Fear of recurrence is significant, especially in young survivors of breast cancer
Practicing meditation and other relaxation techniques can reduce cancer survivors fear that they will face a recurrence of the disease, a new study has shown.
The findings, presented on the first day of the worlds largest annual showcase for the latest cancer research, are part of a new push by specialists to improve the psychological wellbeing of patients.
Patients reduction in fear was large enough to improve survivors psychological and emotional wellbeing, said Dr Jane Beith, a medical oncologist at the University of Sydney in Australia.
The study was conducted primarily with young survivors of breast cancer, and used muscle relaxation, meditative relaxation, and visualization to try to reduce fear of cancer recurrence.
Fear of recurrence is significant, especially in young survivors of breast cancer. The studys authors said 70% of this group had a fear of recurrence so distressing that it negatively affects medical follow-up behavior, mood, relationships, work, goal-setting, and quality of life.
Fifty per cent of all cancer survivors characterized their fear of recurrence this strongly.
Researchers randomly split 222 cancer survivors into two groups. In one group, a trained therapist delivered five sessions of 60- to 90-minute relaxation sessions. The second group received no psychological interventions.
Researchers used a standard metric to measure fear of cancer recurrence (called an FCRI test), in which higher scores indicate more fear, and scores for patients in the relaxation group dropped significantly. The average FCRI score for the group that went on to receive relaxation treatment was 82.7 before it started, versus 85.7 for the group that received no treatment. After the sessions, scores of patients in the Conquer Fear program reduced by 18.1 points on average, versus 7.6 points for the group that did not receive therapy.
The gains also appeared to appreciate over time. Patients who had received therapy reported a drop of 27.2 points after six months, compared to 17.8 points on average for the group that did not receive therapy.
Meditation is just one of several psychological treatments being presented to cancer specialists at the American Society of Clinical Oncologys (ASCO) annual conference, the worlds largest such gathering. Increasingly, oncologists have looked to psychologists to treat depression, anxiety and fear borne out of a cancer diagnosis.
In a way, were rediscovering the wheel, said Gary Rodin, a psychiatrist, head of the department of supportive care at the Princess Margaret Cancer Centre in Toronto, Canada, and the lead author of another study presented at ASCO. The medical advances in cancer care became much more developed, medicine became more technologized, and I think until recently there was less attention to the psychological and social aspects of cancer quality of life.
It really was a movement from patients and families to have this aspect of cancer care be taken as seriously as the other aspects, chemotherapy and surgery, he said.
At least three studies presented at ASCO highlight oncologists move toward psychology in treatment, ranging from face-to-face psychotherapy to relaxation techniques to online programs.
Modern psychologists first began work with cancer specialists by designing awareness campaigns about preventable cancers. For example, nearly one-quarter of worldwide cancer deaths are attributable to tobacco alone, according to the World Health Organization.
Psychologists then began surveying and treating the emotional well-being of cancer patients, part of a steady rise in psychology research centered on cancer prevention and treatment in the 1990s. The studies presented at ASCO represent both psychologists most recent work to improve the emotional lives of cancer patients and oncologists increasingly mainstream adoption of such techniques.
Another study presented at ASCO, authored by Rodin, found patients with advanced cancer could benefit from psychotherapy. The Canadian study of 305 cancer patients found up to six sessions of therapy delivered over the same period of months reduced depressive symptoms in 52% of patients, versus 33% who received usual cancer care.
The sessions were delivered by nurses, oncologists, psychologists or social workers, and were meant to prepare patients for end-of-life care. Rodin said he has trained workers in 20 countries on the model, with hopes to continue studying the therapeutic model internationally.
Although cultures differ, religions vary by country the closer one gets to being a patient with advanced disease, the more similar the problems, he said. If youve had a family member go through an advanced and progressive cancer, you know this.
A third study looked at the possibility of using the internet to deliver some psychic relief to cancer patients. The study of 129 cancer patients looked at whether an eight week, online psychology program could relieve some cancer patients most potent psychological symptoms: fatigue, anxiety and depression.
The majority of patients in the study were women with early stage breast cancer. Though anxiety and depression were not quelled by the online program, a scale used to measure fatigue, seen as a major quality of life marker for cancer patients, improved significantly.
Delivery of psychological support to patients at this early time in the course of their cancer care is hampered with lack of access, time, and resources on both the patients and the providers side, said the lead author of the study, Viviane Hess, a medical oncologist at the University Hospital in Basel, Switzerland. With this online intervention, we aim to close that gap.
Authors of the study on fear of recurrence also acknowledged that therapy was time intensive. Authors who used relaxation techniques and therapy hoped other formats, such as delivery via internet, in a group, or by phone, may be possible.
For Hess, the success of an online program pointed to a need to standardize and translate such programs for the next generation of patients at-risk of cancer: millennials.
Online psychological support will be much more important in the years to come, as the digital generation reaches the age when they are at higher risk of cancer, Hess said. This, she said, was an intervention that could deliver much-needed psychologist support in the comfort of the patients living rooms or other favorite wifi spots.