Background The most common, persistent concern among breast cancer survivors is the fear that their disease will return, yet few interventions targeting fear of cancer recurrence (FCR) have been developed. This pilot study examined the feasibility, acceptability, and preliminary efficacy of a home-delivered cognitive bias modification (CBM) intervention to reduce FCR. The intervention, Attention and Interpretation Modification for Fear of Breast Cancer Recurrence (AIM-FBCR), targeted two types of cognitive biases (i.e., attention and interpretation biases). Methods Breast cancer survivors (n=110) were randomized to receive eight sessions of one of two versions of AIM-FBCR or a control condition program. Computer-based assessments of cognitive biases and a self-report measure of FCR were administered pre-intervention, post-intervention, and 3 months post-intervention. Results Improvements in health worries (p=.019) and interpretation biases (rates of threat endorsement, p<.001; and reaction times for threat rejection, p=.007) were found in those who received AIM-FBCR as compared to the control arm. While only 26% of participants who screened into the study agreed to participate, the trial otherwise appeared feasible and acceptable, with 83% of those who began the intervention completing at least 5 of 8 sessions, and 90% reporting satisfaction with the computer-based program used. Conclusions This pilot study suggests the promise of AIM-FBCR in reducing FCR in breast cancer survivors. Future research should attempt to replicate these findings in a larger-scale trial using a more sophisticated, user-friendly program and additional measures of improvement in more diverse samples. ClinicalTrials.gov Identifier: NCT01517945.

Background: Adults with metastatic cancer frequently report anxiety and depression symptoms, which may impact health behaviors such as advance care planning (ACP).Objective: The study leveraged Acceptance and Commitment Therapy (ACT), an evidence-based approach for reducing distress and improving health behaviors, and adapted it into a multi-modal intervention (M-ACT) designed to address the psychosocial and ACP needs of anxious and depressed adults with metastatic cancer.The study evaluated M-ACT's acceptability, feasibility, and efficacy potential. Design:The study was designed as a single-arm intervention development and pilot trial.Setting/Subjects: The trial enrolled 35 anxious or depressed adults with stage IV cancer in community oncology clinics, with a referred-to-enrolled rate of 69% and eligible-to-enrolled rate of 95%.Measurements: M-ACT alternated four in-person group sessions with three self-paced online sessions.Acceptability and feasibility were assessed through enrollment, attendance, and satisfaction ratings. Outcomes and theorized intervention mechanisms were evaluated at baseline, mid-intervention, post-intervention, and 2month follow-up.Results: Participant feedback was used to refine the intervention. Of participants starting the intervention, 92% completed, reporting high satisfaction. One-quarter did not begin M-ACT due to health declines, moving, or death. Completers showed significant reductions in anxiety, depression, and fear of dying, and increases in ACP and sense of life meaning. In this pilot, M-ACT showed no significant impact on pain interference. Increases in two of three mechanism measures predicted improvement on 80% of significant outcomes. Conclusions:The M-ACT intervention is feasible, acceptable, and shows potential for efficacy in community oncology settings; a randomized trial is warranted.

Objectives: To determine the preliminary feasibility, acceptability, and effects of Meaning-Centered Grief Therapy (MCGT) for parents who lost a child to cancer. Methods: Parents who lost a child to cancer and who were between six months and six years post-loss and reporting elevated levels of prolonged grief were enrolled in open trials of MCGT, a manualized, one-on-one cognitive-behavioral-existential intervention that utilized psychoeducation, experiential exercises, and structured discussion to explore themes related to meaning, identity, purpose, and legacy. Parents completed 16 weekly sessions, 60–90 minute in length, either in person or through videoconferencing. Parents were administered measures of prolonged grief disorder symptoms, meaning in life, and other assessments of psychological adjustment pre-intervention (T1), mid-intervention (T2), post-intervention (T3), and at three months post-intervention (T4). Descriptive data from both the in-person and videoconferencing open trial were pooled. Results: Eight of 11 (72%) enrolled parents started the MCGT intervention, and 6 of 8 (75%) participants completed all 16 sessions. Participants provided positive feedback about MCGT. Results showed post-intervention longitudinal improvements in prolonged grief (d = 1.70), sense of meaning (d = 2.11), depression (d = 0.84), hopelessness (d = 1.01), continuing bonds with their child (d = 1.26), posttraumatic growth (ds = 0.29 – 1.33), positive affect (d = 0.99), and various health-related quality of life domains (ds = 0.46 – 0.71). Most treatment gains were either maintained or increased at the three-month follow-up assessment. Significance of Results: Overall, preliminary data suggest that this 16-session, manualized cognitive-behavioral-existential intervention is feasible, acceptable, and associated with transdiagnostic improvements in psychological functioning among parents who have lost a child to cancer. Future research should examine MCGT with a larger sample in a randomized controlled trial.

Objective: The study aims to examine the prevalence and common themes of unfinished business (UB) and its associations with distress among advanced cancer patients. Methods: A total of 223 patients from a larger randomized controlled trial of Individual Meaning-Centered Psychotherapy (IMCP) completed self-report questionnaires that assessed UB and UB-related distress, hopelessness, desire for hastened death, anxiety and depression, quality of life, spiritual well-being, and purpose/meaning. Unfinished business themes were identified by qualitative analysis of open-ended data. Results: A total of 161 (72%) patients reported the presence of UB. The mean UB-related distress score was 7.01 (SD = 2.1) out of 10. Results of independent t tests showed that patients with UB reported significantly higher levels of anxiety and lower levels of existential transcendence than patients without UB. Linear regression equations indicated that UB-related distress significantly predicted hopelessness (F1,154 = 9.54, P < 0.05, R2 = 0.058), anxiety (F1,154 = 4.31, P < 0.05, R2 = 0.027), personal meaning (F1,136 = 6.18, P < 0.05, R2 = 0.043), and existential transcendence (F1,119 = 6.7, P < 0.05, R2 = 0.053). Ten UB themes emerged from open-ended responses; UB themes were not associated with UB-related distress or psychological adjustment. Conclusions: Unfinished business was both prevalent and distressing in our sample. Findings underscore the need to develop and implement interventions designed to help patients resolve or find solace with UB.

The authors alone are responsible for the views expressed in this letter and they do not necessarily represent the decisions, policy or views of the World Health Organization. The letter is based in part upon work from Action CA16207 "European Network for Problematic Usage of Internet", supported by the European Cooperation in Science and Technology (COST).