CAPO Digest

CAPO Digests are summaries of recent psychosocial oncology research which have published in peer-reviewed journals in and out of the main psychosocial oncology outlets that may be of interest to CAPO members. We hope you enjoy these Digests. If you are interested in submitting a CAPO Digest please contact the CAPO office at [email protected].

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  • 10 Sep 2020 8:34 AM | Anonymous

    Digest Commentator: Dr. Violet D'Souza, PhD, MS, MSc, BDS. Research Associate, Faculty of Dentistry, University of Toronto


    Cancer disparity continues to exist worldwide, affecting those with limited access to care, especially those living in rural areas. Compared to those living in urban areas, rural cancer survivors are less informed and experience higher levels of anxiety and distress, non-cancer-related comorbidities, and mortality. The study described the common health information needs of breast, prostate, and colorectal cancer survivors living in rural areas.


    This cross-sectional study was conducted with breast, prostate, and colorectal cancer survivors who received treatment at the Wake Forest Baptist Comprehensive Cancer Center in North Carolina. Participants were between two to five years post-diagnosis, at least 40 years of age, spoke English, and lived in a small town or rural area. The rurality was defined based the Zip code. The data were collected through a mailed/telephone-administered survey, which included 23 health information needs questions (binary outcomes) on follow-up care topics under eight domains: tests and treatment, side effects and symptoms, emotional and interpersonal needs, health promotion, fertility, occupation, and insurance. A large proportion of the questions were taken from a National Cancer Institute study on health information needs in adult cancer survivors.


    Of the contacted 345 cancer survivors, 170 with complete data were included in the analyses. Of them, 74 had prostate cancer, 69 had breast cancer, and 27 had colorectal cancers. The most common information needs were about side effects and symptoms (58%), health promotion (54%), tests and treatment (41%), decreasing the risk of future cancers (36%), nutrition and diet (30 %), weight (26 %), and physical fitness (25 %). Furthermore, over 25% reported needing more information about symptoms, late and long-term side effects, how to deal with fatigue, and when to seek medical attention. The number of endorsed needs were significantly higher for younger participants, those belonging­­­­ to an ethnic minority, the less educated, and the financially stressed when compared with older participants who were not a member of an ethnic minority, possessed higher levels of education, and were not financially stressed.

    Why I like this article:

    The findings of this study are valuable given the paucity of literature on rural cancer survivors. Indeed, this is one of the largest studies ever conducted on rural cancer survivors. This study helps to identify vulnerable survivors among those living in rural areas: those with a younger age, lower education, lower income, and ethnic minority members. The side-effect-related questions were endorsed by 20-30% of participants, suggesting their value in exploring the unmet informational needs of cancer survivors. Given the differences in the healthcare system and demographics between the US and Canada, it might be interesting to explore them in Canadian cancer survivors.


    Even though risk cannot be estimated in cross-sectional studies, the authors of this study used risk ratios as the measure of effects.  

    Original article:

    Palmer NR, Avis NE, Fino NF, Tooze JA, Weaver KE. Rural cancer survivors' health information needs post-treatment. Patient Educ Couns. 2020;103(8):1606-14.

    Journal website:

  • 26 Jun 2019 12:20 PM | Deleted user

    Digest Commentator: Georden Jones, Ph.D. Student in Clinical Psychology, University of Ottawa, supervised by Dr. Sophie Lebel

    Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Cancer survivors are faced with multiple physical and psychological symptoms which significantly impact their quality of life. Rehabilitation programs including physical and psychological components have demonstrated effectiveness to improve patients’ function and return to normal lives, however little is known about optimal duration of rehabilitation programs and factors associated with clinically relevant change. This study aimed to assess outcomes (health-related quality of life (HRQOL), fatigue, and level of physical activity) following a one-week Inpatient Educational Program (IEP) and investigate factors associated with clinically relevant change. 

    Breast, prostate and gastrointestinal patients who were diagnosed within the past ten years and referred to the IEP at The Norwegian Resource Center for Coping with Cancer (Montebello-Center) were invited to participate in the study. A Norwegian general population sample (NORMS) was used as a comparison group. The IEP was offered over 6 days for a total of 30 hours and aimed to improve participants’ level of coping with cancer-specific health problems and to motivate the participants to adopt a healthy lifestyle. The IEP was facilitated by a multidisciplinary healthcare team and was comprised of lectures (50-55%), guided group physical activity (20-25%), and group sessions (25%). Topics included: cancer and its treatment, risk of adverse effects, work, social resources and support, sexuality, psychological reactions, and lifestyle.

    Participants completed questionnaires prior to the IEP (T0) and three months post-IEP (T1). The questionnaire package included sociodemographic and medical questions, the Fatigue Questionnaire, the Medical Outcomes Study Short Form 36 (SF-36), and the Nord-Trondelag Health Study Physical Activity Questionnaire (HUNT 1 PA-Q).

    Of the 482 patients who were invited to participate, 332 (69%) agreed. At T1 235/482 (49%) participants completed pre and post measures. The median age of participants was 59.4 y, 63% of participants were female, 57% were diagnosed with breast cancer, 32% prostate cancer, and 11% gastrointestinal cancer. At both time points, participants had higher levels of fatigue and lower levels of HRQOL than the NORMS. Females showed significant changes in physical and total fatigue and in general health and vitality. Males showed improvement in role limitations due to physical problems. No changes were found in level of physical activity. Clinically relevant improvements on significant outcomes ranged from 30-36% and higher education and relapse or progression before T0 were associated with higher improvement in total fatigue scores for females. Study limitations include the lack of a control group, low participation rates at T1 (49%), and the sample may be more representative of females diagnosed with breast cancer.

    Why I liked this article:
    This study demonstrated that short-term rehabilitation programs may be effective in improving psychosocial outcomes for cancer survivors and that tailoring content and activities by gender may be needed to target specific outcomes.

    Health rehabilitation programs are available in Canada for diverse chronic illnesses such as cardiac illnesses, stroke, and acquired brain injuries whereas such programs are less common in oncology. However, oncology rehabilitation programs are more commonly offered in other Western countries such as Norway. This raises questions for me 1) Does the Canadian healthcare system perceive cancer more as an acute illness compared to other countries? 2) Could moving towards a rehabilitation model of cancer survivorship care improve survivors’ transition from tertiary to primary care in the Canadian healthcare system?

    Citation of original article: Gjerset, G. M., Kiserud, C. E., Loge, J. H., Fosså, S. D., Wisløff, T., Gudbergsson, S. B., ... & Thorsen, L. (2019). Changes in fatigue, health-related quality of life and physical activity after a one-week educational program for cancer survivors. Acta Oncologica, 1-8.

    Journal website:

  • 29 May 2019 1:18 PM | Deleted user

    Digest Commentator(s): Jonathan Avery, Ph.D., Post-Doctoral Research Fellow, Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network, Toronto)

    Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    In caring for patients with advanced cancer, there may come a time when clinicians have to tell their patients that tumor-directed treatments are no longer effective, and the side-effects and complications outweigh the benefits. In such cases, a timely decision to stop this type of treatment is associated with better patient outcomes. However, empirical research has demonstrated a tendency towards more aggressive tumor directed therapy closer to end of life (EOL) particularly in the adolescent and young adult (AYA) population. In the article “Rather one more chemo than one less. . .”: Oncologists and Oncology Nurses’ Reasons for Aggressive Treatment of Young Adults with Advanced Cancer, Laryionava et al. explored the reasons as to why this tendency occurs. 

    Twenty-nine qualitative face-to-face semi-structured interviews were conducted with oncologists (n= 22) and nurses (n= 7) working at the Department of Hematology & Oncology at the University Hospital of Munich, Germany. The sample consisted of fellows (n= 13; 45%), senior physicians (n= 9; 31%), and nurses (n= 7; 24%), who varied in their working experience from 8 months to 34 years. Their age range was 22–64 years.  An interview guide was developed that asked specific questions and probes about oncologists and oncology nurses’ views on treatment decisions with young adult patients with advanced cancer. Interviews were analyzed using the grounded theory approach.

    The authors highlight three themes that explain the tendency for more aggressive treatments with AYA closer to EOL: 1) Patient’s preference for further treatment; 2) Oncologists and nurses’ perception of unfairness of dying at a young age; 3) Oncologist’s identification with patients.

    Why I liked this article

    What is most interesting about this article is how the results illustrate the decision to stop tumor-directed therapy with AYA is complicated and multi-factorial involving the consideration of patient preferences and, what the authors describe as, the “emotional entanglement” of clinicians. This entanglement emerges from the clinicians’ own thoughts and feelings from treating a young adult dying from cancer. Participant quotations highlight that not only does it feel unfair when young adult dies from cancer, there appears to be something inherent with the stage of life of the AYA that “we”, as health professionals, reflect fondly on. Falling in love, having a family, and establishing our lives are significant and meaningful life experiences that we value and cherish. Caring for young adults with advanced cancer and seeing their hopes and dreams ripped away is very difficult to witness because of our own experiences and fondness for that stage of life. This difficulty appears to be impacting the clinical judgement as to whether aggressive tumor-directed treatments close to end of life would be an appropriate or effective mode of therapy for AYA.

    As a post-doctoral research fellow developing my own program of research, I find this type social dynamic between clinician and patient very interesting. For better or for worse, the emotional entanglement emerging from this study can at times impact how care is provided. I hope to explore this type of dynamism in my own research particularly in the area of AYA palliative care to ensure that both clinicians’ and patients’ well-being are considered when approaching difficult circumstances such as EOL care. 

    Laryionava K, Heubner P, Hiddemann W, Winkler E. "Rather one more chemo than one less...":Oncologists and oncology nurses' reasons for aggressive treatment of young adults with advanced cancer. Oncologist. 2018;23(2):256-262.

  • 14 May 2019 3:16 PM | Deleted user

    Digest Commentator: Nicole Anna Rutkowski, PhD student in Clinical Psychology, School of Psychology, University of Ottawa

    Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Digest Commentary

    Returning to work is an important milestone and financial necessity for many cancer survivors, however many misperceptions and barriers preclude survivors from successfully transitioning back into a working environment. This article addresses an important gap in cancer survivorship, as little research has been done within the Canadian context on cancer survivors’ experiences returning to work. The Canadian Partnership Against Cancer launched a Return to Work Initiative to gain a better understanding of Canadian cancer survivors’ needs as they transition back into the work force.  The purpose of this study was to determine survivors’ and caregivers’ concerns related to working, challenges employers face accommodating survivors, and ways to better support employees, managers, and caregivers.  

    In order to gain a comprehensive understanding, the Return to Work Initiative examined the perspectives of survivors, caregivers, and workplace representatives. During the preliminary phase, the researchers conducted a literature review, an environmental scan, and conducted key informant interviews. The findings suggested a shortage of services available to survivors experiencing challenges resuming work activities. With a greater understanding of the lack of resources and programs available for survivors, the researchers turned their focus to trying to understand the individual experience of survivors and their caregivers. A national online survey captured cancer survivors’ (n=410) and caregivers’ (n=60) challenges when returning to work. To gain the perspective of employers, in-depth interviews were conducted with 41 workplace representatives (i.e. managers, union leaders, insurers). After the initial analysis, results were reviewed and discussed with cancer survivors and employers through separate focus groups to develop solutions for identified challenges. Recommendations were developed on how to better meet the needs of cancer survivors returning to work.       

    Despite many survivors reporting feeling supported by employers, concerns remained. Major concerns for survivors included decreased income, an inability to resume previous work activities, a lack of accommodations, difficulties negotiating with employers, and a lack of information on assistive programs. Interestedly, many similar concerns were raised amongst employers, survivors, and caregivers. All expressed a need for more education on workplace accommodations, improved communication, and a need for additional community resources and supports. Additionally, receiving more information on how to access financial supports was deemed to be important by survivors and caregivers.  Employers expressed interested in addressing survivors’ return to work concerns, however they also encountered difficulties navigating insurance and government sponsored benefits for employees. Unfortunately, survivors re-entering the workplace were not seen as a priority due to the relatively low numbers of cases and an absence of re-entry policies for cancer survivors. Importantly, survivors expressed fears of informing employers of their diagnosis due to perceived negative repercussions on job duties, promotions, and possible termination. Limitations of the study included convenience sampling which likely contributed to a well-educated, predominately female sample and a high portion of breast cancer survivors (46%). Further, employers may have over emphasized the support provided to employees and minimized weaknesses.   

    Why I liked this article:

    This article provides insight into some of the barriers cancer survivors, caregivers, and employers face regarding return to work. By understanding the challenges and unique experiences of these groups we can begin to develop and implement adequate re-entry policies and programs to ensure cancer survivors receive appropriate support as they transition back to the work place.

    Fitch MI & Nicoll I. (2019). Returning to work after cancer: Survivors’, caregivers’ and employers’ perspectives. Psycho‐Oncology; 1-7.

    Journal website:


  • 1 Apr 2019 4:56 PM | Deleted user

    Digest Commentator: Breanna Lane, B.A. (Hons), Department of Psychology, Faculty of Science, Memorial University of Newfoundland

    Digest Editor: Mary Ann O'Brien, Ph.D., Department of Family and Community Medicine, University of Toronto

    Digest Commentary

    Fear of cancer recurrence (FCR) is one of the most prevalence, high priority and lasting psychosocial implications of a cancer diagnosis. Researchers have begun to examine the cognitive mechanisms that perpetuate FCR. Exploration of avoidance and cognitive appraisal as moderating factors for FCR and functioning has been unsuccessful. Rumination plays a disruptive role in cognitive functioning and emotional distress associated with anxiety and depression, and therefore may provide insight into the development of psychological illness for individuals with cancer. Liu et al. reported data from a cross-sectional study that examined potential interactions between FCR and rumination in relation to self-reported symptoms of anxiety and depression.

    Of the 927 approached to participate in the study, 388 eligible adults diagnosed with cancer were recruited following service utilization at the National University Cancer Institute Singapore. Eligible participants could understand English or Mandarin, were currently in remission, and completed treatment at least one year ago. Participants had a mean age of 55.6y(SD = 11.6y), 80.2% identified as female, and 70.7% reported being diagnosed with Stage I/II cancer. Participants completed a series of outcome measures including the Fear of Cancer Recurrence Inventory (FCRI), Ruminative Response Scale (RRS), and the Hospital Anxiety and Depression Scale (HADS). The FCRI severity scale, which has been validated independently as the FCRI Short Form, was also used in subsequent analysis.

    An interaction between FCR and rumination was associated with depression symptoms. When rumination was high in individuals with high FCR, rumination was associated with more severe depression symptoms compared to those with high FCR and low rumination. Independent of rumination, a significant relationship between high FCR and more severe depression symptoms remained. These relationships suggest that individuals with high FCR may ruminate or fixate on cancer fears, which contribute to low mood, negative thoughts, and distress. Using anxiety as the outcome the interaction between FCR and rumination was not replicated; individually FCR and rumination were associated with anxiety. Body-checking is a frequent behavioural reaction to FCR which can perpetuate fears and compulsive checking, and therefore it is possible that FCR could contribute to anxiety without individuals engaging in rumination. Finally, the significant association between rumination and anxiety suggests that anxious thoughts and feelings can create a cognitive cycle that contributes to anxiety symptoms. The cross-sectional design and symptom self-report limits the ability to determine causal factors contributing to mental health symptoms. However, overall, this study provides crucial insights into the relationships between essential psychological concerns often experienced by cancer survivors and illustrates the potential implications of maladaptive cognitive coping styles.

    Why I liked this article:

    With the development of novel treatments to target psychological symptoms associated with coping with cancer, greater insight into the mechanisms of change is essential for enhancing the efficacy and effectiveness of interventions. Individuals with high FCR and maladaptive coping strategies, like rumination, may be particularly vulnerable for developing severe symptoms of depression. Therefore, this study provides preliminary evidence for the use of interventions that disrupt rumination and teach alternative skills to assist with positive coping and reduce the risk for the development of psychopathology.

    Liu, J., Peh, C.-X., Simard, S., Griva, K. &  Mahendran R. (2018). Beyond the fear that lingers: The interaction between fear of cancer recurrence and rumination in relation to depression and anxiety symptoms. Journal of Psychosomatic Research, 111, 120-126. DOI:

    Journal of Psychosomatic Research website:

    Author Website:

  • 22 Jan 2019 3:58 PM | Brandon Davenport (Administrator)

    Digest Commentator(s): David Michael Langelier MD, FRCPC, Dip CSCN (EMG), Cancer Rehabilitation Fellow, Princess Margaret Hospital, University of Toronto

    Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Digest Commentary

    Background: The expectation of health care providers to understand and appropriately prescribe complimentary therapies (CT) to cancer patients increases on an annual basis. Unfortunately, this increasing demand for physician competency in complimentary services have not yet been appropriately reflected in the way physicians are trained. Therefore, when confronted with a patient inquiring about various CTs, clinicians often look to clinical practice guidelines in order to safely and effectively prescribe outside their scope of knowledge. This article highlights areas of CT interest to patients and suggests particular CTs for future research and guideline development based on patient preferences.

    Research Design: In April 2018, Qureschi et al. published a more extensive analysis into survivor’s interest and use of CTs in the journal of Integrative Cancer Therapies. This involved a cross-sectional survey of 212 ambulatory cancer patients with no restrictions on tumor type, stage, or current treatment status. The study’s goals were to gather a more comprehensive picture of which CTs were being used, which were of highest interest, and whether particular physical symptoms, perceived stress, and spirituality were related to certain interests. The authors also examined barrier perception and whether clinical practice guidelines were available for CTs with the highest interest.

    Results: Overall, 75% of patients had used or were currently using CTs. The most frequently reported CTs were biologic (e.g. vitamins B12 and D, calcium) followed by mind/body (e.g. yoga, massage, mindfulness-based stress reduction), then energy-based (e.g. acupuncture) and alternative CTs (e.g. naturopathy). The largest perceived barriers were a lack of CT awareness and insufficient evidence on the CTs effectiveness. Lack of support from health providers contributed only minimally to CT participation. In all CTs except cannabinoids, higher levels of perceived stress corresponded to higher levels of CT interest.

    Importance: In the era of patient-centered-care, health care practitioners must acknowledge the high use of CTs and be attune to which CTs are important to the patient. This article highlights the specific CTs requiring a research focus and this corresponds to the gap in available clinical practice guidelines. To fill this gap, guidelines are needed particularly in the areas of biologic (i.e. vitamin B12, vitamin D) and mind-body (i.e. breathing/relaxation) CTs. Additionally, as a health care provider this article flags awareness and further education as two specific barriers to CT involvement. Health care providers in oncology have a shared responsibility to know and share the evidence behind various CTs with patients, even if the evidence is limited.

    Citation: Qureshi M, Zelinski E, Carlson LE. Cancer and Complimentary Therapies: Current Trends in Survivors’ Interest and Use. Integrative Cancer Therapies. 2018 Apr 1:1534735418762496. DOI: 101177/1534735418762496.

    Journal website:

    Author Website:

  • 15 Aug 2018 2:10 PM | Brandon Davenport (Administrator)

    Digest Commentator: Julia Parrott, Undergraduate student, School of Psychology, University of Ottawa

    Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Adolescents and young adults (AYA) (ages 15-39) with long term illnesses present a unique challenge for the clinicians addressing their palliative care. Spirituality and religiosity have previously been identified as important parts of helping cancer patients increase their quality of life. Yet, there is a lack of research in exactly how to address AYA religious and spiritual perspectives. AYA are in the process of defining who they are; shaping their own opinions on the meaning of life, independence and identity. Being sick while in this transitional phase makes them vulnerable to decreased physical and mental health outcomes. The purpose of this study was to identify ways to address the spiritual and/or religious components of palliative care in AYA’s with long term illness.

    Methods: The “Resilience in Adolescence and Young Adults” study was used for a subset of the sample (n=17). The authors looked at one site from this multisite, prospective longitudinal study and only included individuals aged 14-25 years at the time of their cancer diagnosis. To be eligible, the diagnosis required immediate treatment with multi-agent systemic chemotherapy. Nervous-system tumors were excluded because of the difference in treatment protocol. Quantitative data were analyzed from questionnaires completed at enrollment and qualitative data were collected from one-on-one semi-structured interviews. These interviews were transcribed and analyzed in three steps at three different time points; six months, six to 12 months and 12 to 18 months post-diagnosis. Researchers focused on the participants’ self-reported “religiousness” and “spirituality” and categorized the participants according to how they self-identified and not according to their qualitative narratives. The participants were not provided with definitions of religiousness and spirituality. The theme of hope was included in the qualitative analysis due to the frequency with which it was mentioned.

    Results:  Collectively, participants completed 44 interviews. Participants were about 17 years old and most were non-Hispanic white. More participants self-identified as “spiritual” rather than “religious”. Those who identified as “spiritual” and not necessarily “religious” were more likely to look for meaning but struggled with articulating their needs. This group was also more likely to express hopeful statements. Most AYA expressed some existential questioning. There was no consistent definition of religion or spirituality, but there was a common theme of hope. The AYA used hope to discuss the lessons they have learned, how they are going to approach the future and reconcile with the diagnosis. Those who rejected “religion” and “spirituality” demonstrated a negative perception of the divine or were truly agnostic. In the development of palliative guidelines for AYA, the authors emphasized respecting the AYA developing autonomy, while encouraging the exploration of spirituality even if the AYA do not outwardly express this interest. They recommend doing this through discussing hopes, worries, meaning, and changing life perspectives.

    Why I liked the article: I liked how the authors focused on respecting the AYA self-identification and allowed them to explore their own interpretation of spirituality and religion. By focusing on constructs that relate to spirituality like hope, worries, and meaning, care providers can help make these existential concepts more accessible. This could lead to improved support for AYAs in their spiritual journeys while battling cancer.

    Citation: Barton, K. S., Tate, T., Lau, N., Taliesin, K. B., Waldman, E. D., & Rosenberg, A. R. (2018). “I’m Not a spiritual person.” How hope might facilitate conversations about spirituality among teens and young adults with cancer. Journal of Pain and Symptom Management. doi:10.1016/j.jpainsymman.2018.02.001

    Journal website:

  • 15 Aug 2018 2:10 PM | Brandon Davenport (Administrator)

    Digest Commentator: Maclean Thiessen MD MN BSc FRCPC, Breast and GI Medical Oncology Fellow, Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, Alberta; Scholar in Residence, The College, University of Calgary, Calgary, Alberta

    Digest Editor:  Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    In general, chemotherapy is administered for one of two reasons: 1) As part of a strategy to cure cancer or 2) as part of a strategy to control disease and improve survival and/or symptoms for patients whose malignancy cannot be cured. In many types of cancer, when chemotherapy is being used as part of a curative strategy, the most important part of the treatment strategy is surgery – with chemotherapy

    being given either before or after surgery to improve the chance that the cancer will not come back. Colon cancer patients who have disease limited to the colon, but have involvement of regional lymph nodes, are usually offered chemotherapy after surgery. Chemotherapy has been demonstrated to improve survival by about one third in patients with lymph node positive colon cancer (1, 2). Historically, chemotherapy is given for a total of six months to these patients. While chemotherapy can substantially reduce the risk of recurrence, receiving chemotherapy for half a year can have a substantial impact on a person’s life for many reasons including cumulative toxicity and prolonged time away from work.

    At the 2017 American Society of Clinical Oncology (ASCO) meeting, prospectively-designed pooled analysis of individual patient data from six large clinical trials was presented (3). In this analysis, patients with node positive, resected colon cancer had been randomized to receive either three or six months of standard post-surgical chemotherapy. At 39 months median follow-up, the shorter three-month treatment was found to be non-inferior(4) to the six-month treatment. In simple terms, non-inferiority means that, statistically, the three-month duration of treatment was found to be no worse than the six- month duration of treatment. In a subset analysis, three months of treatment was found to be inferior to six months, with three-year disease free survival decreased by 1.7% (95% CI = -4.3% to 0.9%) from 64.4% to 62.7% for patients who received three months of chemotherapy compared to those who received six months. Six months of treatment compared to three months of treatment was associated with higher rates of neurotoxicity, severe enough to interfere with activities of daily living.

    Why I liked the article: Less toxicity and faster completion of treatment will undoubtedly help to lessen the psycho-social impact of the colon cancer experience for many patients. While the results of this study have not matured, and other studies exploring three versus six months in this same population are underway, this report is exciting. These early results suggest that the biggest benefit of chemotherapy in this population occurs in the first three months, after which there may be an opportunity to further tailor treatment around patient’s pathological risk features and psycho-social needs.


    1. Andre T, de Gramont A, Study Group of Clinical Research in Radiotherapies Oncology OMRG. An overview of adjuvant systemic chemotherapy for colon cancer. Clin Colorectal Cancer. 2004;4 Suppl 1:S22-8.

    2. Andre T, de Gramont A, Vernerey D, Chibaudel B, Bonnetain F, Tijeras-Raballand A, et al. Adjuvant fluorouracil, leucovorin, and oxaliplatin in stage II to III colon cancer: Updated 10-year survival and outcomes according to BRAF mutation and mismatch repair status of the MOSAIC study. J Clin Oncol. 2015;33(35):4176-87.

    3. Shi Q, Sobrero A, Shields A, Yoshino T, Paul J, Taieb J, et al., editors. Prospective pooled analysis of six phase III trials investigating duration of adjuvant (adjuv) oxaliplatin-based therapy (3 vs 6 months)

    for patients (pts) with stage III colon cancer (CC): The IDEA (International Duration Evaluation of Adjuvant chemotherapy) collaboration. American Society of Clinical Oncology; 2017; Chicago, Illinois, USA. J Clin Oncol. 2017;35 (suppl; abstr LBA1).

    4. Mauri L, D&#39;Agostino RB, Sr. Challenges in thedesign and interpretation of noninferiority trials. N Engl J Med. 2017;377(14):1357-67.

    Journal website:

    Author Blog:

  • 15 Aug 2018 2:09 PM | Brandon Davenport (Administrator)

    Digest Commentator: Sophie Lebel, PhD, C.Psych, School of Psychology, University of Ottawa

    Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    Fear of cancer recurrence is a growing area of research, now with its own IPOS Special Interest Group called FORWARDS. As a researcher and clinician working on fear of cancer recurrence, I frequently get asked this question: “Fear of cancer recurrence is present in almost all of my patients but how can I help them deal with this fear? I am not sure it is something that can be changed”. Until recently, this feeling was warranted as there was only one published trial of an intervention to address fear of cancer recurrence (Herschbach et al, 2009), which showed that both group Cognitive Behavioral Therapy and group supportive expressive therapy were efficacious in reducing this fear. In November 2017, Butow and colleagues published the results of their trial of an individual therapy to address fear of cancer recurrence in cancer survivors in the Journal of Clinical Oncology. The intervention is called ConquerFear and consists of five face-to face individual sessions that cover attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting. Specifically, the intervention teaches strategies for controlling worry and excessive threat monitoring, modifying unhelpful beliefs about worry, and developing appropriate monitoring and screening behaviors, educates about follow-up and strategies (e.g., exercise) to reduce risk of recurrence, addresses existential issues, and promotes goal setting. One of the interesting features of this trial is that the intervention was compared to a nonspecific attention control intervention (five sessions of face-to-face relaxation training). The effects of the therapy were also assessed at 3- and 6-months post therapy. Participants (95% female) were 222 stage 0 to III breast, Dukes’ stage A to C colorectal, and Stage IA to IIB melanoma survivors who were disease-free and who displayed elevated levels of fear of cancer recurrence before being enrolled in the trial (as defined as a score of ≥ 13 on the Fear of Cancer Recurrence Inventory). Participants had completed adjuvant treatment 2 months to 5 years previously. They were randomly assigned to either ConquerFear or the control group. Twenty-six therapists from 17 sites across Australia participated and delivered both interventions. ConquerFear participants had clinically and statistically greater improvements than control participants from baseline to completion of the intervention on their fear of cancer recurrence score and these differences were still statistically significant at 3- and 6-month post-intervention. There were also significantly greater improvements reported by ConquerFear participants in general anxiety, cancer-specific distress, and mental quality of life and metacognitions from baseline to end of the intervention, however few of these differences were significant at the subsequent follow-ups. Interestingly, ConquerFear was effective regardless of baseline fear of cancer recurrence levels, stage of disease, age, education, and country of birth.

    Why I liked the article: In conclusion, yes, it is possible to help patients deal with their fear of cancer recurrence. A next step will be to see how these interventions fare when implemented in clinical settings.

    Citation: Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, Tesson S,O’Connell R, Girgis A, Gebski VJ, Asher R, Mihalopoulos C, Bell ML, Zola KG, Beith J, Thewes B. Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence. J Clin Oncol. 2017 Nov 2:JCO2017731257. doi: 10.1200/JCO.2017.73.1257.

    Journal website:

  • 15 Aug 2018 2:08 PM | Brandon Davenport (Administrator)

    Digest Commentator: Andrea Johnson, PhD (C), School of Social Work, University of British Columbia

    Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

    As more adolescents and young adults (AYAs) (ages 15-39) are surviving a diagnosis of cancer, greater attention is being directed towards their psychosocial wellbeing as cancer survivors. Over the past decade, there has been increasing research and practice interest in the prevalence of mental health outcomes (eg. mood and anxiety disorders) experienced by this cohort after treatment. There is a small but robust literature base that has demonstrated peaks of psychological distress experienced by AYAs following treatment completion. However, what remains unknown are the associations between developmental life stage, cancer survivorship, and mental health outcomes for people diagnosed with cancer. Specifically, are AYAs at greater risk for adverse mental health outcomes when compared to cancer-free AYAs and older adult cancer survivors. This article reports on a study designed to answer this question.

    The Canadian Community Health Survey (CCHS) was used as a population-based instrument in this study. This survey collects annual health-related data from Canadians of different ages. The final sample size in this study was 239, 316 and this included four combined annual cycles (2007-2010) of respondents. This sample was dichotomized into AYAs (ages 15-39) and older adults (ages 40+). Outcomes of interest in this study were: self-perceived general health status, self-perceived mental health status, and self-reported mood and anxiety disorders diagnosed by a professional. Weighted logistic regression was used to analyze the relationships between age, cancer survivorship, and psychosocial outcomes of respondents.

    Cancer survivorship was found to be strongly associated with poor self-perceived mental health and mood and anxiety disorders among AYAs. AYA survivors of cancer were more likely to report mood and anxiety disorders than both AYAs without a history of cancer and older adults who were cancer survivors. This increased prevalence held for both self-perceptions of mental health and self-reported clinically diagnosed mood and anxiety disorders. Notably, 15.1% of AYA cancer survivors and 5.4% of AYAs without cancer reported a diagnosis of anxiety. 14.8% of AYA cancer survivors and 5.7% of AYAs without cancer reported a diagnosis of a mood disorder.

    This study advances understanding of the mental health outcomes of AYA cancer survivors. It clearly argues that it is the intersection between developmental stage and a history of cancer that leaves AYA cancer survivors vulnerable to distress.

    Why I liked the article: I really liked how this study compared psychological outcomes between AYAs with and without cancer. The psychological distress observed of AYA cancer survivors may be wrongly dismissed in practice as typical “storm and stress” expected of AYAs. The adverse mental health outcomes experienced by AYAs in this survey however surpassed those of AYAs without cancer. There remain significant gaps in AYA psychosocial oncology care. Greater efforts must be made to both understand and respond to the psychological distress experiences of AYAs.

    Article: Lang, M.J., Giese-Davis, J., Patton, S.B. & Campbell, J.T. (2017). Does age matter? Comparing post-treatment psychosocial outcomes in young adult and older adult cancer survivors with their cancer-free peers. Psycho-Oncology. Advance online publication. doi:10.1002/pon.4490.

    Journal website:

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