Objectives: Over half of those diagnosed with ovarian cancer report high levels of fear about cancer recurring or progressing (FCR/P). Conquer Fear is an evidence-based psychological intervention developed to address FCR/P in cancer survivors. This intervention has demonstrated effectiveness in reducing FCR/P in other cancer types including melanoma, breast, and bowel. It is unclear whether Conquer Fear is effective in reducing FCR/P in advanced cancer populations. Therefore, this study aimed to assess suitability of Conquer Fear intervention content for ovarian cancer survivors.
Methods: Participants were recruited through Ovarian Cancer Australia and invited to complete an online survey and interview. The survey included demographic questions and the Fear of Progression Questionnaire (short-form) (FoP-Q-SF) and was completed prior to the interview, held online using video-conference. Interviews involved review of intervention content using think aloud methodology. Interviews were audio-recorded and transcribed verbatim. Data was analysed using thematic analysis.
Results: Twenty-seven ovarian cancer survivors participated in an interview. Median age was 60 years, and most participants (74%) were diagnosed with stage III – IV disease. Scores on the FoP-Q-SF ranged between 20 – 50 (median= 40; SD= 8.05) and 67% met the clinical cut-off (≥36) for FoP. Intervention content requiring the most significant adaptation included symptom checking and FoP content. Changes to symptom checking content was required to remove information about physical symptom checking, tailoring information to the often-vague symptoms associated with ovarian cancer. Some participants indicated concerns about mortality and communicating with others about the cancer. We identified 6 interrelated themes: death; follow-up as a safety net; life-limiting nature of ovarian cancer; symptom sensitivity; uncertainty, and trauma of reminders of the cancer experience. Fears centralised around disease progression and were driven by death-related anxiety. Ovarian cancer was perceived as life-limiting, requiring ongoing management and monitoring which contributed to overall feelings of uncertainty. Follow-up periods were short and reduced concerns associated with ambiguous symptoms which may otherwise be interpreted as evidence of disease progression. Participants (52%) indicated the intervention would be most useful soon after initial treatment completion. Participants commented on the feasibility of intervention activities and associated time-commitment.
Conclusions: Ovarian cancer survivors indicated Conquer Fear was suitable, however changes are required. Tailoring is necessary to meet the needs of those with advanced cancer, particularly in the context of content related to disease progression and time-commitment. Future research should trial the utility of this intervention in reducing FCR/P levels in survivors with advanced disease.