Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Fear of cancer recurrence in long-term colorectal cancer survivors: a randomized controlled trial of TG-iConquerFear - a therapist-guided eHealth intervention (122433)

Johanne D Lyhne 1 2 , Ben Smith 3 , Signe Timm 1 2 , Britt Klein 4 5 , Belinda Thewes 6 , Afaf Girgis AM 7 , Adeola Bamgboje-Ayodele 7 8 , Lisa Beatty 9 10 , Joanna Fardell 11 , Per Fink 12 13 , Phyllis Butow 14 , Lisbeth Frostholm 12 13 , Lars Henrik Jensen 1 2
  1. Institute for Regional Health Research, Vejle, Denmark
  2. Department of Oncology, Vejle Hospital, , University Hospital of Southern Denmark, Vejle , Denmark
  3. The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney , NSW, Australia
  4. Health Innovation & Transformation Centre, Federation University Australia, Ballarat, Australia
  5. Biopsychosocial and eHealth Research & Innovation Hub, Federation University Australia, Ballarat, Australia
  6. Rural Clinical School, School of Medicine and Psychology, Australian National University, Canberra, Australia
  7. Ingham Institute for Applied Medical Research, South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, Liverpool, NSW, Australia
  8. Discipline of Design, School of Architecture, Design and Planning, University of Sydney, Sydney , NSW, Australia
  9. Flinders University Institute of Mental Health & Wellbeing, College of Education, Psychology & Social Work, Flinders University , Adelaide , Australia
  10. Psycho-Oncology Cooperative Research Group, Adelaide , Australia
  11. Behavioural Sciences Unit, School of Clinical Medicine, University of New South Wales, Sydney , NSW, Australia
  12. Clinic for Functional Disorders, Aarhus University Hospital , Aarhus , Denmark
  13. Department of Clinical Medicine, Aarhus University , Aarhus, Denmark
  14. School of Psychology, University of Sydney , Sydney , NSW, Australia

Purpose: Despite the availability of effective interventions, fear of cancer recurrence (FCR) remains a prevalent concern among cancer survivors, underscoring the need for more accessible approaches. This trial aimed to assess the efficacy of a 10-week therapist-guided (TG) eHealth intervention, TG-iConquerFear.

Methods: This randomized controlled trial enrolled adult colorectal cancer survivors (CRCS) who had completed curative-intented treatment between March 2014 and December 2018, and reported Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) scores ≥22. Eligible participants were randomized to TG-iConquerFear or web-based self-help exercises. Guidance were delivered asynchronously and in written. The predefined primary outcome was the between-group difference in FCRI total score change at three months post-intervention (T2), analyzed according to intention-to-treat.

Results: Of 9,946 eligible CRCS, 5,515 (55%) completed FCR screening, and 299 (5%) reported clinically significant FCR. 103 (47%) were randomized to TG-iConquerFear (n=49) or augmented control (n=54). Main reasons for non-inclusion included new cancer diagnoses (n=34) or FCR not affecting everyday life (n=32). Participants completed 4.5 out of 6 modules on average. Total FCRI score decreased more from baseline to T2 in the TG-iConquerFear group (mean -21.7, 95% CI [-30.1, -13.3]) compared to the self-help group (mean -2.6 95% CI [-7.8, 2.6]). This represents a between-group difference at T2 of 19.1 (95% CI [10.0, 28.3], p < 0.001) and a standardized effect size (Cohen’s d) of 0.62 (95% CI [0.13 - 1.1]). A significantly higher proportion of TG-iConquerFear participants were in the non-clinical range at T2 compared to self-help participants (81.5% vs. 42.9%, p = 0.002). Number needed to treat was n=3.

Conclusions: The TG-iConquerFear intervention demonstrated a statistically and clinically significant reduction in FCR in a population of long-term CRCS.