Telephone-delivered acceptance and commitment therapy may be effective in reducing the interference of fatigue with functioning and improving the quality of life among survivors of metastatic breast cancer, according to a recent study published by Mosher et al in the Journal of Clinical Oncology.
Background
As a result of medical advances, more than 169,000 patients are living with metastatic breast cancer in the United States. Addressing debilitating symptoms has become increasingly crucial; however, fatigue remains a significant challenge—affecting up to 63% of patients and severely impacting daily functioning.
Acceptance and commitment therapy is a behavioral intervention that has shown promise in pilot studies among patients with advanced cancer. Rather than aiming to reduce symptoms, the goal of this therapeutic strategy is to promote psychological flexibility, consisting of mindfulness/acceptance and commitment/behavior change processes.
“Breast cancer is one of the most common cancers affecting women throughout the world. We don't have effective [treatments] for fatigue in advanced cancer. [We were] drawn to acceptance and commitment therapy as a potential behavioral intervention to help reduce the negative impact of fatigue on functioning because it has shown evidence of effectiveness for patients with chronic pain as well as [those] with mental health conditions,” detailed lead study author Catherine Mosher, PhD, a behavioral scientist in the Department of Psychology at the Indiana University Indianapolis School of Science and an affiliate scientist at the Regenstrief Institute.
“Mindfulness involves focused attention on the present moment, including symptoms that one may be experiencing and thoughts and feelings, and having an attitude of compassionate acceptance of those experiences. We hypothesized that this would interrupt more maladaptive reactions to fatigue—such as ruminating about the fatigue or catastrophizing—and also by being more in tune with [the patient’s] body, more aware of what [they are] experiencing, [they] can make choices that enrich quality of life,” she indicated.
Study Methods and Results
In the clinical trial, researchers randomly assigned 250 survivors of metastatic breast cancer to receive six weekly telephone-delivered sessions of acceptance and commitment therapy or education/support.
The researchers revealed that the brief remote conversations with therapists offered during the telephone-delivered acceptance and commitment therapy intervention may have encouraged the participants to practice mindfulness in their daily lives, thereby leading to reduced fatigue interference with functioning.
The intervention also demonstrated evidence of feasibility and the potential to reduce sleep interference with patient functioning. Cancer-related fatigue is often exacerbated by the physiological consequences of inadequate sleep.
“The [patients we] worked with in the study often reported that their sleep quality had improved because they were practicing mindfulness at bedtime and that was allowing them to feel a greater sense of peace in their life,” explained senior study author Shelley Johns, PsyD, ABPP, Associate Professor of Medicine at the Indiana University School of Medicine, a clinician-scientist at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and a research scientist at the Regenstrief Institute. “The [acceptance and commitment therapy] intervention helped participants to fall asleep with greater ease. We think that the sleep quality improved for some participants because they were practicing mindfulness, which has been shown to support enhanced sleep,” she added.
Conclusions
The findings may inform clinical care by demonstrating that a novel, telephone-delivered acceptance and commitment therapy intervention can reduce fatigue interference with functioning in patients with metastatic breast cancer and reduce sleep interference. Training in acceptance and commitment therapy is currently accessible to physicians from various disciplines.
The researchers plan to explore the efficacy of the intervention in culturally diverse cancer populations as well as disseminate the intervention.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
