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Cancer. 2020 Jan 1;126(1):211-218. doi: 10.1002/cncr.32518. Epub 2019 Sep 20.

Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial.

Author information

1
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
2
Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana.
3
Indiana University School of Nursing, Indianapolis, Indiana.
4
Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Charleston, West Virginia.
5
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
6
Research and Clinical Trials, Indiana University Simon Cancer Center, Indianapolis, Indiana.
7
Department of Psychology, Butler University, Indianapolis, Indiana.

Abstract

BACKGROUND:

Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancer survivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence-based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group-based ACT for FCR in BCS.

METHODS:

Post-treatment BCS (91 patients with stage I-III disease) with clinical FCR randomly were assigned to ACT (6 weekly 2-hour group sessions), survivorship education (SE; 6 weekly 2-hour group sessions), or enhanced usual care (EUC; one 30-minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post-traumatic stress, depression, QOL, and other FCR-related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1 month after the intervention (T3), and 6 months after the intervention (T4) using intent-to-treat analysis.

RESULTS:

Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within-group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between-group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P < .001) and EUC (Cohen d, 0.61; P < .01). For 10 of 12 secondary outcomes, only ACT produced significant within-group reductions across all time points. By T4, significant moderate to large between-group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR-related psychological distress.

CONCLUSIONS:

Group-based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.

KEYWORDS:

acceptance and commitment therapy (ACT); anxiety; breast neoplasms; fear; quality of life; survivorship

PMID:
31539169
PMCID:
PMC6906228
[Available on 2021-01-01]
DOI:
10.1002/cncr.32518

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