Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Establishing a world-first evidence- and consensus-based clinical pathway for fear of cancer recurrence: optimal on paper, but is it feasible in practice? (#106)

Ben Smith 1 2 3 4 , Natalie Taylor 5 , Alison Pearce 2 6 , Verena Wu 3 7 , Afaf Girgis 1 , Heather Shepherd 8 , Gail Garvey 9 , Jia (Jenny) Liu 10 11 , Laura Kirsten 4 12 , Iman Zakhary 13 , Annie Miller 14 , Carolyn Ee 15 16 17 , Dan Ewald 18 , Joanne Shaw 4 19
  1. South West Sydney Clinical Campuses, University of New South Wales (UNSW) Sydney, Liverpool, NSW, Australia
  2. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
  3. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  4. Psycho-Oncology Cooperative Research Group, The University of Sydney, Sydney, NSW, Australia
  5. UNSW Medicine & Health, UNSW Sydney, Sydney, NSW, Australia
  6. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
  7. South West Sydney Clinical Campuses, University of New South Wales (UNSW) Sydney, Liverpool, NSW, Australia
  8. Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney,, Sydney, NSW, Australia
  9. School of Public Health, The University of Queensland, Brisbane, QLD, Australia
  10. The Kinghorn Cancer Centre, St Vincent’s Hospital, Sydney, NSW, Australia
  11. St Vincent’s Healthcare Clinical Campus, UNSW Sydney, Sydney, NSW, Australia
  12. Nepean Cancer Services, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia
  13. Multicultural Services, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
  14. Cancer Council NSW, Sydney, NSW, Australia
  15. NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
  16. Caring Futures Institute, Flinders University, Adelaide, SA, Australia
  17. Chris O’Brien Lifehouse Cancer Centre, Sydney, NSW, Australia
  18. Sydney University Medical School, Northern Rivers University Centre for Rural Health, Lismore, NSW, Australia
  19. School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia

Aims

Fear of cancer recurrence (FCR) is not routinely addressed in clinical practice, meaning many cancer survivors forego effective interventions. We aimed to develop an evidence- and consensus-based clinical pathway to assist healthcare professionals identify and manage FCR.

Methods

Healthcare professionals and researchers managing/studying FCR in adult cancer survivors were invited to participate in a two-round Delphi study through professional organisations (e.g., COSA) and Twitter. The Round 1 online survey presented 38 items regarding FCR: 1) screening; 2) triage, assessment, and referral; 3) stepped care treatment (e.g., stepped care is appropriate for managing FCR). Participants rated how optimal (i.e., representative of best-practice) and feasible (i.e., able to be implemented in practice) items were on a 5-point Likert scale, with qualitative feedback optional. Consensus was defined as ≥80% of participants (strongly) agreeing an item was optimal, with feasibility ratings guiding future implementation. Round 1 items without consensus were re-presented in Round 2 alongside summarised Round 1 responses and new items from content analysis of qualitative feedback.

Results

With 96 participants (target n=48) in Round 1 (89% healthcare professionals, 34% nursing), 26/38 items reached consensus as optimal, 6/38 as feasible. There was moderate-high consensus regarding: FCR screening (6/7 items); triage, assessment, and referral (4/6 items). Consensus varied regarding stepped care for different FCR levels: specialist care for severe FCR (5/5 items); supported self-management for moderate FCR (2/6 items); universal care for minimal-mild FCR (4/6 items). Content analysis indicated necessity for: refining FCR conversation timing; tailoring FCR treatment to survivor preference, FCR severity, and resources; and healthcare professional training. Round 2 presented 10 original and 13 new items, with the finalised pathway to be presented at the meeting.

Conclusions

This is a world-first clinical pathway for optimal FCR care. Tailored strategies are needed to address feasibility of implementation in varied contexts and populations.