Investigating the effectiveness of a psycho-educational intervention to reduce fear of cancer recurrence in people at high-risk of developing another primary melanoma

Abstract

Melanoma is the fourth most common cancer in Australia and its incidence continue to increase. The diagnosis and treatment of melanoma can impact upon many aspects of an individual’s life, including psychological and emotional well-being. In recognition of the psychological consequences of melanoma, Australian and New Zealand and other international guidelines for management of melanoma recommend psychological support be available alongside clinical care. This randomised controlled trial examined the efficacy of a psycho-educational intervention to reduce fear of cancer recurrence (FCR) and improve psychological adjustment in this patient group, compared to usual care. Methods: The intervention comprised a newly developed psycho-educational resource and three telephone-based psychology sessions over a one month period, timed in accordance with dermatological appointments. Participants were randomly assigned to the intervention (n=80) or usual care (n=84). Assessments were completed at baseline, one and six months following dermatological appointments. Linear mixed models were used to examine differences between treatment and control groups for patient-reported outcomes, including FCR, anxiety, stress, depression, melanoma-related knowledge, health behaviours, satisfaction with melanoma care, unmet needs, and health-related quality of life. Results: At six months, the intervention group reported lower FCR Severity, Triggers and Distress scores than the control group in the baseline-adjusted models; the between-group mean difference was -1.9 for FCR Severity (95% CI:-3.1,-0.7; p=0.002), -2.0 for FCR Triggers (95% CI:-3.3,-0.7; p=0.003) , and -0.7 for FCR Distress (95% CI:-1.3,-0.1; p=0.03). The decrease in FCR Severity (but not Triggers or Distress) remained statistically significant after adjusting for other covariates (p=0.04). At six months, the intervention group also reported lower stress (-1.6, 95% CI:-3.1,-0.2; p=0.03) and improved melanoma-related knowledge (1.7, 95% CI:0.8, 2.6; p=0.0004) compared to controls. Conclusion: This newly-developed, evidence-based, psycho-educational intervention was effective in reducing FCR and stress, and increasing melanoma-related knowledge in people at high risk of developing another melanoma.