A Blended e-Health Intervention for Fear of Progression in Advanced GYN Cancer

Up to 70% of patients with advanced cancer experience significant levels of FOP. FOP is the most common psychosocial concern among GYN and other cancer survivors. Current FOP interventions are time, resourceintensive, and administered by psychologists, limiting access and sustainability. Further, most have focused on early-stage cancer. Advanced cancer patients are severely understudied. The “Day by Day” intervention was adapted from “Conquer Fear,” which has shown effectiveness in reducing FOP in cancer survivors treated with curative intent. The proposed intervention is the first to use a blended e-Health intervention to address FOP in patients with advanced cancer. Our preliminary pilot studies established feasibility of a 1:1 nurse-led, videoconferencing intervention in patients with stage III or IV gynecologic or lung. Based on our experience, we adapted the intervention to a group and online format. We developed didactic, patient, and additional mindfulness practice videos hosted on the website. We tailored the intervention to patients with advanced cancer, with a focus on Acceptance and Commitment therapy because it addresses common existential concerns and valuesdriven goals and actions. We will conduct a randomized pilot study to test the feasibility and efficacy of this blended e-Health intervention in patients with stage 3 or 4 gynecologic cancer. The intervention consists of 2 group videoconferencing sessions, 3 web-based self-study modules, and a brief check-in call with the facilitator (nurse or social worker). The intervention modules focus on the cancer experience, values and goal setting, unhelpful beliefs about worry, skills practices, managing triggers, and important conversations. The Enhanced Usual Care group will be delivered in the same format and consists of education only. Sessions focus on the stress response, clinical trial participation, identifying reliable information online, and healthy lifestyle education. Feasibility measures include enrollment rate, attrition, and attendance. Participants complete questionnaires assessing FOP, distress, anxiety, metacognitions, and mindfulness at baseline, 6, and 10 weeks and an evaluation survey at T2 or drop-out. Given the increasing number of survivors needing help with FOP and the lack of trained clinicians, a multidisciplinary approach is needed to meet the demand. Implementing brief nurse and social worker guided FOP interventions may be scalable and address barriers to accessing treatment. Studies incorporating novel delivery models such as blended models will facilitate access and sustainability. Further, including a group component can foster support and may be less resource intensive. This blended eHealth intervention may offer high applicability to underserved communities where mental health providers are scarce. Use of an e-health platform with group support may facilitate access, engagement, and sustainability.