Blended Cognitive Behavioral Therapy Can Reduce Fear of Cancer Recurrence

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After being diagnosed with breast cancer, many people have the understandable fear that the cancer will come back (recurrence). About one-third of cancer survivors report a high fear of recurrence.

It’s normal to be afraid of something that is threatening to you. Still, if the fear is getting in the way of you enjoying your life and finding pleasure in things that you used to enjoy, it might be a good idea for you to seek help from someone who has expertise in dealing with the fear of cancer recurrence.

A small Dutch study suggests that a specific type of counseling therapy, called blended cognitive behavior therapy, can help ease the fear of a cancer recurrence in survivors.

The research was published online on May 4, 2017 by the Journal of Clinical Oncology. Read the abstract of “Efficacy of Blended Cognitive Behavior Therapy for High Fear of Recurrence in Breast, Prostate, and Colorectal Cancer Survivors: The SWORD Study, a Randomized Controlled Trial.”

The study included 88 men and women who had been diagnosed with breast, prostate, or colorectal cancer:

  • about 40% were diagnosed with breast cancer
  • about 33% were diagnosed with prostate cancer
  • about 27% were diagnosed with colorectal cancer
  • it had been about 2.5 years since the participants had been diagnosed
  • it had been about 2 years since the participants’ last cancer treatment
  • about half the participants had sought psychological help in the past

To find participants for the study, the researchers asked 750 cancer survivors at five Dutch hospitals to complete a survey that asked them to rate their level of fearfulness about eight statements on recurrence or developing a new cancer. Fearfulness ratings ranged from 1 (never) to 4 (almost always). Overall, total scores ranged from 8 to 32 -- the lower the score, the lower the fear of recurrence.

People who scored 14 or higher were classified as having a high fear of recurrence and were invited to be in the study. Ultimately, 88 people decided to participate.

The 88 people were randomly assigned to 3 months of either blended cognitive behavior therapy or usual care to help overcome the fear of recurrence.

Blended cognitive behavior therapy consisted of:

  • five individual, 1-hour, face-to-face counseling sessions
  • three 15-minute Internet chat consultations
  • access to an informational website

If the participants didn’t have access to the Internet, the three chat consultations were replaced with three 15-minute telephone consultations and the informational website was replaced with a workbook.

People in the usual care group didn’t receive blended cognitive behavior therapy, but they were allowed to use psychosocial support during the study period.

After the 3 months of treatment, the participants again completed the survey asking them to rate their level of fearfulness about the eight statements on recurrence.

People who received blended cognitive behavior therapy had their fear of recurrence ease more than people who received usual care. This difference was statistically significant, which means that it was likely because of the blended cognitive behavior therapy and not just due to chance. None of the people in the study had their fear of recurrence go up during the study.

Overall, about 33% of people who received blended cognitive behavior therapy had their fear of recurrence ease significantly, while none of the people who received usual care had their fear ease significantly.

While this study was small, the results are very encouraging and suggest that blended cognitive behavior therapy may be a good option for people who are struggling with fear of recurrence after breast cancer treatment.

If you’ve been diagnosed with breast cancer and feel your fear of recurrence is extremely high, you may want to talk to your doctor about this study. Ask your doctor if she or he can recommend a blended cognitive behavior therapy program that might be right for your unique situation. You also may want to ask someone on your medical team if they know of programs that are available.


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