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Cited by 95Cancer survivorship and careMindfulness and Compassion InterventionsPalliative and Oncologic Care

Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial

Open access
Mosher, Catherine E., Secinti, Ekin, Li, Ruohong, Hirsh, Adam T., Bricker, Jonathan, Miller, Kathy D., Schneider, Bryan, Storniolo, Anna Maria +4 more·2018·Supportive Care in Cancer
DOI 10.1007/s00520-018-4045-0PMC PMC5924573
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Abstract

Purpose: Breast cancer is the leading cause of cancer mortality in women worldwide. With medical advances, metastatic breast cancer (MBC) patients often live for years with many symptoms that interfere with activities. However, there is a paucity of efficacious interventions to address symptom-related suffering and functional interference. Thus, this study examined the feasibility and preliminary efficacy of telephone-based acceptance and commitment therapy (ACT) for symptom interference with functioning in MBC patients. Methods: Symptomatic MBC patients (N = 47) were randomly assigned to six telephone sessions of ACT or six telephone sessions of education/support. Patients completed measures of symptom interference and measures assessing the severity of pain, fatigue, sleep disturbance, depressive symptoms, and anxiety. Results: The eligibility screening rate (64%) and high retention (83% at 8 weeks post-baseline) demonstrated feasibility. When examining within-group change, ACT participants showed decreases in symptom interference (i.e., fatigue interference and sleep-related impairment; Cohen’s d range = − 0.23 to − 0.31) at 8 and 12 weeks post-baseline, whereas education/support participants showed minimal change in these outcomes (d range = − 0.03 to 0.07). Additionally, at 12 weeks post-baseline, ACT participants showed moderate decreases in fatigue and sleep disturbance (both ds = − 0.43), whereas education/support participants showed small decreases in these outcomes (ds = − 0.24 and − 0.18 for fatigue and sleep disturbance, respectively). Both the ACT and education/support groups showed reductions in depressive symptoms (ds = − 0.27 and − 0.28) at 12 weeks post-baseline. Group differences in all outcomes were not statistically significant. Conclusions: ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients and warrants further investigation. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

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Crossref · 10.1007/s00520-018-4045-0

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

9 of 34 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    MBC patients experience persistent symptoms that cause suffering, impairment, and disability.

    “While there are medical advances to increase the longevity of metastatic breast cancer (MBC) patients, important symptoms persist that are a major source of suffering, impairment, and disability [2–8].”
    Quote in the paperSubstantial claim3 of 7 sources checked
    • cites [2] Aranda S, Schofield P, Weih L, Yates P, Milne D, Faulkner R, Voudouris N (2005) Mapping the quality of life and unmet needs of urban women with metastatic breast cancer. Eur J Cancer Care (Engl) 14(3):211–222. https://doi.org/10.1111/j.1365-2354.2005.00541.x source
    • cites [3] Given BA, Given CW, Sikorskii A, Hadar N (2007) Symptom clusters and physical function for patients receiving chemotherapy. Semin Oncol Nurs 23(2):121–126. https://doi.org/10.1016/j.soncn.2007.01.005 source
    • cites [4] Mosher CE, Duhamel KN (2012) An examination of distress, sleep, and fatigue in metastatic breast cancer patients. Psychooncology 21(1):100–107. PMCID: PMC3756885. https://doi.org/10.1002/pon.1873 source

      The Discussion (page unavailable) describes high levels of distress, fatigue, and sleep problems in metastatic breast cancer patients and reports that these problems co-occur with functional impairment. It does not establish that the symptoms cause disability; the reported relationships are associations. The Results (page unavailable) also note that most participants could carry out daily activities. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [5] Cleeland CS, Mayer M, Dreyer NA, Yim YM, Yu E, Su Z, Mun Y, Sloan JA, Kaufman PA (2014) Impact of symptom burden on work-related abilities in patients with locally recurrent or metastatic breast cancer: results from a substudy of the VIRGO observational cohort study. Breast 23(6):763–769. https://doi.org/10.1016/j.breast.2014.08.004 source
    • cites [6] Low CA, Stanton AL (2015) Activity disruption and depressive symptoms in women living with metastatic breast cancer. Health Psychol 34(1):89–92. https://doi.org/10.1037/hea0000052 source

      The Results report depressive symptoms and illness-related disruption of social and recreational activities in women with metastatic breast cancer; the Discussion says both were relatively stable over three months. The paper did not assess cancer-related physical symptoms, and it does not establish the broader claim that persistent symptoms cause suffering and disability in MBC patients generally. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [7] Willis K, Lewis S, Ng F, Wilson L (2015) The experience of living with metastatic breast cancer—a review of the literature. Health Care Women Int 36(5):514–542. https://doi.org/10.1080/07399332.2014.896364 source
    • cites [8] Lam WWT, Tsang J, Yeo W, Suen J, Ho WM, Yau TK, Soong I, Wong KY, Kwong A, Suen D, Sze WK, Ng AWY, Girgis A, Fielding R (2013) The evolution of supportive care needs trajectories in women with advanced breast cancer during the 12 months following diagnosis. Support Care Cancer 22:635–644 source
  • Interpretationcitation

    Mindfulness may be a mechanism by which ACT leads to reduced perceptions of symptom severity and interference.

    “Mindfulness is a core element of ACT and may be a mechanism by which the intervention leads to reduced perceptions of symptom severity and interference [20].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J (2006) Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 44(1):1–25. https://doi.org/10.1016/j.brat.2005.06.006 source

      The Committed action section (p. 10) identifies mindfulness as a process used in ACT, and the Other studies section (p. 19) reports reduced believability of psychotic symptoms after ACT. The paper does not establish mindfulness specifically as the mechanism for reduced perceptions of symptom severity and interference; its mediational studies (pp. 17–18) examine other processes. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    ACT's emphasis on life values rather than symptom control may lead to more adaptive behaviors in service of stated values.

    “Furthermore, ACT’s emphasis on life values rather than symptom control may lead to more adaptive behaviors in service of stated values [20].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [20] Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J (2006) Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 44(1):1–25. https://doi.org/10.1016/j.brat.2005.06.006 source
  • Premisecitation

    Pilot studies suggest that interventions with similar components to ACT, such as MBSR, may reduce fatigue interference and severity in post-treatment cancer survivors with persistent fatigue.

    “results of pilot studies suggest that interventions with similar components to ACT, such as mindfulness-based stress reduction (MBSR), may reduce fatigue interference and severity in post-treatment cancer survivors with persistent fatigue [43,44].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [43] Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K (2015) Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology 24(8):885–893. https://doi.org/10.1002/pon.3648 source
    • cites [44] Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, Tong Y, Wilhelm L, Carpenter JS, Von AD, Wagner CD, de Groot M, Schmidt K, Monceski D, Danh M, Alyea JM, Miller KD, Kroenke K (2016) Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors. Support Care Cancer 24(10):4085–4096. https://doi.org/10.1007/s00520-016-3220-4 source
  • Findingown data

    Differences between study conditions were not statistically significant.

    “Differences between study conditions were not statistically significant; however, because this is a pilot study, we focused on effect sizes rather than statistical significance, especially given group imbalances in primary outcomes at baseline.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 21
  • May combine two claims. 19

  • Classified as probably not a substantial claim.

    Premisecitation

    The most prevalent, persistent, and disabling symptoms in MBC patients include pain, fatigue, sleep disturbance, depression, and anxiety.

    “The most prevalent, persistent, and disabling symptoms in MBC patients include pain, fatigue, sleep disturbance, depression, and anxiety [2,9–12].”
    Quote in the paperSubstantial claim2 of 5 sources checked
    • cites [2] Aranda S, Schofield P, Weih L, Yates P, Milne D, Faulkner R, Voudouris N (2005) Mapping the quality of life and unmet needs of urban women with metastatic breast cancer. Eur J Cancer Care (Engl) 14(3):211–222. https://doi.org/10.1111/j.1365-2354.2005.00541.x source

      The Description of the sample and Discussion (page numbers unavailable) report substantial fatigue and difficulties with pain and insomnia among women with advanced breast cancer. The Introduction also discusses psychological distress, but the paper does not identify depression and anxiety specifically as prevalent symptoms or establish that the listed symptoms are persistent and disabling. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [9] Grabsch B, Clarke DM, Love A, McKenzie DP, Snyder RD, Bloch S, Smith G, Kissane DW (2006) Psychological morbidity and quality of life in women with advanced breast cancer: a cross-sectional survey. Palliat Support Care 4(1):47–56 source
    • cites [10] Kissane DW, Grabsch B, Love A, Clarke DM, Bloch S, Smith GC (2004) Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Aust N Z J Psychiatry 38(5):320–326. https://doi.org/10.1080/j.1440-1614.2004.01358.x source
    • cites [11] Koopman C, Nouriani B, Erickson V, Anupindi R, Butler LD, Bachmann MH, Sephton SE, Spiegel D (2002) Sleep disturbances in women with metastatic breast cancer. Breast J 8(6):362–370. https://doi.org/10.1046/j.1524-4741.2002.08606.x source

      The Discussion reports sleep disturbance in 63% of the women with metastatic breast cancer and clinically significant depressive symptoms in 30%; it also discusses pain. Fatigue is mentioned but was not assessed, and the paper does not establish anxiety—or the five symptoms collectively—as the most prevalent, persistent, and disabling symptoms in this population. Page numbers are unavailable in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [12] Palesh OG, Collie K, Batiuchok D, Tilston J, Koopman C, Perlis ML, Butler LD, Carlson R, Spiegel D (2007) A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biol Psychol 75(1):37–44. https://doi.org/10.1016/j.biopsycho.2006.11.002 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Mindfulness is a core element of ACT.

    “Mindfulness is a core element of ACT and may be a mechanism by which the intervention leads to reduced perceptions of symptom severity and interference [20].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [20] Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J (2006) Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 44(1):1–25. https://doi.org/10.1016/j.brat.2005.06.006 source

  • May combine two claims.

    Findingown data

    Both ACT and education/support groups showed small decreases in depressive symptoms (ds = −.27 and −.28) and anxiety (ds = −.18 and −.08) between baseline and 12-week follow-up.

    “Both the ACT and education/support groups showed small decreases in depressive symptoms (ds = −.27 and −.28) and anxiety (ds = −.18 and −.08) between baseline and 12-week follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At baseline, ACT group showed higher levels of global symptom interference, fatigue interference, sleep-related impairment, and sleep disturbance than education/support group.

    “Regarding study outcomes at baseline, the ACT group showed higher levels of global symptom interference, fatigue interference, sleep-related impairment, and sleep disturbance than the education/support group (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At 12-week follow-up, ACT group showed moderate decreases in fatigue and sleep disturbance (both ds = −.43), whereas education/support showed small decreases (ds = −.24 and −.18).

    “At the 12-week follow-up, the ACT group showed moderate decreases in fatigue and sleep disturbance (both ds = −.43), whereas the education/support group showed small decreases in these outcomes (ds = −.24 and −.18 for fatigue and sleep disturbance, respectively).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of 158 MBC patients approached, 50 consented, 50 declined, 38 were ineligible, and 20 could not be reached via phone.

    “Of the 158 MBC patients who were approached, 50 consented, 50 declined to participate, 38 were ineligible, and 20 could not be reached via phone.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    83% (39/47) completed 8-week follow-up, and 79% (37/47) completed 12-week follow-up.

    “Additionally, 83% (39/47) completed the 8-week follow-up, and 79% (37/47) completed the 12-week follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    About one-third of approached patients refused study participation, with the primary reason being lack of interest.

    “About one-third of approached patients refused study participation, with the primary reason being lack of interest.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    ACT group had small to moderate decreases in fatigue interference and sleep-related impairment (d range = −.23 to −.31), while education/support had effect sizes close to zero at both follow-ups.

    “Regarding change in fatigue interference and sleep-related impairment, small to moderate decreases were found for the ACT group (d range = −.23 to −.31), whereas the education/support group had effect sizes close to zero at both follow-ups (Fig. 2c and 2d).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    ACT group showed small decreases in global symptom interference (ds = −.19 and −.14) and education/support showed small increases (ds = .11 and .20).

    “Regarding change in global symptom interference, the ACT group showed small decreases (ds = −.19 and −.14) and the education/support group showed small increases (ds = .11 and .20) in this outcome (Fig. 2a).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The sample consisted primarily of Caucasian and college-educated patients from a single institution in the midwestern United States.

    “Finally, the sample consisted of primarily Caucasian and college-educated patients from a single institution in the midwestern United States.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Symptomatic MBC patients (N=47) were randomly assigned to six telephone sessions of ACT or six telephone sessions of education/support.

    “Symptomatic MBC patients (N=47) were randomly assigned to six telephone sessions of ACT or six telephone sessions of education/support.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    ACT warrants further investigation.

    “ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients and warrants further investigation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Because this is a pilot study, the authors focused on effect sizes rather than statistical significance, especially given group imbalances in primary outcomes at baseline.

    “Differences between study conditions were not statistically significant; however, because this is a pilot study, we focused on effect sizes rather than statistical significance, especially given group imbalances in primary outcomes at baseline.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The eligibility screening rate and retention demonstrated feasibility.

    “The eligibility screening rate (64%) and high retention (83% at 8 weeks post-baseline) demonstrated feasibility.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Cronbach's alphas across all measures ranged from .74 to .96.

    “In this study, Cronbach’s alphas across all measures ranged from .74 to .96.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Preliminary findings suggest that ACT warrants further study in patients with advanced cancer.

    “These preliminary findings suggest that ACT warrants further study in patients with advanced cancer.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    A minority of patients in this study had high levels of depressive symptoms and anxiety at baseline, which limited room for improvement during the intervention period.

    “A minority of patients in this study had high levels of depressive symptoms and anxiety at baseline, which limited room for improvement during the intervention period.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The goal of ACT is to increase psychological flexibility so that unwanted internal experiences interfere less with engagement in meaningful activities.

    “the goal of ACT is to increase psychological flexibility so that unwanted internal experiences (e.g., physical symptoms, feelings, thoughts) interfere less with patients’ engagement in meaningful activities [19].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Feros DL, Lane L, Ciarrochi J, Blackledge JT (2013) Acceptance and commitment therapy (ACT) for improving the lives of cancer patients: a preliminary study. Psychooncology 22(2):459–464. https://doi.org/10.1002/pon.2083 source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Taking a non-judgmental stance towards symptoms during mindfulness practice may interrupt maladaptive reactions to them, such as rumination.

    “For example, taking a non-judgmental stance towards symptoms during mindfulness practice may interrupt maladaptive reactions to them, such as rumination.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    ACT has resulted in reduced distress in a few pilot studies with cancer patients.

    “ACT has resulted in reduced distress in a few pilot studies with cancer patients [25], and meta-analytic evidence suggests that ACT is an efficacious treatment for distress in patients with chronic pain [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Hulbert-Williams NJ, Storey L, Wilson KG (2015) Psychological interventions for patients with cancer: psychological flexibility and the potential utility of Acceptance and Commitment Therapy. Eur J Cancer Care (Engl) 24(1):15–27. https://doi.org/10.1111/ecc.12223 source

  • May combine two claims.

    Interpretationown data

    ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients.

    “ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients and warrants further investigation.”
    Quote in the paperSubstantial claim

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

    Interpretationcitation

    This finding aligns with meta-analytic evidence suggesting that psychoeducation has significant short-term effects on distress in cancer patients.

    “This finding aligns with meta-analytic evidence suggesting that psychoeducation has significant short-term effects on distress in cancer patients [45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Faller H, Schuler M, Richard M, Heckl U, Weis J, Küffner R (2013) Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol 31(6):782–793. https://doi.org/10.1200/JCO.2011.40.8922 source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    ACT warrants further investigation in this understudied population.

    “As all patients in the current trial had one or more clinically meaningful symptoms at screening, changes in symptom outcomes following a brief intervention are noteworthy and suggest that ACT warrants further investigation in this understudied population.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Linear mixed-effects model analyses were used to assess preliminary efficacy of ACT, and an intent-to-treat framework was implemented.

    “Linear mixed-effects model analyses (SAS Proc Mixed) were used to assess the preliminary efficacy of ACT, and an intent-to-treat framework was implemented.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Fidelity checklists were developed for both study conditions, and one psychologist randomly selected 18% of audiorecordings to review for adherence to the manuals.

    “Fidelity checklists were developed for both study conditions, and one of the psychologists randomly selected 18% of audiorecordings to review for adherence to the manuals.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    ACT is efficacious for decreasing distress and promoting physical well-being and self-management in patients with medical conditions such as diabetes and chronic pain.

    “ACT is efficacious for decreasing distress and promoting physical well-being and self-management in patients with medical conditions, such as diabetes and chronic pain [23,24].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [23] Hann KEJ, McCracken LM (2014) A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: outcome domains, design quality, and efficacy. J Contextual Behav Sci 3(4):217–227. https://doi.org/10.1016/j.jcbs.2014.10.001 source
    • cites [24] Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL (2007) Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. J Consult Clin Psychol 75(2):336–343. https://doi.org/10.1037/0022-006X.75.2.336 source

  • Classified as probably not a substantial claim.

    Premisecitation

    The primary goal of ACT is not distress reduction, but rather living a full, meaningful life despite distress and other symptoms.

    “the primary goal of ACT is not distress reduction, but rather living a full, meaningful life despite distress and other symptoms [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Hayes SC, Strosahl KD, Wilson KG (2012) Acceptance and commitment therapy, second edition: the process and practice of mindful change. Guilford Press, New York source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Research assistants administering assessments were blind to study condition.

    “Trained research assistants administering the assessments were blind to study condition.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The average fidelity rating was 99%.

    “The average fidelity rating was 99%.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Meta-analytic evidence suggests that ACT is an efficacious treatment for distress in patients with chronic pain.

    “ACT has resulted in reduced distress in a few pilot studies with cancer patients [25], and meta-analytic evidence suggests that ACT is an efficacious treatment for distress in patients with chronic pain [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Hann KEJ, McCracken LM (2014) A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: outcome domains, design quality, and efficacy. J Contextual Behav Sci 3(4):217–227. https://doi.org/10.1016/j.jcbs.2014.10.001 source

  • May combine two claims.

    Study design and conductnone given

    Primary and secondary outcomes were assessed with valid self-report measures that have been used with cancer patients.

    “Primary and secondary outcomes were assessed with valid self-report measures that have been used with cancer patients.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    Randomization was performed by a person who was not a study interviewer or therapist using a SAS procedure and was stratified by patient performance status (ECOG 0 or 1 vs. 2).

    “Randomization was performed by a person who was not a study interviewer or therapist using a SAS procedure and was stratified by patient performance status (self-reported ECOG scores 0 or 1 vs. 2) because this factor informs cancer treatment decision-making [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Cardoso F, Harbeck N, Fallowfield L, Kyriakides S, Senkus E (2012) Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23:vii11–vii19 source

  • Classified as probably not a substantial claim.

    Interpretationown data

    Preliminary effect size estimates suggest that ACT deserves further study, especially with respect to fatigue and sleep-related outcomes in this population.

    “Preliminary effect size estimates suggest that ACT deserves further study, especially with respect to fatigue and sleep-related outcomes in this population.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    The extent to which findings generalize to diverse MBC patients warrants study.

    “The extent to which findings generalize to diverse MBC patients warrants study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Although the authors controlled for group differences at baseline, the ACT group had greater room for improvement on key outcomes.

    “Thus, although we controlled for group differences at baseline, the ACT group had greater room for improvement on key outcomes.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    Given that ACT involves the gradual development of skills, greater change in key outcomes may have been evidenced during a longer follow-up period.

    “Given that ACT involves the gradual development of skills, greater change in key outcomes may have been evidenced during a longer follow-up period.”
    Quote in the paperNot a substantial claim
37 of 37

  • The paper relies on this without support.

    Telephone delivery enhances feasibility for MBC patients in rural areas and those with physical impairments.

    “delivered it via telephone to enhance feasibility for patients in rural areas and those with physical impairments.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Use of ACT among people with cancer has increased over the past two decades.

    “There has been increasing use of ACT among individuals with cancer in the past two decades [23–25].”

    From Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model (2021) · cites this paper as [25]

    The Introduction (page not available) says ACT had recently been applied to cancer patients in several pilot trials, and this paper reports another such trial. It does not establish that ACT use increased over the past two decades. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • In the authors' pilot study, only about half of the sample had elevated fatigue interference at baseline.

    “It should be noted that only about half of the pilot sample had elevated fatigue interference at baseline”

    From Protocol of a randomized trial of acceptance and commitment therapy for fatigue interference in metastatic breast cancer (2020) · cites this paper as [23]

    The Results (Participant Characteristics; page unavailable) report that 47% of patients had elevated fatigue at baseline, which supports 'about half.' But that figure refers to fatigue severity, not fatigue interference; the Methods (Measures; page unavailable) identify these as separate outcomes. The copy does not give the proportion with elevated fatigue interference. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In the authors' pilot study, the effect of study condition on fatigue interference at 1 month post-intervention was moderate (d = −.30).

    “In our pilot study, we found a moderate effect (d = −.30) of study condition on fatigue interference at 1 month post-intervention [23].”

    From Protocol of a randomized trial of acceptance and commitment therapy for fatigue interference in metastatic breast cancer (2020) · cites this paper as [23]

    The Results (Preliminary Efficacy; page unavailable) report small-to-moderate decreases in fatigue interference within the ACT group at the 8- and 12-week follow-ups (d range −.23 to −.31). They do not report d = −.30 as an effect of study condition at one month post-intervention; the mixed-effects analysis found no main effect of study group on fatigue interference. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • In the authors' pilot trial, the retention rate was 83% (39/47) at 8 weeks post-intervention.

    “and the retention rate (83% [39/47] at 8 weeks post-intervention).”

    From Protocol of a randomized trial of acceptance and commitment therapy for fatigue interference in metastatic breast cancer (2020) · cites this paper as [23]

    The Results (Feasibility) report that 83% (39/47) completed the 8-week follow-up. The Abstract (Results) specifies that this was 8 weeks post-baseline, not 8 weeks post-intervention, so the claim misstates the timing. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In the authors' pilot study, among patients with moderate to severe baseline fatigue interference, the effect of study condition on fatigue interference at 1 month post-intervention was strong (d = −.59).

    “Indeed, among patients with moderate to severe baseline fatigue interference in our pilot study, we found a strong effect (d = −.59) of study condition on fatigue interference at 1 month post-intervention.”

    From Protocol of a randomized trial of acceptance and commitment therapy for fatigue interference in metastatic breast cancer (2020) · cites this paper as [23]

    The Results (Preliminary Efficacy; page unavailable) report decreases in fatigue interference in the ACT group and little change in the education/support group. They do not report an analysis limited to patients with moderate-to-severe baseline fatigue interference or a study-condition effect of d = −.59 at one month post-intervention; the reported −.23 to −.31 values are within-group changes, and the group difference was not statistically significant. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

2 of the 46 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. McGuire DB, Sheidler VR (1992) Pain. In: Groenwald SL, Frogge MH, Goodman M, Yarbro CH (eds) Manifestations of cancer and cancer treatment. Jones and Bartlett Publishers, Boston, pp 441–985
  2. Hayes SC, Smith S (2005) Get out of your mind and into your life: the new acceptance and commitment therapy. New Harbinger, Oakland

Cited by

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Related

Authors
Mosher, C. E., Secinti, E., Li, R., Hirsh, A. T., Bricker, J., Miller, K. D., Schneider, B., Storniolo, A. M., Mina, L., Newton, E. V., Champion, V. L., & Johns, S. A.
Affiliations
  • Indiana University – Purdue University Indianapolis (US)
  • Indiana University (US)
  • University of Washington (US)
  • Indiana University Melvin and Bren Simon Comprehensive Cancer Center (US)
  • Banner MD Anderson Cancer Center (US)
  • Indiana University Indianapolis (US)
  • Regenstrief Institute (US)
Corresponding author
Mosher, Catherine E.
ORCID
Venue
Supportive Care in Cancer
Publisher
Springer Science and Business Media LLC
Published
2018-01-12
Volume
26
Issue
6
Pages
1993-2004
ISSN
  • 0941-4355 (ISSN-L)
  • 1433-7339
DOI
10.1007/s00520-018-4045-0
PMC
PMC5924573
OpenAlex
W2782922821
Cited by
95
References
46
Citations by year
2026: 2 · 2025: 8 · 2024: 7 · 2023: 16 · 2022: 18 · 2021: 19 · 2020: 10 · 2019: 13 · 2018: 2
FWCI
4.13
Type
journal article
Language
en
Open access
Licence
Locations
  • Supportive Care in Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • Purdue University Indianapolis (Indiana University) (submittedVersion)
Funders
  • National Cancer Institute (K07CA168883, K05CA175048)
  • Walther Cancer Foundation (0175.01)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
acceptance and commitment therapy, metastatic breast cancer, symptom interference, telephone-delivered intervention, fatigue, sleep disorders, depressive symptoms, anxiety, pain, feasibility, psycho-oncology
MeSH terms
Adult, Aged, Breast Neoplasms, Female, Humans, Middle Aged, Neoplasm Metastasis, Pilot Projects, Acceptance and Commitment Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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