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Cited by 21Mindfulness and Compassion InterventionsCancer survivorship and carePalliative and Oncologic Care

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

Open access
Mosher, Catherine E., Krueger, Ellen, Secinti, Ekin, Johns, Shelley A.·2021·Psycho-Oncology
DOI 10.1002/pon.5712PMC PMC8429217
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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. © 2021 John Wiley & Sons Ltd.

Integrity signals

Registry

Crossref · 10.1002/pon.5712

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 19 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    Class 1 (32% of patients) had normal levels of all symptoms.

    “Class 1 (n=65, 32%) was the least symptomatic with normal levels of all symptoms.22,23”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [22]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [23] source

      The Abstract Results describe cut scores distinguishing normal from mild symptoms, supporting the use of “normal” as a symptom-severity category. The paper does not identify a Class 1 or report that 65 patients (32%) had normal levels of all symptoms. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Many advanced cancer patients have symptoms that interfere with functioning.

    “Many advanced cancer patients have symptoms that interfere with functioning.1–3”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [1] source

      The Results report that moderate-to-severe symptoms became more common as disease stage worsened, and the Discussion associates greater symptom burden with poorer performance status. These passages support that many patients with advanced cancer have symptoms, but they do not establish that the symptoms themselves interfere with functioning. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [2] source

      The Discussion reports that pain and fatigue affected a majority of patients after the onset of bone metastases and notes the potential for bone destruction to cause loss of mobility. This supports substantial symptoms with a functional consequence in advanced breast cancer, but the paper does not establish the claim for advanced cancer patients generally or measure how often symptoms interfered with functioning. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [3] source

      The Results (Patient Factors Associated with Symptom Prevalence; page not provided) report that 49.6% of late-stage lung and colorectal cancer patients had at least one moderate or severe symptom, supporting the claim that many advanced cancer patients have symptoms. The paper measures symptom severity, not whether those symptoms interfere with functioning, so that part is not established by this source. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingown data

    Latent profile analysis identified three patient classes based on symptom severity.

    “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%).”
    Quote in the paperSubstantial claim
  • Findingown data

    Class 2 (19% of patients) had normal levels of all symptoms except for mild sleep problems and moderate fatigue.

    “Class 2 (n=39, 19%) reported normal levels of all symptoms except for mild sleep problems and moderate fatigue.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Female gender was associated with a higher likelihood of being in class 3 than class 1 (OR=.37, CI [.14, .94]).

    “Female gender, lower income, and being diagnosed with breast as compared to prostate cancer were associated with a higher likelihood of being in class 3 than class 1 (gender: OR=.37, CI [.14, .94]; income: OR=4.80, CI [1.34, 17.13]; breast vs. prostate cancer: OR=.11, CI [.02, .60]).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 11
  • May combine two claims. 13
  • The quote only partly states this claim. 10
  • Borderline: one of the tests for a substantial claim is unclear. 1

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Our results in combination with prior research provide a strong rationale for large-scale trials of ACT to reduce symptom interference in advanced cancer and promote feasible engagement in activities that enrich quality of life.

    “Our results in combination with prior research10–13 provide a strong rationale for large-scale trials of ACT to reduce symptom interference in advanced cancer and promote feasible engagement in activities that enrich quality of life.”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites [10] source
    • cites [11] source
    • cites [12] source
    • cites [13] source

      The Introduction describes ACT as an approach to reducing symptom interference and supporting engagement in valued activities. The Discussion calls for larger randomized trials, but the intervention this paper tested combined ACT with coping skills training; its results do not establish the effects of ACT alone. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims. The quote only partly states this claim.

    Interpretationown data

    Results were largely consistent with the hypothesis that patients with higher symptom levels would show higher psychological inflexibility, cognitive fusion, and values obstruction and lower values progress, peaceful acceptance, mindfulness, and activity engagement.

    “Results were largely consistent with our hypothesis.”
    • Also stated in: § Discussion · hedged
      “Results are largely consistent with our hypothesis and the ACT model,8 suggesting that patients with even mild to moderate symptoms show greater attempts to control their thoughts and feelings and less peaceful acceptance of their illness.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] source

      The Research on ACT section (p. 12) reports that higher psychological flexibility is associated with better psychological outcomes, consistent with the broad direction of the proposed relationship. The paper does not report the citing authors’ patient results or establish the stated pattern for each named measure, including values obstruction, peaceful acceptance, and activity engagement. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    Patients with even mild to moderate symptoms show greater attempts to control their thoughts and feelings and less peaceful acceptance of their illness.

    “Results are largely consistent with our hypothesis and the ACT model,8 suggesting that patients with even mild to moderate symptoms show greater attempts to control their thoughts and feelings and less peaceful acceptance of their illness.”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Values and committed action have received limited empirical attention in cancer, with one study linking values obstruction to greater symptom burden in advanced breast cancer.

    “Values and committed action have also received limited empirical attention in cancer, with one study linking values obstruction to greater symptom burden in advanced breast cancer.14”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Acceptance of cancer showed small-to-moderate, negative correlations with distress outcomes in a meta-analysis.

    “Acceptance of cancer showed small-to-moderate, negative correlations with distress outcomes in a meta-analysis.40”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • Borderline on S1 (asserted), S4 (based): unclear from the text.

    Findingnone given

    Peaceful acceptance and mindfulness were significantly associated with all symptoms except pain.

    “Peaceful acceptance and mindfulness were significantly associated with all symptoms (rs= −.58 – −.22, ps<.01) except for pain (rs= −.14, −.18, ps=.05, .01, respectively).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Class 3 (48% of patients) had normal pain, mild levels of sleep problems, anxiety, and depressive symptoms, and moderate fatigue.

    “Class 3 (n=97, 48%) was the most symptomatic with mild levels of sleep problems, anxiety, and depressive symptoms, moderate fatigue, and normal pain.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Lower psychological inflexibility was associated with a higher likelihood of being in classes 1 or 2 than class 3, controlling for gender and income.

    “Lower levels of psychological inflexibility, cognitive fusion, and values obstruction were associated with a higher likelihood of being in classes 1 or 2 than class 3.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Greater mindfulness was associated with a higher likelihood of being in class 1 than class 3, controlling for gender and income.

    “Additionally, greater levels of values progress, peaceful acceptance, mindfulness, and activity engagement were associated with a higher likelihood of being in class 1 than class 3.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Values progress was significantly associated with lower anxiety and depressive symptoms, but not with fatigue, sleep disturbance, or pain.

    “Values progress was significantly associated with lower anxiety and depressive symptoms (rs=−.34, −.39, ps<.01, respectively), but associations with other symptoms fell short of statistical significance (rs=−.18 – −.16, ps=.01–.02).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Greater mindfulness was associated with a higher likelihood of being in class 2 than class 3, controlling for gender and income.

    “Of these four variables, only greater mindfulness and activity engagement were associated with a higher likelihood of being in class 2 than class 3.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Greater activity engagement was associated with a higher likelihood of being in class 1 than class 3, controlling for gender and income.

    “Additionally, greater levels of values progress, peaceful acceptance, mindfulness, and activity engagement were associated with a higher likelihood of being in class 1 than class 3.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Lower values obstruction was associated with a higher likelihood of being in classes 1 or 2 than class 3, controlling for gender and income.

    “Lower levels of psychological inflexibility, cognitive fusion, and values obstruction were associated with a higher likelihood of being in classes 1 or 2 than class 3.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Greater activity engagement was associated with a higher likelihood of being in class 2 than class 3, controlling for gender and income.

    “Of these four variables, only greater mindfulness and activity engagement were associated with a higher likelihood of being in class 2 than class 3.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All five symptoms (fatigue, sleep disturbance, anxiety, depressive symptoms, pain) were significantly correlated with psychological inflexibility, cognitive fusion, values obstruction, and activity engagement.

    “Significant correlations were found between all five symptoms and psychological inflexibility, cognitive fusion, values obstruction, and activity engagement (rs= −.65-.66, ps<.01).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Greater peaceful acceptance was associated with a higher likelihood of being in class 1 than class 3, controlling for gender and income.

    “Additionally, greater levels of values progress, peaceful acceptance, mindfulness, and activity engagement were associated with a higher likelihood of being in class 1 than class 3.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Greater values progress was associated with a higher likelihood of being in class 1 than class 3, controlling for gender and income.

    “Additionally, greater levels of values progress, peaceful acceptance, mindfulness, and activity engagement were associated with a higher likelihood of being in class 1 than class 3.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only greater mindfulness and activity engagement were associated with a higher likelihood of being in class 2 than class 3; values progress and peaceful acceptance were not.

    “Of these four variables, only greater mindfulness and activity engagement were associated with a higher likelihood of being in class 2 than class 3.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Lower cognitive fusion was associated with a higher likelihood of being in classes 1 or 2 than class 3, controlling for gender and income.

    “Lower levels of psychological inflexibility, cognitive fusion, and values obstruction were associated with a higher likelihood of being in classes 1 or 2 than class 3.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Symptom measures included items assessing symptom severity and interference with functioning.

    “Symptom measures included items assessing symptom severity and interference with functioning.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Advanced cancer patients with mild to moderate symptoms reduce their involvement in social, leisure, and work activities and perceive less progress in achieving values-based goals than those with normal symptom levels.

    “Our results suggest that advanced cancer patients with mild to moderate symptoms reduce their involvement in social, leisure, and work activities and perceive less progress in achieving values-based goals than those with normal symptom levels.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The AAQ-II was moderately correlated with distress and showed similar correlations with symptoms relative to other ACT measures (e.g., FFMQ-SF, CFQ).

    “Although these questions could not be fully addressed in our study, the measure was moderately correlated with distress and showed similar correlations with symptoms relative to other ACT measures (e.g., FFMQ-SF, CFQ).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    LPA is an exploratory approach and results warrant replication.

    “Finally, LPA is an exploratory approach and, thus, results warrant replication.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    From an ACT perspective, patients with higher levels of psychological inflexibility are expected to have greater symptom interference, but not necessarily more severe symptoms than other patients.

    “From an ACT perspective, patients with higher levels of psychological inflexibility are expected to have greater symptom interference, but not necessarily more severe symptoms than other patients.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Self-as-context was not examined.

    “In addition, self-as-context was not examined.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    ACT theorists view cancer-related symptoms as normative.

    “ACT theorists view cancer-related symptoms as normative.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The incremental and discriminant validity of the AAQ-II has been questioned.

    “Additionally, the incremental and discriminant validity of the AAQ-II has been questioned.39”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cognitive fusion has rarely been examined in the cancer literature, with one study associating it with greater distress in survivors of various cancers.

    “However, cognitive fusion has rarely been examined in the cancer literature, with one study associating it with greater distress in survivors of various cancers.26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The majority of patients were non-Hispanic White.

    “The majority of patients were non-Hispanic White, and the cross-sectional design precluded examination of temporal relationships between variables.”
    Quote in the paperNot a substantial claim
29 of 29

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Cites

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Research works printed but not linked: 2

  1. Northwestern University, 2020, PROMIS® Score Cut Points
  2. Clark SL, 2009, Relating Latent Class Analysis Results to Variables Not Included in the Analysis

Cited by

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Related

Authors
Mosher, C. E., Krueger, E., Secinti, E., & Johns, S. A.
Affiliations
  • Indiana University – Purdue University Indianapolis (US)
  • Department of Psychology Indiana University‐Purdue University Indianapolis Indianapolis IN USA
  • Regenstrief Institute (US)
Corresponding author
Mosher, Catherine E.
ORCID
Venue
Psycho-Oncology
Publisher
Wiley
Published
2021-05-03
Volume
30
Issue
9
Pages
1485-1491
ISSN
  • 1057-9249 (ISSN-L)
  • 1099-1611
DOI
10.1002/pon.5712
PMC
PMC8429217
OpenAlex
W3158646272
Cited by
21
References
37
Citations by year
2026: 2 · 2025: 7 · 2024: 1 · 2023: 6 · 2022: 5
FWCI
2.04
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Psycho-Oncology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
  • Walther Cancer Foundation
  • National Cancer Institute
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
advanced cancer, symptom experience, acceptance and commitment therapy, psychological inflexibility, cognitive fusion, mindfulness, activity engagement, symptom profiles, fatigue, sleep disorders, pain, anxiety, depressive symptoms
MeSH terms
Anxiety Disorders, Depression, Humans, Male, Prostatic Neoplasms, Surveys and Questionnaires, Mindfulness, Acceptance and Commitment Therapy

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