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Research in Review

Blended Cognitive Behavior Therapy Decreases Fear of Cancer Recurrence

May 24, 2017

Survivors of cancer with fear of cancer recurrence may be effectively treated with a blended therapeutic approach involving face-to-face and online sessions, according to a study published in the Journal of Clinical Oncology (published online May 2017; doi:10.1200/JCO.2016.70.5301).


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Fear of cancer recurrence is an issue that affects an estimated 33% of cancer survivors. Blended cognitive behavior therapy has the potential to reduce the severity of fear of recurrence, but limited data exists to support this claim.

A group of Dutch researchers led by Marieke van de Wal, MSc, conducted a study to evaluate the effects of blended cognitive behavior therapy in cancer survivors with fear of recurrence treated for breast, prostate, or colorectal cancer. A total of 88 patients (36 breast cancer, 30 prostate cancer, and 22 colorectal cancer) with a high fear of cancer recurrence (Cancer Worry Scale [CWS] score ≥ 14) at 6 months to 5 years after treatment were randomly selected to receive blended cognitive behavior therapy (n = 45) or usual care (n = 43). Patients completed CWS questionnaires at baseline and after 3 months of care.

Intervention spanned 3 months and consisted of 5 individual face-to-face 1-hour sessions, combined with 3 e-consultations (15 minutes each) and access to a website. Patients in the usual-care group had no restrictions regarding the use of psychosocial support.

Primary outcome of the study was fear of recurrence severity assessed with the CWS.

Results of the analysis showed that patients who received blended cognitive behavior therapy demonstrated significantly less fear of recurrence than those who received usual care (mean difference, -3.48; 95% CI, -4.69 to -2.28; P < .001) with a moderate-to-large effect size. Clinically significant improvement in fear of recurrence was significantly higher in the blended cognitive behavior therapy group compared with the usual care group (13/45 vs 0/43, respectively; P < .001). Self-rated improvement was also higher in the blended cognitive behavior therapy group compared with the usual care group (30/42 vs 12/38, respectively; P < .001).

Authors of the study concluded that “[Blended cognitive behavior therapy] has a statistically and clinically significant effect on the severity of [fear of cancer recurrence] in cancer survivors and is a promising new treatment approach.”—Zachary Bessette

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