CBT for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature

CBT for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature

BMC cancer, 2022

The fear of cancer recurrence (FCR) stands out as one of the most prevalent, persistent, and disruptive forms of psychological distress experienced by breast cancer survivors during their post-treatment phase. An estimated 50% of breast cancer survivors (BCSs) report experiencing moderate to high levels of FCR. Yet, many tend to report an unmet need for help with managing FCR at treatment completion. Several studies have indicated that up to 70% of BCSs grapple with FCR, and this heightened fear is associated with long-term functional impairments.

Previous studies have shown that BCSs with FCR use maladaptive coping behaviors, such as excessive reassurance-seeking, anxious avoidance, intrusive thoughts, denial, or self-blame, highlighting the significant impact FCR has on their mood, screenings, and quality of life. As the need for clinically relevant interventions arises, cognitive behavioral therapy (CBT) has proven to be more effective than usual care in reducing FCR, with reported effect sizes of − 0.20 to − 0.73.

This review of seventeen studies offers evidence on different CBT interventions for reducing FCR among breast cancer survivors and the quality of reporting in randomized controlled trials (RCTs). Clinicians can use this information to identify effective approaches for minimizing FCR's negative impact and design tailored interventions for BCSs. These findings underscore the importance of tailored interventions to address FCR and improve the well-being of breast cancer survivors.

Key Findings:

  • Approximately two-thirds of the CBTs studies reviewed adopted a group format with four to eight sessions have shown to have better outcomes in reducing FCR scores than individual formats. 
  • Face-to-face RTCs with a minimum duration of one month of CBT interventions have demonstrated greater effectiveness in reducing Fear of Cancer Recurrence (FCR) scores and higher quality of reporting compared to RCTs with briefer online or telephone delivery methods.


Highlights from the Meta-Analysis

“In terms of FCR outcomes, the study findings showed the effectiveness of CBTs on FCR for BCSs and suggested which approaches hold promise for reducing FCR.”

“Most reviewed studies showed significant reductions in the FCR scores of the intervention groups at the post-intervention and follow-up time points..”


At Feeling Good Institute, we specialize in advanced CBT interventions designed to meet the unique psychological needs of individuals facing significant life challenges, including the aftermath of serious illnesses. This study provides evidence for CBT interventions' positive influence on the Fear of Cancer Recurrence (FCR) among Breast Cancer Survivors (BCS) during the post-treatment phase.

Research Brief Author: Mor Frenkiel, AMFT

Citation: Park, SY., Lim, JW. Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature. BMC Cancer 22, 217 (2022). https://doi.org/10.1186/s12885-021-08909-y

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