Fear of Cancer Recurrence

One of the most common worries women have after finishing cancer treatment is fear of their cancer coming back. You may hear this called ‘fear of cancer recurrence’ or, for some women, ‘fear of cancer progression’.

Having these fears is a natural and expected reaction. And we know a certain amount of worry can help us problem-solve and find ways to move through our concerns. For example, your fear of a recurrence may lead you to seek further useful information from your medical team or to join a support group. Fears may motivate you to take positive actions that help you feel more in control. For some women, though, their fear is so strong that it will interfere with their day-to-day life and relationships. This may make planning for the future difficult.

With time, most women say their fear of the cancer coming back does lessen, although for many it never completely goes. However, many women also say there are things you can do to help manage your fear of recurrence.

This factsheet discusses cancer recurrence and suggests some tips on how to help you manage your fears. It includes:

• What does ‘cancer recurrence’ mean?

• Why are women fearful?

• Types of fears

• Common worry times

• Day-to-day approaches to managing your fears

• Carers’feelings

• Some techniques for managing the fear of recurrence

• Findinginformationonlin

• Further information and support

It is important to remember that not all women with ovarian cancer will have a recurrence. But if you do, there are usually treatments available to help.
We encourage women to speak with their specialist doctor about possible recurrence and treatments.

Cancer recurrence means cancer that has come back (recurred). This is usually after a period during which you have had no symptoms and the cancer cannot be detected anywhere in your body.

Ovarian cancer may come back:

• in the same place it began (local recurrence)

• in the lymph nodes near to where it began (regional recurrence)

• in another area of your body some distance from the original cancer (tumour). This is called a ‘distant recurrence’ or ‘metastasis’. The most common places in the body for ovarian cancer to spread to are the bowel, liver and lungs.

There are several treatments available to treat a recurrence of ovarian cancer, no matter where it comes back. Examples include chemotherapy (most common), surgery, biological therapies and radiotherapy.

Will my cancer come back (recur)?

Knowing how likely it is a cancer will come back depends on several factors such as the type of cancer, the stage and grade of the original cancer, and which treatments you have already had. Speak with your cancer specialist as they will know your individual situation the best.

I am personally in a good spot at the moment as last month I reached the 10-year mark, and that is pretty good going for Stage III, so I am feeling most fortunate. Mind you, I still experience real fear when tests are due. One never really feels safe again.

You and your doctor may suspect your cancer has come back if you begin to have symptoms similar to those you had when you were first diagnosed. Or, you may notice other changes in your health. Your doctor will be able to explain what symptoms to watch out for that might suggest the cancer has come back. It is important you report these to your doctor.

Your doctor may also suspect your cancer has come back based on changes found in your follow-up physical examination, or if your CA125 level has been rising; see Ovarian Cancer Australia’s factsheet on CA125 for more information. Some women may have signs the cancer has come back even though their CA125 isn’t rising. If tests or symptoms suggest your cancer has recurred, it may then be confirmed by an ultrasound or computed tomography (CT) scan.

It is important to know that for some women, the CA125 test result is not an accurate marker for confirming their cancer has come back.

Responding to new symptoms

Many women speak of feeling that any symptom they develop is a sign their cancer has come back. But developing symptoms does not always mean
your cancer has come back. Many symptoms have nothing to do with cancer. However, if you have concerns or a symptom is persistent or severe, see your GP or cancer specialist for advice.

Always tell your doctor about any new symptoms or symptoms that have returned.

Remember: Every change is not cause for alarm! For changes that persist, remember to use common sense in taking steps to address them. Managing fear of recurrence is about finding a balance – you don’t need to react to everything urgently. But nor do you want to ignore important symptoms. It is about finding that balance and reacting when necessary.

Fear of the cancer coming back is the most common concern in the first year after treatment finishes. Although most women say the fear lessens over time, it can have a huge impact on their day- to-day life at the time, as well as on those around them.

It is well documented that a significant shock in your life, such as a diagnosis of cancer, can cause a deep sense of loss and grief. Even if your cancer is cured or you are in remission, the sense of loss the cancer causes can continue to affect you for a long time. You can be left feeling uncertain about your future.

Uncertainty about the future and having to take ‘new steps’ in life often creates a space for fear. Considering all this, it is not surprising that the first things women worry about once their treatment is over are:

• What if my cancer comes back?

• How will I cope if it does?

• Is there treatment to help cancer that comes back?

• How will my children, partner and friends cope?

• If it comes back, will it be worse than last time?

These are difficult questions. Unfortunately, not all of them have clear answers. Unanswered questions can leave you feeling scared, lonely, sad, depressed or helpless. You may feel unable to stop thinking about your cancer coming back, see a future or make plans. However, the answers to many of your questions may not be negative. And there are things you can do for yourself, as well as working with professional support, to help you gradually move away from that gnawing fear that your cancer will come back.

When women worry about cancer coming back, they may have fears relating to:

• what this would mean for those close to them – they don’t want to cause anyone more stress, especially children (if they have them)

• coping with more treatment – fears of the side effects, possible pain and treatment success

• taking time off work, study or family life again

• attending follow-up appointments and tests

• loss, grief and possibly dying.

There are different feelings surrounding the fear of cancer coming back. How much you worry can depend on:

• your age

• the stage of your cancer

• the level of support you have

• your personality type

• your past experiences

• your individual circumstances with your family, work/studies and general lifestyle.

Research shows some women worry more intensely about their cancer coming back, including:

• women who had a lot of side effects from their initial treatment (e.g. pain, fatigue, depression, nausea and vomiting)

• younger women

• women who feel isolated and may have little or no support

• women who feel they didn’t get enough information about their cancer, its treatment and side effects, especially about sexual changes that may happen after treatment

• women who suffered anxiety and/or depression before their cancer diagnosis.

Managing your fears may seem impossible and there may be times when your thoughts feel completely out of control. Enjoying day-to-day life can be difficult if you are constantly worrying about your cancer coming back. Relationships (intimate, work and others) can be affected. You may find it hard to make plans for future events such as holidays, family celebrations (birthdays, birth of a baby, new year celebrations) and children’s school activities.

But there are some practical things you can do to help lessen your worries and bring a greater sense of control over your fears. It is important to look after yourself when your treatment is over. Focus on living a healthy lifestyle and asking for the help and support you need. Many women find this difficult but getting help will relieve stress and provide long-term benefits. It can also lessen the time you may worry about your cancer coming back.

We discuss further ideas in ‘Day-to-day approaches to managing your fears’ and ‘Some techniques for managing the fear of recurrence’.

My biggest fear was I would not see my daughter live her life. Every other fear paled into insignificance.

Worrying about your cancer coming back can happen at any time. But some things may trigger the fear more than others, including:

• going to follow-up appointments, and knowing that a follow-up appointment is approaching

• starting anything new – job, fitness class, studies

• anniversary dates such as the date you were diagnosed or finished treatment

• birthdays, holidays and festivals such as Christmas, and other special occasions such as births or weddings

• hearing someone you know has been diagnosed with cancer

• media stories about people with cancer or about deaths from cancer

• developing symptoms that you cannot explain such as headache, abdominal pain or sore throat

• having long-term side effects from your treatment such as fatigue

• any stressful event within your family – marriage break-ups, job changes or financial difficulties.

At first it may seem impossible to manage your fears. But with time and effort many women say the intensity of their fears lessens and they can move forward. Below are practical tips that may help control your fears of a recurrence. It is important to remember that what works for one person may not work for another. But it is worth trying several things to see what works best for you.

If your feelings of anxiety persist and are affecting your day-to-day life, you may need further help. We address this in ‘Further information and support’.

Recognise your triggers and have a plan

Work out what triggers your fears the most. For some, it might be the leadup to follow-up appointments, scans and blood tests; for others, it may be the anniversary of being diagnosed. These events can cause severe anxiety as they bring up bad memories and overwhelm some women.

It is not always there on a daily basis but if cancer comes into the news or I am going back for a follow-up test or if I hear about a friend having cancer – then I start to worry about my cancer coming back.

Whatever triggers you, have a plan in place to manage the fear. For example, in the few days before your follow-up appointment, plan to do something special every day, like meet a friend for coffee, have a massage or go out to dinner with someone special. On the day of the appointment, plan another activity to ‘reward’ yourself for getting through the appointment.

Remember – the feelings will pass.

I used to find it quite confronting when my specialist would say: ‘I’ll just send you for a scan to rule out …’ But now I find it reassuring because if my doctor is vigilant and I do have a recurrence, it will be found early hopefully.”

Challenge unhelpful thoughts

Balancing out your fears against what really is happening or ‘might’ happen is very important. Thoughts about your cancer coming back are completely normal after you finish treatment. It is important to manage these thoughts and lessen the impact they can have on your daily life. Sometimes thoughts can seem to ‘have a mind of their own’ and race ahead, generating more and more worry. Being aware these thoughts are not helpful is important.

When unhelpful thoughts come into your head, stop and ask yourself the following questions:

• Am I letting my thoughts get away with me?

• Are my fears reasonable/logical?

• How would I comfort or advise a friend having thoughts about their cancer coming back?

Allowing thoughts to spiral out of control is something we have all felt. In the table we give examples of unhelpful thoughts, and suggest some more realistic or positive thoughts.

Challenging your fears doesn’t mean you are ignoring them. It simply means you are finding ways to manage the fear attached to the thoughts.

One woman who has had ovarian cancer described the way she did this very clearly:

Try to imagine your mind like a big house with lots of rooms and in one room is the cancer and your fear of it coming back, but you don’t have to spend all your time in that room. Spend some time in the other rooms, such as those where there are family/friends who love you, or the one where you can make plans. It doesn’t mean you can’t go back into the room where your cancer and fear of recurrence is, but just remember to go out and close the door on it sometimes. Be in the present.

Challenging unhelpful thoughts is not always easy; read ‘Some techniques for managing the fear of recurrence’ for other helpful ideas to help address feelings of fear.

Talk about your fears

Many women say talking to others about their fear helps. This may be difficult and make you feel uncomfortable. And some people say they don’t talk about their fears as they don’t want to worry or burden those close to them. Most people feel valued and pleased if you confide in them. They will want to provide support where they can but might not know the best way to do this. You and your close family and friends may be hiding your fears from each other, to protect each other. Yet you may have similar fears. Sharing your fears with each other

can help reduce loneliness and isolation. One research study has shown that not expressing your concerns about your cancer coming back was associated with worrying more.

It is important you feel safe with who you are talking to. Remember to do it in your own time and not feel you must talk if you are not ready.

You may gain support from talking to:

• friends and family, who can continue to comfort and support you after your treatment is over – but they may need reminding you still have fears and need to adjust to life after treatment

• your doctors and nurses, who can help you understand which of your fears are realistic and which are not

• other women who have had ovarian cancer–join a support group (online, tele-support or face to face) where you can discuss your fears with women who have been through similar experiences to you. Call Ovarian Cancer Australia for further information on 1300 660 334 or see www.ovariancancer.net.au

• counsellors who are trained to help people understand and handle fear
  of cancer recurrence. They can work closely with you to find methods
  to manage your fears and anxiety. Social workers, psychologists and psychiatrists are all excellent options for counselling. Start by asking your medical team where you are having treatment if there is ongoing counselling support available. You can also talk to your GP about whether you are eligible for some reduced-cost counselling sessions under a GP mental health care plan.

Family love you and let you know how important you are, and this calms your worry. Without them I would have been so lonely – I can’t even go there. Without support it would have just been terrible.

If your fear of recurrence is ongoing and significantly affecting your overall mood, you should speak with your GP or specialist doctor. They may recommend medication to help with your anxiety or feelings of sadness. This is only one of several options along with counselling and other supports. For more information about how to join a support group or seek counselling call Ovarian Cancer Australia on 1300 660 334.

Don’t be isolated in this – get involved with Ovarian Cancer Australia, chat to other women who have had a similar experience as no-one else quite understands it like they will. This is such a relief.

Don’t miss follow-up appointments

Going to follow up appointments can trigger fear about your cancer coming back. But it is important you attend these appointments even if they make you anxious. Regularly attending the appointments gives you the chance to ask your specialist doctors and nurses about your fears and discuss ways to help you feel less anxious. They can link you in with other professionals such as counsellors, dietitians, exercise physiologist and social workers, who can all help with your road to recovery.

Most women say they feel reassured after their follow-up appointment. It is often the build-up to the appointment that is most challenging time. Read ‘Recognise your triggers and have a plan’ section above for further tips on how to cope with a follow-up appointment.

I used to always get anxious before a follow-up appointment, but with each positive result, my fears have diminished. At my five years visit I felt like I didn’t need to worry any more.

Focus on being healthy and well

It can help to focus on being healthy rather than the possibility of becoming unwell again. As hard as it is, this has been shown to help reduce anxiety and make you feel more in control of your life again. If you feel healthy you will worry less about your cancer coming back. Putting energy into being healthy rather than worrying about a cancer recurrence is well worth it.

Eat a healthy diet with lots of fresh fruit and vegetables. Avoid excessive sugar, red meat, alcohol and fats. Get regular exercise each day. Exercise has been proven to help combat fatigue and make you feel better. You can access an exercise physiologist with a care plan from your GP to help you feel confident about the best type of exercise for your particular needs. This might include walking, riding your bike, or doing a yoga or Pilates class. Meditation helps many women focus and feel calmer and not worry so much about their cancer returning. Other complementary therapies shown to help women reduce their stress level are acupuncture, Tai Chi, massage, music therapy and guided meditations. Others find comfort in prayer.

Other ways proven to help people feel mentally and emotionally healthy is knowing they are contributing to society: being an active member of your local community. Some people find it helps to join a neighborhood group wanting to make change in your community or volunteer at your local charity shop for a few hours every month. Being around people who care about others is comforting and a good distraction from our fears.

Many women express the importance of having a laugh where possible despite difficult circumstances. Nurture your hobbies and spend time with those you love most. Let people know what is best for you – talking about your health or doing ‘normal’ things like going to a movie or meeting for coffee. These can sometimes be the best ‘medicine’ to help with feeling healthy and well. Establishing what is important to you and prioritising these activities and people can help in maintaining your emotional wellbeing.

Be kind and patient with yourself

Remember, recovering from cancer treatment takes time. Although it can be difficult, try to be patient and not expect too much too soon. It can be extremely hard to watch others live their busy and full lives while you still feel tired and worried about your cancer coming back. You may have feelings of guilt that you cannot go back to work or study yet, take the children to school or attend to home duties like you used to. You need to be kind to yourself and keep reminding yourself that things often become more tolerable and the fear of recurrence generally lessens with time. If fear of cancer recurrence continues to persist over time, we recommend you see your GP to ask for help.

Make plans and look ahead – go on that holiday!

Many women feel unable to plan or think about events in the future. These sorts of things can seem very challenging:

• booking a holiday

• planning future changes in your work/business

• planning your retirement

• dreaming about special occasions with your children or grandchildren (births, weddings and special birthday parties)

• starting new intimate relationships

• taking up a new hobby, training course or looking for a new job

• doing volunteer work.

Some women say they ‘no longer feel they will make old bones’. Or they say they feel they are living in a parallel universe and no longer part of ordinary life. If you no longer feel you have a future, it may not seem worth planning ahead, or you may be scared to plan in case you are not around to enjoy it.

Not making plans can mean you stay stuck and lose out on the chance to do things that could give you pleasure. So, make plans around things that matter to you, even if they seem small. It might be something like a special event at the end of next week. You might choose to plan to do something around an activity or hobby you used to enjoy before you had cancer. Others might prefer to start new hobbies or have different goals after their cancer treatment finishes. This is very normal and can give you a new lease on life after a very difficult time.

The important thing is to remind yourself of what is important to you outside your ‘world of cancer’. Having something to look forward to, or new to try, gives life a sense of purpose. This can all be an excellent distraction from any negative thoughts about your cancer coming back.

Moving away from the feeling of being a ‘cancer patient’ and trying to move towards being an active participant in society again can be very healing. Planning events and actively taking part in them will bring new energy and strengthen your ability to believe that you still do have a future.

Caring for someone who has been through cancer and its treatment can be very rewarding, but it can also have challenging times. Carers may also have fears about the cancer coming back. But they may find it hard to express their concerns for fear of upsetting or worrying the person they are caring for.

If you can share your fears with someone you trust, it may help ease the burden. Carers may find some of the tips in this factsheet useful. For more information about caring for someone with cancer:

Scientists all over the world are carrying out research studies into the prevention, screening, diagnosis and treatment of ovarian cancer and management of its side effects. While these studies are important, researchers are also aware of
the huge impact a cancer diagnosis can have on your emotional wellbeing. This has led to an increase in research in this area, including studies into the fear of recurrence and ways to manage these fears.

For example, researchers at the University of Sydney tested techniques to help people with cancer address the fear of their cancer coming back, including:

• attention training technique

• detached mindfulness

• postponing worry

We describe each technique below.

Because it is normal, and in some ways helpful, to have a realistic concern about your cancer coming back, these techniques don’t try to get rid of your fears, but rather try to help you stop getting too caught up in always worrying about your cancer coming back.

I found it incredibly helpful to work out how mind and emotions are connected.

ATTENTION TRAINING TECHNIQUE (ATT)

When someone gets anxious or stressed, they tend to direct their attention in particular ways. For example, they may think over and over about something they did that they regret, or about something they heard that worries them. Or they may focus on how awful or unfair their situation is, and how it is stressing them.

Using up our attention on these things sets up a cycle of self-focused attention. This only serves to increase worry and stress, maintain low mood and promote unhelpful behaviour, such as going to the GP for extra tests, which may provide short-term relief but ultimately only serve to make someone feel more under threat. The more we focus on a problem, the more sensitive we become to it and the more it grows. For example, the more we focus our attention on a dripping tap in the middle of the night, the more irritating it becomes.

These thoughts may feel impossible or beyond your control to change. However, increasing scientific evidence suggests people can train their attention, and in doing so they become less likely to suffer high levels of worry and unpleasant emotions.

ATT involves using simple techniques to give you better attention control. ATT
is designed to help people put their attention where they want to, rather than where it goes automatically. ATT helps people decrease their tendency to brood over a problem. It can help people to shift their attention more flexibly when unwanted thoughts about cancer recurrence happen.

To get the most out of ATT, it is recommended that you practise for 15 minutes each day for a month. It is like going to a ‘gym’ for your attention! That is, the attention training exercises are just like using gym equipment – the more you exercise your attentional muscles, the more you build them up, and the more ability you develop.

At first, I thought ATT was a bit weird, but the more I did it, the more I enjoyed feeling like I was in control over what I thought about, not my brain!

DETACHED MINDFULNESS

Detached mindfulness has been described as being aware of internal events (e.g. thoughts or feelings) without any attempt to judge, react or suppress them. Detached mindfulness is not aiming to suppress your thoughts, as doing this uses up a lot of energy and means you will actually think about your worries more. Try this thought suppression experiment to better understand how this might work:

For three minutes try to avoid all thoughts about a blue giraffe. Don’t allow yourself to have any thought connected with it, try to push it away. What did you notice? Did you think of a blue giraffe?

Now let your mind roam freely for three minutes and if you have thoughts of blue giraffes watch them in a passive way as part of an overall landscape of thoughts, much like you would watch passing clouds in the sky. What do you notice? How important are any thoughts about a blue giraffe the second time around?

As you might notice, actively trying not to think about these things can sometimes only serve to increase your thoughts about them.

Detached mindfulness means being more aware or mindful of your thinking. It involves learning to:

• step back and become an observer of your own thoughts

• understand that the self is much greater than just the content of our thoughts

• see thoughts and feelings as just passing internal events

• accept your thoughts and feelings for what they are and observe them without judging them, reacting to them or trying to get rid of them.

You can think of detached mindfulness as similar to the way you might manage a child playing up when you are out shopping. You could pay a great deal of attention to the child and try to control the child’s behaviour. But if the child craves attention, this response could make things worse. It is usually better not to actively engage with the child but to keep a passive/caring watch over the child without doing anything.

Your negative thoughts and beliefs are like that child. If you pay them a great deal of attention, if you control them or use punishment, they misbehave even more. It is better not to try and control or actively engage with them, just keep an awareness of everything. As you do this, try to be aware of yourself as an observer of these things.

The aim of detached mindfulness is not to get rid of worries about cancer recurrence but to help you become less involved with them.

You can learn to view your worries not as truths but as individual passing internal events – like leaves floating down a stream or clouds passing in the sky. If you can view your thoughts like this, they will cause you much less distress, or the distress that they cause can be reduced.

There are many detached mindfulness exercises; here we outline three you may like to practise at home. Once you have got the hang of them, you can use them the next time you have a troubling thought about cancer recurrence: for example, watch the thought, just like you watched the cloud or the tiger in the examples below. Watch and react without noticing or engaging with it.

TIGER TASK

With your eyes closed, form an image of a tiger. Do not attempt to influence or change the image in any way. Just watch the image and the tiger’s behaviour. The tiger may move, but don’t make it move. It may blink, but don’t make it blink.

The tiger may wag its tail, but don’t make it do that. Watch how the tiger has its own behaviour. Do nothing, but simply watch the image, see how the tiger is simply a thought in your mind, that it is separate from you and it has a behaviour all of its own. After the practice, notice whether you made the tiger move – or did it happen spontaneously?

If you can experience the movement as spontaneous, this is a state of detached mindfulness. You can apply this form of observation to thoughts or images of a negative kind and see what happens with them. Do they change?

CLOUDS METAPHOR

One way to understand detached mindfulness and what it requires is to consider experiencing your thoughts as you would experience clouds passing in the sky. The clouds are part of the earth’s weather system, and it would be impossible and unnecessary to try and control them. Try to treat your thoughts and feelings like you would treat passing clouds and allow them to occupy their own space and time in the knowledge that they will eventually pass you by.

WORRY POSTPONEMENT

Worry, like fear of cancer coming back, can be useful, in that it can trigger you to do something to solve a problem. But worry can often happen without you even being aware of what triggered it. Because of this, worry can interfere in our daily life. One way of dealing with this is to only allow yourself to worry at a particular time – create a ‘worry period’. By learning to postpone your worry successfully it will:

• mean your worries are less intrusive in your life

• allow you to manage your worry effectively

• give you a feeling of better self-control.

This is similar to the example earlier about imagining your mind as a big house in the ‘Challenge unhelpful thoughts’ section. Another example is to imagine someone who is self-employed. If the mobile rings during work, the choice is to answer it and disrupt the current work or to let the caller leave a message and return the call later. It is about choosing when to think about things rather than responding to every thought as it appears.

Below we outline the steps you can take to postpone your worry. Be prepared to practise this approach repeatedly. It takes time and patience.

1. Create a worry period: Choose a time, place and length of time for worrying. Make sure you are comfortable and free from distractions. The duration should be no more than 20 minutes, and at the same time and place each day and more than two hours before bedtime.

2. Postpone your worry: During the day when you worry, tell yourself you will postpone each worry to the worry period. Write down each worry as it comes into your head but then put it away. Be firm with yourself and keep reminding yourself you will have time to focus on your worry later. This can help you to return to whatever it is that is important or enjoyable for you to focus on in that moment.

3. Come back to your worries at the designated worry period: When your worry period comes around, settle yourself down at the place you had planned and take some time to reflect on the worries you had during the day. If you have any worries after your worry period, just write them down for the next day.

To begin with many people, say worry postponement feels strange and is an effort to put in practice. But with time and practice and sticking to the ‘rules’ it can work. People are often surprised by how they can postpone their worries and have a greater sense of self.

But remember: It is not compulsory to use up your worry time – if you do not get back to it, don’t be hard on yourself – you can always do it tomorrow. And with time you may find you do not even need the worry postponement time at all.

The internet has an enormous amount of information about ovarian cancer and fear of recurrence. Try not to use online information as a substitute for the information from your doctor and other members of your healthcare team. Not all information online is accurate or will be suitable for you.

I remember spending a lot of time searching the internet for information and scaring myself to death. I would advise anyone with cancer, especially when you first find out, not to look on the internet.

While there are some very good websites, some sites provide wrong or biased information. If you want to search online, focus on websites from reputable cancer organisations and universities. You will find plenty of these sites throughout our Resilience Kit and on our website (www.ovariancancer.net.au).

When you are unwell, it can be overwhelming to try and sort through information. But you could ask a family member or friend to help if you are feeling unable to do this.

If you have continuous feelings of sadness, anxiety and fear of your cancer coming back, we strongly advise you to seek medical help. Asking your medical team for a referral to a psychologist can also help with controlling your fears of cancer recurrence.

Call Ovarian Cancer Australia on 1300 660 334 for further information about support groups and networks that can help you connect with other women in similar circumstances. They can also suggest how you can connect you with counsellors and psychologists who specialise in helping people with cancer.

Writer: Annie Angle
Editor: Rosemary Moore
This resource has been reviewed by several expert health professionals. Reviewed December 2018.

REVIEWERS

• Nadia Addabbo

• Jan Antony

• Jennifer Kennedy

• Dr Ben Smith, Translational Research Fellow, Centre for Oncology Education and Research Translation, Ingham Institute and University of New South Wales

• Professor Phyllis Butow, AM, University of Sydney

• Nicole Kinnane, Nurse Consultant Gynaecology, Peter MacCallum Cancer Centre

• Professor Jane Turner, Faculty of Medicine, University of Queensland

• Dr Dani Bullen, Clinical Psychologist, Peter MacCallum Cancer Centre

• Assoc. Professor Orla M. McNally, Consultant Gynaecological Oncologist, Royal Women’s Hospital

 © University of Sydney, 2013

Ovarian Cancer Australia would like to acknowledge the University of Sydney for the use of handouts from the ConquerFear study which were adapted in collaboration with Professor Phyllis Butow and Dr Ben Smith to form the “Techniques” section of this resource.

Authors of the original ConquerFear materials are Afaf Girgis - (University of New South Wales), Belinda Thewes - (School of Psychology, University of Sydney), Cathy Mihalopoulos - (Deakin University), Jane Beith - (Central Sydney Area Health Service), Jemma Gilchrist - (Macquarie University), Louise Sharpe - (School of Psychology, University of Sydney), Margaret Turner - (University of Queensland, Melanie Bell - (School of Psychology, University of Sydney), Phyllis Butow - (School of Psychology, University of Sydney).