A pilot randomized controlled trial of a mind-body resiliency program for fear of cancer recurrence: Qualitative findings.
Authors: Markwart Michaela , Tsuchiyose Erika , Yeh Gloria Y. , Park Elyse R. , Wagner Lynne I. , Peppercorn Jeffrey M. , Denninger John W. , Hirschberg April , Lee Hang , Siefring Emma , Mizrach Helen , Li Raissa , Mian Zainab , Cantillon Audrey , Bullock Andrea J. , Hall Daniel L. 
Published: October 2023

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Background: Up to 70% of cancer survivors have elevated fear of cancer recurrence (FCR). Behavioral approaches are promising for managing FCR but lack testing in a scalable, synchronous, remotely-delivered, group format. This NCCIH-funded pilot RCT tested an adapted mind-body resiliency program (IN FOCUS) in comparison to a usual care control (UC; referral to virtual, cancer support groups). Methods: Adult survivors of any non-metastatic cancer (N=64) were recruited from two Boston-area academic medical centers (July 2021-March 2022). Inclusion criteria included primary treatment, elevated FCR (FCR Inventory severity≥16), English fluency, no undertreated serious mental illness, and access to Zoom. Survivors were randomized (1:1) to either 8 sessions of IN FOCUS or UC. Individual exit interviews were conducted virtually with high rates of completion (91% IN FOCUS, 94% UC). Open-ended questions probed survivors on study enjoyableness, convenience, helpfulness, odds of future skill use, satisfaction, and FCR. Interviews were recorded, transcribed, and analyzed using hybrid deductive/inductive coding by three coders (MM, ET, DH) with a senior coder (GY) for resolving discrepancies. Themes were iteratively collapsed and expanded through consensus. Results: Survivors randomized to IN FOCUS found group delivery (i.e., hearing insights from others, sharing similar cancer experiences) and learning a variety of new skills (i.e., positive psychology such as appreciations and humor, relaxation/breathing, CBT and health behaviors) as the most enjoyable and helpful aspects. Some survivors voiced challenges with scheduling, limited time for group discussion, and length of sessions. Homework was helpful yet challenging for survivors to implement independently. Virtual delivery and electronic materials were identified as most convenient, but some wished the manual was less dense and printed as a hard copy. Survivors valued the group facilitator’s rapport, empathy, and group diversity in terms of cancer diagnosis, but desired more diversity in age, race, and gender. IN FOCUS survivors described reductions in FCR, primarily attributed to cognitive (i.e., self-efficacy, changed perspective) and health behavior changes. However, several IN FOCUS survivors reported having no change in FCR, due to needing more time to incorporate skills or recent health events. UC survivors described benefits from reading study surveys, which prompted survivors to reflect on their psychosocial functioning, and coping skills. Conclusions: The IN FOCUS intervention and study materials were well-received and participants appreciated the integration of a variety of skills, in particular positive psychology followed by relaxation, CBT, and health behavior skills. Findings will guide future optimization and efficacy testing with heterogenous cancer survivors with FCR. Clinical trial information: NCT04876599 .