Preliminary Outcomes of a Culturally Adapted Fear of Recurrence Therapy (FORT) for Turkish Breast Cancer Survivors: A Randomized Controlled Trial.

BACKGROUND

Fear of cancer recurrence (FCR) is a major psychological burden for breast cancer survivors, impairing daily functioning and quality of life. Fear of Recurrence Therapy (FORT), a cognitive-behavioral group intervention, has shown efficacy in Western settings. This study evaluated the effectiveness of an adapted FORT program in Turkish breast cancer survivors.

METHODS

A single-blind, parallel-group randomized controlled trial was conducted between February and March 2025. Stage I-III survivors within 5 years post-treatment (N = 100) were randomized (1:1) to FORT or a CBT-based intervention. Both interventions comprised six weekly online sessions; however, the adapted version of FORT program was extended to 150 min per session, while the CBT group maintained 120-min sessions. The primary outcome was FCR (Fear of Cancer Recurrence Inventory). Secondary outcomes were anxiety and depression (HADS), distress (Emotion Thermometer), quality of life (EORTC QLQ-C30), intolerance of uncertainty (IUS-12), self-efficacy (SEMCD), and coping skills (CCQ). Analyses followed intention-to-treat (ITT) and per-protocol (PP) principles.

RESULTS

ITT analysis showed significant reductions in FCR in both groups; the ANCOVA-adjusted mean difference favoring FORT was -5.99 points (95% CI -10.95 to -1.03, p = 0.018, partial ω2 = 0.047). Between-group differences favored FORT on FCRI subscales (triggers, metacognitions, emotion-focused coping) and intolerance of uncertainty (F(1,95) = 2.174, p = 0.032). PP analysis indicated additional benefits for anxiety (F(1,84) = 5.735, p = 0.019), depression (t = -2.174, p = 0.032), and functional quality of life (z = -2.079, p = 0.038). Adherence was high, with most participants completing all sessions.

CONCLUSIONS

Adapted FORT reduced FCR and psychological distress among Turkish survivors. Its effective online delivery demonstrates feasibility and scalability, supporting integration into psycho-oncological care.

TRIAL REGISTRATION: NCT06676228.