No abstract

Developing an awareness about cross-cultural practices regarding cancer disclosure issues allows the clinician to become more sensitive to the expectations of culturally and individually diverse cancer patients. To this end, all healthcare professionals should be informed about how the patient would like to be informed of a diagnosis and how involved he or she would like family members to be. In addition, an awareness of the use of nonverbal communication in some cultures and the psychosocial impact of certain terms, such as "cancer," is essential. Often, phrases such as "malignant tumor" or "growth" are less inflammatory and are more readily accepted. In ascertaining a knowledge of various cultural preferences and developing a sensitivity to these preferences, clinicians are better able to provide effective care to individuals from a variety of cultural and individual backgrounds.

Objective: Anxiety symptoms are common among cancer survivors. This study evaluated whether an acceptance-based group intervention delivered by social workers in community oncology clinics improved anxiety and related symptoms, and healthcare use, relative to enhanced usual care (EUC). Method: This multi-site trial included 135 survivors of various cancers with moderate to high anxiety about cancer/ survivorship, 1.5-24 months after treatment. Participants were randomized 1:1 to a 7-session acceptance and commitment therapy (ACT)-based group (Valued Living) or EUC (access to onsite supportive care plus resource list). Questionnaires were administered at baseline, 1, 2, 5, and 8 months post-randomization, diagnostic interviews at baseline, 2, and 8 months, and healthcare use tracked throughout. Outcomes included anxiety symptoms (primary), related symptoms, and healthcare use. Putative moderators included age, anxiety, and avoidance. Results: In intent-to-treat comparisons to EUC, Valued Living (VL) showed a nonsignificant pattern of greater improvement on anxiety symptoms ( p = .08), improved significantly more on cancer-related post-traumatic stress ( p = .002), fear of recurrence ( p = .003), and energy/fatigue ( p = .02), and missed significantly fewer medical appointments ( p < .05). Conditions improved similarly on depressive symptoms, sense of meaning, and most severe anxiety or depressive disorder. Effects were moderated: VL participants with higher baseline anxiety or avoidance (+1SD) improved more on anxiety, meaning ( p s ≤ .01), and disorder severity ( p = .05) than their EUC counterparts. Conclusions: An acceptance-based group intervention delivered in community oncology clinics enhanced psychological recovery and energy levels, and reduced missed medical appointments for anxious cancer survivors, with stronger effects for more distressed participants. Public Health SignificanceThis trial demonstrated that an acceptance and commitment therapy (ACT)-based group intervention for anxious cancer survivors, as delivered by clinical social workers in community cancer care clinics, accelerated psychological recovery and energy levels, and reduced missed medical appointments. The effects were stronger and broader for more anxious and avoidant participants, demonstrating that cancer survivors with more pronounced psychological symptoms benefitted most.

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.