Phone-call trial to ease fears of cancer survivors

Short follow-up phone calls to reduce fear of recurrence among breast cancer survivors could ease the strain on GPs and cancer nurses, researchers believe.

Elizabeth Rudebeck became worried about her daughters future. Picture: John Devlin

A new trial is under way to see whether specialist nurses can help patients to deal with worries over the chances of the disease coming back, which affect up to 60 per cent of patients.

Dr Susanne Cruickshank, from Stirling University, will trial offering 30-minute phone calls, known as Mini-AFTERs, to recovering patients who are likely to have the greatest fears about the disease returning.

Cancer diagnoses are on the rise, however advances in treatment mean that more people are surviving the disease than ever before. More than 46,000 women living in Scotland have had a breast cancer diagnosis in the past 20 years.

Cruickshank said: “When you have the diagnosis there is a lot of support. At the end of treatment you are sent back to your normal life. Even with successful outcomes, you cannot always prevent cancer coming back.

“Fear of recurrence starts incrementally; you start focusing on the fears about the cancer coming back rather than the reality of it actually coming back.

“For many people being fearful is a natural thing. But for some it can become excessively worrying.”

There are no existing services of this kind in the UK, therefore concerned patients repeatedly return to their GP or their breast cancer nurse for support, she said.

The project is based on a longer six-session programme called AFTER, which has already been shown to help improve the quality of life after cancer.

Cruickshank added: “The overall goal is to develop something that’s going to improve their lives. It is so important that health professionals can understand and challenge these fears. A fear of recurrence can be a normal thing but on the other hand it can have a major impact on people’s lives.”

Cruickshank plans to survey specialist nurses all over the country to establish current working practices on how they identify and deal with breast cancer patients to provide support on fears of recurrence. This will be followed by more in-depth interviews with a smaller group of nurses to explore what challenges could arise for medics.

If the study is successful, a pilot will be rolled out to patients to see if it can reduce levels of anxiety and fear.

Mary Allison, Scotland director for Breast Cancer Now, which will fund the research, said: “We know that fear and anxiety is an entirely natural response to the threat of cancer returning.

“For many women, this may be short-lived but for some they can experience problematic anxiety levels
for longer periods of time. That’s why we need to understand how best to manage this fear.

“More than 46,000 women in Scotland living today have had a breast cancer diagnosis in the last 20 years. We hope this research can help women with breast cancer to have the best quality of life after their treatment.”

‘You have been through so much’

Coping with life after treatment was a major challenge for Elizabeth Rudebeck, who was diagnosed with breast cancer in 2012 when she found a lump while finishing breastfeeding her young daughter.

Doctors thought the cancer had spread, however scans revealed it could be removed as it was contained in her breast and lymph glands.

The 35-year-old went ahead with a mastectomy and gruelling bouts of chemotherapy and radiotherapy to rid her of the cancer.

Despite her good prognosis, the mother-of-one has struggled to shake off her concerns that the disease might return.

Rudebeck, now 39, said: “I had lots of family support when I was having treatment, which was great as you don’t feel good and you need all the help you can get.

“For so much time you are looking forward to getting back to normal, but when it happens it is hard to adjust.

“You don’t feel normal, your body has changed and you have been through so much.”

In the months after treatment, Rudebeck felt very anxious about the cancer coming back so she regularly went to her GP for scans and x-rays.

Another major worry was being able to care for her daughter Rose, now six, who was very young when her mother was having treatment.

Rudebeck, of Kelvindale, Glasgow, said: “For a long time I was very worried by aches and pains.

“I needed to get further away from the treatment and to feel a bit more confident before I could let that go.

“When you have a young child, all you want is to see them grow up, so you worry.”