Precision oncology promises greater clarity through molecular diagnosis, biomarker-guided treatment and increasingly personalised care. Yet more sophisticated testing does not necessarily eliminate uncertainty but rather it often changes its form. Patients may wait anxiously for genomic results, receive complex or inconclusive findings, identify an actionable alteration without an accessible treatment, or enter an early-phase trial where the likelihood and durability of personal benefit remain uncertain. Even when treatment is effective, fear may shift towards toxicity, resistance, scan results and what comes next.
This talk will explore how fear of cancer recurrence and progression arises within modern precision oncology and how clinicians and health systems can respond. Drawing on our work developing and implementing a brief clinician-delivered intervention for fear of cancer recurrence, I will discuss its ongoing adaptation for fear of cancer progression across advanced cancers. This work incorporates communication about prognosis and uncertainty, scanxiety, symptom vigilance, self-management of worry and referral to psycho-oncology.
The talk will move beyond individual communication to consider systems-level interventions. Stepped-care models can embed routine identification and normalisation of cancer-related worry, provide brief first-line support within oncology care, and enable escalation to targeted psychological intervention for those with persistent or severe fear.
Statewide navigation models can also reduce uncertainty by connecting molecular testing, multidisciplinary interpretation, clinical trials and supportive care. Navigation provides continuity, helps patients understand what results mean, prepares them for multiple possible outcomes and ensures there is a clear next step even when no treatment match is found.
Precision medicine is not truly personalised unless it addresses both biological complexity and the persistent uncertainty experienced by patients and families.