乌鸦传媒

CHICAGO -- Experimental psychosocial intervention seemed to help cancer patients over their fear of cancer relapse better than a relaxation techniques, researchers reported here.

Patients who received five face-to-face 60- to 90-minute intervention, which included attention training and detached mindfulness, over a 10-week period achieved an 18.1 point reduction on the Fear of Cancer Recurrence Inventory (FCIR) versus a 7.6-point decline among those in the relaxation control group, according to of the University of Sydney, and colleagues.

Greater reductions in fear of recurrence were also observed in the study arm at 3 months (-7.6, 95% CI -13.9 to -1.4, P=0.02) and 6 months (-7.8, 95% CI -14.2 to -1.4, P=0.02) compared with relaxation techniques, she said in a presentation at the American Society of Clinical Oncology (ASCO) annual meeting.

"The reduction in fear of recurrence in the psychological intervention group was large enough to improve survivors' psychological and emotional well-being," she said. "The majority of participants were young women with breast cancer, but we expect the intervention may be appropriate for other patients who have moderate to high fear of recurrence."

Participants were disease-free stage I-III breast, colorectal, or melanoma cancer survivors, who were 2 months to 5 years post-treatment, and who scored above the clinical cut-off (≥13) on the FCRI severity subscale.

The "Conquer Fear" intervention also uses techniques for "challenging unhelpful metacognitions, values clarification and psycho-education," the authors explained. This focusing on the moment learing to control attention, and engaging in appropriate follow-up with professionals.

Those in the control arm received five 60-minute, individual, face-to-face relaxation sessions for 10 weeks that incorporated muscle relaxation, meditative relaxation, visualization, and quick relaxation techniques.

Both groups received instructions for home-based practice.

"In this study, the interventions were delivered by experienced psycho-oncologists. It is possible that community psychologists or other professionals who have basic training in cognitive therapy could deliver the interventions, given appropriate training and supervision," Beith said.

They enrolled 222 patients in the phase II trial. She noted that about 50% of all cancer survivors reported moderate the high recurrence fears, while 70% of breast cancer patients expressed the same, Beith said at an ASCO press conference.

The authors reported that reduction in recurrence fears between baseline and immediately post-treatment was significantly more in the stud arm participants versus the control arm (difference in change -10.5, 95% CI -16.1 to -4.9), P<0.001).

"The pattern of change in outcomes over time was consistent between treatment groups as no significant linear trends in treatment effects over time were observed," they wrote.

"Those concerns about what lies ahead in the cancer journey, and how that impacts a patient's quality of life and how to cope with them effectively is really a lifelong issue for most cancer patients," said press conference moderator Richard Schilsky, MD, ASCO chief medical officer.

Although the return of breast cancer after 25 years as a metastatic disease, such as in the in the case of actress and singer , is an outlying event, "it is [still] terrifying for women who are breast cancer survivors," said ASCO expert Don Dizon, MD, of Massachusetts General Hospital Cancer Center in Boston.

In a second related study, a "manualized psychotherapeutic intervention," called CALM, helped alleviate distress and facilitate adjustment for patients with advanced cancer, who face "the challenge of living meaningfully in the face of impending mortality," explained Gary Rodin, MD, of Princess Margaret Cancer Centre in Toronto, and colleagues.

CALM consists of three to six individual sessions delivered over 3-6 months and incorporates four domains:

• Symptom management and communication with healthcare providers
• Changes in self and relations with close others
• Sense of meaning and purpose
• The future and mortality

In the Managing Cancer and Living Meaningfully (CALM) study, 151 patients were assigned to the study protocol while 154 patients received usual care (control arm).

The authors reported that compliance with the intervention was 77.5%, while attrition was 28% (16% deceased, 8% lost to follow-up, and 4% withdrew).

The CALM group reported less severe depressive symptoms versus controls at 3 moths (ΔM1-M2=1.09, P<0.04, Cohen's d=0.23) and 6 months (ΔM1-M2=1.33, P<0.01, Cohen's d=0.29).

"Other statistically significant findings in psychological well-being and preparation for the end of life at 3- and 6- months also favored CALM vs [usual care]," the authors noted.

"These studies show that we as oncologists can intervene in the psychosocial space to improve the quality of life for our patients, and can also improve other factors that are quite important such as psychosocial functioning," Dizon said. "These studies reinforce that patients are more than their diseases and we, as oncologists, have an obligation to find out how our patients are doing living with their disease."