Fears of recurrence (FoR) are likely to be experienced by most people who have been treated for cancer and around a third report that ‘they worry very much’. People with excessive fears of recurrence can become preoccupied and report excessive personal checking, frequent intrusive thoughts throughout the day and night, poor sleep, high levels of anxiety and lower quality of life. However, these fears are rarely addressed in clinical practice. Clinical nurse specialists (CNSs) routinely provide emotional and psychological support for people with cancer, yet evidence suggests that even when people express FoR to CNSs these are not always addressed.
Humphris and Ozakinci (2008) have developed an intervention for addressing fear of recurrence based on Leventhal’s self-regulation model. The AFTER intervention demonstrates significant reduction in fear. AFTER represents A=Assessment, F=Family, T=Thoughts and feelings, E=Examination and R= Returning of cancer and review. Having identified an effective tool for managing FoR there is now an imperative to embed it in practice. This raises a number of challenges around resource and questions as to who should deliver the intervention. While those with severe FoR may require referral to clinical psychologists, mild to moderate FoR can be debilitating without being regarded as sufficiently severe to warrant referral. A brief version of the AFTER has been developed to support those with mild to moderate FoR, which can be delivered by health professionals other than clinical psychologists.
An appropriate part of the work of the CNS is to enable people to discriminate between unrealistic fears and signs and symptoms of actual recurrence, to ensure early presentation of new disease. However, it is unclear whether CNSs would be willing or able to deliver the Mini-AFTER intervention. This presentation will report on current work in the UK to explore questions about how CNSs address and manage FoR.