Acceptance-and-Commitment Therapy May Reduce Fear of Cancer Recurrence
NEW YORK (Reuters Health) - Group-based acceptance-and-commitment therapy (ACT) reduces fear of cancer recurrence (FCR) in breast-cancer survivors, according to results of a pilot study.
"Most interesting was the superiority of ACT over both survivorship education and enhanced usual care in reducing fear of recurrence 6 months post-intervention," said Dr. Shelley A. Johns of Indiana University School of Medicine, in Indianapolis.
"Although we hypothesized superiority of ACT, given its focus on strengthening survivors' coping skills, we were pleasantly surprised by the magnitude of the effect in comparison to the other arms in our randomized pilot study," she told Reuters Health by email.
Up to 70% of breast-cancer survivors report clinically significant FCR. Cognitive behavioral therapy (CBT) is a common psychotherapeutic intervention for these patients, but its reported effect size is limited.
ACT emphasizes acceptance while living mindfully according to one's values, whereas CBT aims to change unhelpful thoughts and feelings.
Dr. Johns's team did a pilot randomized trial comparing group-based ACT with survivorship education and enhanced usual care in 91 breast-cancer survivors with clinically significant FCR (FCR scores of at least 13/36 on the nine-item FCR Inventory-Short Form, or FCRI-SF).
Overall, 94.5% of participants completed the study, and about 89% of participants completed all four assessments (baseline, end of intervention at six weeks, one month after the intervention, and six months after).
FCR severity six months after the intervention was lower in all treatment groups, but only ACT produced significant improvement at each time point, the researchers report in Cancer, online September 20.
As measured by Cohen's d, ACT showed significantly larger reductions in FCR severity at the end of the intervention (0.68, a moderate effect) and at six months (0.80, a large effect) compared with survivorship education. ACT was also superior to enhanced usual care at six months (0.61, a moderate effect).
On pairwise comparisons, at six months, ACT was found to be superior to survivorship education with regard to 10 of the 12 secondary outcomes and superior to enhanced usual care with regard to 7 of the 12 secondary outcomes with moderate to large effect sizes.
Survivorship education did not differ significantly from enhanced usual care with regard to FCR severity or any of the secondary outcomes.
"These pilot results suggest that breast-cancer survivors with clinically significant fear of recurrence may derive the most benefit from a skills-based intervention that goes beyond what is generally offered in practice," Dr. Johns said.
"In our ACT groups, survivors learned to focus on the present moment through mindfulness-meditation practices and accept their fear with greater ease. They also clarified their values and established weekly goals to expand patterns of values-based action in their lives," she added.
"Cancer survivors struggling with fear of recurrence may benefit from ACT-based skills training," she concluded. "An increasing number of healthcare providers are being trained in ACT, so you may wish to refer survivors with fear of recurrence to an ACT provider in your community. The Association for Contextual Behavioral Science offers a web page you may search to find a local ACT provider: https://contextualscience.org/civicrm/profile. "
Dr. Louise Sharpe of The University of Sydney, Australia, who studies FCR, told Reuters Health by email, "There is a recent systematic review that confirms that psychological interventions are efficacious for FCR, and that contemporary CBTs (which focus on processes, rather than content of beliefs, would include ACT, as well as mindfulness and metacognitive therapy) are more efficacious than traditional CBT. So, we might expect in a larger, definitive trial that ACT might show promise for the management of FCR."
"However," she said, "we already have efficacious treatments that have been shown in large-scale trials to be more efficacious than well-matched treatments, so these should really be used in favor of the protocol used in this study."
"FCR is a problem and does respond to psychological treatment, and physicians should refer patients who have high levels of fear and worry, particularly if they are preoccupied by those fears and worries," Dr. Sharpe said.
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