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A new study published in the Journal of Palliative Medicine looks at a novel intervention to reduce fear of progression and trauma symptoms in advanced cancer using written exposure to worst-case scenarios.

“My study is about developing and testing a wholly novel intervention to reduce cancer-related trauma progression and fear of cancer progression (FoP) among adults with later-stage cancer,” study author Joanna J. Arch told us. “Specifically, we adapted a cutting-edge treatment for trauma in general populations to reduce cancer-related trauma symptoms and FoP in adults with advanced cancer.” 

The intervention, titled EASE, is based on written exposure therapy—an efficacious five-session intervention to reduce post-traumatic symptoms in general populations with low attrition, high acceptability among racially diverse adults. Written exposure is as effective as gold-standard trauma treatments requiring at least twice as many sessions, making it far more feasible for wide dissemination and implementation. EASE adapts this effective therapy to help advanced cancer survivors reduce their imagined future trauma. 

"EASE is based on evidence that cancer-related trauma symptoms focus on the future rather than past, that imagining feared future events in concrete detail reduces anxiety and increases coping, and that written exposure for worst-case future scenarios in anxious adults reduces worry,” Arch told us. “Based on these findings, EASE has advanced cancer survivors write in concrete detail about their single biggest fear about the future with cancer and how they can cope with it.” 

This allows them to ‘name and tame’ their imagined worst-case scenario in ways that reduce anxiety, FoP, and trauma symptoms by reducing avoidance and increasing coping. The researchers hoped that EASE would effectively reduce FoP and cancer-related trauma symptoms, and improve mental health and well-being for adults with later stage (stage 3 and 4) cancer.

“For over a decade, I've been researching ways to translate science-backed psychological interventions for general populations with elevated anxiety, fear, and trauma symptoms to the specific needs of cancer populations with elevated, cancer-specific anxiety, fear, and trauma symptoms,” Arch told us. “Both in reviewing the research and in our clinical practice, I noticed that written exposure therapy was a highly efficient and effective way to reduce trauma symptoms in general populations- and was easy to learn and disseminate.  I started wondering whether the intense fears of the unknown future with cancer might be reduced by adapting written exposure to address them.”

The research team treated 29 adults with stage III and IV cancer (or high-risk or incurable blood cancer) and elevated FoP or cancer-related trauma symptoms with EASE, and measured how they responded immediately afterwards as well as at three and 4.5 month follow-up. EASE was delivered by Telehealth (that is, online videoconferencing).

“Primary outcomes of cancer-related trauma symptoms and FoP improved significantly from pre to both follow-ups by predominantly large effect sizes,” Arch told us. “Secondary outcomes of anxiety, depression, hopelessness, fear of death/dying, and fatigue improved significantly by follow-up." 

Among participants, 86% (25/29) completed all five EASE sessions and the main follow-up survey; surveys and interviews with participants after finishing the study indicated high acceptability.

“I was surprised at how acceptable and effective the intervention seemed to be, at least in this pilot study,” Arch told us. “However, as this study is the very first time EASE was used, this study was not large or randomized. Now we need to follow-up these promising findings by conducting a large, randomized clinical trial with EASE and a control group.”

If these results replicate in a randomized trial, the researchers believe it will offer clinicians an easy-to-learn, relatively brief intervention to reduce fear of the future and improve broader mental health among distressed adults diagnosed with later-stage cancer. Until now, almost no published interventions have targeted FoP and cancer-related trauma symptoms among adults with advanced cancer, apart from a small pilot in the U.S. and a larger trial in China.