Acceptance and commitment therapy for patient fatigue interference and caregiver burden in advanced gastrointestinal cancer: Results of a pilot randomized trial

Abstract

Background: Fatigue often interferes with functioning in patients with advanced cancer, resulting in increased family caregiver burden. Acceptance and commitment therapy, a promising intervention for cancer-related suffering, has rarely been applied to dyads coping with advanced cancer. Aim: To examine the feasibility, acceptability, and preliminary efficacy of acceptance and commitment therapy for patient-caregiver dyads coping with advanced gastrointestinal cancer. Primary outcomes were patient fatigue interference and caregiver burden. Design: In this pilot trial, dyads were randomized to six weekly sessions of telephone-delivered acceptance and commitment therapy or education/support, an attention control. Outcomes were assessed at baseline and at 2 weeks and 3 months post-intervention. Setting/participants: Forty patients with stage III–IV gastrointestinal cancer and fatigue interference and family caregivers with burden or distress were recruited from two oncology clinics and randomized. Results: The eligibility screening rate (54%) and retention rate (81% at 2 weeks post-intervention) demonstrated feasibility. At 2 weeks post-intervention, acceptance and commitment therapy participants reported high intervention helpfulness (mean = 4.25/5.00). Group differences in outcomes were not statistically significant. However, when examining within-group change, acceptance and commitment therapy patients showed moderate decline in fatigue interference at both follow-ups, whereas education/support patients did not show improvement at either follow-up. Acceptance and commitment therapy caregivers showed medium decline in burden at 2 weeks that was not sustained at 3 months, whereas education/support caregivers showed little change in burden. Conclusions: Acceptance and commitment therapy showed strong feasibility, acceptability, and promise and warrants further testing. Trial Registration: ClinicalTrials.gov NCT04010227. Registered 8 July 2019, https://clinicaltrials.gov/ct2/show/NCT04010227?term=catherine+mosher&draw=2&rank=1

Effectiveness of Acceptance and Commitment Therapy for people with advanced cancer: A systematic review and meta‐analysis of randomized controlled trials

“…Our results revealed that Acceptance and Commitment Therapy remarkably improved QoL of people with advanced cancer, which coincides with the results of a meta‐analysis involving people with cancer (Zhao et al, 2021). Notably, each of the four studies (Li et al, 2022; Mosher et al, 2022; Rost et al, 2012; Serfaty et al, 2019) included in this meta‐analysis consistently presented significant improvement of QoL, and low heterogeneity was found across these studies. This is possibly because people with advanced cancer who receive Acceptance and Commitment Therapy may attempt to normalize their distressing thoughts and live in the moment.…”

“…A total of 488 people with advanced cancer were included in eight RCTs, with sample sizes varying from 40 to 122. Two studies (Mosher et al, 2019; Zhang et al, 2021) focused on mixed cancer types, and five targeted a single type of cancer, including ovarian (Rost et al, 2012), breast (Mosher et al, 2018), lung (Li et al, 2022; Mosher et al, 2019), pancreatic (Pan et al, 2020) and gastrointestinal (Mosher et al, 2022) cancers. Participants' mean age varied from 40.2 to 62.6 years.…”

“…All studies included the six core processes of Acceptance and Commitment Therapy. The interventions were performed by psychologists (Mosher et al, 2022;Rost et al, 2012), nurses (Pan et al, 2020;Zhang et al, 2021), a PhD candidate in nursing (Li et al, 2022) and social workers with experience in using Acceptance and Commitment Therapy (Mosher et al, 2018(Mosher et al, , 2019Serfaty et al, 2019). The interventions lasted between 6 weeks and 4 months, with the most common length being 6 or 8 weeks, delivering 4-12 sessions in total.…”

“…Four studies (Li et al, 2022;Mosher et al, 2022;Rost et al, 2012;Serfaty et al, 2019), involving 169 participants, measured QoL.…”

“…This review provides some insights, but the direct effectiveness of Acceptance and Commitment Therapy for people with advanced cancer remains inconclusive. The rigorously designed RCTs (Li et al, 2022; Mosher et al, 2022; Pan et al, 2020; Zhang et al, 2021) conducted recently in this field may provide new and stronger evidence. Therefore, we performed a systematic review and meta‐analysis of RCTs to specifically explore the effectiveness of Acceptance and Commitment Therapy for people with advanced cancer and to inform clinical nursing interventions.…”