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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

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



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.


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.


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.


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


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

[Available on 2021-01-01]

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