Jani Lamarche

Fear of cancer recurrence (FCR) affects approximately 50% of family caregivers. While FCR in cancer patients has been well-documented, less is known about the experience of FCR in family caregivers. This study aimed to qualitatively explore the distinct characteristics of FCR in family caregivers. A focus group and semi-structured interviews were conducted via videoconferencing with family caregivers of cancer survivors (stages I–III, finished treatment, no recurrence). Participants were recruited through Canadian hospitals, community partners, and social media. The focus group and qualitative interviews explored family caregivers’ experiences of FCR, including its content, frequency, impact, and management. A reflexive thematic analysis was used. In total, twenty family caregivers participated. Six participated in the focus group. Sixteen participated in the interviews. Two participated in both. Family caregivers described their experience of FCR as all-consuming, constant, and marked by a sense of helplessness. Qualitative analysis revealed a major theme of relational aspects of FCR in family caregivers, with the following four inter-related themes: patient-centric hypervigilance, self-silencing, FCR as isolating, and finding support. This qualitative study examined the experiences of family caregivers living with FCR. Our findings highlight that relational factors shape how family caregivers experience and manage their FCR. High-quality survivorship care should be redefined to include FCR interventions tailored to family caregivers.

Background: New treatments are contributing to individuals living longer with advanced, metastatic, or incurable (AMI) cancers. The impact of these treatments is unpredictable, resulting in considerable uncertainty for these patients. Currently, there are no interventions that effectively address uncertainty in AMI cancers. To fill this gap, we designed the Adapting to life with Cancer Cognitive ExisteNtial Therapy (ACCENT) intervention. Aim: To evaluate the feasibility, acceptability, and preliminary efficacy of ACCENT in AMI cancers. Methods: ACCENT was delivered online for 6 consecutive weekly sessions of 1.5 hours to five groups of six to seven patients. Thirty‐two patients were interested in participating, but 2 did not complete the assessments pre‐ or post‐intervention. A pragmatic feasibility study was conducted using data collected in routine clinical practice. Participants completed the Intolerance of Uncertainty Scale—Short Form, the Generalized Anxiety Disorder scale, and the Impact of Events Scale before and after the intervention. Post‐intervention, participants answered open‐ended questions to assess acceptability, rated their perceptions of improvement and usefulness, and completed the Satisfaction with Therapy and Therapist Scale. Results: ACCENT appears feasible with participants completing the intervention and all assessments between January 2022 and November 2023. It appears acceptable with an attrition rate of 12.5%, and a high degree of attendance and satisfaction. There was a non‐significant decrease in intolerance of uncertainty, and a significant decrease in anxiety, and cancer‐specific distress post‐intervention. Conclusion: A randomized controlled pilot study is warranted to further evaluate ACCENT in patients with AMI cancers.

Objective: Fear of cancer recurrence (FCR) is common, persistent, and associated with lower quality of life, impaired functioning, and psychological distress in family caregivers (FC) of individuals with a cancer diagnosis. Interventions are needed to specifically target FCR in FC. This study aimed to pilot test the adapted Family Caregiver—Fear Of Recurrence Therapy (FC‐FORT) to establish its feasibility, acceptability, and clinical significance.Methods: This pilot study used a mixed‐method, parallel, two‐group randomized control trial (FC‐FORT vs. waitlist control group) design. Women FC were recruited through Canadian hospitals, community partners, and social media. FC in the intervention group completed 7 weekly sessions of virtual group therapy (FC‐FORT) and an exit interview. All participants completed questionnaires at baseline, post‐intervention, and 3‐month follow‐up. Feasibility (e.g., recruitment, allocation, fidelity), acceptability (e.g., dropout, completion, satisfaction) and clinical significance of secondary outcomes were evaluated. Descriptive statistics, mixed ANOVAs, and conventional content analyses were used.Results: Regarding feasibility, 22 FC were recruited, 18 were randomized and therapist fidelity was 87%. As to acceptability, 67% of participants completed 5 sessions (33% dropout). Questionnaire completion rate was 92%. FC satisfaction was 80%. Analyses did not reveal any significant differences on the secondary outcomes between groups. Qualitative analyses revealed high importance, helpfulness, satisfaction, and group cohesion. Suggestions were made by FC for improvements.Conclusions: This is one of the first interventions to address FCR in FC. While acceptability of FC‐FORT was good, important feasibility issues need to be addressed before moving forward with a larger randomized control trial.Trial Registration: NCT, NCT05441384. Registered July 1st, 2022, https://classic.clinicaltrials.gov/ct2/show/NCT05441384

Fear of cancer recurrence (FCR) is common, persistent, and is associated with lower quality of life, impaired functioning, and psychological distress in cancer patients. Studies suggest that family caregivers of cancer patients experience equal or greater levels of FCR than patients themselves. In the past 5 years, several interventions have demonstrated their ability to reduce FCR among cancer patients and in patient-caregiver dyads. However, to date, no intervention exists to individually target family caregiver’s FCR. The aims of the proposed pilot study are to (1) assess the feasibility and acceptability of the newly adapted Family Caregiver–Fear Of Recurrence Therapy (FC-FORT) intervention to inform a larger randomized control trial study, and (2) estimate the clinical significance of FC-FORT. Initial evaluation of FC-FORT revealed high user satisfaction and usability. A parallel, two-group, pilot randomized controlled trial comparing FC-FORT to a waitlist control (care as usual) will be conducted. Participant inclusion criteria are (a) women family caregivers taking care of adult cancer patients (no recurrence), (b) experiencing clinical levels of FCR, (c) access to a computer/internet connection, and (d) living in Canada. Participants (n = 36) will be recruited at Ottawa and Toronto hospitals, previous study participant pools, through social media and community partners across Canada. Participants in the intervention group will complete the FC-FORT intervention (7 consecutive weeks of virtual group therapy and homework). Participants in the control group will be offered the intervention after their participation in the study. All participants will be asked to complete questionnaire packages at baseline (T0), immediately post-intervention (7 weeks; T1) and at 3-months post-intervention (T2). Feasibility (e.g., recruitment, allocation, fidelity), acceptability (e.g., dropout, completion, satisfaction) and clinical significance of secondary outcomes will be evaluated (i.e., FCR illness uncertainty). Participants in the intervention group will be asked to complete measures of group cohesion and therapeutic alliance and take part in a semi-structured exit interview exploring their overall experience with FC-FORT. This project will evaluate the acceptability and feasibility of the newly adapted FC-FORT to inform a larger trial. NCT, NCT05441384. Registered July 1st, 2022, https://classic.clinicaltrials.gov/ct2/show/NCT05441384

Background: Family caregivers of cancer survivors experience equal or greater levels of fear of cancer recurrence (FCR) than survivors themselves. Some interventions have demonstrated their ability to reduce FCR among cancer survivors and dyads (patient and caregivers). However, to date, no validated intervention exists to focus solely on family caregiver's FCR.Objectives: This study aimed to (1) adapt the evidence-based in-person Fear Of Recurrence Therapy (FORT) for family caregivers (referred here in as FC-FORT) and to a virtual delivery format and (2) test its usability when offered virtually.Methods: The adaptation of FC-FORT was overseen by an advisory board and guided by the Information Systems Research Framework. Following this adaptation, female family caregivers and therapists were recruited for the usability study. Participants took part in 7 weekly virtual group therapy sessions, a semi-structured exit interview and completed session feedback questionnaires. Therapists were offered a virtual training and weekly supervision. Fidelity of treatment administration was assessed each session. Quantitative data were analyzed using descriptive statistics. Exit interviews were transcribed verbatim using NVivo Transcription and coded using conventional content analysis. Results were presented back to the advisory board to further refine FC-FORT.Results: The advisory board (n = 16) met virtually on 7 occasions to adapt FC-FORT (i.e., patient manuals, virtual format) and discuss recruitment strategies. Minor (e.g., revised text, adapted materials to virtual format) and major adaptations (e.g., added and rearranged sessions) were made to FC-FORT and subsequently approved by the advisory board. Four family caregivers and three therapists took part in the first round of the usability testing. Six family caregivers and the same three therapists took part in the second round. Overall, participants were very satisfied with FC-FORT's usability. Qualitative analysis identified 4 key themes: usability of FC-FORT, satisfaction and engagement with content, group cohesion, and impact of FC-FORT. All participants indicated that they would recommend FC-FORT to others as is.Conclusions: Using a multidisciplinary advisory board, our team successfully adapted FC-FORT and tested its usability using videoconferencing. Results from this study indicate that the efficacy and acceptability of FC-FORT are now ready to be tested in a larger pilot study.

Key points: Several fear of cancer recurrence (FCR) interventions have demonstrated their efficacy but are not yet implemented in routine clinical care. Clinicians have expressed an interest in receiving FCR training, but access and availability are limited. This paper reports on the evaluation of a 5h workshop over 2 days on the Fear Of Recurrence Therapy (FORT) intervention. 40 international psychosocial oncology clinicians were provided the workshop at no cost. Evaluation measures included feedback on the workshop, and preliminary outcome measures of their knowledge, self‐efficacy, usage, and implementation barriers/enablers. Majority of participants utilized some or most of the FORT intervention. Results from the training indicate that it was effective, feasible and acceptable.

Objective: Over the past 20 years, immunotherapy and targeted therapy (TT) have been extending the life expectancy and providing hope for a growing number of patients with advanced and metastatic cancer. However, the efficacy, side effects, and overall prognosis of these treatments are highly unpredictable. Recent research suggests that these patients may be experiencing significant uncertainty which impacts their functioning. This study reviewed the literature on the experiences of uncertainty for individuals with advanced or metastatic cancer patients who are receiving immunotherapy or TT.Method: A systematic literature review was conducted. Data was extracted from studies by pairs of reviewers. Literature quality was appraised using the Critical Appraisal Skills Program checklist. Following data extraction, thematic synthesis was used to summarize findings across studies and generate overarching themes.Results: Fifteen qualitative studies were included. Findings highlighted impacts of various sources of uncertainty (financial, emotional, social), unmet needs related to uncertainty (practical, informational, communication), and recommendations for the management of uncertainty. Clinical implications and study limitations were indicated.Conclusions: Findings were situated within Mishel's Uncertainty in Illness Theory and the literature on supportive care for advanced cancer populations. Recommendations related to improving healthcare provider communication and balancing hope and expectations for treatment outcomes were highlighted. Further research is needed to investigate experiences of uncertainty in this population. Tailored interventions for uncertainty may be warranted.

Objectifs : Offrir une thérapie par videoconference pour soulager la peur de la récidive du cancer (PRC) par l’entremise de la vidéoconférence. Déterminer la faisabilité et l’efficacité de ce traitement dans un contexte clinique. Matériel et méthodes : Thérapie par vidéoconférence cognitivoexistentielle une fois par semaine pour six semaines. Résultats : Diminution progressive de la PRC et de la détresse psychologique reliée au cancer. Satisfaction adequate de la vidéoconférence. Conclusion : L’utilisation de la vidéoconférence permettrait à un plus grand nombre de survivants de cancer d’être traités pour leur PRC.