CIFeR - A Clinician-led Intervention to Address Fear of Cancer Recurrence

STUDY DESIGN:

The study is designed as a parallel cluster-randomized controlled trial with oncologists (cluster unit) treating breast, ovarian, and prostate cancer at the oncology departments at Aarhus University Hospital (AUH), Vejle Hospital (VH), Aalborg University Hospital (AAUH), and Copenhagen University Hospital (CUH), and randomized 1:1 to intervention versus active control.

Participants:

All oncologists treating breast, ovarian, and prostate cancer at the participating departments are eligible for the study and will be recruited by our collaborators at the participating departments. Eligible patients score >= 13 on the FCRI-SF and have completed their primary treatment i.e., surgery, adjuvant chemotherapy, and/or radiotherapy, for breast, ovarian, lung and prostate cancer at the participating departments between three weeks and three months previously.

Procedure:

Patients scheduled for a follow-up visit with the participating oncologists will receive a secure e-mail invitation to participate in the study and a link to a RedCap questionnaire. Patients willing to participate will provide their informed consent electronically and complete the 9-item FCRI-SF. Patients scoring >= 13 are provided with additional information about the study and asked for their consent to participate.

One week before the planned follow-up consultation, they will be asked to complete a RedCap baseline questionnaire (T1). One week and three months after the consultation, the patients will be asked to complete the RedCap post-intervention (T2) and follow-up questionnaires (T3).

Oncologists will complete a RedCap baseline questionnaire assessing age, gender, years of experience, and self-efficacy in managing patient FCR. Oncologists will then be allocated to the intervention or active control arm using a stratified randomization sequence generated by the Aarhus University clinical trial unit ensuring a balanced allocation of oncologists according to the cancer type treated. Oncologists will then receive a link to online CIFeR training and report their post-training self-efficacy for managing patient FCR. During the consultation, the oncologist will deliver the CIFeR intervention and complete a brief 5-item checklist on whether they delivered all five components and, if not, why. After including all patients, the oncologist is asked to complete a follow-up RedCap questionnaire on self-efficacy in managing patient FCR.

The CIFeR intervention:

The intervention includes five components informed by theoretical models and existing interventions for FCR: 1) FCR normalization: reassurance that FCR is a common and normal phenomenon after treatment for cancer, 2) Providing prognostic information: asking patients whether they would like information about their risk of recurrence and, if yes, providing this information, 3) Providing education and take-home information on red-flag recurrence symptoms, 4) Brief advice on managing worry: distraction, meditation, mindfulness, reassurance, and links to online resources to manage FCR, and 5) referral to a psychologist if FCR is high (FCRI-SF >= 22), or if deemed helpful by the patient or clinician. Access will be provided to ConquerFear-Group delivered online by trained psycho-oncologists.

Outcome measures:

Patients:

The primary outcome is the change in FCR, assessed with the 9-item Fear of Cancer Recurrence Inventory Short Form (FCRI-SF). Secondary outcomes include a) anxiety and depression assessed with the The Hospital Anxiety and Depression Scale (HADS), b) patient reported intervention usefulness assessed with the Patient Centered Communication Scale (PCC), c) metacognition assessed with the metacognitions questionnaire (MCQ-30), d) unmet needs assessed with Subscale of the Survivors Unmet Need Survey (SUNS-8), e) rumination assessed with the Penn State Worry Questionnaire (PSWQ), and f) General Quality of Life (QoL) assessed with the EQ-5D for later use in cost-effectiveness analysis. All measures will be completed at all three time-points (T1-T3).

At six months, the investigators will ask a subset of 15-20 patients to participate in a semi-structured phone interview about their experience with the intervention.

Oncologists:

Oncologists complete a general item on self-efficacy in managing patient FCR together with the 27-item Self-efficacy in Patient-Centeredness Questionnaire (SEPCQ-27) at baseline, post-training (only oncologists in the intervention group), and after completed inclusion. Based on a suggested framework for implementation outcomes, the investigators will assess with 11-point scales: 1) acceptability, 2) appropriateness, 3) feasibility, together with 4) fidelity, measured as the average number of components oncologists report having delivered to patients, and 5) sustainability measured as the proportion of oncologists in the intervention group who report having used CIFeR at least once within the last three months, measured six months after completed inclusion. Six months after the inclusion of their last patient, all oncologists will be asked to participate in a semi-structured interview and provide feedback on the CIFeR-training and their experiences with the intervention, including perceived utility and the perceived barriers and facilitators to implementing CIFeR in routine care. The investigators will also examine CIFeR e-training analytics regarding access and time spent on the various parts.