Background:

Fear of cancer recurrence (FCR) is among cancer survivors’ top unmet needs and has a large impact on the quality of life of patients and care partners. This guideline makes recommendations based on evidence-based strategies and/or interventions to screen, assess, and manage FCR in adults living with cancer and their care partners to improve patient outcomes.

Methods:

The FCR Guideline Working Group, composed of clinical psychologists, nurses, patient representatives, and a methodologist, was convened at the request of the Ontario Health Psychosocial Oncology Program. The Group worked from November 2021 to January 2024 with the Program in Evidence-Based Care to produce evidence-based recommendations. The process included: systematic review, evaluation, and interpretation of evidence; development of recommendations; internal review by content and methodology experts; and external review sent to Ontario clinicians and other stakeholders.

Results:

We recommend that adults living with cancer complete, at each clinical encounter, a single-item FCR measure, the FCR-1r, because it can be added into the Edmonton Symptom Assessment System, currently administered across cancer centres in Ontario. We recommend that those scoring ≥5 on the FCR-1r complete a standardized FCR assessment tool. We propose a matched care approach for interventions based on level of FCR (low, moderate, and high), starting with psychoeducation for all and reserving FCR-specific cognitive behavioural therapy or mind-body interventions for those with high FCR. For implementation, based on feedback by reviewers we added: a glossary to explain FCR screening and assessment tools and interventions; a flow chart to indicate stages to follow in managing FCR; and websites with resources for patients, physicians, and administrators to aid in the usability of the recommendations. In addition to posting the guideline on the Ontario Health website and publishing the guideline and systematic review, we are actively presenting the recommendations and resources to various psychosocial oncology committees, conferences, and cancer centres in Ontario.

Conclusions:

FCR has a large negative impact on patients and care partners. This comprehensive guideline focuses on recommendations that are important and relevant to patient care that can be implemented in cancer centers with relative ease and that make use of existing resources.