Aims: Among the most frequent problems of cancer patients is the fear about the recurrence or spread of the disease which we called fear of progression (FoP). FoP is a realistic concern, which should be treated if it reduces the quality of life of the patients severely. We developed and compared the effectiveness of two psychotherapeutic interventions against dysfunctional FoP.
Patients and methods: 174 cancer patients were recruited from two rehabilitation clinics and randomly assigned to either a four-session cognitive-behavioral group therapy (CB) focused specifically on FoP or a supportive-experiential group therapy (SE) that included topics selected by the patients. The main inclusion criterion for both groups was a critical cut-off score in the Fear of Progression Questionnaire - Short Form.
The main outcome criterion was FoP assessed with the Fear of Progression Questionnaire before (T1) and after (T2) the intervention, as well as three (T3) and 12 months (T4) after discharge. Secondary outcomes were anxiety, depression, quality of life and cost-effectiveness of both interventions. 91 cancer patients of the same clinics recruted by the same research stuff one year later (same inclusion criteria but no additonal psychotherapy) served as a control group.
Results: FoP decreased significantly over time in both intervention groups (effect size 0.62 for the CB, 0.56 for the SE) in contrast to the control group that showed only short-term improvements (ES = 0.09). The interventions were also effective in reducing the secondary outcomes except life satisfaction. Our health economic analysis demonstrated a superior cost-effectiveness for the CB therapy. The best predictor for the long term response to therapy was the educational level of our patients.
Conclusions: Fear of progression, one of the main sources of distress for cancer patients, can be reduced with short psychotherapeutic interventions.