Trial design 
The COMFORT trial is designed as a prospective, randomised, controlled, single-centre superiority trial with two parallel groups and a primary endpoint of psychological distress 18 weeks post-enrolment. The study will randomise patients who have experienced a cancer recurrence since March 2020 into two groups on a 1:1 basis: one that receives compassion-focussed therapy and radical breathing retraining and the other control group who receives TAU. As all patients will be endorsing elevated levels of distress, it is possible that they will be indicated for individual psychosocial care, as part of the hospital’s psycho-oncology service (CNS, Social Work, Psychology & Psychiatry), but this is likely to be controlled for across both groups. Figure Study flowchart