This study was supported by TUBİTAK under the Grant Number 223K032.
Objectives
Fear of cancer recurrence (FCR) is a common psychological burden among cancer survivors. While interventions like Fear of Recurrence Therapy (FORT) have demonstrated effectiveness, culturally adapted versions remain limited. This study evaluated a culturally adapted FORT protocol for Turkish breast cancer survivors compared to a Cognitive Behavioral Therapy (CBT)-based intervention. It was hypothesized that FORT would yield greater reductions in FCR and improvements in related psychological outcomes.
Sample and Setting
Eighty-seven breast cancer survivors in remission were recruited through convenience sampling via online platforms. All had completed primary treatment within the past five years and reported elevated distress. The intervention was delivered online in a closed-group format across six weekly sessions.
Procedures
A single-blind, two-arm randomized controlled trial was conducted. Participants were randomly assigned to either the FORT or CBT-based group. Distress was assessed using the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer. Assessments were completed at baseline (T0) and post-intervention (T1). The primary outcome, FCR, was measured by the Fear of Cancer Recurrence Inventory–Turkish version. Secondary outcomes included intolerance of uncertainty, coping, self-efficacy, and quality of life, each measured using validated Turkish versions of standardized instruments. Analyses followed a per-protocol approach using independent samples tests and ANCOVA.
Results
No baseline differences were observed. FORT participants showed significantly greater improvements in Total FCR (p=0.005, d=-0.611), anxiety (p=0.008, d=-0.579), and functional quality of life (p=0.014, d=0.304). ANCOVA confirmed significant group differences in FCR Triggers (F=7.243, p=0.009), Metacognitions (F=5.679, p=0.019), Emotion-Focused Coping (F=5.679, p=0.019), anxiety (F=5.735, p=0.019), and intolerance of uncertainty (F=8.745, p=0.004).
Conclusion and Clinical Implications
The culturally adapted FORT protocol demonstrated superior efficacy. Findings highlight the importance of delivering culturally sensitive psychological interventions in cancer survivorship care.