Symptom experiences in advanced cancer: Relationships to acceptance and commitment therapy constructs

Abstract

Objective This study examined relations between acceptance and commitment therapy (ACT) constructs and symptom‐based subgroups of advanced cancer patients. Methods Patients with advanced breast, gastrointestinal, lung, and prostate cancer (N = 201) completed questionnaires assessing five common symptoms and ACT variables (i.e., psychological inflexibility, cognitive fusion, values obstruction and progress, peaceful acceptance, mindfulness, and activity engagement) on one occasion. Results Latent profile analysis showed three patient classes: (1) normal levels of all symptoms (32%); (2) normal levels of all symptoms except for mild sleep problems and moderate fatigue (19%); and (3) normal pain, mild levels of sleep problems, anxiety, and depressive symptoms, and moderate fatigue (48%). Controlling for demographic covariates, lower psychological inflexibility, cognitive fusion, and values obstruction were associated with a higher likelihood of being in classes 1 or 2 than class 3. In addition, greater values progress, peaceful acceptance, mindfulness, and activity engagement were associated with a higher likelihood of being in class 1 than class 3. Of these four factors, only greater mindfulness and activity engagement were associated with a higher likelihood of being in class 2 than class 3. Conclusions Advanced cancer patients show heterogeneous symptom profiles, and even mild to moderate symptom levels are related to greater withdrawal from personally meaningful activities and less acceptance of cancer and internal experiences (e.g., symptoms, thoughts, feelings). Findings are consistent with the ACT model and support further testing of ACT to address symptom interference with functioning in advanced cancer patients.

Total Pain and Illness Acceptance in Pelvic Cancer Patients: Exploring Self-Efficacy and Stress in a Moderated Mediation Model

“…The ability to mitigate, if only partially, such negative total pain experiences allows patients to lower their stress levels and improve their ability to manage illness-related situations, which in turn will improve their capacity to adjust to their illness. This interpretation is supported by Mosher et al’s [ 39 ] study, which found that more activities directed at overcoming the negative consequences of cancer and the acceptance of cancer were associated with fewer symptoms of pain.…”

Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review

“…The majority of articles examined Acceptance and Commitment Therapy for patients (n = 15; 58%). 16,[47][48][49][50][52][53][54]57,58,60,65,67,69 Of these, 10 papers were focused on people with advanced cancer. 16,47,49,50,[52][53][54]57,58,60 Four were focused on Acceptance and Commitment Therapy for families or caregivers 62,63,66,68 , two a mix of both patients and caregivers.…”

“…16,[47][48][49][50][52][53][54]57,58,60,65,67,69 Of these, 10 papers were focused on people with advanced cancer. 16,47,49,50,[52][53][54]57,58,60 Four were focused on Acceptance and Commitment Therapy for families or caregivers 62,63,66,68 , two a mix of both patients and caregivers. 48,55 Three were focused on staff 45,56,61 and a further three involved people who had been bereaved.…”

“…Nearly half of the 26 studies included were conducted in the USA (n = 11; 42%), [45][46][47][48][49][50][51][52][53][54][55] around a quarter in the UK (n = 6; 23%) [56][57][58][59][60][61] and a quarter in Australia (n = 6; 23%). [62][63][64][65][66][67] Articles identified were published from 2012 to 2023 (see Supplemental File: Figure 1).…”

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

“…Psychological flexibility plays an important role in circumstances, such as advanced cancer, over which one can exert little or no control (Davis et al, 2017). It is associated with psychological and physical symptoms and QoL in people with advanced cancer (Mosher et al, 2017(Mosher et al, , 2021Novakov, 2021). Thus, given its aim of psychological flexibility, Acceptance and Commitment Therapy may be particularly well-suited for people with advanced cancer as it normalizes their distressing experiences and addresses existential concerns such as the loss of meaning and purpose by encouraging them to live in the present and engage in meaningful activities, thereby alleviating their psychological and physical symptoms (Moreno et al, 2022;Vehling et al, 2019).…”