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Symptom experiences in post-treatment cancer survivors: associations with acceptance and commitment therapy constructs

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Abstract

Purpose

Acceptance and Commitment Therapy (ACT) has improved symptom and quality-of-life outcomes in pilot research with post-treatment cancer survivors. To further test the ACT model, the present study examined relationships between ACT constructs and subgroups of post-treatment survivors based on the severity of common symptoms.

Methods

Survivors who had completed primary treatment for stage I or II cancer (N = 203) participated in this one-time survey. Latent class analysis (LCA) was used to identify subgroups of survivors based on the severity of fatigue, sleep disturbance, pain, anxiety, and depressive symptoms. Multinomial logistic regressions employing Vermunt’s 3-step approach were used to examine ACT constructs (e.g., mindfulness, acceptance, values progress) as correlates of survivor subgroups based on symptoms.

Results

The LCA showed three survivor classes: (1) mild-to-moderate levels of all symptoms except for normal pain intensity; (2) mild anxiety, moderate fatigue, and normal levels of all other symptoms; and (3) normal levels of all symptoms. Lower mindfulness, acceptance, and values progress and higher cognitive fusion, psychological inflexibility, and values obstruction were associated with a greater likelihood of being in class 1 or 2 than in class 3.

Conclusion

Findings are consistent with the ACT model. Survivors with greater symptom burden reported greater withdrawal from personally meaningful activities and less acceptance of their cancer diagnosis and internal experiences (e.g., thoughts, feelings, symptoms). Findings provide strong justification for further testing of ACT to reduce symptom-related suffering in cancer survivors.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

The authors thank Patrick V. Stutz, B.A., and the cancer teams at IU Health and Eskenazi Health for their assistance with this study.

Funding

This research was supported by the National Cancer Institute (K07CA168883: Mosher; K05CA175048: Johns and Mosher; T32CA117865: Krueger) and the Walther Cancer Foundation (0175: Johns).

Author information

Authors and Affiliations

  1. Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA

    Ashley B. Lewson, Shelley A. Johns, Ellen Krueger, Kelly Chinh & Catherine E. Mosher

  2. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Shelley A. Johns

  3. Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA

    Shelley A. Johns

  4. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Kelley M. Kidwell

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  1. Ashley B. Lewson
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  2. Shelley A. Johns
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  3. Ellen Krueger
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  4. Kelly Chinh
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  5. Kelley M. Kidwell
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  6. Catherine E. Mosher
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Contributions

Shelley A. Johns and Catherine E. Mosher contributed to the study conception and design. Data collection was performed by Kelly Chinh, and data analyses were performed by Ellen Kreuger and Ashley B. Lewson. The first draft of the manuscript was written by Ashley B. Lewson and Catherine E. Mosher, and all authors reviewed, edited, and approved the final manuscript.

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Correspondence to Ashley B. Lewson.

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The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Indiana University Institutional Review Board.

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

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Lewson, A.B., Johns, S.A., Krueger, E. et al. Symptom experiences in post-treatment cancer survivors: associations with acceptance and commitment therapy constructs. Support Care Cancer 29, 3487–3495 (2021). https://doi.org/10.1007/s00520-020-05854-7

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  • DOI: https://doi.org/10.1007/s00520-020-05854-7

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