Fear-focused Self-compassion Therapy for young breast cancer patients' fear of cancer recurrence: Study protocol of a randomized controlled trial

Liuyu Wei, Xiaomin Yang, Shasha Sun, Yunlei Yu, Juan Xie, Jiang Zhao, Xiao Wang, Lei Zhu, Juntao Yao, Liuyu Wei, Xiaomin Yang, Shasha Sun, Yunlei Yu, Juan Xie, Jiang Zhao, Xiao Wang, Lei Zhu, Juntao Yao

Abstract

Background: In China, there are a growing number of young women being diagnosed with breast cancer. Fear of Cancer Recurrence (FCR) has become one of the major psychological concerns reported by young breast cancer patients. Yet, there is a lack of psychological intervention tailored for reducing FCR for Chinese young breast cancer patients. In the current study, the Fear-focused Self-compassion Therapy is developed to help Chinese young breast cancer patients to manage FCR. The therapy was developed based on FCR development theories and self-compassion related therapy. The primary objective is to evaluate the short-term and long-term effectiveness of Fear-focused Self-compassion Therapy. The secondary objective is to examine the underlying mechanisms of therapy in reducing FCR in young breast cancer patients.

Methods: The Fear-focused Self-compassion Therapy consists of 8-week face to face group sessions. This study will be a randomized controlled trial with 160 Chinese young female breast cancer patients with severe FCR. Participants will be randomized to the therapy group or a usual care control group (1:1). Measurements will be completed at baseline, immediately completing intervention, 3, 6, and 12 months later. Primary outcomes are FCR severity, and secondary outcomes include symptoms of depression and anxiety, satisfaction with therapy, and cost-effectiveness of the therapy.

Discussion: If successful, this study will provide an effective psychological intervention to treat FCR for young breast cancer patients in China, and illuminate the underlying mechanisms of the Fear-focused Self-compassion Therapy in reducing FCR.

Clinical trial registration: ClinicalTrials.gov: NCT04965428. Registered 23rd July 2021, https://ichgcp.net/clinical-trials-registry/NCT04965428?cond=fear+of+cancer+recurrence&draw=2&rank=1.

Keywords: China; Fear-focused Self-compassion Therapy; RCT; fear of cancer recurrence; young breast cancer patients.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Wei, Yang, Sun, Yu, Xie, Zhao, Wang, Zhu and Yao.

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA-A Cancer J Clin. (2021) 71:209–49. 10.3322/caac.21660
    1. Feng RM, Zong YN, Cao SM, Xu RH. Current cancer situation in China: good or bad news from the 2018. Global cancer statistics? Cancer Commun. (2019) 39:1–12. 10.1186/s40880-019-0368-6
    1. Wang K, Ren Y, Li H, Zheng K, Jiang J, Zou T, et al. . Comparison of clinicopathological features and treatments between young ( ≤ 40 years) and older (>40 years) female breast cancer patients in West China: a retrospective, epidemiological, multicenter, case only study. PLoS ONE. (2016) 11:e0152312. 10.1371/journal.pone.0152312
    1. Crist JV, Grunfeld EA. Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psychooncology. (2013) 22:978–86. 10.1002/pon.3114
    1. Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, et al. . Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. (2013) 7:300–22. 10.1007/s11764-013-0272-z
    1. Yang Y, Li W, Wen Y, Wang H, Sun H, Liang W, et al. . Fear of cancer recurrence in adolescent and young adult cancer survivors: a systematic review of the literature. Psychooncology. (2019) 28:675–86. 10.1002/pon.5013
    1. de Kruijf EM, Bastiaannet E, Rubertá F, de Craen AJM, Kuppen PJK, Smit VTHBM, et al. . Comparison of frequencies and prognostic effect of molecular subtypes between young and elderly breast cancer patients. Mol Oncol. (2014) 8:1014–25. 10.1016/j.molonc.2014.03.022
    1. Kamińska M, Ciszewski T, Kukiełka-Budny B, Kubiatowski T, Baczewska B, Starosławska MM-SE, et al. . Life quality of women with breast cancer after mastectomy or breast conserving therapy treated with adjuvant chemotherapy. Ann Agric Environ Med. (2015) 22:724–30. 10.5604/12321966.1185784
    1. Zhang X, Zhang L, Jia Z, Cheng Y. Fear of cancer recurrence and its influencing factors in convalescent young breast cancer patients. Nurs Teach Sect. (2019) 34:80–3. 10.3870/j.issn.1001-4152.2019.18.080
    1. Lebel S, Beattie S, Arés I, Bielajew C. Young and worried: age and fear of recurrence in breast cancer survivors. Heal Psychol. (2013) 32:695–705. 10.1037/a0030186
    1. Thewes B, Bell ML, Butow P, Beith J, Boyle F, Friedlander M, et al. . Psychological morbidity and stress but not social factors influence level of fear of cancer recurrence in young women with early breast cancer: results of a cross-sectional study. Psychooncology. (2013) 22:2797–806. 10.1002/pon.3348
    1. Vickberg SMJ. The concerns about recurrence scale (CARS): a systematic measure of women's fears about the possibility of breast cancer recurrence. Ann Behav Med. (2003) 25:16–24. 10.1207/S15324796ABM2501_03
    1. Savard J, Ivers H. The evolution of fear of cancer recurrence during the cancer care trajectory and its relationship with cancer characteristics. J Psychosom Res. (2013) 74:354–60. 10.1016/j.jpsychores.2012.12.013
    1. Herschbach P, Dinkel A. Fear of progression peter. Recent Results Cancer Res. (2014) 197:11–29. 10.1007/978-3-642-40187-9_2
    1. Butow P, Sharpe L, Thewes B, Turner J, Gilchrist J, Beith J. Fear of cancer recurrence: a practical guide for clinicians. Oncol. (2018) 32:32–8.
    1. Koch L, Bertram H, Eberle A, Holleczek B, Schmid-Höpfner S, Waldmann A, et al. . Fear of recurrence in long-term breast cancer survivors - Still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the Cancer Survivorship - a multi-regional population-based study. Psychooncology. (2014) 23:547–54. 10.1002/pon.3452
    1. Lebel S, Tomei C, Feldstain A, Beattie S, McCallum M. Does fear of cancer recurrence predict cancer survivors' health care use? Support Care Cancer. (2013) 21:901–6. 10.1007/s00520-012-1685-3
    1. Thewes B, Quinn V, Christensen S, de Wal M van, Prins J, Zachariae R, et al. . Prevalence and predictors of fear of cancer recurrence 7-9 years post-surgery in a nationwide cohort of women treated for early stage breast cancer. Psychooncology. (2016) S3:180.
    1. Burm R, Thewes B, Rodwell L, Kievit W, Speckens A, Van De Wal M, et al. . Long-term efficacy and cost-effectiveness of blended cognitive behavior therapy for high fear of recurrence in breast, prostate and colorectal Cancer survivors: follow-up of the SWORD randomized controlled trial. BMC Cancer. (2019) 19:462. 10.1186/s12885-019-5615-3
    1. Tomei C, Lebel S, Maheu C, Lefebvre M, Harris C. Examining the preliminary efficacy of an intervention for fear of cancer recurrence in female cancer survivors: a randomized controlled clinical trial pilot study. Support Care Cancer. (2018) 26:2751–62. 10.1007/s00520-018-4097-1
    1. Zhang X, Zhang L, Jia Z, Cheng Y. Application and effect evaluation of marital self-disclosure intervention on the fear of cancer recurrence in young breast cancer patients. Chinese J Nurs. (2019) 54:1610–4. 10.3761/j.issn.0254-1769.2019.11.002
    1. Crane-Okada R, Kiger H, Sugerman F, Uman GC, Shapiro SL, Wyman-McGinty W, et al. . Mindful movement program for older breast cancer survivors: a pilot study. Cancer Nurs. (2012) 35:1–13. 10.1097/NCC.0b013e3182280f73
    1. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. . Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. (2014) 37:185–95. 10.1007/s10865-012-9473-6
    1. Lengacher CA, Reich RR, Paterson CL, Ramesar S, Park JY, Alinat C, et al. . Examination of broad symptom improvement resulting from mindfulness-based stress reduction in breast cancer survivors: a randomized controlled trial. J Clin Oncol. (2016) 34:2827–34. 10.1200/JCO.2015.65.7874
    1. Dieng M, Butow PN, Costa DSJ, Morton RL, Menzies SW, Mireskandari S, et al. . Psychoeducational intervention to reduce fear of cancer recurrence in people at high risk of developing another primarymelanoma: results of a randomized controlled trial. J Clin Oncol. (2016) 34:4405–14. 10.1200/JCO.2016.68.2278
    1. Chen D, Sun W, Liu N, Wang J, Zhao J, Zhang Y, et al. . Fear of cancer recurrence: a systematic review of randomized, controlled trials. Oncol Nurs Forum. (2018) 45:703–12. 10.1188/18.ONF.703-712
    1. Sharpe L, Thewes B, Butow P. Current directions in research and treatment of fear of cancer recurrence. Curr Opin Support Palliat Care. (2017) 11:191–6. 10.1097/SPC.0000000000000288
    1. Tauber NM, O'Toole MS, Dinkel A, Galica J, Humphris G, Lebel S, et al. . Effect of psychological intervention on fear of cancer recurrence: a systematic review and meta-analysis. J Clin Oncol. (2019) 37:2899–915. 10.1200/JCO.19.00572
    1. Germino BB, Mishel MH, Crandell J, Porter L, Blyler D, Jenerette C, et al. . Outcomes of an uncertainty management intervention in younger African American and caucasian breast cancer survivors. Oncol Nurs Forum. (2013) 40:82–92. 10.1188/13.ONF.82-92
    1. Fardell JE, Thewes B, Turner J, Gilchrist J, Sharpe L, Smith A., Ben, et al. . Fear of cancer recurrence: a theoretical review and novel cognitive processing formulation. J Cancer Surviv. (2016) 10:663–73. 10.1007/s11764-015-0512-5
    1. Simonelli LE, Siegel SD, Duffy NM. Fear of cancer recurrence: a theoretical review and its relevance for clinical presentation and management. Psychooncology. (2017) 26:1444–54. 10.1002/pon.4168
    1. Heathcote LC, Eccleston C. Pain and cancer survival: a cognitive-affective model of symptom appraisal and the uncertain threat of disease recurrence. Pain. (2017) 158:1187–91. 10.1097/j.pain.0000000000000872
    1. Neff KD. Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self Identity. (2003) 2:85–101. 10.1080/15298860309032
    1. Allen AB, Leary MR. Self-compassion, stress, and coping. Soc Personal Psychol Compass. (2010) 4:107–18. 10.1111/j.1751-9004.2009.00246.x
    1. Krieger T, Altenstein D, Baettig I, Doerig N, Holtforth MG. Self-compassion in depression: associations with depressive symptoms, rumination, and avoidance in depressed outpatients. Behav Ther. (2013) 44:501–13. 10.1016/j.beth.2013.04.004
    1. Wren AA, Somers TJ, Wright MA, Goetz MC, Leary MR, Fras AM, et al. . Self-compassion in patients with persistent musculoskeletal pain: relationship of self-compassion to adjustment to persistent pain. J Pain Symptom Manage. (2012) 43:759–70. 10.1016/j.jpainsymman.2011.04.014
    1. Yip VT, Tong MW E. Self-compassion and attention: self-compassion facilitates disengagement from negative stimuli. J Posit Psychol. (2020) 16:1–17. 10.1080/17439760.2020.1778060
    1. Gilbert P. The origins and nature of compassion focused therapy. Br J Clin Psychol. (2014) 53:6–41. 10.1111/bjc.12043
    1. Arch JJ, Brown KW, Dean DJ, Landy LN, Brown KD, Laudenslager ML. Self-compassion training modulates alpha-amylase, heart rate variability, and subjective responses to social evaluative threat in women. Psychoneuroendocrinology. (2014) 42:49–58. 10.1016/j.psyneuen.2013.12.018
    1. Kirschner H, Kuyken W, Wright K, Roberts H, Brejcha C, Karl A. Soothing your heart and feeling connected: a new experimental paradigm to study the benefits of self-compassion. Clin Psychol Sci. (2019) 7:545–65. 10.1177/2167702618812438
    1. Neff K, Germer CK. A pilot study and randomized controlled trial of the mindful self-compassion program. J Clin Psychol. (2013) 69:28–44. 10.1002/jclp.21923
    1. Ferrari M, Hunt C, Harrysunker A, Abbott MJ, Beath AP, Einstein DA. Self-compassion interventions and psychosocial outcomes: a meta-analysis of RCTs. Mindfulness. (2019) 10:1455–73. 10.1007/s12671-019-01134-6
    1. Zhu L, Wang J, Liu S, Xie H, Hu Y, Yao J, et al. . Self-compassion and symptoms of depression and anxiety in chinese cancer patients: the mediating role of illness perceptions. Mindfulness. (2020) 11:2386–96. 10.1007/s12671-020-01455-x
    1. Zhu L, Yao J, Wang J, Wu L, Gao Y, Xie J, et al. . The predictive role of self-compassion in cancer patients' symptoms of depression, anxiety, and fatigue: a longitudinal study. Psychooncology. (2019) 28:1918–25. 10.1002/pon.5174
    1. Dodds SE, Pace TWW, Bell ML, Fiero M, Negi LT, Raison CL, et al. . Feasibility of cognitively-based compassion training (CBCT) for breast cancer survivors: a randomized, wait list controlled pilot study. Support Care Cancer. (2015) 23:3599–608. 10.1007/s00520-015-2888-1
    1. Gonzalez-Hernandez E, Romero R, Campos D, Burychka D, Diego-Pedro R, Baños R, et al. . Cognitively-based compassion training (CBCT®) in breast cancer survivors: a randomized clinical trial study. Integr Cancer Ther. (2018) 17:684–96. 10.1177/1534735418772095
    1. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, KrleŽa-Jerić K, et al. . Spirit 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. (2013) 13:1501–7. 10.7326/0003-4819-158-3-201302050-00583
    1. Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. . SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. (2013) 346:1–42. 10.1136/bmj.e7586
    1. Simard S, Savard J. Fear of cancer recurrence inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer. (2009) 17:241–51. 10.1007/s00520-008-0444-y
    1. Campo RA, Bluth K, Santacroce SJ, Knapik S, Tan J, Gold S, et al. . A mindful self-compassion videoconference intervention for nationally recruited posttreatment young adult cancer survivors: feasibility, acceptability, and psychosocial outcomes. Support Care Cancer. (2017) 25:1759–68. 10.1007/s00520-017-3586-y
    1. Sadeghi ZH, Yazdi-Ravandi S, Pirnia B. Compassion-focused therapy on levels of anxiety and depression among women with breast cancer: a randomized pilot trial. Int J Cancer Manag. (2018) 11:67019. 10.5812/ijcm.67019
    1. Butow P, Kelly S, Thewes B, Hruby G, Sharpe L, Beith J. Attentional bias and metacognitions in cancer survivors with high fear of cancer recurrence. Psychooncology. (2015) 24:416–23. 10.1002/pon.3659
    1. Garnefski N, Kraaij V. The cognitive emotion regulation questionnaire: psychometric features and prospective relationships with depression and anxiety in adults. Eur J Psychol Assess. (2007) 23:141–9. 10.1027/1015-5759.23.3.141
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. (1983) 67:361–70. 10.1111/j.1600-0447.1983.tb09716.x
    1. Neff KD. The development and validation of a scale to measure self-compassion. Self Identity. (2003) 2:223–50. 10.1080/15298860309027
    1. Rabin R, De Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. (2001) 33:337–43. 10.3109/07853890109002087
    1. Bouwmans C, De Jong K, Timman R, Zijlstra-Vlasveld M, Van Der Feltz-Cornelis C, Tan SS, et al. . Feasibility, reliability and validity of a questionnaire on healthcare consumption and productivity loss in patients with a psychiatric disorder (TiC-P). BMC Health Serv Res. (2013) 13:217. 10.1186/1472-6963-13-217
    1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life the remarkable universality of half a standard deviation. Med Care. (2003) 41:582–92. 10.1097/01.MLR.0000062554.74615.4C

Source: PubMed

3
订阅