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

Aslı Eyrenci¹, Levent Ertuna², Ozan Bahçivan³

¹Maltepe University, İstanbul, Türkiye.

Psycho-Oncology

|November 30, 2025

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.

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