Implementation study of a Clinician Intervention to Reduce Fear of Recurrence in Cancer Survivors

This is an implementation study assessing the feasibility of a brief oncologist-lead educational/communication study to address fear of cancer recurrence (FCR) in breast cancer survivors in routine clinics. All participants (medical and radiation breast oncologists) will be given access to online CIFeR training hosted on the Thinkific platform, featuring didactic material on the prevalence, severity, clinical features and outcomes of FCR, description of the CIFeR (the Clinician Intervention to Reduce Fear of Recurrence (CIFeR) intervention) intervention and evidence supporting its efficacy captured in short videos of the study team, and videos of clinicians and patients modelling intervention delivery. The course is expected to take 30-60 minutes (1 session) to complete. After they have completed the training, they will be asked to complete a post-training measure of self-efficacy to manage FCR. They will then be asked to use CIFeR with suitable patients for the next 6 months. Oncologists will identify patients suitable for the CIFeR intervention by asking each patient as they attend for follow-up “Do you ever worry that your cancer will come back?” All patients who indicate any worry will be offered CIFeR. The CIFeR intervention can be delivered face-to-face or via a TeleHealth appointment. The CIFeR intervention involves: 1) FCR normalisation and reassurance delivered by the clinician during the consultation 2) Provision of concrete prognostic information (if desired by the patient) 3) Take-home education sheet on red-flag recurrence symptoms 4) Brief advice on strategies to manage worry 5) Referral to psychologist if FCR is severe or the patient requests additional help. The 5-component intervention was developed by the investigators from our systematic review of existing interventions* and results of cross-sectional surveys on FCR, FCR theoretical models and expert input (including psycho-oncologists, clinicians and consumers at the 2018 Psycho-Oncology Co-Operative Group Concept Development Workshop). The CIFeR intervention has also already been tested in a multicentre, single-arm Phase I/II study** to determine the usefulness, feasibility and efficacy of CIFeR. Results showed it to be feasible, acceptable and potentially efficacious in reducing FCR in breast cancer patients. We now seek to explore the barriers and facilitators to implementing this low-cost brief intervention within oncology practice in Australia. Intervention adherence will be self-reported by oncologists (tick box for the first 3 patients they complete the intervention on). Completion rates for the training will be assessed through accessing Thinkific website analytics. * Liu J, Butow P, Beith J: Systematic review of clinician interventions for managing fear of cancer recurrence in adult cancer survivors. Presented at the Medical Oncology Group of Australia Annual Scientific Meeting, 2018, Adelaide, Australia, 2018. Manuscript in preparation ** Liu J, Butow P, Bui KT, Serafimovska A, Kiely BE, Hui M, Goodwin A, McNeil C, Costa D, Beith J. CIFeR: A novel Clinician-lead Intervention to address Fear of cancer Recurrence (FCR) in breast cancer survivors. In Preparation.