Feasibility and preliminary efficacy of iConquerFear: a self-guided digital intervention for fear of cancer recurrence
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Purpose: Approximately 50% of cancer survivors experience moderate-severe fear of cancer recurrence (FCR). Self-guided digital interventions have potential to address the high level of FCR-related unmet needs at scale, but existing digital interventions have demonstrated variable engagement and efficacy. This study aimed to evaluate the feasibility and preliminary efficacy of iConquerFear, a five-module self-guided digital FCR intervention. Methods: Eligible curatively treated breast cancer survivors were recruited. Participants reporting clinically significant FCR (≥ 13 on the Fear of Cancer Recurrence Inventory-Short Form; FCRI-SF) were given access to iConquerFear. Feasibility was indicated by > 50% of eligible participants enrolling in iConquerFear and recording moderate (≥ 120 min) or greater usage. Preliminary efficacy was evaluated via changes in self-reported FCR severity, anxiety, depression, intrusions and metacognitions from baseline to immediately and 3 months post-intervention. Results: Fifty-four (83%) of 65 eligible participants enrolled in iConquerFear; six subsequently withdrew. Thirty-nine (83%) participants recorded moderate ( n = 24; 120–599 min) or high ( n = 15; ≥ 600 min) usage. Engagement levels increased with participant age ( p = 0.043), but were lower in participants with higher baseline FCR ( p = 0.028). Qualitative feedback indicated engagement was sometimes limited by difficulties with navigation and relating to featured survivors. Participants reported significantly improved FCR (mean reduction (95%CI): baseline to post-intervention − 3.44 (− 5.18, − 1.71), baseline to 3-month follow-up − 4.52 (− 6.25, − 2.78), p = < 0.001). Conclusion: iConquerFear is a feasible and potentially efficacious intervention for reducing FCR in breast cancer survivors. Easier navigation and more relatable examples may enhance engagement. Implications for Cancer Survivors: iConquerFear may help address moderate but burdensome FCR levels in cancer survivors.
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The digital group retention rate was higher than the digital iConquerFear intervention retention rate of 36%.
“However, our digital group retention rate was comparably higher than the digital iConquerFear intervention of 36% [20], an intervention which utilises user-led delivery rather than facilitator-led.”
From Adapting an in-person acceptance and commitment therapy–based psychological intervention for fear of cancer recurrence into a digital format: a real-world evaluation during the COVID-19 pandemic (2025) · cites this paper as [20]
The Results (Participants; page unavailable) report that 36.2% completed all iConquerFear modules, and the Introduction identifies it as self-guided. The cited paper does not call 36% a retention rate: it separately reports that 63.8% completed both follow-up questionnaires. The citing authors’ own group rate cannot be assessed from this source. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThere was broad consensus among the reviewed studies that entirely self-managed web-based interventions were not as effective as those supplemented with one-to-one follow-up, peer forums, or group format.
“Overall, there was a broad consensus amongst the studies that entirely self-managed web-based interventions were not as effective as those supplementing the web-based content with either a one-to-one follow up with nurses, coaches, doctors, access to peer forums, or taking place in a group format [51, 60, 68].”
From Web-based interventions for fear of cancer recurrence: A scoping review with a focus on suggestions for the development and evaluation of future interventions (2024) · cites this paper as [51]
The Introduction reports that a clinician-supervised program reduced fear of cancer recurrence, while two self-guided trials found reductions comparable to their control groups. The Discussion (Correlates of engagement; page not provided) suggests coach or therapist contact may improve engagement and efficacy. The paper does not establish a broad consensus that entirely self-managed interventions are less effective, or assess peer forums and group formats. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe reviewed studies suggested that lasting access to resources and ability to actively interact with content after the intervention concludes was important for web-based interventions seeking to reduce FCR beyond the trial period.
“Overall, the reviewed studies suggested that lasting access to the resources and the ability to actively interact with the content after the intervention concludes was important for web-based interventions that seek to reduce FCR beyond the trial period [51].”
From Web-based interventions for fear of cancer recurrence: A scoping review with a focus on suggestions for the development and evaluation of future interventions (2024) · cites this paper as [51]
The Methods (Procedure; page unavailable) say participants retained unrestricted access to all modules for 22 weeks, beyond the recommended 10-week intervention. The Discussion describes interactive exercises, and reports that FCR improvements were maintained at three months. The paper does not establish that continued access or interaction after the intervention was important to maintaining those improvements. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOlder age was associated with greater iConquerFear engagement, consistent with findings that old age was not a predictor of engagement but a predictor of uptake.
“However, older age was associated with greater iConquerFear engagement [51], which was consistent with Cillessen et al.’s [64] findings that old age was not a predictor of engagement, but a predictor of uptake.”
Ten reviewed interventions were entirely self-guided.
“10 interventions were entirely self-guided. [33, 35, 36, 39–41, 47, 51, 54, 55].”
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“Reductions in FCR were accompanied by decreases in maladaptive metacognitions and distress related to intrusive thoughts about cancer, previously shown to partially mediate the effects of ConquerFear on FCR [45].”
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Self-citationWalsh, E. A., Popok, P., Ream, M. E., Bainter, S. A., Perdomo, D. M., Taub, C. J., Saez-Flores, E., Kesmodel, S. B., Blomberg, B. B., & Antoni, M. H. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-07939-5 · Cited by 4 · see citing works
Envisioning Possibilities and Challenges of AI for Personalized Cancer Care
Kong, E. W. S., Huang, K., & Gautam, A. (2024) · ACM Conference on Computer Supported Cooperative Work (CSCW) · doi:10.1145/3678884.3681885 · Cited by 3 · see citing works
Sinclair, F., Gillanders, D., Hewitt, C., Rooney, N., Bonathan, C., McAllister, L., Correia, M., Devlin, L., & Hendry, K. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09946-0 · Cited by 1 · see citing works
Interventions to Reduce Fear of Cancer Recurrence Among People With Cancer: Scoping Review
Li, N., Wensley, C. J., Reynolds, L., Baraza, W., Leyton, T. O., & Jull, A. (2026) · JMIR Cancer · doi:10.2196/81579 · Cited by 2 · see citing works
Hundal, J., Chen, J., Russell, K. B., Carfang, L., Bedeau, A. J., Giguère, L., Ouattara, M. M., Sehabi, G., Lebel, S., Shen, S., et al. (2026) · American Society of Clinical Oncology Educational Book · doi:10.1200/edbk-26-517396 · Cited by 1 · see citing works
Kuhn, N. B. L., Maukel, L., & Tibubos, A. N. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-10781-0 · Cited by 1 · see citing works
Lyhne, J. D., Smith, A. B., Carstensen, T. B. W., Beatty, L., Bamgboje‐Ayodele, A., Klein, B., Jensen, L. H., & Frostholm, L. (2025) · JMIR Cancer · doi:10.2196/63486 · Cited by 1 · see citing works
Self-citationPark, S., & Park, S. (2025) · Asian Social Work and Policy Review · doi:10.1111/aswp.70018
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Karatlı, S., Karatlı, S. K. Ç., Çelik, S., Eren, T., & Yazılıtaş, D. (2026) · Healthcare · doi:10.3390/healthcare14162665
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- Authors
- Smith, A. ‘., Bamgboje‐Ayodele, A., Jegathees, S., Butow, P., Klein, B., Salter, M., Turner, J., Fardell, J., Thewes, B., Sharpe, L., Beatty, L., Pearce, A., Beith, J., Costa, D., Rincones, O., Wu, V. S., Garden, F. L., Kiely, B. E., Lim, K., Morstyn, L., Hanley, B., Hodgkin, R., Beattie, A., & Girgis, A.
- Affiliations
- Liverpool Hospital (AU)
- The University of Sydney (AU)
- Federation University (AU)
- The University of Queensland (AU)
- Westmead Hospital (AU)
- Flinders University (AU)
- Chris O’Brien Lifehouse (AU)
- Camden and Campbelltown Hospitals (AU)
- Breast Cancer Network Australia (AU)
- Cancer Council Queensland (AU)
- Cancer Council Western Australia (AU)
- Cancer Council NSW (AU)
- Corresponding author
- Smith, Allan ‘Ben’
- ORCID
- Venue
- Journal of Cancer Survivorship
- Published
- 2022-07-25
- Volume
- 18
- Issue
- 2
- Pages
- 425-438
- ISSN
- 1932-2259 (ISSN-L)
- 1932-2267
- PMC
- PMC9309991
- OpenAlex
- W4287307474
- Cited by
- 23
- References
- 68
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 4 · 2023: 4
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Cancer Survivorship (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- FedUni ResearchOnline (Federation University Australia) (submittedVersion, cc-by)
- Funders
- Ingham Institute Breast Cancer Research Grant made possible by charitable donations through Narellan Rotary Club
- University of New South Wales
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- fear of cancer recurrence, breast cancer survivors, intervention feasibility, user engagement, anxiety, depression, intrusive thoughts, metacognition
- MeSH terms
- Cancer Survivors, Anxiety, Breast Neoplasms, Fear, Feasibility Studies, Female, Humans, Neoplasm Recurrence, Local
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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