A Nurse-Led Hybrid Psychoeducational and Psychosocial Intervention to Reduce Fear of Recurrence Among Head and Neck Cancer Survivors in a Low- and Middle-Income Country: A Quasi-Experimental Study

Abstract

A BSTRACT Fear of cancer recurrence (FoR) is a major psychosocial concern among head and neck cancer (HNC) survivors, affecting quality of life (QoL) and emotional well-being. Evidence on structured nurse-led interventions for this population, especially in low- and middle-income countries (LMICs), remains scarce. To evaluate the effectiveness of a nurse-led hybrid psychoeducational and psychosocial intervention—delivered using bilingual educational media—in reducing FoR and improving psychosocial outcomes among HNC survivors. A quasi-experimental pre-post control design was implemented at two tertiary hospitals in Indonesia. Seventy-two HNC survivors were recruited and allocated to intervention ( n = 36) and control ( n = 36) groups. The 8-week program included six nurse-led sessions integrating structured education, cognitive-behavioral counseling, peer and family support, and bilingual print and digital modules. Outcomes were assessed at baseline, 1, 3, and 6 months using validated FoR, QoL, and psychological distress measures. Mixed-model ANOVA and correlation analyses. The intervention group showed a significant reduction in FoR ( F = 8.92, P < 0.001), with improvements in emotional, social functioning, lower anxiety, and depression. This hybrid, nurse-led program effectively reduced FoR and enhanced psychosocial well-being among HNC survivors in an LMIC context, supporting its feasibility for routine survivorship care.