Quick impact summary
- People living with breast and bowel cancer had significant reductions in fear of cancer recurrence after using the mindfulness-based program, MindOnLine.
- People living in metropolitan and rural and remote areas all had a reduction in fear of cancer recurrence overall after using the program, however there was a larger improvement for those living in metropolitan areas.
- Online mindfulness programs are a viable way to deliver care to people living with breast, bowel or prostate cancer, and can significantly improve their wellbeing.
- MindOnLine has the potential to be scaled nationally and reach people living in rural and regional areas.
Fear of cancer recurrence a common condition among cancer survivors
A common experience for people living with cancer is the fear of cancer returning or progressing. This fear can endure long after the patient has received treatment and been cleared of the disease. According to Senior Research Fellow at Deakin’s School of Nursing and Midwifery Natalie Winter, over 50% of people living with cancer experience fear that it will recur and require support and stress management techniques to help manage these fears.
“Fear of recurrence can be linked with other emotional and physical symptoms, such as anxiety and fatigue, and can impact on people’s overall quality of life,” Winter said.
“It stems from this ongoing worry of, ‘Will my cancer come back?’ ‘When is it going to come back?’ ‘Is it going to be worse than before?’ Excessive thoughts like this can be debilitating.”
Many previous studies use face-to-face programs, some being intensive and requiring participants to complete actives such as a whole day of silence. Mindfulness programs are known to improve this fear of cancer recurrence, but there has been limited evidence as to whether mindfulness can be effectively delivered online and whether brief interventions can be effective.
Responding to this need, a research team from Deakin University completed a pilot randomised control trial of an online mindfulness program for people diagnosed with melanoma in 2019.
“This was our pilot study of the online mindfulness-based intervention program, MindOnLine, and the results of the six-week trial found that it significantly decreased fear of cancer recurrence in people living with melanoma,” Winter said.
The research prompted further interest in the study for people with other forms of cancer, given that one’s fear response can vary according to how aggressive their particular cancer is known to be.
Winter said there is a growing need for psychosocial support for cancer patients during and after treatment. “Appointment times with doctors are so short, it’s really difficult for them to cover absolutely everything in a consultation,” she said. “Having an easily accessible mindfulness program as a back-up that doctors would be able to say to their patients, ‘Hey, try this over the next two months,’ could really help with the patient’s wellbeing going forward.”
MindOnLine has the potential to be scaled nationally and by reaching people living in rural and regional areas, helps to overcome barriers in accessing face-to-face care.
Online nine-week mindfulness intervention for people with breast, prostate and bowel cancers
In partnership with the Department of Health, Victoria, as well as national advocacy and community organisations, leading healthcare services and other universities, researchers at Deakin University conducted a trial of the MindOnLine program for people experiencing breast, prostate or bowel cancer.
“We aimed to determine the impact of the nine-week program on people’s fear of cancer recurrence after nine weeks and six months later,” Winter said.
“We invited adults living in Australia, who had finished cancer treatment in the last five years for breast, prostate or bowel cancer, and who had an elevated level of fear of cancer recurrence, to participate in the study.”
The MindOnLine program was a brief, self-directed, online intervention that incorporated weekly education videos and twice-daily mindfulness audios promoting mind awareness and emotion regulation.
Winter said over 400 people have taken part in the study.
“Participants received a new education video each week, which explained what mindfulness was, how it relates to cancer, and how mindfulness can help with that fear of cancer recurring,” she explained.
“The education piece was important alongside the mindfulness exercises, because it provided people with a theoretical understanding of what they were doing and what the role of mindfulness was in their wellbeing.”
Outcomes
After using MindOnLine, participants had a significant reduction in fear of cancer recurrence, anxiety, and depression – both at the nine-week point, and nine months after completing the program.
The results found that people living with breast and bowel cancer had significant reductions in fear of cancer recurrence, while those with prostate cancer had little.
People living in metropolitan and rural and remote areas all had a reduction in fear of cancer recurrence overall, however there was a larger improvement for those living in metropolitan areas.
“We will be doing further studies to understand the different responses, so we can only speculate about them at this stage,” Winter said.
“One of the reasons prostate cancer patients might have had little reduction could be to do with how men relate to the concept of mindfulness and whether that is different to women or to people with other types of cancer. As a general statement, men also didn’t have as much worry to begin with, and were a little more ready to stop thinking about the cancer once treatment was done.”
Overall, the study found that online mindfulness programs are a viable way to deliver care to people living with breast, bowel or prostate cancer, and can significantly improve their wellbeing. Here is what two of the participants had to say about it:
“The MindOnLine program addresses my very real and troubling challenges and helps me look at them with more hope and a more optimistic view. And the program also helps me to see that my fears (of cancer recurring) are normal in this situation. I can be, and am starting to be more compassionate and understanding of my feelings and thoughts.”
“It made me feel someone cared. End of cancer treatment leaves me feeling discarded and irrelevant and utterly alone with no help or care from anyone.”
Winter said participants enjoyed the fact that they could access the program in their own time. “It wasn’t as prescriptive as needing to go to a group at a set time at a set location,” she said. “And people felt they could get on with their day more easily, not having as much fear.
“This project is exciting because it will give us the evidence of how interventions can be brief while still having a big impact on people’s recovery and ongoing life after cancer. It’s something that helps reduce fear and anxiety in the community. Being able to support people beyond their treatment, where they do have less frequent interactions with the healthcare system, is important.”
Exploring the potential of MindOnLine for people living with all types of cancer across the disease trajectory
The team is also looking into further studies to better understand the ways MindOnLine can better support people in the community reduce their fear of cancer recurrence.
“We’re looking potentially at three studies,” Winter explained. “Two studies will focus on specific groups of people in the community, including those from priority populations. We use a co-design approach for our studies so that we know the interventions are meeting people’s needs. We are keen to understand what different community groups think in terms of the program and what changes we may need to make it so that it’s something they are more likely to use.
“The third study will involve opening it up to different types of cancer. We’ve tested it with breast, bowel, prostate and melanoma cancers. Now we want to see how it helps people with other types of cancers across Australia, so that we can have the widest impact possible when it comes to rolling out.”
Read the full report titled: Efficacy of an online mindfulness program (MindOnLine) to reduce fear of recurrence in people living with–and beyond–breast, prostate or colorectal cancer: a randomized controlled trial
Project title: MindOnLine: a 9-week online intervention for people living with breast, bowel or prostate cancer
Time period: 2020-2024
Funding: $715,644 NHMRC Partnership grant
Research leads: Professor Patricia Livingston, Professor Vicki White
Project manager: Dr Natalie Winter
Research team: Trish Livingston, Vicki White, Natalie Winter, Lahiru Russell, Liliana Orellana, Mari Botti, Bodil Rasmussen, Helena Romaniuk, Michael Jefford, Afaf Girgis, Cathy Mihalopoulos, David Austin, Anna Ugalde, Richard Chambers, Ben Smith, Kathryn Whitfield, Kate Gillan, Addie Wootten, Dishan Herath, Jo Phipps-Nelson, Sally Sara, Madhu Singh, David Campbell, Kirsten Pilatti, Eric O, Brindha Pillay, Maria Ftanou, Phil Dundee, Michael O’Callaghan, Sue Evans.
Partners and supporters: Victorian State Government Department of Health, Peter MacCallum Cancer Centre, Western Health, Barwon Health, Epworth HealthCare, Breast Cancer Network of Australia, Prostate Cancer Foundation of Australia, Smiling Mind, University of NSW, Monash University, Cancer Council Victoria, Flinders Medical Centre, Australian Prostate Centre.
Help Us Expand MindOnline: A Call to Philanthropic Partners
We are seeking visionary philanthropic partners to help us expand MindOnline — a pioneering digital mental health support program — so that it can reach people living with all cancer types and extend its impact to carers.
MindOnline has shown a positive impact on the mental health wellbeing of people living with cancer. But right now, its reach is limited. With your support, we can:
- Scale MindOnline across Australia, ensuring that no patient is left behind regardless of the cancer type or where people live.
- Test and refine the program with a broader, more diverse patient population, allowing us to tailor support to individual needs and improve outcomes in all cancer types.
- Extend MindOnline to carers, who often face immense emotional and psychological strain while supporting loved ones through treatment and recovery.
This is a unique opportunity to invest in a scalable, evidence-based solution that addresses the often-overlooked mental health challenges of cancer. Your funding will directly enable:
- Clinical trials and real-world testing across multiple cancer types
- Development of tailored modules for carers
- Refinement of program content and delivery
- Strategic partnerships to embed MindOnline into cancer care pathways
Together, we can transform how mental health is supported in cancer care — making it more inclusive, accessible, and effective for patients and carers alike.
If you’re ready to be part of this transformative journey, we’d love to speak with you.
Contact us on health-transformation@deakin.edu.au
