Stepped Care Empowers Providers to Manage Cancer Survivors’ Recurrence Anxiety, Part 3

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Dr. Shelly Johns joins Physician’s Weekly and explains why a stepped care approach to managing fear of cancer recurrence is recommended. Beginning with oncology providers acknowledging and normalizing patient fears, followed by screening to identify severity, they can offer tailored interventions ranging from informational handouts to cognitive behavioral therapy or specialist referrals based on the level of distress. Hear more from Dr. Johns on clinician empowerment and the importance of patient education.

Transcript: 
I’m Shelly Johns. I’m a board certified clinical health psychologist and an associate professor of medicine at the Indiana University School of Medicine. And I’m also a research scientist at the Regenstrief Institute in the Center for Health Services Research.

We and many researchers are recommending more of a stepped care approach to managing fear of recurrence. So the first step of that would be the oncology providers inquiring about fear of recurrence and then acknowledging, normalizing, validating that fear, coupled with heightening survivor’s awareness of their actual risk of recurrence and what things that they should be looking for in terms of symptoms or bodily sensations that will warrant giving the oncologist a call for further evaluation. Then from there, we really recommend screening for fear of recurrence, so that then we can identify individuals who have more of a mild, moderate, or severe level, and then refer appropriately.

So individuals with mild fear of recurrence, which is very common. Sometimes just giving them a pamphlet, a handout that describes fear of recurrence and normalizes it, and then also gives some ideas or some suggestions for coping skills. Sometimes that’s really all some survivors need, especially if they have mild fear of recurrence. People with more moderate fear of recurrence could be referred to an oncology social worker or a nurse who might be trained in some evidence-based strategies for managing fear of recurrence in the brief format. So a few sessions of cognitive behavioral therapy could potentially be useful for our survivors that have more of a severe level of fear of recurrence. A referral to a psychologist or a psychiatrist who has deeper training in some of these issues and can deliver more of a full package of an evidence-based treatment would be warranted.