The AFTER intervention: a structured psychological approach to reduce fears of recurrence in patients with head and neck cancer.

Head and neck cancer and its treatment have profound effects on function, self-image, and mental health. Fears of recurrence are one of the major concerns of cancer survivors that endure and can influence the patients' ability to adjust and plan for the future. This paper describes the design and development of the adjustment to the fear, threat or expectation of recurrence (AFTER) intervention which targets recurrence fears, inappropriate checking behaviour, and beliefs about cancer, adopting recognized cognitive behavioural and health psychology principles, particularly Leventhal's self-regulation model. The intervention includes structured sessions, manualized delivery by a specialist nurse, invitation to caregiver, expression of fears, examination and change of beliefs, and checking behaviour. Initial testing showed acceptability (nurse satisfaction ratings by patient) of the intervention which may have applicability for patients who have been treated with cancer at other sites.