Randomized trial of acceptance and commitment therapy for anxious cancer survivors in community clinics: Outcomes and moderators.

Abstract

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.

Intervention and Mediation Effects of Target Processes in a Randomized Controlled Trial of Acceptance and Commitment Therapy for Anxious Cancer Survivors in Community Oncology Clinics

“…We examined mediation for the anxiety-related outcome measures, each of which showed 1 All participants had to report current anxiety about cancer or cancer survivorship; 97% also screened positive for anxiety symptoms in daily life and 57% screened positive for depressive symptoms in daily life (Arch et al, 2021).…”

“…significant or marginally significant condition differences in change from Pre to 6-month followup in the main outcome analyses (Arch et al, 2021). Anxiety symptom outcomes were measured with the Hospital Anxiety and Depression Scale-Anxiety subscale (Pre α = .64; Zigmond & Snaith, 1983).…”

“…The present study applies these methodological recommendations and advances in a mediation analysis of the Valued Living RCT (Arch et al, 2021). This RCT tested group-based ACT vs. minimally-enhanced usual care (MEUC) for anxious adults who recently completed cancer treatment and were transitioning into cancer survivorship, a challenging period wherein some cancer survivors experience a new onset or continuation of clinically significant anxiety disorders and related symptoms (e.g., Arch et al, 2020).…”

“…Consistent with the care model in this setting, the intervention was delivered by onsite oncology clinical social workers. The interventionists showed impressive adherence to the manualized intervention content (Arch et al, 2021) despite most of them having minimal or no prior ACT experience and limited study-specific training (reading sections of a book and completing a multi-day training for the study) and supervision (provided only during the first four of 12 cohorts of the RCT).…”

“…Because there were no significant cohort-clustering effects in the main RCT outcomes (Arch et al, 2021), cohort was not modeled in the present study.…”