Feasibility and preliminary efficacy of iConquerFear: a self-guided digital intervention for fear of cancer recurrence

Allan 'Ben' Smith; Adeola Bamgboje-Ayodele; Sharuja Jegathees; Phyllis Butow; Britt Klein; Marj Salter; Jane Turner; Joanna Fardell; Belinda Thewes; Louise Sharpe; Lisa Beatty; Alison Pearce; Jane Beith; Daniel Costa; Orlando Rincones; Verena S Wu; Frances L Garden; Belinda E Kiely; Karen Lim; Lisa Morstyn; Brigid Hanley; Rosemerry Hodgkin; Annette Beattie; Afaf Girgis

doi:10.1007/s11764-022-01233-9

Feasibility and preliminary efficacy of iConquerFear: a self-guided digital intervention for fear of cancer recurrence

J Cancer Surviv. 2024 Apr;18(2):425-438. doi: 10.1007/s11764-022-01233-9. Epub 2022 Jul 25.

Authors

Allan 'Ben' Smith^{1

2}, Adeola Bamgboje-Ayodele^{3

4}, Sharuja Jegathees^{3

5}, Phyllis Butow⁶, Britt Klein⁷, Marj Salter⁵, Jane Turner⁸, Joanna Fardell^{9

10}, Belinda Thewes¹¹, Louise Sharpe¹¹, Lisa Beatty¹², Alison Pearce^{13

14}, Jane Beith¹⁵, Daniel Costa¹¹, Orlando Rincones⁵, Verena S Wu^{3

5}, Frances L Garden⁵, Belinda E Kiely¹⁶, Karen Lim¹⁷, Lisa Morstyn¹⁸, Brigid Hanley¹⁹, Rosemerry Hodgkin²⁰, Annette Beattie²¹, Afaf Girgis^{3

5}

Affiliations

¹ Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia. ben.smith@unsw.edu.au.
² Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia. ben.smith@unsw.edu.au.
³ Faculty of Medicine and Health, South West Sydney Clinical Campuses, University of New South Wales (UNSW Sydney), Liverpool, Australia.
⁴ Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁵ Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, BC NSW, 1871, Australia.
⁶ Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia.
⁷ Health Innovation & Transformation Centre (HITC) & Biopsychosocial and eHealth Research & Innovation (BeRI), DVC-R&I Portfolio, Federation University Australia, Churchill, Australia.
⁸ Department of Psychiatry, University of Queensland, Brisbane, Australia.
⁹ School of Clinical Medicine, Discipline of Paediatrics, UNSW Medicine & Health, UNSW Sydney, Sydney, Australia.
¹⁰ Western Sydney Youth Cancer Service, Westmead Hospital, Westmead, Australia.
¹¹ School of Psychology, University of Sydney NSW, Sydney, Australia.
¹² College of Education, Psychology & Social Work, Flinders University, Adelaide, Australia.
¹³ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
¹⁴ Sydney School of Public Health, University of Sydney, Sydney, Australia.
¹⁵ Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
¹⁶ South Western Sydney Local Health District, Campbelltown Hospital, Campbelltown, NSW, Australia.
¹⁷ South Western Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia.
¹⁸ Breast Cancer Network Australia (BCNA), Camberwell, Australia.
¹⁹ Cancer Council Queensland, Fortitude Valley, Australia.
²⁰ Cancer Council Western Australia, Perth, Australia.
²¹ Cancer Council New South Wales, Sydney, Australia.

Abstract

Purpose: Approximately 50% of cancer survivors experience moderate-severe fear of cancer recurrence (FCR). Self-guided digital interventions have potential to address the high level of FCR-related unmet needs at scale, but existing digital interventions have demonstrated variable engagement and efficacy. This study aimed to evaluate the feasibility and preliminary efficacy of iConquerFear, a five-module self-guided digital FCR intervention.

Methods: Eligible curatively treated breast cancer survivors were recruited. Participants reporting clinically significant FCR (≥ 13 on the Fear of Cancer Recurrence Inventory-Short Form; FCRI-SF) were given access to iConquerFear. Feasibility was indicated by > 50% of eligible participants enrolling in iConquerFear and recording moderate (≥ 120 min) or greater usage. Preliminary efficacy was evaluated via changes in self-reported FCR severity, anxiety, depression, intrusions and metacognitions from baseline to immediately and 3 months post-intervention.

Results: Fifty-four (83%) of 65 eligible participants enrolled in iConquerFear; six subsequently withdrew. Thirty-nine (83%) participants recorded moderate (n = 24; 120-599 min) or high (n = 15; ≥ 600 min) usage. Engagement levels increased with participant age (p = 0.043), but were lower in participants with higher baseline FCR (p = 0.028). Qualitative feedback indicated engagement was sometimes limited by difficulties with navigation and relating to featured survivors. Participants reported significantly improved FCR (mean reduction (95%CI): baseline to post-intervention - 3.44 (- 5.18, - 1.71), baseline to 3-month follow-up - 4.52 (- 6.25, - 2.78), p = < 0.001).

Conclusion: iConquerFear is a feasible and potentially efficacious intervention for reducing FCR in breast cancer survivors. Easier navigation and more relatable examples may enhance engagement.

Implications for cancer survivors: iConquerFear may help address moderate but burdensome FCR levels in cancer survivors.

Keywords: Oncology; cancer; eHealth; fear of cancer recurrence; online; psycho-oncology; self-management; survivorship; web-based.

MeSH terms

Anxiety / therapy
Breast Neoplasms* / therapy
Cancer Survivors*
Fear
Feasibility Studies
Female
Humans
Neoplasm Recurrence, Local