A qualitative examination of cognitive behavioral therapy strategies and health management content to reduce fear of cancer recurrence among breast cancer survivors: Results from the FoRtitude study

Authors

Dori M. Beeler, Atrium Health Levine Cancer, USA.
Elizabeth Jeter, Wake Forest School of Medicine, USA.
Brianna N. Leitzelar, Wake Forest School of Medicine, USA.
Sarah N. Price, Wake Forest School of Medicine, USA.
Daniel L. Hall, Massachusetts General Hospital, USA.
Pamela J. Raper, Wake Forest School of Medicine, USA.
Beverly J. Levine, Wake Forest School of Medicine, USA.
Victoria J. Dunsmore, University of North Carolina School of Medicine, USA.
Janet A. Tooze, Wake Forest School of Medicine, USA.
Jenna Duffecy, University of Illinois, USA.
David Victorson, Northwestern University, USA.
William Gradishar, Northwestern University, USA.
Thomas Saphner, Advocate Health - MidwestFollow
Mary Lou Smith, Research Advocacy Network, USA.
Frank Penedo, University of Miami, USA.
David C. Mohr, Northwestern University, USA.
David Cella, Northwestern University, USA.
Lynne I. Wagner, Wake Forest School of Medicine, USA.

Recommended Citation

Beeler DM, Jeter E, Leitzelar BN, et al. A qualitative examination of cognitive behavioral therapy strategies and health management content to reduce fear of cancer recurrence among breast cancer survivors: Results from the FoRtitude study. J Health Psychol. Published online July 28, 2025. doi:10.1177/13591053251354867

Abstract

Fear of recurrence (FoR) is common among breast cancer survivors (BCS). We sought to understand BCS' cognitive behavioral therapy (CBT) and health management content (HMC) intervention component experiences, to aid interpretation of previous findings, and inform future research. HMC comprised health-related content, including managing comorbidities and nutritional information. BCS with elevated FoR were randomized to CBT components (vs HMC) over 4 weeks. Post-participation interviews and additional data from FoRtitude BCS (N = 101) were analyzed. BCS were on average 55 years old (range 26-76 years), White (96%), non-Hispanic (93%), and diagnosed with early-stage breast cancer (87%). Analysis identified four themes: increased self-efficacy, including immediate access and interaction, managing emotional arousal, managing perceived risk of recurrence, and opportunities for future FoRtitude refinements. CBT and HMC play mechanistically distinct yet complementary roles in reducing FoR through increased self-efficacy supported by emotion- and problem-focused coping. Combining such content may be advantageous for reducing BCS' FoR.Clinicaltrials.gov: link, NCT03384992.

Document Type

Article

PubMed ID

40721359