Effectiveness of a stepped-care model to address fear of cancer recurrence in patients with early-stage melanoma: results at 6- and 12-month follow-up

Purpose: To investigate the effectiveness of the Melanoma Care Program, an evidence-based, psychological intervention delivered through a stepped-care model, to address fear of cancer recurrence (FCR) in patients with early-stage melanoma at 6- and 12-month follow-up, when implemented into routine practice.

Methods: Individuals with stage 0-II melanoma participated in FCR severity screening using the Fear of Cancer Recurrence Inventory. Participants with an FCR severity score of ≤ 12 were offered usual care. Participants with an FCR severity score of ≥ 13 were offered a psychoeducational booklet and a stepped-care model offering participants up to 5 psychotherapeutic telehealth sessions with a clinical psychologist. Multivariable linear mixed modelling was used to analyse outcomes at 1 week, 6 months, and 12 months post-intervention, including FCR severity (primary outcome), symptoms of depression, anxiety, and stress, melanoma-related knowledge, and health-related quality of life.

Results: One hundred and forty-three participants (111 women, mean age of 54.6 years) were screened; 115 (80%) participants had an FCR severity score ≥ 13, and of these, 112 (97%) participated in the intervention. Seventy-four participants (66%) completed 12-month follow-up. Adjusted multivariable linear mixed modelling demonstrated that the significant reduction in FCR severity found at 1 week post-intervention (mean change from baseline: -3.79; 95% CI: -4.72, -2.85; p < 0.001) was maintained at 6 months (mean change from baseline: -4.28; 95% CI: -5.30, -3.27; p < 0.001) and 12 months (mean change from baseline: -4.59; 95% CI: -5.62, -3.57; p < 0.001).

Conclusions: The Melanoma Care Program maintained effectiveness at 6- and 12-month follow-up when implemented into routine clinical practice for people with early-stage melanoma.