Group-based psychological interventions for fear of cancer recurrence: A scoping review protocol

Introduction

Fear of cancer recurrence (FCR) describes the fear, worry or concern relating to the possibility that cancer will return¹. Persistent and excessive FCR can be highly distressing, chronic and disabling, with moderate to high levels impacting 59% of cancer survivors². Low levels of FCR are generally transient and can be managed very well with support from family, friends and the nursing team³. Higher levels are associated with persistent worry, preoccupation with body checking and frequent contact with healthcare providers seeking reassurance⁴. This results in impaired quality-of-life, poor psychosocial adjustment, significant emotional distress and higher healthcare costs^5,6. FCR is more prominent in younger adult cancer survivors (88%) and in women, with no significant association with time from diagnosis^7,8. This suggests that without treatment or intervention, FCR likely persists over time. FCR is among the most commonly reported concerns by cancer survivors and remains the largest unmet need for these patients^8–10.

Several psychological models have been developed that have informed interventions for FCR including mindfulness-based therapy, acceptance and commitment therapy, Cognitive Behavioural therapy and psychoeducation¹⁰. Meta-analytic findings suggest that contemporary Cognitive Behavioural Therapies, focusing on cognitive processing and metacognitions are particularly effective in reducing FCR. They are promising both in terms of effectiveness and cost-effectiveness from reducing psychological distress and FCR-related healthcare costs^11–13. While effective FCR psychological interventions have been developed, most oncology services have limited resources to deliver these therapies to meet the needs of the growing number of cancer survivors. There is a need to develop feasible ways to deliver evidence-based approaches for the management of FCR. These may include self-guided psychoeducational literature, online resources, telephone-based psychotherapy sessions and one-to-one or group-based consultations with specialist psychologists. A stepped or matched approach model to the management of FCR is recommended that involves stratified care tailored to different levels of FCR severity^14–16. This model incorporates different specialist clinicians (Oncologist, Oncology nurse, Psych-Oncology specialist) in addition to a variety of delivery methods (online, group-based, one-to-one)^3,14. Patients with mild to moderate levels of FCR may benefit from non-mental health specialists, while patients experiencing high levels warrant individual intervention with specialist Psycho-Oncology personnel^3,15.

To date, many studies have focussed on the different psychological interventions while incorporating different delivery formats (face to face, remote online, blended)^11,16. Blended and remote online interventions provide advantages for accessibility, flexibility and cost-effectiveness while face-to-face increases adherence, reduces attrition rates and facilitates increased treatment intensity^17,18. There is a growing trend to adapt a group-based approach to many of these interventions, which can effectively maximise resources to address the needs of a greater number of cancer survivors while fostering peer support^19–21. Although a number of studies have specifically focussed on group-based interventions for FCR, there is much variation in how these programmes are delivered. This scoping review aims to explore and map the characteristics and contexts in which group based-interventions have been delivered in order to determine the feasibility and best format for future studies and implementation into clinical practice. While previous reviews examined the effectiveness of psychological interventions on FCR, this scoping review will address a gap in current evidence synthesis in relation to group-based interventions^10–12. A cursory search of the Cochrane Database, MEDLINE, PROSPERO, and Open Science Framework revealed no scoping or systematic reviews focusing specifically on the FCR group-based therapies could be located.

Objective

The purpose of this review is to identify how group-based psychological interventions for fear of cancer recurrence are delivered and integrated into clinical practice and community settings.

Review questions:

Inclusion criteria

Types of sources

Both experimental and quasi-experimental study designs including randomised controlled trials, non-randomised control trials, before and after studies and interrupted time-series studies will be considered. Analytical observational studies including prospective and retrospective cohort studies, case control studies and analytical cross-sectional studies will be included for consideration. In addition, observational study designs including case series, individual case reports and descriptive cross-sectional studies will be considered. Systematic reviews that meet the inclusion criteria will also be considered. This scoping review will exclude literature sources from conference material, protocols, non-cancer literature, dissertations and book reviews.

Methods

The Joanna Briggs Institute (JBI) methodology will be followed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) will guide the reporting of the scoping review^22,23. The protocol will be registered on Open Science Framework.

Search strategy

The search strategy will be determined by the research team in consultation with a specialist university librarian. It will be peer reviewed by an independent specialist librarian. The aim will be to identify both published and unpublished studies. Reference lists from eligible studies and relevant journals will be checked to identify any relevant studies that may have been missed through the electronic searches. The search will not be limited by study design or year but will be limited to papers available only in the English language. Databases to be searched include EMBASE, MEDLINE, CINAHL Ultimate (EBSCO), PsycInfo, Web of Science and Google Scholar. An internet search of the first five pages of www.google.com will be carried out to identify any relevant grey literature.

Search terms are outlined in the sample search strategy in Table 1.

Source of evidence selection

The results of the search will be collated and exported to Covidence and duplicates will be removed²⁴. Following a pilot test, titles and abstracts will be screened by three independent reviewers (COB, AD, BOR) for assessment against the inclusion criteria. All titles and abstracts, and remaining full texts will be screened in duplicate. COB will screen 100% of papers in all categories and the duplicate screen will be completed between AD and BOR. Reasons for exclusion of the full text citations will be recorded and reported in the scoping review. Any conflicts that arise between reviewers at this stage will be resolved through discussion between the three reviewers, and by a fourth reviewer (MP) if necessary, to reach consensus. The search selection criteria will be pilot tested with an initial review of 50 titles and abstracts. Once consensus has been reached, the search selection will begin. Full text screening will be piloted with a random representative selection of papers to reach consensus. The team will meet to discuss discrepancies and make modifications to the application of the eligibility criteria as needed.

Data extraction

Data will be extracted from papers included in the scoping review by three independent reviewers (COB, AD, BOR) using a data extraction tool developed by the reviewers adapting the TIDieR framework (Table 2)²⁵. A pilot test on the first 5 articles will be performed to determine consistency in data extraction and coding. The data extraction tool will be adjusted as appropriate during the pilot testing process and any changes will be reported in the final scoping review.

The data extracted will include author information, publication year and type, geographical location and participant characteristics (total number, mean age, gender, cancer type). Additional data to be extracted will be aligned with the objectives and questions of the review including study setting (e.g., hospital, community), intervention delivery format (e.g., face-to-face, online), level of FCR if recorded and type of psychological intervention. If appropriate, authors of papers will be contacted if additional or missing information are required.

Data analysis and presentation

Data will directly align with the scoping review objectives and questions and will be presented in tabular format, accompanied by a narrative summary. The results of the search and the study inclusion/ exclusion process will be reported in the final scoping review and presented in a PRISMA flow diagram.