Estudio de los hallazgos en la ecocardiografía

referral to an experienced psychosocial care professional should be considered.

Secondly, identifying high FCR in clinical practice remains a challenge. There is no consensus on the best self-report screening measure available to support the health- care professional in identifying patients with high FCR. Due to its length and complexity the SI-FCRI, a semi-structured interview [13], may be particularly useful for psychosocial professionals whereas a FCR self-report questionnaire, such as the CWS or FCRI, could be considered by medical healthcare professionals [2,6,8]. However, informally assessing the frequency, duration and intensity of FCR via questioning during clinical assessment is also valid approach and is recommended as a supplement to the use of screening questionnaires. Third, healthcare professionals have an important role to play in recog- nizing behavioral factors associated with FCR, such as increased contact with healthcare services or avoidance. Sometimes behaviors are hard to miss as it directly affects the professional himself, for instance, the frequent request for an extra medical exam or telephone consultation in order for a patient to feel reassured. However, behavior may also be less overt; a breast cancer survivor answering “yes” to the question if she performs breast self-exams, without mentioning that she does this up to fifteen times a day; or the prostate cancer survivor who cancels all his meetings with the general practitioner and urologist because he is too afraid for a bad result on his PSA-test. When in doubt, a case should be discussed in a multidisciplinary meeting, or in consultation with a psychosocial professional. When FCR is detected medical professionals can also play an important role in educating patients about FCR normalizing mild to moderate or transient FCR and referring those with moderate-to-high FCR for more specialized psychological intervention. Finally, it is important that medical professionals pay atten- tion to FCR in partners or caregiver as well.

6.2 Psycho-oncology health professionals.

In chapter 7 we tentatively conclude that bCBT is an effective, feasible and acceptable psychological intervention to reduce FCR severity in breast, prostate and colorectal can- cer survivors. If future research shows that the intervention effects are sustained at the long run, a logical next step would be the implementation into standard care. However further research is needed to explore the feasibility, acceptability and uptake outside of the clinical trial setting. Should the SWORD intervention proceed to implementation this will be the first evidence-based intervention for FCR to become widely available for Dutch cancer survivors.

box 6. Recommendations

– Medical healthcare professionals should be aware of the prevalence of high FCR, its characteristics, available screening methods and the available options for psychological interventions and additional support services.

– First results of bCBT for FCR are promising. Options for implementation of this intervention should be explored.

RefeRenCes

1. Vickberg SMJ. The Concerns About Recurrence Scale (CARS): A systematic measure of women’s fears about the possibility of breast cancer recurrence. Annals of Behavioral Medicine. 2003;25(1):16-24.

2. Simard S, Savard J. Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer. 2009;17(3):241-51. 3. Lebel S, Ozakinci G, Humphris G, Mutsaers B, Thewes B, Prins J, Dinkel A, Butow P. From normal

response to clinical problem: definition and clinical features of fear of cancer recurrence. Support Care Cancer. 2016. Epub.

4. Thewes B, Butow P, Zachariae R, Christensen S, Simard S and Gotay C. Fear of cancer recurrence: a systematic literature review of self-report measures. Psycho-Oncology. 2012;21: 571–587. 5. Zebrack B. Developing a new instrument to assess the impact of cancer in young adult survivors

of childhood cancer. Journal of Cancer Survivorship. 2009;3(3);174-80.

6. Douma KFL, Aaronson NK, Vasen HFA, et al. Psychological distress and use of psychosocial sup- port in familial adenomatous polyposis. Psychooncology. 2010; 19: 289–298

7. Van de Poll-Franse LV, Horevoorts N, van Eenbergen M, Denollet J, Roukema JA, Aaronson NK, Vingerhoets A, Coebergh JW, de Vries J, Essink-Bot M, Mols F, Profiles RG. The Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship registry: scope, rationale and design of an infrastructure for the study of physical and psychosocial outcomes in cancer survivorship cohorts. Eur J Cancer. 2011 Sep;47(14):2188–2194

8. Custers JA, van den Berg SW, van Laarhoven HW, Bleiker EM, Gielissen MF, Prins JB. The Cancer Worry Scale: detecting fear of recurrence in breast cancer survivors. Cancer Nurs 2014;37:E44–50 9. Custers JA, Gielissen MFM, Janssen SHV, de Wilt JHW, Prins JB. Fear of cancer recurrence in

colorectal cancer survivors. Support Care Cancer. 2016;24:555–62.

10. Simard S, Thewes B, Humphris G, Dixon M, Hayden C, Mireskandari S, Ozakinci G. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7(3):300-22.

11. Crist JV, Grunfeld EA. Factors reported to influence fear of recurrence in cancer patients: a system- atic review. Psycho-oncology. 2012;22(5):978-86.

12. Lebel S, Ozakinci G, Humphris G, Thewes B, Prins J, Dinkel A and Butow P. Current state and future prospects of research on fear of cancer recurrence. Psycho-Oncology. 2016 (epub ahead of print), doi: 10.1002/pon.4103.

General discussion

171

8