Telephone therapy reduces impact of fatigue among survivors of metastatic breast cancer
Key takeaways:
- Survivors who participated in acceptance and commitment therapy reported less fatigue interference with functioning.
- Researchers are studying the approach for people with advanced gastrointestinal cancer.
Telephone-delivered acceptance and commitment therapy reduced fatigue’s interference with functioning among survivors of metastatic breast cancer, according to results of a randomized controlled trial.
The approach also improved quality of life.
Acceptance and commitment therapy (ACT) is a behavioral intervention. It is not designed to reduce symptoms; rather, the goal is to encourage psychological flexibility through mindfulness/acceptance and commitment/behavior change approaches.
The trial included 250 survivors of stage IV metastatic breast cancer.
Researchers randomly assigned participants to six weekly ACT sessions delivered by phone (n = 116) or a control approach of education/support (n = 120). Participants completed self-report assessments at baseline, and follow-up assessments took place at 2 weeks, 3 months and 6 months after completion of the assigned regimen.
Results showed those assigned the ACT intervention reported significantly less fatigue interference at 2 weeks and 6 months after the intervention.
Survivors assigned ACT demonstrated a steady decrease in sleep interference, whereas those assigned to the control group did not.
Results showed no significant difference in engagement in daily activities or quality of life (QOL) between groups with the exception of functional QOL, which appeared significantly better among those assigned ACT at 2 weeks and 6 months after the intervention (P = .006).
“As evidence begins to accumulate for the benefits of ACT in cancer populations, we hope it’s more widely disseminated to clinicians and leads to better quality of life,” Catherine E. Mosher, PhD, a behavioral scientist in Indiana University’s department of psychology, told Healio. “As patients live for many years with advanced cancer, there have been tremendous medical advances. We also want tremendous advances in terms of their supportive care.”
Healio spoke with Mosher about the motivation for the study, the implications of the findings and the next steps in research.
Healio: How problematic is fatigue interference with functioning among survivors of metastatic breast cancer?
Mosher: It’s a major problem. Fatigue is the top concern of this population, and it’s because it interferes with important activities as well as their mood and ability to concentrate. It certainly has a downstream impact on quality of life.
Healio: What motivated you and your team to evaluate telephone-delivered ACT in this population?
Mosher: ACT is a form of psychotherapy that has a strong evidence base in both chronic pain and mental health literatures. We wondered if it would also help patients with cancer. We used a telephone-based approach to have the broadest reach to rural and underserved populations in Indiana. Little did we know that a pandemic would happen, so that turned out to be a good approach.
Healio: How did you conduct the study?
Mosher: We recruited patients with metastatic breast cancer in Illinois and Indiana who reported at least moderate fatigue interference with functioning and were not at the very end of life.
We did an initial assessment of their fatigue and quality of life, and then we randomly assigned them to one of two conditions — either six weekly phone sessions of ACT or six weekly sessions of what we called education/support. This is very similar to interventions delivered by social workers at cancer centers throughout the country. It’s focused on supportive listening and education on quality-of-life concerns and referrals to resources. It was a very rigorous control group.
Healio: What did you find?
Mosher: The ACT group reported significantly decreased fatigue interference with functioning at both 2 weeks and 6 months post-intervention compared with the education/support control group, and the same result was found for functional quality of life. This includes the ability to engage in activities and accept the illness, which is very much targeted in ACT.
Healio: Do you think ACT could similarly benefit patients with other cancer types?
Mosher: We certainly hope so. We are evaluating this intervention for patients with advanced gastrointestinal cancer, as well as for their family caregivers, who often are stressed. We’re evaluating this in a multisite, NCI-funded trial that began in August.
Healio: Is there anything else you’d like to mention?
Mosher: In contrast to other interventions that aim to reduce fatigue severity, our intervention is aimed at reducing fatigue’s interference with functioning. Fatigue severity was actually stable over time in our sample. Our ACT intervention reduced the negative impact of fatigue on the participants’ quality of life, even though the fatigue itself wasn’t changing all that much.
Reference:
For more information:
Catherine E. Mosher, PhD, can be reached at cemosher@iu.edu.
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