Fear of cancer doesn’t end when treatment stops
Treatment is over. The checkups are going well. Yet getting back to life after cancer often turns out to be harder than expected. Many cancer survivors continue to experience the effects of the disease or treatment long afterward. For example, a visit to the hospital, a follow-up appointment, or a reminder of the treatment can cause anxiety.
To support people who have had cancer in this process, researchers at Radboudumc, together with cancer survivors and Minddistrict, developed the online self-help module “Healthier Thinking After Cancer.” The training helps participants change automatic negative thought patterns into more positive ones. As a result, people experience less stress and anxiety.
The module emerged from a collaboration between the Center of Expertise on Late Effects of Cancer (LATER Clinic) and the Department of Psychiatry at Radboudumc. Both teams recognized the same challenge in practice: how do you support people who have completed medical treatment but are still experiencing the psychological consequences of cancer?
One of the driving forces behind the project is behavioral scientist Janna Vrijsen, a senior researcher at Pro Persona and professor of Mental Fitness at Radboudumc. In a previous interview for Validation Friday, she explained how small changes in thinking and behavior can have a significant long-term impact. That idea also forms the basis of this module.
Why Old Anxiety Sometimes Keeps Coming Back
People who have had cancer sometimes react strongly to signals from their bodies or situations related to illness. A follow-up appointment can cause anxiety even days in advance. For some people, even seeing a hospital building or the Waal Bridge near Nijmegen on the way to Radboudumc is enough to trigger feelings of fear or anxiety. These automatic reactions can significantly impact daily life.
Research shows that after cancer, people may automatically pay more attention to illness-related information. They also often interpret information related to illness or treatment more negatively. This way of processing information increases the risk of anxiety and mood symptoms.
The need for support for these symptoms is growing. It is estimated that by 2032, approximately 1.4 million Dutch people will be living with or after cancer. Psychological help often becomes available only when symptoms are severe enough to warrant a diagnosis. In addition, wait times in mental health care are long.
Healthier Thinking After Cancer offers an accessible form of support for people experiencing mental health symptoms after cancer. The goal is to address symptoms early on and prevent them from worsening.
Healthier Thinking After Cancer Changes Thought Patterns
The Healthier Thinking After Cancer module aims to influence the automatic thought processes of cancer survivors. The module is based on Cognitive Bias Modification (CBM), a method that has previously been successfully applied to treat anxiety and mood disorders.
The training lasts about four weeks and consists of short sessions of about fifteen minutes. During a training session, participants are shown a set of two photos 75 times. Half of the photos are related to a hospital setting; the other half are related to positive feelings. At a certain point, an arrow appears on the screen instead of one of the photos. The participant then presses the corresponding arrow on the keyboard as quickly as possible. This exercise repeatedly trains the participant’s attention.
Participants are also shown short stories and photos of the hospital. For each, two possible interpretations are provided: one based on cancer or illness, and one with a more positive explanation of the situation. This encourages people to choose the positive interpretation.
The goal is for participants to:
- Automatically notice positive information
- Reduce or prevent negative feelings associated with hospitals
- Develop or reinforce more positive reactions to hospitals and illness-related feelings
By repeating this regularly, the automatic way in which a person processes information changes step by step. Researchers call this a cognitive bias.
According to Janna Vrijsen, these types of interventions align well with what we now know about behavioral change. “Minor differences between people, and within a single person over time, can have a very significant effect in the long run.” It’s not about a single major breakthrough, but rather about small changes that accumulate over time.
Developed in collaboration with cancer survivors
A key goal of the project was to optimize the module so that it effectively meets the needs of both people who have had cancer and the healthcare providers who wish to use it.
To this end, researchers from Radboudumc, cancer survivors, and Minddistrict worked closely together. Through interviews, user tests, and feedback sessions, they examined how the module is perceived and where improvements can be made.
Cancer survivors contributed their insights on the content, user-friendliness, and design of the intervention. In addition, they appear in various videos as experts by experience. Their personal stories provide a sense of recognition and resonate with the questions and experiences of others who have gone through cancer. Users will remain involved throughout the module’s further development. “The fact that we developed the module together with cancer survivors makes it very valuable,” says Janna.
Minddistrict contributed expertise in the field of ehealth and helped make the intervention available as an online self-help module. To investigate how the module works in practice, researchers are monitoring participants during and after the training. Through questionnaires and interviews, they are assessing how users experience the module, what effects they notice, and where there is room for improvement.
Initial feedback is positive
The updated module has been available since November 2025. So far, 25 participants have completed the training. Initial feedback is positive. Participants report that the module is accessible and easy to follow. In addition, the training appears to make people more aware of their own thought patterns.
For example, one participant said that through the exercises, they realized how strong their tendency was to immediately jump to negative scenarios. Another participant noted that the hospital images were confrontational at first, but that this discomfort gradually subsided over the course of the training sessions.
Meanwhile, interviews with participants are ongoing. Healthcare providers are also being involved to gain insight into how the module can best be implemented in practice. Ultimately, the goal is to make the module accessible via kanker.nl to a large group of people who experience mental health issues after cancer.
Want to read more?
In an earlier interview for Validatie Vrijdag, Janna Vrijsen shares her perspective on mental health. She also discusses cognitive biases, small behavioral changes, and why these, in particular, can have a significant long-term impact.
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Validation Friday
Improving healthcare. That’s what Minddistricter Barry Meesters works for. Just like the researchers, university medical centres and healthcare organisations he collaborates with every day. Together, they work on the development, validation and dissemination of online interventions that truly make a difference. For the Validation Friday series, Barry speaks with researchers about their personal motivations, dedication and the impact of their work.
Interested or would you like to grab a coffee with Barry sometime? Feel free to send him a message.
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