Systematic review of interventions by non-mental health specialists for managing fear of cancer recurrence in adult cancer survivors

Abstract

Purpose: Fear of cancer recurrence (FCR) affects 50-70% of cancer survivors. Evidence-based psychological interventions for FCR are effective but resource-/time-consuming. This systematic review identified interventions by non-mental health specialists addressing FCR, evidence of a relationship between specialist communication and FCR and stakeholder perspectives on how specialist communication can address FCR.

Methods: A systematic literature review was conducted using nine databases (Medline Ovid, EMBASE, Cochrane, CINAHL, Scopus, PsychINFO, Informit, Web of Science and Google Scholar). Included studies were English, published 1997-2018, on adult cancer patients examining 'fear'/'worry' and 'cancer recurrence'/'progression' and 'health communication'/'medical encounter'/'interventions'. Data was extracted, summarised and rated for quality by two authors.

Results: Of 6248 articles screened, 16 were included. No phase III randomised controlled trials were found. Five studies piloted an intervention, three were correlational studies, five were cross-sectional patient surveys and three were specialist surveys. Four out of five interventional studies were nurse-led: one trained patients in discussing FCR with their specialist while three delivered supportive counselling and/or taught strategies to manage FCR. The last intervention trained mixed health professionals to manage FCR through normalisation, education and lifestyle strategies. Three intervention studies measured FCR objectively, and two demonstrated a reduction in FCR in the short term. Consultation duration, empathy and clear information delivery were associated with FCR. Patients indicated desire to discuss FCR; however, specialists indicated discomfort with managing FCR.

Conclusions: Research on non-mental health practitioner-led interventions to address FCR is lacking. Further studies on whether specialist interventions delivered during follow-up consultations are useful in managing FCR are required.

Keywords: Cancer; Fear of recurrence; Intervention; Patient education; Review; Survivorship.