Our research team culturally adapted a metacognition-based, manualized ‘ConquerFear’ intervention for local cancer survivors with high fear of cancer recurrence (namely ConquerFear-HK). The ConquerFear-HK also has a less resource-intensive web-based version (eConquerFear-HK) developed by our research team for those with mild-to-moderate fear of caner recurrence. We are conducting an ongoing randomised controlled trial (RCT) to test the effectiveness of ConquerFear-HK in managing high FCR.

To date, several psychological interventions for fear of cancer recurrence are available. A novel, evidence- and theoretically-based intervention, namely ConquerFear, was recently developed to specifically target fear of cancer recurrence using the contemporary cognitive-behavioral approach. Given that beliefs about risk of cancer recurrence are not completely irrational, the ConquerFear (Hong Kong version called 'ConquerFear-HK’) intervention rather puts a focus on metacognitions (MCQ; i.e. beliefs about worry). Through face-to-face sessions led by trained therapists, the ConquerFear intervention therefore aims to help cancer patients with high FCR mainly by modifying metacognitive knowledge, disrupting maladaptive information processing, and promoting valued-based living. The potential effectiveness of ConquerFear in treating fear of cancer recurrence has been well-documented. In Chinese context, we recently developed and pilot-tested a culturally-adapted intervention version (ConquerFear-HK) for local cancer survivors with high feat, which showed that survivors receiving the ConquerFear-HK intervention had significantly improvements on fear of cancer recurrence and MCQ from pre-intervention to post-intervention.

Cancer diagnosis and its treatments often lead to the experience of physical symptoms. Unrelieved physical symptoms are distressing, potentially leading to poor long-term psychological well-being. Current guidelines recommend regular symptom screening and appropriate interventions, enabling affected cancer patients to self-manage their symptoms. However, there is no routine systematic symptom distress screening and management protocol offered in local oncology centres in HKSAR’s health care systems.  

While advanced or metastatic cancer is incurable, recent treatment advances mean many affected patients can survive longer. Psychological well-being is inevitably challenged in individuals with metastatic cancer because of the profound and diverse stresses and burdens associated with it. These invariably include physical suffering and disability, the threat of impending mortality, dramatic alterations in support needs and personal relationships, and the challenge of navigating a complex health care system and making treatment decisions that have life and death implications. While the primary task at the end of life may be to face death with comfort, dignity and a sense of meaning, those with advanced disease earlier in the illness trajectory and/or with a longer expected survival, face the simultaneous challenges of engaging in life while facing the imminence of death. Sustaining such “double awareness” is challenging and the inability to do so may lead to high fear of cancer progression. There is evidence that as high as 70% of patients with advanced cancer experience moderate to high levels of fear of cancer progression. Hence, it is imperative to develop interventions for patients in managing the challenges of advanced cancer. 

Our recent study and other studies showed that maladaptive metacognitive styles play an important role in the development of high fear of cancer recurrence. However, the current evidence only partially explained the underlying mechanism of fear of cancer recurrence.  A larger proportion of fear of cancer recurrence variability was left unexplained. To develop better interventions we must identify other potential contributing factor(s) producing fear of cancer recurrence. Intolerance of uncertainty (IU) has been linked to anxiety-related disorders. IU involves beliefs about the importance of having certainty in life and one’s ability to unmanage unpredictability or ambiguity. Research suggests that IU plays an important role in the acquisition and maintenance of worries. Persistence of IU may result in biased information processing in the context of ambiguity, threatening interpretations of uncertainty and negatively reinforcing certainty-seeking behaviors. Given all cancer survivors face the uncertainty of cancer recurrence, the ability of individuals to cope with that uncertainty may have impact on fear of cancer recurrence. However, little is known about the role of IU in fear of cancer recurrence. Therefore, we are conducting a longitudinal study, which aims to examine the role of IU and negative metacognitive beliefs in fear of cancer recurrence among cancer survivors. 

In 2017, Professor Phyllis Butow of the University of Sydney, Australia and her research team developed an intervention called, ‘Conquer Fear’ (Hong Kong version called 'ConquerFear-HK’:「慮而不累」自主計劃課程), based upon Metacognitive Therapy, and incorporating components of the Common Sense Model of Illness Representation and Acceptance and Commitment Therapy. It was designed specifically to reduce fears of cancer recurrence and its effects in cancer survivors. 

Chemotherapy-induced peripheral neuropathy (CIPN), chemical nerve damage leading to sensation disturbances, is a known common side effect of many chemotherapy drugs used in the treatment of cancer and can be a significant dose-limiting factor in chemotherapy treatment. CIPN can be intrusive and impair activities of daily living and health-related quality of life. CIPN affects up to 68% of cancer patients within the first month of chemotherapy, with 30% of patients still affected after six months or longer. A significant risk factor for developing CIPN is chemotherapy drug type and cumulative dosage; but other risk factors are also implicated such as older age, history of neuropathy, chemotherapy cycles received and symptom burden. While the risk factors for developing CIPN are becoming better understood, it is unclear why some patients recover from CIPN and others experience CIPN in the longer-term. 

Our recent study estimated that respectively, 26% and 11.2% of local cancer survivors were in subclinical and clinically-significant FCR group ranges. Understanding what might distinguish clinical from subclinical and nonclinical levels of FCR would greatly benefit early identification and perhaps therapeutic intervention for preventing progression of FCR to a clinical level, as it can inform who to target and what kind of intervention or information to provide.

Sleep disturbance has been reported to be highly prevalent in cancer patients during cancer treatment and survivors of cancer continue to experience chronic sleep disturbance following the cessation of treatment. Reported up to 79% in cancer patients during active treatment, and up to 51% following treatment at 9 years post diagnosis, sleep disturbance continues to place significant burden on cognitive, social and affective functioning. Another highly prevalent variable that has been commonly reported to co-occur with sleep disturbance for patients with cancer is psychological distress. 34.3% of cancer patients that experienced high distress also appeared to experience sleep disturbance.

According to the cancer survivorship care quality framework, there are five domains which are essential to address cancer survivors’ needs including (1) prevention and surveillance for recurrences and new cancers, (2) surveillance and management of physical effects, (3) surveillance and management of psychosocial effects, (4) surveillance and management of chronic medical conditions, and (5) health promotion and disease prevention. Locally, domains 1 and 4 are being addressed during the routine clinical follow-ups, but there is no systematic approach to address domains 2, 3, and 5. Hence, our cancer survivorship care programme in JCICC focuses to fill the service gaps. Based on the framework for cancer survivorship care quality published recently, we developed a multidisciplinary based cancer survivorship clinic targeting cancer patients at post-treatment survivorship. The multidisciplinary team consists of an APN nurse practitioner, a dietitian, an exercise physiologist and a psychologist/counsellor. During the visit, participants receive a personalized (1) assessment and recommendation on managing physical and psychological symptoms, (2) assessment and recommendation on dietary advice, (3) assessment and recommendation on physical activity, and (4) advice on managing potential psychosocial issues. This 120-minutes survivorship care programme adopts a self-management framework emphasizing the five core skills of problem-solving, decision making , resource utilisation, communication with health care professionals, and action planning.