Managing Cancer And Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer

Lo, Chris; Hales, Sarah; Jung, Judy; Chiu, Aubrey; Panday, Tania; Rydall, Anne; Nissim, Rinat; Malfitano, Carmine; Petricone-Westwood, Danielle; Zimmermann, Camilla; Rodin, Gary

doi:10.1177/0269216313507757

Cited by 136 publications

(152 citation statements)

References 61 publications

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“…The ways in which clinical practice may change to address these issues is dependent on context and available resources. Supportive interventions for oncology teams have been developed to improve awareness and communication about end of life issues to alleviate distress and promote quality of life (24,(39)(40)(41). Their implementation may allow for earlier identification and treatment of patients having difficulty acknowledging and adapting to advanced disease.…”

Section: Discussionmentioning

confidence: 99%

“…Participants in this study were part of a clinical trial examining the efficacy of a brief psychotherapy intervention, Managing Cancer And Living Meaningfully (CALM) (24,27) to alleviate distress in patients with advanced cancer. It was delivered by clinicians (i.e.…”

Section: Setting/contextmentioning

confidence: 99%

“…Death anxiety is distressing to the family (20) and may hinder advance care planning and preparation for the end of life (22). A death anxiety scale tailored for use in patients with advanced cancer, the Death and Dying Distress Scale (DADDS) (23), has recently been validated and employed as an outcome in clinical trials (24). However, the interpretation and clinical utility of self-reported scores may not be evident without further linkage to the phenomenology of death anxiety as it emerges in clinical settings (25,26).…”

Section: Introductionmentioning

confidence: 99%

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Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

Shaw

Chrysikou

Davis

et al. 2017

Patient Education and Counseling

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How to cite TSpace itemsAlways cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page. Aim: To inform our understanding of death anxiety in patients with advanced cancer by exploring the relationship between this self-reported symptom and its clinical presentation. Design: Participants were part of a psychotherapy trial in advanced cancer. First therapy session transcripts were analyzed using interpretive description in patients reporting low, moderate and high death anxiety on the Death and Dying Distress Scale (DADDS). Setting/participants: 16 participants (10 women and 6 men) with advanced or metastatic cancer were recruited at The Princess Margaret Cancer Centre, Toronto, Canada. In this sample, 6 reported low death anxiety scores (DADDS 0-19), 5 moderate (DADDS 20-50), and 5 high (DADDS 51-75). Results: The low death anxiety group exhibited psychological readiness for death, or contrastingly, non-reflectiveness about death. The moderate group recognized the imminence of mortality, which impacted treatment decisions and future plans. Prior experience with death was discussed as raising the salience of mortality. The high group felt dominated by powerful emotions and could not make sense of their situation. Their distress was exacerbated by substantial relational concerns. Conclusions: Self-reported death anxiety is affected by the awareness and ability to reflect on mortality. DADDS scores may facilitate exploration of this symptom as part of a clinical assessment and may serve to guide treatment approaches. Greater attention to death anxiety is consistent with and recommended by contemporary approaches to palliative care.

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Section: Discussionmentioning

confidence: 99%

Section: Setting/contextmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

Shaw

Chrysikou

Davis

et al. 2017

Patient Education and Counseling

Self Cite

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“…In an intervention-only phase 2a pilot trial of 50 patients with advanced cancer, CALM was associated with reductions in depressive symptoms and death anxiety and an increase in spiritual well-being 21. These results were promising, leading to the present phase 2b pilot trial in which we have introduced procedures for randomisation and improved rigour in preparation for a phase 3 confirmatory trial.…”

Section: Introductionmentioning

confidence: 88%

“…CALM is a brief, manualised, individual psychotherapy consisting of 3–6 sessions delivered over 3–6 months that addresses four empirically derived domains: symptom management and communication with healthcare providers, changes in self and relations with close others, sense of meaning and purpose, and concerns related to the future and mortality 16 21 24. CALM is individualised in that it is tailored to the particular needs of the patient in content and process.…”

Section: Methodsmentioning

confidence: 99%

Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

Hales

Chiu

et al. 2016

BMJ Support Palliat Care

Self Cite

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How to cite TSpace itemsAlways cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.This article was made openly accessible by U of T Faculty. Please tell us how this access benefits you. Your story matters. In an intervention-only phase 2a trial, CALM showed promising results, leading to the present 2b study, which introduces procedures for randomization and improved rigor in preparation for a phase 3 randomized controlled trial (RCT). Aims:To test trial methodology and assess feasibility of a confirmatory RCT.Design: A parallel-arm RCT (intervention vs. usual care) with 3 and 6 month follow-ups. Assessment of feasibility included rates of consent, randomization, attrition, intervention non-compliance and usual care contamination. Primary outcome: depressive symptoms (Patient Health Questionnaire-9; PHQ-9). Secondary outcomes: major depressive disorder (MDD), generalized anxiety, death anxiety, spiritual wellbeing, attachment anxiety and avoidance, self-esteem, experiential avoidance, quality of life and posttraumatic growth. Bayesian conjugate analysis was used in this low-powered setting.Setting/participants: Sixty adult patients with advanced cancer from the Princess Margaret Cancer Centre.Results: Rate of consent was 32%, randomization 78%, attrition 25%, non-compliance 37% and contamination 17%. There was support for potential treatment effects on: PHQ-9, Odds Ratio (OR) = Conclusions:A phase 3 CALM RCT is feasible and should aim to detect effect sizes of d = 0.40, with greater attention to issues of compliance and contamination. Registration: ClinicalTrials.gov NCT02353546.

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Individual meaning‐centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer

Breitbart

Pessin

Rosenfeld

et al. 2018

Cancer

235

218

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This study provides further support for the efficacy of IMCP as a treatment for psychological and existential/spiritual distress in patients with advanced cancer. Significant treatment effects (small to moderate effect sizes) were observed in comparison with usual care, and somewhat more modest differences in improvement (small effect sizes) were observed in comparison with SP. Thus, the benefits of meaning-centered psychotherapy appear to be unique to the intervention and highlight the importance of addressing existential issues with patients approaching the end of life. Cancer 2018. © 2018 American Cancer Society.

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Managing Cancer And Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer

Abstract: CALM may be a feasible intervention to benefit patients with advanced cancer. The results are encouraging, despite attrition and small effect sizes, and support further study.

Cited by 136 publications

References 61 publications

Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

Individual meaning‐centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer

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