Tailoring Cognitive-Behavioral Therapy to Treat Anxiety Comorbid With Advanced Cancer

Abstract

Patients with advanced cancer often experience debilitating anxiety symptoms that interfere with quality of life and relate to worse medical outcomes. Although cognitive behavioral therapy (CBT) is an empirically-validated, first-line treatment for anxiety disorders, clinical trials of CBT for anxiety typically exclude patients with medical comorbidities in general, and those with terminal illnesses, such as advanced cancer, in particular. Moreover, CBT has generally targeted unrealistic fears and worries in otherwise healthy individuals with clinically significant anxiety symptoms. Consequently, traditional CBT does not sufficiently address the cognitive components of anxiety in patients with cancer, especially negative thought patterns that are rational but nonetheless intrusive and distressing, such as concerns about pain, disability and death, as well as management of multiple stressors, changes in functional status and burdensome medical treatments. In this paper, we describe a treatment approach for tailoring CBT to the needs of this population. Three case examples of patients diagnosed with terminal lung cancer are presented to demonstrate the treatment methods along with outcome measures for anxiety and quality of life.

The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy

“…1 Patients often reported an escalation of anxiety when experiencing somatic symptoms like nausea, fatigue, or pain, which may be functionally limiting and difficult to interpret. 38 A possible explanation for the change in anxiety and emotional well-being could be that the patients in this study increased their aerobic capacity (VO 2peak , 1RM) and functional capacity (6MWD) significantly. It must be assumed that patients who consent to participate in an intervention of this nature expect to improve their fitness, strength, and functioning.…”

Randomized Pilot Trial of a Telephone Symptom Management Intervention for Symptomatic Lung Cancer Patients and Their Family Caregivers

“…While most prior symptom management trials with cancer patient-caregiver dyads have emphasized patient care, 32, 45–49 TSM has a dual focus on patient and caregiver concerns. The intervention involves a blend of evidence-based cognitive-behavioral and emotion-focused strategies 42, 45, 50–53 to address patient and caregiver anxiety and depressive symptoms and patient pain, fatigue, and breathlessness. These primary outcomes were chosen because they are amenable to non-pharmacologic intervention and prevalent in this population.…”

Development of a Symptom Management Intervention

“…Researchers have recognized the need to modify activity pacing for advanced cancer patients. Specifically, Greer and colleagues 48 have suggested creating several activity schedules that vary according to the patient’s symptom level.…”