Abstract
Abstract Background Fear of recurrence (FoR) is a prevalent concern among breast cancer survivors (BCS) yet few accessible interventions exist. This study evaluated a targeted eHealth intervention, “FoRtitude,” to reduce FoR using cognitive behavioral skills training and telecoaching. Methods BCS (N = 196) were recruited from an academic medical center and 3 National Cancer Institute Community Oncology Research Program community sites, had stage 0-III breast cancer, were 1-10 years post-primary treatment, with moderate to high FoR and familiarity with the internet. Using the Multiphase Optimization Strategy, participants were independently randomized to three cognitive behavioral skill (Relaxation, Cognitive restructuring, Worry practice) versus an attention control condition (health management content; HMC), and to telecoaching (motivational interviewing) versus no telecoaching. Website content was released across 4 weeks and included didactic lessons, interactive tools, and a text-messaging feature. BCS completed the Fear of Cancer Recurrence Inventory (FCRI) at baseline, 4 and 8 weeks. FCRI scores over time were compared using mixed-effects models. All statistical tests were 2-sided. Results FCRI scores decreased statistically significantly from baseline to post-intervention (T0=53.1 [SD = 17.4], T2=41.9 [SD = 16.2]; p < 0.001). The magnitude of reduction in FCRI scores was comparable across CBT and attention control HMC conditions and was predicted by increased self-efficacy. Telecoaching was associated with lower attrition and greater website use (mean adherence score = 26.6 [SD = 7.2] vs. 21.0 [SD = 10.5]; p < 0.001). Conclusions BCS experienced statistically significant reductions in FoR post-intervention, but improvements were comparable between CBT and attention controls. Telecoaching improved adherence and retention. Future research on optimal integration of CBT and HMC, dose, and features of eHealth delivery that contributed to reducing FoR is needed. In the COVID-19 era, remote delivery has become even more essential for reaching survivors struggling with FoR.
