, increase FCR and they might n…”
BackgroundRemote Psychological Interventions for Fear of Cancer Recurrence: Scoping Review.
Cincidda, C., Pizzoli, S. F. M., & Pravettoni, G. (2022) · JMIR Cancer · doi:10.2196/29745 · Cited by 34 · see citing works
“Specifically, patients address irrational thoughts through cognitive reframing to reduce catastrophic interpretations of physical symptoms and emotions [19,21-23].”
BackgroundResultInfluentialBu, X., Jin, C., Fan, R., Cheng, A. S. K., Ng, P. H. F., Xia, Y., & Liu, X. (2022) · BMC Cancer · doi:10.1186/s12885-022-09224-w · Cited by 32 · see citing works
“When fear of cancer recurrence is left unaddressed, it tends to remain stable across disease trajectories over time [19].”
BackgroundCognitive Behavior Therapy for Fear of Cancer Recurrence: A Case Study
van de Wal, M., Servaes, P., Berry, R. R., Thewes, B., & Prins, J. B. (2018) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-018-9545-z · Cited by 33 · see citing works
“In contrast to two other interventions for the treatment of FCR (Butow et al., 2013, 2017; Lebel et al., 2014), this intervention is developed as an individually delivered blended therapy: a combination of face-to-face contact with e-health or telephone consultations.”
BackgroundMethodMaheu, C., Hébert, M., Louli, J., Yao, T., Lambert, S., Cooke, A., Black, A., & Kyriacou, J. (2019) · Cancer Reports · doi:10.1002/cnr2.1172 · Cited by 31 · see citing works
Self-citationSymptom burden and integrative medicine in cancer survivorship
Cutshall, S. M., Cha, S. S., Ness, S. M., Stan, D. L., Christensen, S. A., Bhagra, A., Price, K. A. R., Thompson, C. A., Hashmi, S. K., Chon, T. Y., et al. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-015-2666-0 · Cited by 31 · see citing works
“They often experience social and emotional sequelae of cancer and its treatment, including fear of recurrence [7, 15], stress [7, 16], and financial issues [17].”
Dirkse, D., Hadjistavropoulos, H. D., Alberts, N. A., Karin, E., Schneider, L. H., Titov, N., & Dear, B. F. (2020) · Journal of Cancer Survivorship · doi:10.1007/s11764-019-00810-9 · Cited by 29 · see citing works
Fear of cancer recurrence: A study of the experience of survivors of ovarian cancer
Kyriacou, J., Black, A., Drummond, N., Power, J., & Maheu, C. (2017) · Canadian Oncology Nursing Journal · doi:10.5737/23688076273236242 · Cited by 30 · see citing works
“A 13-question interview guide, based on the Model of Fear of Cancer Recurrence (MFCR; Lebel et al., 2014) was used to elicit answers about the women’s emotions, thoughts and beliefs about FCR.”
BackgroundMethodResultInfluentialSelf-citationInterventions addressing fear of cancer recurrence: challenges and future perspectives
Prins, J. B., Deuning‐Smit, E., & Custers, J. A. E. (2022) · Current Opinion in Oncology · doi:10.1097/cco.0000000000000837 · Cited by 29 · see citing works
“their particular focus, including (in)tolerance of uncertainty [11], metacognitive beliefs about worry”
BackgroundHealth-Related Quality of Life in Non-Hodgkin Lymphoma Survivors: A Prospective Cohort Study
Kang, D., Cho, J., Kim, I. R., Kim, M. K., Kim, W. S., & Kim, S. J. (2017) · Cancer Research and Treatment · doi:10.4143/crt.2017.207 · Cited by 28 · see citing works
Petricone‐Westwood, D., Jones, G., Mutsaers, B., Leclair, C. S., Tomei, C., Trudel, G., Dinkel, A., & Lebel, S. (2018) · International Journal of Behavioral Medicine · doi:10.1007/s12529-018-9748-6 · Cited by 27 · see citing works
Self-citationNovel Clinician-Lead Intervention to Address Fear of Cancer Recurrence in Breast Cancer Survivors
Liu, J., Butow, P. N., Bui, K. T., Serafimovska, A., Costa, D. S. J., Kiely, B. E., Hui, M. N., Goodwin, A., McNeil, C. M., & Beith, J. M. (2021) · JCO Oncology Practice · doi:10.1200/op.20.00799 · Cited by 27 · see citing works
“001).(13) The lower ES from the CIFeR study is expected because of the inclusion of women with lower baseline FCR, and the delivery of a brief oncologist intervention rather than an intense, weekly psychologist-delivered intervention.”
BackgroundImai, F., Momino, K., Katsuki, F., Horikoshi, M., Furukawa, T. A., Kondo, N., Toyama, T., Yamaguchi, T., & Akechi, T. (2019) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/hyz005 · Cited by 23 · see citing works
Addressing fear of recurrence: improving psychological care in cancer survivors
Tomei, C., Lebel, S., Maheu, C., & Mutsaers, B. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3103-8 · Cited by 24 · see citing works
“The first and second authors discussed the process for adapting the group intervention therapist and patient manuals (for more information on the intervention, please see [5]).”
BackgroundInfluentialSelf-citationReb, A. M., Borneman, T., Economou, D., Cangin, M. A., Cope, D. G., Ma, H., Ruel, N., Sharpe, L., Patel, S. K., Cristea, M., et al. (2020) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2020.101855 · Cited by 26 · see citing works
“Researchers testing other nurse-led FOP interventions have reported improvements in FOP and distress (Lebel et al., 2014; Lengacher et al., 2016; Liu et al., 2019).”
BackgroundCoutts‐Bain, D., Sharpe, L., & Russell, H. (2023) · Journal of Behavioral Medicine · doi:10.1007/s10865-023-00422-w · Cited by 26 · see citing works
“However, a recent, and FCR-specific, cognitive-existential group intervention has effectively reduced FCR in a randomized-controlled trial (Lebel et al., 2014).”
BackgroundDevelopment and Feasibility of a Group Cognitive-Behavioral Therapy for Fear of Cancer Recurrence
Savard, J., Savard, M.-H., Caplette-Gingras, A., Casault, L., & Camateros, C. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.08.001 · Cited by 23 · see citing works
Kuswanto, C. N., Sharp, J. L., Stafford, L., & Schofield, P. E. (2022) · Stress and Health · doi:10.1002/smi.3180 · Cited by 26 · see citing works
“…nature of cancer may lead to heightened sensitivity towards benign somatic experiences, such as fatigue, so that physical symptoms may be interpreted as cancer recurrence (Koch et al., 2013; Lebel et al., 2014, 2018; Lee‐Jones et al., 1997; McGinty et al., 2016; Mishel, 1988; Simard et al., 2013).”
BackgroundFear of Cancer Recurrence and Sleep in Couples Coping With Early-Stage Breast Cancer
Perndorfer, C., Soriano, E. C., Siegel, S. D., Spencer, R. M. C., Otto, A. K., & Laurenceau, J.-P. (2022) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac018 · Cited by 21 · see citing works
Chen, R., Yang, H., Zhang, H., Chen, J., Liu, S., & Li, W. (2023) · BMC Psychology · doi:10.1186/s40359-023-01211-5 · Cited by 23 · see citing works
“It is suggested that medical professionals can reconstruct patients’ cognition of illness through cognitive behavioral therapy and health education [45] by teaching patients the methods of symptom identification and symptom management after an operation.”
BackgroundBatehup, L., Gage, H., Williams, P., Richardson, A. M., Porter, K., Simmonds, P., Lowson, E., Dodson, L., Davies, N., Wagland, R., et al. (2021) · European Journal of Cancer Care · doi:10.1111/ecc.13499 · Cited by 21 · see citing works
“It is deemed “normal” amongst adults with a cancer history, and a degree of concern is considered functional to prompt self-protective responses and staying alert to signs of recurrence (Lebel et al., 2014).”
BackgroundThe fear of cancer recurrence literature continues to move forward: a review article
Maheu, C., & Galica, J. (2017) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000323 · Cited by 20 · see citing works
Self-citationAssociation of worry about cancer to benefit finding and functioning in long-term cancer survivors
Jones, S. M. W., Ziebell, R. A., Walker, R. L., Nekhlyudov, L., Rabin, B. A., Nutt, S., Fujii, M., & Chubak, J. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3537-z · Cited by 22 · see citing works
Fear of cancer recurrence in lymphoma survivors: A descriptive study
Latella, L. E., Rogers, M., Leventhal, H., Parker, P. A., Horwitz, S. M., Matasar, M. J., Bylund, C. L., Kissane, D. W., Franco, K., & Banerjee, S. C. (2019) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2019.1677840 · Cited by 19 · see citing works
“Cancer survivors experience varying levels of FCR, and it can range from a ‘normal’ level of natural concern of a real threat to a ‘clinical’ level of nonsensical, irrational, or excessive fear; however, there is no gold standard measurement to demarcate these levels.(3,6) According to a systematic review, between 39%…”
BackgroundFear of cancer recurrence: An overview and Australian perspective
Butow, P. N., Fardell, J. E., & Smith, A. B. (2015) · The Sydney eScholarship Repository (The University of Sydney) · Cited by 19 · see citing works
Caring for patients with oral cancer in Taiwan: The challenges faced by family caregivers
Liang, S., Chang, T.-T., Wu, W., & Wang, T.-J. T. (2018) · European Journal of Cancer Care · doi:10.1111/ecc.12891 · Cited by 19 · see citing works
Lamarche, J., Cusson, A., Nissim, R., Avery, J., Wong, J., Maheu, C., Lambert, S. D., Laizner, A. M., Jones, J., Esplen, M. J., et al. (2023) · Frontiers in Digital Health · doi:10.3389/fdgth.2023.1129536 · Cited by 18 · see citing works
“It consists of 6 consecutive weekly group or individual sessions of 90–120 min each and weekly assigned homework (38, 39) (See Table 1 for a detailed description of each session).”
BackgroundMethodSelf-citationFamilial aspects of fear of cancer recurrence: current insights and knowledge gaps
Faraji, A., Dehghani, M., & Khatibi, A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1279098 · Cited by 21 · see citing works
Parker, P. A., Banerjee, S. C., Matasar, M. J., Bylund, C. L., Schofield, E., Li, Y., Jacobsen, P. B., Astrow, A. B., Leventhal, H., Horwitz, S. M., et al. (2020) · Psycho-Oncology · doi:10.1002/pon.5371 · Cited by 17 · see citing works
“Cancer worry and fear of cancer recurrence are frequently present during this transition.(2) These challenges and some strategies to”
BackgroundMaheu, C., Lebel, S., Tomei, C., Singh, M. D., & Esplen, M. J. (2014) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2014.12.003 · Cited by 16 · see citing works
Self-citationMoran, C., Tomei, C., Lefèbvre, M., Harris, C. A., Maheu, C., & Lebel, S. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3600-4 · Cited by 18 · see citing works
“Lebel et al. 2014 [3] piloted a 6-week manualized cognitive-existential (CE) group intervention for FCRwith womenwith breast and ovarian cancer (n = 44).”
BackgroundMethodInfluentialSelf-citationDieng, M., Khanna, N., Kasparian, N. A., Costa, D. S. J., Butow, P. N., Menzies, S. W., Mann, G. J., Cust, A. E., & Morton, R. L. (2019) · Applied Health Economics and Health Policy · doi:10.1007/s40258-019-00483-6 · Cited by 16 · see citing works
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Rudolph, B., Wünsch, A., Herschbach, P., & Dinkel, A. (2017) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/s-0043-107774 · Cited by 15 · see citing works
“[19] Lebel S, Maheu C, Lefebvre M et al.”
BackgroundGálvez‐Hernández, C. L., Boyes, A., Mondragón, A. O., Romo-González, A. G., Mohar, A., Mesa-Chávez, F., Oñate-Ocaña, L. F., & Villarreal-Garza, C. M. (2021) · Revista de investigaci�n Cl�nica · doi:10.24875/ric.21000068 · Cited by 14 · see citing works
Fear of recurrence in women with ovarian cancer: A qualitative evidence synthesis
Chomhaill, C. N. G., Ward, J., & Dowling, M. (2023) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2023.102487 · Cited by 14 · see citing works
Üner, F. Ö., & Körükcü, Ö. (2021) · Health & Social Care in the Community · doi:10.1111/hsc.13326 · Cited by 15 · see citing works
Mardani, A., Maleki, M., Hanifi, N., Turunen, H. E., & Vaismoradi, M. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09503-9 · Cited by 16 · see citing works
“Furthermore, healthcare providers play a pivotal role in providing accurate, relevant information, which is essential for effective coping with FCR [49].”
Effects of short-term existential group therapy for breast Cancer patients
Nakamura, C., & Kawase, M. (2021) · BioPsychoSocial Medicine · doi:10.1186/s13030-021-00225-y · Cited by 11 · see citing works
“Label [16] developed a 6-week cognitive-existential group intervention for women with breast cancer or ovarian cancer that focused on fear of cancer recurrence.”
BackgroundThe role of attentional biases in the context of cancer: A systematic review and meta‐analysis
Pradhan, P., Sharpe, L., & Butow, P. N. (2020) · Psycho-Oncology · doi:10.1002/pon.5617 · Cited by 9 · see citing works
Berrett‐Abebe, J., Cadet, T. J., Vitello-Cicciu, J. M., & Maramaldi, P. (2018) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2018.1443987 · Cited by 9 · see citing works
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Lebel, S., Maheu, C., Tomei, C., Mutsaers, B., Bernstein, L. J., Courbasson, C. M. A., Ferguson, S. E., Harris, C. A., Jolicoeur, L. J. A., Lefèbvre, M., et al. (2022) · Journal of Psychosocial Oncology Research and Practice · doi:10.1097/or9.0000000000000077 · Cited by 7 · see citing works
Self-citationPrédiction des instabilités thermoacoustiques dans les turbines à gaz
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“…standalone CBT and mindfulness-based interventions led to significant reductions in FCR levels, as they can change patients’ cognitive patterns, enhance coping skills, and guide patients to focus on their current emotions and experiences with a non-judg-mental attitude to alleviate FCR [42, 43].”
Lyu, M., Siah, C. J. R., Zhao, J., & Cheng, K. K. F. (2023) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2023.102360 · Cited by 6 · see citing works
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Exploring the experiences and priorities of women with a diagnosis of ovarian cancer
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“Multicompo-nent therapies, which integrate informational and emotional support, appear to be the most successful approach to managing illness uncertainty in patients with cancer and their family caregivers [27, 28].”
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“Nursing or psychosocial care staffs who assess the impact of fear of recurrence on survivors and their caregivers and family members may be able to provide or refer distressed individuals to an appropriate intervention such as a focused time-limited support group [37].”
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“This approach was successfully tested in previous FORT studies [43, 46].”
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Psychological gaps in cancer care: Implications for service users and providers
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Comportamiento y salud. Investigación traslacional y aplicada
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Fear of cancer recurrence in informal caregivers of childhood cancer survivors
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- Authors
- Lebel, S., Maheu, C., Lefebvre, M., Secord, S., Courbasson, C., Singh, M., Jolicoeur, L., Benea, A., Harris, C., Fung, M. F. K., Rosberger, Z., & Catton, P.
- Affiliations
- University of Ottawa (CA)
- University Health Network (CA)
- Canadian Partnership Against Cancer (CA)
- York University (CA)
- Ottawa Hospital (CA)
- Jewish General Hospital (CA)
- Corresponding author
- Lebel, Sophie
- Venue
- Journal of Cancer Survivorship
- Published
- 2014-04-23
- Volume
- 8
- Issue
- 3
- Pages
- 485-496
- ISSN
- 1932-2259 (ISSN-L)
- 1932-2267
- OpenAlex
- W2017341504
- Cited by
- 127
- References
- 58
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 5 · 2023: 10 · 2022: 10 · 2021: 17 · 2020: 8 · 2019: 8 · 2018: 10 · 2017: 17 · 2016: 16 · 2015: 7 · 2014: 2
- FWCI
- 6.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Cancer Survivorship (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Nurses Foundation
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- fear of cancer recurrence, cancer survivors, breast cancer, ovarian cancer, group intervention, psychological distress, uncertainty, quality of life, coping, feasibility, manualized intervention
- MeSH terms
- Adult, Aged, Breast Neoplasms, Fear, Feasibility Studies, Female, Humans, Middle Aged, Neoplasm Recurrence, Local, Ovarian Neoplasms, Pilot Projects, Outcome Assessment, Health Care, Survivors
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