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Trial Review
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Trial registered on ANZCTR
Registration number
ACTRN12612000404820
Ethics application status
Approved
Date submitted
21/03/2012
Date registered
11/04/2012
Date last updated
4/08/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
Evaluation of a psychological intervention for fear of cancer recurrence; A longitudinal randomised controlled trial
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Scientific title
Evaluation in a randomised controlled trial, of the efficacy and cost efficacy of an intervention (Conquer Fear) based on the Common Sense Model, S-REF and Relational Frame Theory, in reducing the impact of fear of cancer recurrence (FCR) in disease-free breast, colorectal and melanoma cancer survivors with clinical levels of FCR, compared to a relaxation training comparison intervention.
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Secondary ID [1]
280069
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Nil
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Universal Trial Number (UTN)
Nil
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Trial acronym
Conquer Fear
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Fear of cancer recurrence
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Cancer-specific distress
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Quality of life
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Condition category
Condition code
Cancer
286168
286168
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0
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Breast
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Cancer
286356
286356
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0
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Bowel - Back passage (rectum) or large bowel (colon)
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Mental Health
286357
286357
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0
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Anxiety
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The key goals of the intervention are to: a) teach strategies for controlling worry and excessive threat monitoring ; b) modify underlying unhelpful beliefs about worry; c) develop appropriate monitoring and screening behaviours; d) educate about follow-up care and empirically-supported behavioural change (e.g. weight loss, exercise etc) to reduce the risk of cancer recurrence; e) address existential changes brought about by a cancer diagnosis; f) promote goal-setting.
The intervention is delivered in 5 x 60-90 minute, individual face-to-face sessions by a trained psychologist or psychiatrist. Participants attend one session per fortnight over a period of 10 weeks. An individual approach is required with this group of highly anxious people to ensure effective skill-based training. In our cross-sectional study amongst young women with breast cancer higher FCR was significantly associated with current use of support groups in multivariate analysis. As the direction of the causality between FCR and support group use remains unclear, we believe it is most prudent to demonstrate proof of concept in an individually delivered intervention prior to testing the intervention in a group setting. Each session is accompanied by home-based practice of skills learned in session and home reading to consolidate skill acquisition.
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Intervention code [1]
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Rehabilitation
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Intervention code [2]
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Behaviour
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Comparator / control treatment
Participants randomised to the comparison treatment will receive a 5-session manualized relaxation training program, adapted from an existing program for cancer patients. The relaxation training will be delivered in individual face-to-face sessions of 60-90 minutes in duration by a trained psychologist or psychiatrist. Participants attend one session per fortnight over a period of 10 weeks. Participants receive training in progressive and passive muscle relaxation, meditative relaxation, visualisation and “quick relaxation” techniques, with regular homework exercises and a CD for practice outside sessions.
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Control group
Active
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Outcomes
Primary outcome [1]
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Fear of Cancer Recurrence will be assessed using the 42-item Fear of Cancer Recurrence Inventory (FCRI), the most comprehensive multi-dimensional scale of FCR available, and suitable for patients with mixed cancer diagnoses. The primary outcome variables will be specified as the (i) total FCRI score, and (ii) Severity Subscale of the FCRI.
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Assessment method [1]
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Timepoint [1]
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At completion of treatment and 3 and 6 months later
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Secondary outcome [1]
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Cancer-specific distress will be assessed with the 15 item Impact of Event Scale (IES) with two subscales: intrusion and avoidance.
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Assessment method [1]
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Timepoint [1]
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At completion of treatment and 3 and 6 months later
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Secondary outcome [2]
296339
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Quality of Life (QoL) will be assessed with the AQoL8D, which is a health-related QOL instrument specifically developed for use in people with mental health problems. It is sensitive to change after psychosocial interventions since it includes domains such as depression/anxiety, social function, self esteem. The AQoL8D also allows the calculation of quality-adjusted-life years (QALYs) to be determined (through the health state utility scoring algorithm).
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Assessment method [2]
296339
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Timepoint [2]
296339
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At completion of treatment and 3 and 6 months later
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Secondary outcome [3]
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Economic outcomes, including service use, out of pocket patient and carer costs, and cost of the intervention will be estimated using two methods: 1) Self-report questions regarding use of resources; 2) Research team and provider records relating to delivery of the intervention.
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Assessment method [3]
296340
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Timepoint [3]
296340
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At study completion
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Eligibility
Key inclusion criteria
Eligible patients will have a confirmed past diagnosis of Stage 0-III breast cancer, Dukes stage A-C (corresponding to TNM staging I – IIB and IIIA) colorectal cancer, or stage IA – IIB melanoma. Additional eligibility criteria include being treated with curative intent; completed all hospital-based adjuvant treatments at least 2 months prior to and not more than 5 years prior to study entry; disease free; a score in the clinical range (13 or more) on the Severity Subscale of the Fear of Cancer Recurrence Inventory (FCRI), and able to read and write English and give informed consent.
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Minimum age
18
Years
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Maximum age
85
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Current severe major depression, active psychotic illness or other psychiatric/cognitive condition which would impair the ability to give informed consent.
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Study design
Purpose of the study
Educational / counselling / training
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
The proposed study is a randomised controlled trial, with patients randomly allocated to receive either the conquer fear intervention to reduce the impact of fear of cancer recurrence or relaxation training. Randomization will be performed by a statistician blinded to the identity of participants and therapists, using computer-generated random numbers, and patients will be allocated to the intervention arm or comparison group. The treatment team (other than psychologist) will be blinded to treatment allocation.
Participating sites will identify and write to all potentially eligible cancer survivors informing them of the study and inviting them to indicate interest and permission for the research team to contact them. The study team will contact interested patients to screen them for eligibility, obtain verbal consent, and mail the baseline assessment. All participants will provide written informed consent. Sites will be reimbursed for the psychologists time spent delivering the study interventions. Once recruited, patients will be assigned to a therapist (randomly, if more than one psychologist at their treatment centre is participating) and commence Conquer Fear or relaxation training sessions.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Computer generated random numbers will be used to generate the sequence in which subjects are randomised.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
The proposed study is a randomised controlled trial, with randomisation at the patient level.
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/06/2012
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Actual
19/02/2013
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Date of last participant enrolment
Anticipated
31/01/2016
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Actual
31/01/2016
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Date of last data collection
Anticipated
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Actual
8/11/2016
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Sample size
Target
246
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Accrual to date
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Final
222
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,WA,VIC
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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Cancer Australia
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Address [1]
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Level 14, 300 Elizabeth Street, SURRY HILLS NSW 2010
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Country [1]
284820
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Australia
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Funding source category [2]
284821
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Charities/Societies/Foundations
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Name [2]
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Beyondblue
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Address [2]
284821
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PO Box 6100
Hawthorn West VIC 3122
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Country [2]
284821
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Australia
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Funding source category [3]
284822
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Charities/Societies/Foundations
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Name [3]
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National Breast Cancer Foundation
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Address [3]
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Level 9, 50 Pitt Street, SYDNEY NSW 2000
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Country [3]
284822
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Australia
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Primary sponsor type
University
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Name
University of Sydney
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Address
Research Office, Jane Foss Russell Building (G02), University of Sydney NSW 2006
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Country
Australia
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Secondary sponsor category [1]
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Other Collaborative groups
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Name [1]
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Psycho-Oncology Co-operative Research Group (PoCoG)
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Address [1]
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PoCoG, Transient Building (F12), University of Sydney NSW 2006
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Country [1]
283702
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Australia
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Other collaborator category [1]
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Individual
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Name [1]
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Dr Belinda Thewes
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Address [1]
260589
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Centre for Medical Psychology and Evidence-based Decision Making, Transient Building (F12) University of Sydney NSW 2006
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Country [1]
260589
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Australia
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Other collaborator category [2]
260590
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Individual
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Name [2]
260590
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A/Prof Jane Turner
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Address [2]
260590
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Department of Psychiatry, University of Queensland, Brisbane St Lucia, QLD 4072
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Country [2]
260590
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Australia
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Other collaborator category [3]
260591
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Individual
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Name [3]
260591
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Dr Jemma Gilchrist
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Address [3]
260591
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Psycho-Oncology Department, Westmead Cancer Care Centre, Hawksbury Road Westmead NSW 2145
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Country [3]
260591
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Australia
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Other collaborator category [4]
260592
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Individual
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Name [4]
260592
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Prof Afaf Girgis
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Address [4]
260592
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Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, Locked Mail Bag 7017, Liverpool BC NSW 1871
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Country [4]
260592
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Australia
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Other collaborator category [5]
260593
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Individual
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Name [5]
260593
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Prof Louise Sharpe
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Address [5]
260593
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School of Psychology, Brennan McCallum Building (A18) University of Sydney NSW 2006
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Country [5]
260593
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Australia
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Other collaborator category [6]
260594
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Individual
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Name [6]
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Dr Melanie Bell
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Address [6]
260594
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Psycho-Oncology Co-operative Research Group, Transient Building (F12) University of Sydney NSW 2006
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Country [6]
260594
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Australia
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Other collaborator category [7]
260595
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Individual
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Name [7]
260595
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Aprof Jane Beith
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Address [7]
260595
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Dept of Medical Oncology, Royal Prince Alfted Hospital, Missenden Road Camperdown NSW 2050
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Country [7]
260595
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Australia
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Other collaborator category [8]
260596
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Individual
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Name [8]
260596
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Dr Cathy Mihalopoulos
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Address [8]
260596
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School of Health and Social Development
Level 5, Building J
Deakin University
221 Burwood Highway
Burwood VIC 3125
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Country [8]
260596
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Australia
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Other collaborator category [9]
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Individual
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Name [9]
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Ms Rachel Brebach
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Address [9]
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School of Psychology
Brennan MacCallum Building (A18)
University of Sydney NSW 2006
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Country [9]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Cancer Institute NSW Clinical Research Ethics Committee
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Ethics committee address [1]
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Cancer Institute NSW Australian Technology Park Level 9, 8 Central Avenue Eveleigh NSW 2015
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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28/04/2012
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Approval date [1]
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27/08/2012
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Ethics approval number [1]
286810
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Ethics committee name [2]
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South Eastern Sydney Local Health District HREC
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Ethics committee address [2]
291420
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Room G71 East Wing Edmund Blackett Building Prince of Wales Hospital Randwick NSW 2031
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Ethics committee country [2]
291420
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Australia
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Date submitted for ethics approval [2]
291420
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13/12/2013
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Approval date [2]
291420
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13/12/2013
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Ethics approval number [2]
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HREC/13/POWH/731
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Summary
Brief summary
Do you worry a lot about the possibility of cancer recurrence? Does this worry affect your life? Almost all cancer survivors worry from time to time about the possibility of their cancer returning. For some people these fears are frequent, very distressing and make it hard to enjoy life. If you suffer from frequent or severe worry about the possibility of your cancer coming back, and it is getting in the way of how you wish to lead your life, you may be interested to join a research study comparing two different psychological treatments to help people to better manage fear of cancer recurrence. Hospitals around Australia are conducting the study together with a team of researchers from the Psycho-Oncology Co-operative Research Group at the University of Sydney, led by Prof Phyllis Butow. Am I eligible to be involved in this study? We are seeking people over the age of 18 years who: 1) Have been diagnosed with stage 0-III breast cancer, stage I-IIIA colorectal cancer, or stage IA-IIB melanoma; 2) Have completed hospital-based treatments (surgery, chemotherapy, or radiotherapy) more than 2 months and less than 5 years ago; 3) Have no medical evidence of active cancer; 4) Can speak and read English well; 5) Experience a high level of worry about their cancer coming back What does this study involve? If you decide to participate in the study, you will receive a psychological treatment focused on either the more physical (tension) aspects or the more mental (worry) aspects of fear of cancer recurrence. Which treatment you get, will be decided randomly (by chance). Both treatments will be provided free of charge and will involve attending five individual sessions with a psychologist or psychiatrist, each lasting 60-90 minutes, over a period of 10 weeks (one session per fortnight). You will also be asked to practice some of the techniques you learn during the sessions at home. In addition to attending treatment sessions, you will be asked to complete a questionnaire to evaluate how well your treatment is working at four time-points: 1) before treatment; 2) immediately after you complete treatment; 3) 3 months after you complete treatment; and 4) 6 months after you complete treatment. You may also be invited to participate in a 30-minute phone interview about your experience and satisfaction with the treatment you received. Where do I find more information? If you are interested in being involved or to find out if you are eligible please contact the research co-ordinator (Stephanie Tesson) at the University of Sydney by phoning 02 9351 4518 or emailing conquer.fear@psych.usyd.edu.au This study has been approved by the Human Research Ethics Committee South Eastern Sydney Local Health District (SESLHD)
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Trial website
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Trial related presentations / publications
Book Chapter Butow P, Fardell J, Smith AB. Fear of cancer recurrence. In Holland J et al. (Eds.) Psycho-Oncology 3rd Edition (pp. 625-629). New York: Oxford University Press, 2015. Journal Articles Costa, D., Smith, A., and Fardell, J. The sum of all fears: Conceptual challenges with measuring fear of cancer recurrence. Supportive Care in Cancer 2016; 24:1-3. Impact Factor: 2.364. Fear of cancer recurrence: An overview and Australian perspective. Butow P, Fardell, J, Smith, A. Cancer Forum 2015; 39(2): 95-100. H Index: 10. Smith AB, Thewes B, Turner J, Gilchrist J, Fardell J, Sharpe L, Bell M, Girgis A, Grier M, Byrne D, Clutton S, Butow P. (2015) Pilot of a theoretically grounded psychologist-delivered intervention for fear of cancer recurrence (Conquer Fear). Psycho-Oncol, Published online 1 March 2015. Fardell JE, Thewes B, Turner J, Gilchrist J, Sharpe L, Smith AB, Girgis A, Butow P. Fear of cancer recurrence: A theoretical review and novel cognitive processing formulation. J Cancer Surviv. Published online 19/1/2016. DOI 10.1007/s11136-015-1088-2. Butow P, Bell M, Smith A, Fardell J, Thewes B, Turner J, Gilchrist J, Beith J, Girgis A, Sharpe L, Shih S, Mihalopoulos C, members of the Conquer Fear Authorship Group. (2013) Conquer fear: protocol of a randomised controlled trial of a psychological intervention to reduce fear of cancer recurrence. BMC Cancer, 13(1):201. Conference Presentations Butow, P. A randomised controlled trial (RCT) of a psychological intervention (Conquer Fear) to reduce clinical levels of fear of cancer recurrence in breast, colorectal, and melanoma cancer survivors. Clinical Oncology Society of Australia 43rd Annual Scientific Meeting, Gold Coast, Australia, November 2016. Turner, J. A randomised controlled trial (RCT) of a psychological intervention (Conquer Fear) to reduce clinical levels of fear of cancer recurrence in breast, colorectal, and melanoma cancer survivors. 18th International Psycho-Oncology Society World Congress, Dublin, Ireland, October 2016. Tesson, S. A randomised controlled trial of a psychological intervention to reduce fear of cancer recurrence. Sydney Cancer Conference, Sydney, Australia, September 2016. Sharpe, L. Treatment of chronic physical health problems using cognitive behaviour therapy. World Congress of Behavioural and Cognitive Therapies, Melbourne, Australia, June 2016. Turner, J. Fear of cancer recurrence. European Society of Medical Oncology Asian Meeting. Singapore, December 2015. Smith AB, Thewes B, Turner J, Gilchrist J, Fardell J, Girgis A, Sharpe L, Beith J, Bell M, Mihalopoulos C, Brebach R, Shih S, Butow P. Can you really conquer fear? Development and evaluation of a novel approach to managing cancer survivors’ fear of recurrence in a parallel randomised controlled trial. Victorian Psycho-Oncology Research Conference, Melbourne, Australia, Oct 2015. Smith AB, Fardell J, Thewes B, Coll J, Turner J, Gilchrist J, Girgis A, Sharpe L, Beith J, Mihalopoulos C, Butow P. Screening for clinical levels of fear of cancer recurrence using the Fear of Cancer Recurrence Inventory Severity Subscale: Lessons learnt from the Conquer Fear study. Second International Fear of Cancer Recurrence Symposium, Ottawa, Canada, Aug 2015. Butow P, Turner J, Gilchrist J, Fardell J, Smith AB, Girgis A, Sharpe L, Beith J, Bell M, Mihalopoulos C, Brebach R, Shih S, Thewes B, . Evaluation a theoretically grounded psychologist-delivered intervention for fear of cancer recurrence (Conquer Fear): Pilot results and RCT progress update. Second International Fear of Cancer Recurrence Symposium, Ottawa, Canada, Aug 2015. Turner J, Butow P, Thewes B, Gilchrist J, Beith J, Girgis A, Sharpe L, Bell M, Mihalopoulos C, Shih S, Smith A, Fardell J. They say the odds are good, but I can’t stop thinking about it: Responding to Fear of Cancer Recurrence. Asia-Pacific Journal of Clinical Oncology 2014; 10 (Suppl. 8):77-124. Fardell, J.E. (2013) Psycho-oncology clinicians in research: the importance and methodological considerations of psycho-oncology randomised control trials. Psycho Oncology Co-operative Research Group Professional Day at the Clinical Oncology Society of Australia (COSA), 40th Annual Scientific Meeting, Adelaide, Australia Butow, P., Thewes, B., Turner, J., Gilchrist, J., Bell, M., Smith, A., Fardell, J., Beith, J., Girgis, A., Sharpe, L., Shih, S., Mihalopoulos, C., Fairclough, M., Francis, A. and Grier, M. (2013). Conquer Fear a randomised trial evaluating psychological interventions to reduce fear of cancer recurrence. Research Excellence in Cancer Care - The Inaugural Research Symposium to Support the Diamond Standard of Cancer Care, Royal Brisbane and Women’s Hospital, Australia. Thewes, B., Bell, M., Smith, A., Fardell, J. E., Turner, J., Butow, P. and the PoCoG FCR Working Group (2012). Conquer Fear: The development and pilot testing of a novel psychological treatment for fear of cancer recurrence. . Paper presented at the IPOS 14th World Congress and COSA's 39th Annual Scientific Meeting, Brisbane, Australia. Thewes, B., Bell, M., Smith, A., Fardell, J. E., Turner, J., Butow, P. and the PoCoG FCR Working Group (2012). Conquer Fear: The development and pilot testing of a novel psychological treatment for fear of cancer recurrence. Paper presented at the Sydney Cancer Conference, Sydney, Australia. Workshops Butow P, Turner J, Sharpe L. Fear of recurrence: a novel framework and therapy model. Workshop presented at International Psycho-Oncology Society World Congress, Washington, August 2015. Butow P, Turner J, Sharpe L. Fear of recurrence: a novel framework and therapy model. Workshop presented at International Psycho-Oncology Society World Congress, Washington, August 2015. Butow P, Turner J. Fear of recurrence: a novel framework and therapy model. Workshop presented at International Psycho-Oncology Society World Congress, Lisbon, October 2014.
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Public notes
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Contacts
Principal investigator
Name
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Prof Phyllis Butow
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Address
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PoCoG, Level 6 North
Chris O'Brien Lifehouse (C39Z)
University of Sydney NSW 2006
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Country
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Australia
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Phone
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+61 2 9351 2859
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Ms Stephanie Tesson
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Address
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PoCoG, Level 6 North
Chris O'Brien Lifehouse (C39Z)
University of Sydney NSW 2006
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Country
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Australia
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Phone
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+61 2 9351 2518
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Fax
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+61 2 90365292
Query!
Email
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[email protected]
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Contact person for scientific queries
Name
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Ms Stephanie Tesson
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Address
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PoCoG, Level 6 North
Chris O'Brien Lifehouse (C39Z)
University of Sydney NSW 2006
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Country
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Australia
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Phone
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+61 2 9351 2518
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Fax
8036
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+61 2 90365292
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF