Poorva Pradhan

A Double‐Blind Randomized Sham‐Controlled Trial of Two Online Cognitive Bias Modification Interventions for Fear of Cancer Recurrence in People With Breast or Ovarian Cancer

ABSTRACT Objective In the context of cancer, pain demands interpretation. Our research has found that fear of cancer recurrence (FCR) is associated with the tendency to interpret ambiguous information as health‐related. We aimed to determine whether we could modify these interpretation biases to improve FCR, and pain outcomes. Methods We conducted a double‐blind randomized controlled trial comparing two fully automated Cognitive Bias Modification for Interpretation (CBM‐I) programs to a matched sham. We randomized 174 people with breast or ovarian cancer to one of three groups (pain‐related CBM, cancer‐specific CBM or sham). Participants completed four training sessions, and outcomes were assessed before and after intervention and 2 weeks later. We nominated co‐primary outcomes as FCR and fear of progression (FoP) so that measures were suited to those with and without active disease and measured pain outcomes and other secondary psychosocial outcomes. Results We analyzed data using mixed‐model linear regression and intention‐to‐treat. Results indicated that both the cancer‐specific and pain‐related training groups showed significant improvements in FCR ( F (2,440)  = 17.19, p  < 0.0005) and FoP ( F (2,440)  = 15.03, p  < 0.0005) over time compared to sham. Both versions of CBM were associated with benefits in pain intensity ( F (2,440)  = 6.14, p  < 0.0005) and pain interference ( F (2,440)  = 5.223, p  = 0.001) compared to sham. No other secondary outcomes improved. Conclusion CBM for interpretation is an efficacious treatment for FCR, FoP and pain outcomes in ovarian and breast cancer. This intervention was delivered wholly online, had high completion rates (80%) and therefore is highly scalable. CBM‐I could be part of a stepped care model to meet the large unmet need for people who are living with and beyond cancer.

The role of interpretation biases and symptom burden in fear of cancer recurrence/progression among ovarian cancer survivors

AbstractBackgroundModels of fear of cancer recurrence or progression (FCR/P) suggest that the way in which people interpret ambiguous physical symptoms is an important contributor to the development and maintenance of FCR/P, but research has not investigated this claim. The aim of this study is to fill that gap.MethodsThis was a cross‐sectional study. Sixty‐two women with ovarian cancer reported completed measures of FCR/P, an interpretation bias task and a symptom checklist. The healthy control group (n = 96) completed the interpretation bias task.ResultsWomen with ovarian cancer were more likely to interpret ambiguous words as health‐related compared to healthy women (p < 0.001; Cohen's d = 1.28). In women with cancer, FCR/P was associated with overall symptom burden (r = 0.25; p = 0.04) and interpretation bias score (r = 0.41; p = 0.001), but interpretation bias and symptom burden were not related (r = 0.22; p = 0.09). Interpretation bias did not moderate the relationship between symptoms and FCR/P.ConclusionsWe found that women with ovarian cancer interpreted ambiguous words as health related more often compared to women without cancer, and this bias was greater for women with higher FCR/P. Symptom burden was also associated with FCR/P. However, interpretation bias did not moderate the relationship between physical symptoms and FCR/P. Hence, the central tenet of the Cancer Threat Interpretation model was not supported in women with ovarian cancer.