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Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial

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Abstract

Purpose

Breast cancer is the leading cause of cancer mortality in women worldwide. With medical advances, metastatic breast cancer (MBC) patients often live for years with many symptoms that interfere with activities. However, there is a paucity of efficacious interventions to address symptom-related suffering and functional interference. Thus, this study examined the feasibility and preliminary efficacy of telephone-based acceptance and commitment therapy (ACT) for symptom interference with functioning in MBC patients.

Methods

Symptomatic MBC patients (N = 47) were randomly assigned to six telephone sessions of ACT or six telephone sessions of education/support. Patients completed measures of symptom interference and measures assessing the severity of pain, fatigue, sleep disturbance, depressive symptoms, and anxiety.

Results

The eligibility screening rate (64%) and high retention (83% at 8 weeks post-baseline) demonstrated feasibility. When examining within-group change, ACT participants showed decreases in symptom interference (i.e., fatigue interference and sleep-related impairment; Cohen’s d range = − 0.23 to − 0.31) at 8 and 12 weeks post-baseline, whereas education/support participants showed minimal change in these outcomes (d range = − 0.03 to 0.07). Additionally, at 12 weeks post-baseline, ACT participants showed moderate decreases in fatigue and sleep disturbance (both ds = − 0.43), whereas education/support participants showed small decreases in these outcomes (ds = − 0.24 and − 0.18 for fatigue and sleep disturbance, respectively). Both the ACT and education/support groups showed reductions in depressive symptoms (ds = − 0.27 and − 0.28) at 12 weeks post-baseline. Group differences in all outcomes were not statistically significant.

Conclusions

ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients and warrants further investigation.

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Acknowledgements

The authors thank Susan Daily, B.S., RT (T), Kelly Chinh, B.S., Lauren Hall, LCSW, and Danielle B. Tometich, M.S., for their assistance with this study and the study participants for their time and effort. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or Walther Cancer Foundation.

Funding

This study was supported by a grant from the Walther Cancer Foundation. Catherine Mosher was supported by the National Cancer Institute (K07CA168883 and K05CA175048). Shelley Johns was supported by the National Cancer Institute (K05CA175048) and Walther Cancer Foundation (0175.01). Victoria Champion was supported by the National Cancer Institute (K05CA175048).

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Authors and Affiliations

  1. Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA

    Catherine E. Mosher, Ekin Secinti & Adam T. Hirsh

  2. Department of Biostatistics, Indiana University Fairbanks School of Public Health, Health Sciences Building (RG), 1050 Wishard Blvd. Floors 5 and 6, Indianapolis, IN, 46202, USA

    Ruohong Li

  3. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, PO Box 19024, Seattle, WA, 98109, USA

    Jonathan Bricker

  4. Department of Psychology, University of Washington, Box 351525, Seattle, WA, 98195, USA

    Jonathan Bricker

  5. Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Drive, Indianapolis, IN, 46202, USA

    Kathy D. Miller, Bryan Schneider, Anna Maria Storniolo & Erin V. Newton

  6. Banner MD Anderson Cancer Center, 2946 E Banner Gateway Dr, Gilbert, AZ, 85234, USA

    Lida Mina

  7. School of Nursing, Indiana University, 1111 Middle Drive NU 340G, Indianapolis, IN, 46202, USA

    Victoria L. Champion

  8. Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street, RF-226, Indianapolis, IN, 46202, USA

    Shelley A. Johns

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  1. Catherine E. Mosher
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  2. Ekin Secinti
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  3. Ruohong Li
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  6. Kathy D. Miller
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  7. Bryan Schneider
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  9. Lida Mina
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  10. Erin V. Newton
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  11. Victoria L. Champion
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  12. Shelley A. Johns
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Correspondence to Catherine E. Mosher.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Mosher, C.E., Secinti, E., Li, R. et al. Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial. Support Care Cancer 26, 1993–2004 (2018). https://doi.org/10.1007/s00520-018-4045-0

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