Effectiveness of acceptance and commitment therapy on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer: A meta‐analysis of randomized controlled trials

Abstract

BackgroundCurrent studies have revealed that acceptance and commitment therapy (ACT) can alleviate the adverse effects of cancer; however, its effectiveness on the psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer remains unclear.AimsThe aims of this study were to identify the effectiveness of ACT on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer, and to explore moderators.MethodsPubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL, CNKI, VIP, and Wanfang electronic databases were searched from inception to September 29, 2022. The Cochrane Collaboration's risk‐of‐bias assessment tool II and the Grading of Recommendations Assessment, Development, and Evaluation approach were used to evaluate evidence certainty. The data were analyzed using R Studio. The study protocol was registered with PROSPERO (CRD42022361185).ResultsThe study included 19 relevant studies (1643 patients) published between 2012 and 2022. The pooled results showed that ACT significantly improved psychological flexibility (mean difference [MD] = −4.22, 95% CI [−7.86, −0.58], p = .02) and quality of life (Hedges' g = 0.94, 95% CI [0.59, 1.29], Z = 5.31, p < .01) but did not significantly improve fatigue (Hedges' g = −0.03, 95% CI [−0.24, 0.18], p = .75) or sleep disturbance (Hedges' g = −0.26, 95% CI [−0.82, 0.30], p = .37) in patients with cancer. Additional analyses revealed a 3‐month sustainable effect on psychological flexibility (MD = −4.36, 95% CI [−8.67, −0.05], p < .05), and moderation analysis showed that intervention duration (β = −1.39, p < .01) and age (β = 0.15, p = .04) moderated the effects of ACT on psychological flexibility and sleep disturbance, respectively.Linking Evidence to ActionAcceptance and commitment therapy demonstrates effectiveness for psychological flexibility and quality of life of patients with cancer, but there is a lack of evidence regarding its effects on fatigue and sleep disturbance. In clinical practice, ACT should be designed in more detail and rounded to achieve better results.

Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials

“…Low to moderate quality of evidence suggests non-significant results in improving other symptoms such as fatigue, insomnia, pain, and global symptoms in patients with cancer. These results were partially consistent with those of previous studies (Fang et al, 2023;Zhang et al, 2023). Directly alleviating or eliminating physical symptoms like these is not the primary purpose of ACT.…”

“…On the other hand, some different results deserve attention. First, the non-significant result of fatigue is consistent with Zhang et al (Zhang et al, 2023) but in contradiction to Fang et al (2023) and Maunick et al (2023), and one reason for the divergence is the different criteria of the included participants. The target population of Fang et al (2023) and Maunick et al (2023) is people with advanced cancer and with cancer plus chronic health conditions, which narrows and expands the scope of included participants, respectively compared to us.…”

“…Meta-analytic post-treatment result of ACT for cancer patients on depression in post-intervention and follow-up time-points. Jiang et al 10.3389/fpsyg.2023.1253266 Frontiers in Psychology frontiersin.org Li Z. H. et al, 2021;Zhao et al, 2021;Fang et al, 2023;Maunick et al, 2023;Zhang et al, 2023). On one hand, almost all studies support the association between ACT and the improvement of psychological flexibility and distress (anxiety and depression) in patients with cancer, which is due to the nature and purpose of ACT Li Z. H. et al, 2021;Zhao et al, 2021;Fang et al, 2023;Zhang et al, 2023).…”

“…This systematic review and meta-analysis aimed to evaluate the efficacy of ACT in treating psychological distress in patients with cancer. Compared to recent studies Li Z. H. et al, 2021;Zhao et al, 2021;Fang et al, 2023;Maunick et al, 2023;Zhang et al, 2023), this report has acceptable heterogeneity in the primary outcomes and focused on retrieving evidence from English-language randomized controlled trials to comprehensively investigate the potential effectiveness of ACT in different types of cancer. Furthermore, the GRADE approach had been applied to rate the quality of the evidence summarized (Schünemann et al, 2013).…”

“…Several systematic reviews on the application of ACT in patients with cancer have recently been published Li Z. H. et al, 2021;Zhao et al, 2021;Fang et al, 2023;Maunick et al, 2023;Zhang et al, 2023). These studies summarized the efficacy of ACT on psychological distress or other symptoms (fatigue and sleep disturbance) in people with cancer.…”