Feasibility and Acceptability of Fear-Less: A Stepped-Care Program to Manage Fear of Cancer Recurrence in People with Metastatic Melanoma

Fiona A Lynch; Lynda Katona; Michael Jefford; Allan Ben Smith; Joanne Shaw; Haryana M Dhillon; Steve Ellen; Jo Phipps-Nelson; Julia Lai-Kwon; Donna Milne; Lahiru Russell; Victoria Dax; Justine Diggens; Holly Kent; Alison Button-Sloan; Jane Elliott; Mark Shackleton; Hayley Burridge; Maria Ftanou

doi:10.3390/jcm9092969

Feasibility and Acceptability of Fear-Less: A Stepped-Care Program to Manage Fear of Cancer Recurrence in People with Metastatic Melanoma

J Clin Med. 2020 Sep 14;9(9):2969. doi: 10.3390/jcm9092969.

Authors

Fiona A Lynch¹, Lynda Katona², Michael Jefford^{3

4

5}, Allan Ben Smith⁶, Joanne Shaw⁷, Haryana M Dhillon^{7

8}, Steve Ellen^{1

9}, Jo Phipps-Nelson^{5

10}, Julia Lai-Kwon³, Donna Milne^{10

11}, Lahiru Russell^{12

13}, Victoria Dax¹, Justine Diggens¹, Holly Kent², Alison Button-Sloan^{14

15

16}, Jane Elliott¹, Mark Shackleton^{17

18}, Hayley Burridge¹⁷, Maria Ftanou^{1

19}

Affiliations

¹ Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.
² Department of Psychology and Consultation Liaison Psychiatry, Alfred Health, Melbourne, VIC 3004, Australia.
³ Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.
⁴ Australian Cancer Survivorship Centre, Melbourne, VIC 3000, Australia.
⁵ Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia.
⁶ Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, NSW 2052, Australia.
⁷ Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia.
⁸ Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia.
⁹ Department of Psychiatry, The University of Melbourne, Melbourne, VIC 3010, Australia.
¹⁰ Health Services and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.
¹¹ Department of Skin and Melanoma Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.
¹² School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, VIC 3217, Australia.
¹³ Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, VIC 3128, Australia.
¹⁴ Melanoma Patients Australia, Melbourne, VIC 3000, Australia.
¹⁵ Melanoma Research Victoria Consumer Reference Group, Melbourne, VIC 3000, Australia.
¹⁶ Australian Melanoma Consumer Alliance, Melbourne, VIC 3000, Australia.
¹⁷ Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia.
¹⁸ Department of Medicine, Monash University, Melbourne, VIC 3010, Australia.
¹⁹ Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia.

Abstract

Immunotherapies and targeted therapies have revolutionised treatment of metastatic melanoma and improved survival rates. However, survivors treated with novel therapies are vulnerable to high levels of fear of cancer recurrence or progression (FCR). Existing FCR interventions have rarely been trialled in people with advanced cancer. The current study aimed to evaluate the acceptability and feasibility of Fear-Less: a stepped-care model to treat FCR in people with metastatic melanoma treated with immunotherapy or targeted therapy. Sixty-one outpatients with metastatic melanoma were screened using the Fear of Cancer Recurrence Inventory Short Form (FCRI-SF) and Fear of Progression Questionnaire Short Form (FoP-Q-SF). Survivors with subthreshold FCR were stratified to a self-management intervention while those with clinical levels of FCR were provided with an individual therapy, Conquer Fear. Survivor experience surveys and rescreening were administered post-intervention completion. Results indicated that Fear-Less was an acceptable and feasible FCR intervention. Results provided preliminary support for the potential impact of Fear-Less in reducing FCR. Fear-Less is a promising first step in providing an acceptable and feasible stepped-care model to treat FCR in survivors with metastatic disease.

Keywords: fear of cancer recurrence; metastatic melanoma; stepped care.

Grants and funding

VCSP18019/State Government of Victoria