Randomized trial of acceptance and commitment therapy for anxious cancer survivors in community clinics: Outcomes and moderators.

Abstract

Anxiety symptoms are common among cancer survivors. This study evaluated whether an acceptance-based group intervention delivered by social workers in community oncology clinics improved anxiety and related symptoms, and healthcare use, relative to enhanced usual care (EUC). This multi-site trial included 135 survivors of various cancers with moderate to high anxiety about cancer/survivorship, 1.5-24 months after treatment. Participants were randomized 1:1 to a 7-session acceptance and commitment therapy (ACT)-based group (Valued Living) or EUC (access to onsite supportive care plus resource list). Questionnaires were administered at baseline, 1, 2, 5, and 8 months post-randomization, diagnostic interviews at baseline, 2, and 8 months, and healthcare use tracked throughout. Outcomes included anxiety symptoms (primary), related symptoms, and healthcare use. Putative moderators included age, anxiety, and avoidance. In intent-to-treat comparisons to EUC, Valued Living (VL) showed a nonsignificant pattern of greater improvement on anxiety symptoms (p = .08), improved significantly more on cancer-related post-traumatic stress (p = .002), fear of recurrence (p = .003), and energy/fatigue (p = .02), and missed significantly fewer medical appointments (p < .05). Conditions improved similarly on depressive symptoms, sense of meaning, and most severe anxiety or depressive disorder. Effects were moderated: VL participants with higher baseline anxiety or avoidance (+1SD) improved more on anxiety, meaning (ps ≤ .01), and disorder severity (p = .05) than their EUC counterparts. An acceptance-based group intervention delivered in community oncology clinics enhanced psychological recovery and energy levels, and reduced missed medical appointments for anxious cancer survivors, with stronger effects for more distressed participants. (PsycInfo Database Record (c) 2021 APA, all rights reserved).