Skip to main content
An official website of the United States government
Grant Details

Grant Number: 5R21CA173193-02 Interpret this number
Primary Investigator: Wagner, Lynne
Organization: Northwestern University At Chicago
Project Title: Targeted Ehealth Intervention to Reduce Fear of Recurrence Among Cancer Survivors
Fiscal Year: 2014


DESCRIPTION (provided by applicant): Targeted eHealth intervention to reduce fear of recurrence among cancer survivors. The overall objective of this research proposal is to develop and evaluate a targeted eHealth intervention to reduce fear of cancer recurrence (FoR) among breast cancer survivors using an innovative methodological and delivery approach. Long-term cancer survivors have identified managing FoR as their most pressing unmet need. Conceptually, FoR is multi-dimensional with emotional (fear, anxiety) and cognitive (worry, preoccupation, intrusive thoughts) components. Psychosocial resources, including coping strategies and self- efficacy, are required to process FoR triggers and are a key determinant in FoR severity. Most extensively documented among breast cancer survivors, clinically significant FoR is prevalent (24-56%), lasts for years after cancer treatment, and has negative emotional and behavioral consequences. Even at low to moderate levels, FoR is positively associated with generalized anxiety, depression, symptom burden and quality of life impairments. eHealth interventions have the potential to address this salient and distressing concern through teaching coping strategies to bolster survivor's psychosocial resources, yet these novel approaches have not been explored. Aim 1 is to develop and refine FoRtitude, a targeted FoR eHealth intervention. We will build FoRtitude based on our prior work with the Northwestern University Center for Behavioral Intervention Technologies (CBITs) developing a web-based program for cancer survivors. Intervention components will include three FoR-specific coping strategy modules and telephone coaching, targeting psychosocial resources. We will pilot FoRtitude with breast cancer survivors (n=25) to collect qualitative data on intervention content and design which will be used to refine the intervention. Aim 2 is to conduct a randomized trial to evaluate the effects of four intervention components on FoR among breast cancer survivors (n=144). The Multiphase Optimization Strategy (MOST) is a novel, innovative methodological approach for building and optimizing behavioral interventions. We will use this approach to guide our research aims and design. The MOST framework allows us to evaluate our intervention components with enough statistical power to detect significant effects on FoR, our primary outcome. Five NCI-designated Community Clinical Oncology Programs (CCOPs) will serve as recruitment sites. We will also recruit from our institution, the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Using the MOST framework, results will be used to identify effective intervention components for inclusion in a large-scale confirmatory trial to be conducted through the Eastern Cooperative Oncology Group. Our findings will produce an evidence-based targeted FoR intervention that can be widely disseminated among cancer survivors at relatively low cost and in doing so, will contribute to improving quality of cancer survivorship for this growing population.


Validation of the Lee-Jones theoretical model of fear of cancer recurrence among breast cancer survivors using a structural equation modeling approach.
Authors: Lucas A.R. , Pan J.H. , Ip E.H. , Hall D.L. , Tooze J.A. , Levine B. , Mohr D.C. , Penedo F.J. , Cella D. , Wagner L.I. .
Source: Psycho-oncology, 2023 Feb; 32(2), p. 256-265.
EPub date: 2023-01-09.
PMID: 36468339
Related Citations

A spotlight on avoidance coping to manage fear of recurrence among breast cancer survivors in an eHealth intervention.
Authors: Hall D.L. , Levine B.J. , Jeter E. , Chandler A. , Tooze J.A. , Duffecy J. , Victorson D. , Gradishar W. , Leach J. , Saphner T. , et al. .
Source: Journal of behavioral medicine, 2022 Oct; 45(5), p. 771-781.
EPub date: 2022-08-05.
PMID: 35930212
Related Citations

Targeted eHealth Intervention to Reduce Breast Cancer Survivors' Fear of Recurrence: Results From the FoRtitude Randomized Trial.
Authors: Wagner L.I. , Tooze J.A. , Hall D.L. , Levine B.J. , Beaumont J. , Duffecy J. , Victorson D. , Gradishar W. , Leach J. , Saphner T. , et al. .
Source: Journal of the National Cancer Institute, 2021-11-02; 113(11), p. 1495-1505.
PMID: 34057469
Related Citations

Development and refinement of FoRtitude: An eHealth intervention to reduce fear of recurrence among breast cancer survivors.
Authors: Wagner L.I. , Duffecy J. , Begale M. , Victorson D. , Golden S.L. , Smith M.L. , Penedo F.J. , Mohr D.C. , Cella D. .
Source: Psycho-oncology, 2020 Jan; 29(1), p. 227-231.
EPub date: 2020-01-08.
PMID: 31760667
Related Citations

Longitudinal and dynamic measurement invariance of the FACIT-Fatigue scale: an application of the measurement model of derivatives to ECOG-ACRIN study E2805.
Authors: Estabrook R. , Cella D. , Zhao F. , Manola J. , DiPaola R.S. , Wagner L.I. , Haas N.B. .
Source: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2018 Jun; 27(6), p. 1589-1597.
EPub date: 2018-03-05.
PMID: 29508208
Related Citations

Coping strategies tailored to the management of fear of recurrence and adaptation for E-health delivery: The FoRtitude intervention.
Authors: Wagner L.I. , Duffecy J. , Penedo F. , Mohr D.C. , Cella D. .
Source: Cancer, 2017-05-15; 123(6), p. 906-910.
EPub date: 2017-02-16.
PMID: 28207157
Related Citations

Back to Top