Oral Presentation NSW State Cancer Conference 2023

Short-term effects of a stepped-care model to address fear of cancer recurrence in patients previously diagnosed with early-stage (0-II) melanoma. (#61)

Jake R Thompson 1 2 , Andrea L Smith 3 4 , Serigne N Lo 1 2 , Nadine A Kasparian 5 6 , Robyn PM Saw 1 7 , Mbathio Dieng 2 , Linda Seaman 8 , Linda K Martin 1 9 , Pascale Guitera 1 7 , Donna Milne 10 , Helen Schmid 2 4 , Anne E Cust 1 4 , Iris Bartula 1 2
  1. Melanoma Institute Australia, Wollstonecraft, NSW, Australia
  2. The University of Sydney, Sydney, NSW, Australia
  3. Australian Institute of Health Innovation, Sydney, NSW, Australia
  4. The Daffodil Centre, Sydney, NSW, Australia
  5. University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
  6. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
  7. Royal Prince Alfred Hospital, Sydney, NSW, Australia
  8. Consumer Representative, Sydney, NSW, Australia
  9. University of New South Wales, Sydney, NSW, Australia
  10. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

Introduction:

Fear of cancer recurrence (FCR) is the most frequently reported challenge faced by people diagnosed with melanoma and is associated with lower health-related quality of life and increased anxiety and depression. With the number of Australian’s diagnosed with melanoma expected to double in the 2021-2030 period, we aimed to pilot the implementation of the Melanoma Care Program into routine clinical practice using screening and a stepped care model.

Methods:

Early-AJCC stage (0-II) melanoma patients completed FCR screening using the Fear of Cancer Recurrence Inventory 9-item Severity Short-Form (FCRI-9) and were offered differing intensity of psychological support based on their reported FCR score. Patients with no/low FCR (score: 12) received routine care. Patients with moderate FCR (score: 13-21) were offered a copy of the psychoeducational Melanoma: Questions and Answers (MQA) booklet and 3 psychotherapeutic telehealth sessions. Patients with severe FCR (score: 22) were offered the MQA booklet and 5 psychotherapeutic telehealth sessions. Participants completed the FCRI-9 again one week after their final telehealth session. Linear mixed-effects regression was conducted to analyse the impact of the Melanoma Care Program on FCR in participants who received the intervention, with the number of telehealth sessions received included as an exploratory variable. Mean change over time with accompanying 95% confidence intervals (CI) were calculated, with statistical significance determined at α=0.05.

Results:

A total of 145 early-stage melanoma patients participated in this study and completed FCR screening. Of these, 112 (77%) reached the clinical cut-off point to receive the intervention, 55 (49%) reporting moderate and 57 (51%) severe FCR. Participants who received the intervention reported a statistically significant improvement in FCR one-week post-intervention (adjusted mean change: -3.80; 95% CI: -4.67, -2.92; p<0.001). When stratified, participants who reported moderate FCR (adjusted mean change: -2.87; 95% CI: -4.11, -1.62; p<0.001) and severe FCR (adjusted mean change: -4.85; 95% CI: -6.01, -3.69; p<0.001) at baseline reported a statistically significant improvement in FCR post-intervention.

Conclusions:

The Melanoma Care Program is effective when implemented in routine clinical practice using a stepped-care approach, where patients are screened, and the intensity of the intervention is determined based on baseline FCR severity.