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Cited by 29Mindfulness and Compassion InterventionsCancer survivorship and careDiabetes Management and Education

Symptom experiences in post-treatment cancer survivors: associations with acceptance and commitment therapy constructs.

Open access
Lewson, Ashley B., Johns, Shelley A., Krueger, Ellen, Chinh, Kelly, Kidwell, Kelley M., Mosher, Catherine E.·2021·Supportive Care in Cancer
DOI 10.1007/s00520-020-05854-7PMC PMC8088450
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Abstract

Purpose: Acceptance and Commitment Therapy (ACT) has improved symptom and quality-of-life outcomes in pilot research with post-treatment cancer survivors. To further test the ACT model, the present study examined relationships between ACT constructs and subgroups of post-treatment survivors based on the severity of common symptoms.Methods: Survivors who had completed primary treatment for stage I or II cancer (N = 203) participated in this one-time survey. Latent class analysis (LCA) was used to identify subgroups of survivors based on the severity of fatigue, sleep disturbance, pain, anxiety, and depressive symptoms. Multinomial logistic regressions employing Vermunt's 3-step approach were used to examine ACT constructs (e.g., mindfulness, acceptance, values progress) as correlates of survivor subgroups based on symptoms.Results: The LCA showed three survivor classes: (1) mild-to-moderate levels of all symptoms except for normal pain intensity; (2) mild anxiety, moderate fatigue, and normal levels of all other symptoms; and (3) normal levels of all symptoms. Lower mindfulness, acceptance, and values progress and higher cognitive fusion, psychological inflexibility, and values obstruction were associated with a greater likelihood of being in class 1 or 2 than in class 3.Conclusion: Findings are consistent with the ACT model. Survivors with greater symptom burden reported greater withdrawal from personally meaningful activities and less acceptance of their cancer diagnosis and internal experiences (e.g., thoughts, feelings, symptoms). Findings provide strong justification for further testing of ACT to reduce symptom-related suffering in cancer survivors.

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Crossref · 10.1007/s00520-020-05854-7

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

23 of 49 cited sources checked · 17 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Both pilot RCTs demonstrated moderate to large effects of ACT on psychological outcomes.

    “Both studies demonstrated moderate to large effects of ACT on psychological outcomes [11, 12].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [11] González-Fernández S, Fernández-Rodríguez C, Paz-Caballero MD, Pérez-Álvarez M (2018) Treating anxiety and depression of cancer survivors: behavioral activation versus acceptance and commitment therapy. Psicothema 30:14–20. https://doi.org/10.7334/psicothema2017.396 source
    • cites [12] Johns SA, Stutz PV, Talib TL, Cohee AA, Beck-Coon KA, Brown LF, Wilhelm LR, Monahan PO, LaPradd ML, Champion VL, Miller KD, Giesler RB (2020) Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: a 3-arm pilot randomized controlled trial. Cancer 126:211–218. https://doi.org/10.1002/cncr.32518 source
  • Premisecitation

    In pilot research with post-treatment cancer survivors, ACT has improved symptom and quality-of-life outcomes.

    “Acceptance and commitment therapy (ACT) has improved symptom and quality-of-life outcomes in pilot research with post-treatment cancer survivors.”
    • Also stated in: § Introduction · boosted
      “Pilot studies of ACT have produced promising results in cancer populations, including improved emotional well-being, psychological flexibility, and quality of life [9, 10].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [9] González-Fernández S, Fernández-Rodríguez C (2019) Acceptance and commitment therapy in cancer: review of applications and findings. Behav Med 45:255–269. https://doi.org/10.1080/08964289.2018.1452713 source
    • cites [10] Hassani F, Sadeghi F, Emamipour S, Mirzaei H (2018) Effect of acceptance and commitment group therapy on quality of life and resilience of women with breast cancer. Arch Breast Cancer 5:111–117. https://doi.org/10.19187/ABC.201853111-117 source
  • Interpretationown data

    The findings are consistent with the ACT model.

    “Findings are consistent with the ACT model.”
    • Also stated in: § Discussion · plain
      “Findings are consistent with the ACT model [8] and suggest that post-treatment survivors with higher symptom burden have greater difficulty accepting their cancer diagnosis and internal, present-moment experiences (e.g., thoughts, feelings, symptoms).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J (2006) Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 44:1–25. https://doi.org/10.1016/j.brat.2005.06.006 source
  • Findingown data

    Class 1 (n=29) had mild to moderate levels of all symptoms except for normal pain intensity.

    “Class 1 (n=29) had mild to moderate levels of all symptoms except for normal pain intensity.”
    • Also stated in: § Results · plain
      “LCA showed three survivor classes: (1) mild to moderate levels of all symptoms except for normal pain intensity, (2) mild anxiety, moderate fatigue, and normal levels of all other symptoms, and (3) normal levels of all symptoms.”
    Quote in the paperSubstantial claim
  • Findingown data

    Class 3 (n=105) was characterized by normal levels of all symptoms.

    “Class 3 (n=105) was characterized by normal levels of all symptoms [25].”
    • Also stated in: § Results · plain
      “LCA showed three survivor classes: (1) mild to moderate levels of all symptoms except for normal pain intensity, (2) mild anxiety, moderate fatigue, and normal levels of all other symptoms, and (3) normal levels of all symptoms.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 18
  • May combine two claims. 19

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

    Study design and conductcitation

    Both VQ subscales have also been used with adults with cancer.

    “Both have also been used with adults with cancer [36].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [36] Mosher CE, Tometich DB, Hirsh A, Rand KL, Johns SA, Matthias MS, Outcalt SD, Bricker J, Schneider B, Mina L, Storniolo AM, Newton E, Miller K (2017) Symptom experiences in metastatic breast cancer patients: relationships to activity engagement, value-based living, and psychological inflexibility. Psychooncology 26:1944–1951. https://doi.org/10.1002/pon.4283 source

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

    Study design and conductcitation

    The FFMQ-SF subscales have demonstrated strong internal consistency in cancer survivors and have been related to health outcomes.

    “In research with cancer survivors, these subscales have demonstrated strong internal consistency [29] and have been related to health outcomes [30, 31].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [29] Poulin PA, Romanow HC, Rahbari N, Small R, Smyth CE, Hatchard T, Solomon BK, Song X, Harris CA, Kowal J, Nathan HJ, Wilson KG (2016) The relationship between mindfulness, pain intensity, pain catastrophizing, depression, and quality of life among cancer survivors living with chronic neuropathic pain. Support Care Cancer 24:4167–4175. https://doi.org/10.1007/s00520-016-3243-x source
    • cites [30] Garland SN, Campbell T, Samuels C, Carlson LE (2013) Dispositional mindfulness, insomnia, sleep quality and dysfunctional sleep beliefs in post-treatment cancer patients. Pers Individ Dif 55:306–311. https://doi.org/10.1016/j.paid.2013.03.003 source
    • cites [31] Zimmaro LA, Carson JW, Olsen MK, Sanders LL, Keefe FJ, Porter LS (2020) Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer. Psychooncology 29:263–270. https://doi.org/10.1002/pon.5223 source

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

    Premisecitation

    Survivors' heightened symptoms have a substantial negative impact on their daily activities, functional status, and quality of life.

    “Survivors’ heightened symptoms have a substantial negative impact on their daily activities, functional status, and quality of life [4–6].”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [4] Ekwueme DU, Yabroff R, Guy GP et al (2014) Medical costs and productivity losses of cancer survivors—United States, 2008–2011. MMWR Morb Mortal Wkly Rep 63:505–510
    • cites [5] Nho JH, Kim SR, Park MH, Kweon SS (2018) Symptom clusters and quality of life in breast cancer survivors after cancer treatment in a tertiary hospital in Korea. Eur J Cancer Care (Engl) 27:1–9. https://doi.org/10.1111/ecc.12919 source

      The Discussion (page unavailable) reports that survivors with higher symptom scores had poorer quality of life and that lower symptom scores correlated with better functional status. Table 4 also shows lower physical and role functioning in the higher-symptom groups. The study did not directly measure daily activities or establish that symptoms caused these differences, so the claim's causal wording goes beyond its findings. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [6] Zucca AC, Boyes AW, Linden W, Girgis A (2012) All’s well that ends well? Quality of life and physical symptom clusters in long-term cancer survivors across cancer types. J Pain Symptom Manage 43:720–731. https://doi.org/10.1016/j.jpainsymman.2011.04.023 source

      The Cancer-Specific Physical Symptoms section reports that pain interfered with daily activities for 6% of colorectal cancer survivors, and the Introduction discusses continuing physical limitations and symptoms. But the paper does not establish a substantial negative impact of heightened symptoms across survivors’ functional status and quality of life; it reports generally low symptom levels and good global quality of life among long-term survivors. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

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

    Study design and conductcitation

    PROMIS measures have undergone rigorous psychometric testing, and evidence supports their reliability and validity in cancer survivors.

    “These NIH-funded measures have undergone rigorous psychometric testing [21], and evidence supports their reliability and validity in cancer survivors [19, 22].”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [21] Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai JS, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R, PROMIS Cooperative Group (2010) The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol 63:1179–1194. https://doi.org/10.1016/j.jclinepi.2010.04.011 source
    • cites [19] Jensen RE, Potosky AL, Moinpour CM, Lobo T, Cella D, Hahn EA, Thissen D, Smith AW, Ahn J, Luta G, Reeve BB (2017) United States population-based estimates of Patient-Reported Outcomes Measurement Information System symptom and functional status reference values for individuals with cancer. J Clin Oncol 35:1913–1920. https://doi.org/10.1200/JCO.2016.71.4410 source
    • cites [22] Adams RN, Mosher CE, Rand KL, Hirsh AT, Monahan PO, Abonour R, Kroenke K (2017) The cancer loneliness scale and cancer-related negative social expectations scale: development and validation. Qual Life Res 1:1901–1913. https://doi.org/10.1007/s11136-017-1518-4 source

      In Methods, under “PROMIS measures of social and health-related outcomes” (page unavailable), the paper reports rigorous reliability and validity testing of PROMIS measures and generally good internal consistency for the measures used in its cancer-patient sample. It does not establish their validity specifically in cancer survivors, and the physical-health scale initially had poor internal consistency (α=0.27), improving after removal of an item. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

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

    Premisecitation

    T-scores below 50 for fatigue and below 55 for sleep disturbance, pain, anxiety, and depression are considered normal based on published threshold scores.

    “T-scores <50 for fatigue measures and T-scores <55 for sleep disturbance, pain, anxiety, and depression measures are considered normal based on published threshold scores [25, 26].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [25] Cella D, Choi S, Garcia S, Cook KF, Rosenbloom S, Lai JS, Tatum DS, Gershon R (2014) Setting standards for severity of common symptoms in oncology using the PROMIS item banks and expert judgment. Qual Life Res 23:2651–2661. https://doi.org/10.1007/s11136-014-0732-6 source

      The Results and Discussion describe PROMIS severity thresholds for fatigue, pain interference, anxiety, and depression, including a boundary between normal and mild symptoms near T = 50. The retrieved passages do not establish the claimed exact cutoffs of <50 and <55, and this paper does not assess sleep disturbance. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [26] Northwestern University (2020) PROMIS® Score Cut Points. HealthMeasures. https://www.healthmeasures.net/score-and-interpret/interpret-scores/promis/promis-score-cut-points. Accessed 24 Sep 2020

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

  • Classified as probably not a substantial claim.

    Premisecitation

    From an ACT perspective, cancer survivors with higher physical and psychological symptom interference are expected to show greater psychological inflexibility.

    “Thus, from an ACT perspective, cancer survivors with higher physical and psychological symptom interference are expected to show greater psychological inflexibility.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J (2006) Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 44:1–25. https://doi.org/10.1016/j.brat.2005.06.006 source

      The ACT/RFT theory of psychopathology (pp. 6–7) links psychological inflexibility to difficulty pursuing valued activities, and Research on ACT (p. 13) reports an association between greater flexibility and less disability in people with chronic pain. These passages support the general ACT-based expectation, but they do not establish the proposed relationship between physical and psychological symptom interference and inflexibility specifically in cancer survivors; the cancer study discussed in Mediational studies (p. 18) concerns patients with end-stage cancer. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    These symptoms tend to co-occur, and survivors show heterogeneous clustering and severity of symptoms.

    “These symptoms tend to co-occur, with survivors showing heterogeneous clustering and severity of symptoms [2, 3].”
    • Also stated in: § Discussion · plain
      “Prior research has also found heterogeneity with respect to the clustering and severity of survivors’ symptoms [2, 3].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [2] Agasi-Idenburg SC, Thong MSY, Punt CJA, Stuiver MM, Aaronson NK (2017) Comparison of symptom clusters associated with fatigue in older and younger survivors of colorectal cancer. Support Care Cancer 25:625–632. https://doi.org/10.1007/s00520-016-3451-4 source
    • cites [3] Baden M, Lu L, Drummond FJ, Gavin A, Sharp L (2020) Pain, fatigue and depression symptom cluster in survivors of prostate cancer. Support Care Cancer 28:4813–4824. https://doi.org/10.1007/s00520-019-05268-0 source

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

    Study design and conductcitation

    The AAQ-II has shown good discriminate validity and test-retest reliability.

    “This measure has shown good discriminate validity and test-retest reliability [33].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [33] Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, Waltz T, Zettle RD (2011) Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: a revised measure of psychological inflexibility and experiential avoidance. Behav Ther 42:676–688. https://doi.org/10.1016/j.beth.2011.03.007 source

  • May combine two claims.

    Premisecitation

    Another pilot RCT found that compared to survivorship education and enhanced usual care, group-based ACT was effective in reducing breast cancer survivors' fear of cancer recurrence, general anxiety, and depressive symptoms at 6-month follow-up.

    “Another pilot RCT found that compared to survivorship education and enhanced usual care, group-based ACT was effective in reducing breast cancer survivors’ fear of cancer recurrence, general anxiety, and depressive symptoms at 6-month follow-up [12].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Johns SA, Stutz PV, Talib TL, Cohee AA, Beck-Coon KA, Brown LF, Wilhelm LR, Monahan PO, LaPradd ML, Champion VL, Miller KD, Giesler RB (2020) Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: a 3-arm pilot randomized controlled trial. Cancer 126:211–218. https://doi.org/10.1002/cncr.32518 source

  • May combine two claims.

    Premisecitation

    A few studies have associated greater psychological flexibility and mindfulness with reduced distress in post-treatment survivors, and one study linked greater mindfulness to reduced physical symptoms in breast cancer survivors.

    “To date, a few studies have associated greater psychological flexibility and mindfulness with reduced distress in post-treatment survivors [13–15], and one study linked greater mindfulness to reduced physical symptoms in breast cancer survivors [14].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [13] González-Fernández S, Fernández-Rodríguez C, Mota-Alonso MJ, García-Teijido P, Pedrosa I, Pérez-Álvarez M (2017) Emotional state and psychological flexibility in breast cancer survivors. Eur J Oncol Nurs 30:75–83. https://doi.org/10.1016/j.ejon.2017.08.006 source
    • cites [14] Ikeuchi K, Ishiguro H, Nakamura Y, Izawa T, Shinkura N, Nin K (2020) The relation between mindfulness and the fatigue of women with breast cancer: path analysis. Biopsychosoc Med 14:1–10. https://doi.org/10.1186/s13030-020-0175-y source
    • cites [15] van der Donk LJ, Fleer J, Tovote A, Ranchor AV, Smink A, Mul VEM, Sanderman R, Schroevers MJ (2020) The role of mindfulness and self-compassion in depressive symptoms and affect: a comparison between cancer patients and healthy controls. Mindfulness 11:883–894. https://doi.org/10.1007/s12671-019-01298-1 source

      The Discussion (page not available) reports that mindfulness was inversely associated with depressive symptoms and negative affect in cancer patients. The Participants section says patients had finished radiotherapy at least two months earlier, but the study did not assess psychological flexibility or physical symptoms and excluded people with breast cancer. It therefore supports the mindfulness–distress association in a post-treatment group, not the full claim. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Increased mindfulness has been associated with lower physical and psychological symptoms in breast cancer survivors and less distress in survivors of various cancer types.

    “Increased mindfulness has been associated with lower physical and psychological symptoms in breast cancer survivors [14] and less distress in survivors of various cancer types [7, 15, 44].”
    Quote in the paperNot a substantial claim3 of 4 sources checked
    • cites [14] Ikeuchi K, Ishiguro H, Nakamura Y, Izawa T, Shinkura N, Nin K (2020) The relation between mindfulness and the fatigue of women with breast cancer: path analysis. Biopsychosoc Med 14:1–10. https://doi.org/10.1186/s13030-020-0175-y source
    • cites [7] Hulbert-Williams NJ, Storey L (2016) Psychological flexibility correlates with patient-reported outcomes independent of clinical or sociodemographic characteristics. Support Care Cancer 24:2513–2521. https://doi.org/10.1007/s00520-015-3050-9 source
    • cites [15] van der Donk LJ, Fleer J, Tovote A, Ranchor AV, Smink A, Mul VEM, Sanderman R, Schroevers MJ (2020) The role of mindfulness and self-compassion in depressive symptoms and affect: a comparison between cancer patients and healthy controls. Mindfulness 11:883–894. https://doi.org/10.1007/s12671-019-01298-1 source
    • cites [44] Garland EL, Thielking P, Thomas EA, Coombs M, White S, Lombardi J, Beck A (2017) Linking dispositional mindfulness and positive psychological processes in cancer survivorship: a multivariate path analytic test of the mindfulness-to-meaning theory. Psychooncology 26:686–692. https://doi.org/10.1002/pon.4065 source

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

    Premisecitation

    Commitment and behavior change processes, or value-based actions, have received limited research attention in cancer.

    “Commitment and behavior change processes, or value-based actions, have also received limited research attention in cancer [36, 43].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [36] Mosher CE, Tometich DB, Hirsh A, Rand KL, Johns SA, Matthias MS, Outcalt SD, Bricker J, Schneider B, Mina L, Storniolo AM, Newton E, Miller K (2017) Symptom experiences in metastatic breast cancer patients: relationships to activity engagement, value-based living, and psychological inflexibility. Psychooncology 26:1944–1951. https://doi.org/10.1002/pon.4283 source
    • cites [43] Ciarrochi J, Fisher D, Lane L (2011) The link between value motives, value success, and well-being among people diagnosed with cancer. Psychooncology 20:1184–1192. https://doi.org/10.1002/pon.1832 source

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

    Premisecitation

    An accepting attitude towards cancer has been repeatedly associated with less distress, and cognitive fusion has rarely been studied in cancer, with one survey linking it to greater distress in a heterogeneous sample of cancer survivors.

    “While an accepting attitude towards cancer has been repeatedly associated with less distress [45], cognitive fusion has rarely been studied in cancer, with one survey linking it to greater distress in a heterogeneous sample of cancer survivors [27].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [45] Secinti E, Tometich DB, Johns SA, Mosher CE (2019) The relationship between acceptance of cancer and distress: a meta-analytic review. Clin Psychol Rev 71:27–38. https://doi.org/10.1016/j.cpr.2019.05.001 source
    • cites [27] Gillanders DT, Sinclair AK, MacLean M, Jardine K (2015) Illness cognitions, cognitive fusion, avoidance and self-compassion as predictors of distress and quality of life in a heterogeneous sample of adults, after cancer. J Contextual Behav Sci 4:300–311. https://doi.org/10.1016/j.jcbs.2015.07.003 source

  • May combine two claims.

    Findingown data

    Model fit indices (BIC and AIC) favored the 4-class solution, but class sizes and interpretability were markedly reduced using this model.

    “Although model fit indices (i.e., BIC and AIC) favored the 4-class solution, class sizes and interpretability were markedly reduced using this model.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Significant negative correlations were found between all five symptoms and mindfulness, acceptance, and values progress, except for a non-significant association between pain intensity and values progress.

    “Significant negative correlations were found between all five symptoms and the ACT variables of mindfulness, acceptance, and values progress, except for a non-significant association between pain intensity and values progress.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The 3-class solution fit the data significantly better than the 2-class solution (VLMR p<.05, entropy = 0.95), with enhanced interpretability that was conceptually meaningful.

    “The 3-class solution fit the data significantly better than the 2-class solution (VLMR p<.05, entropy = 0.95), with enhanced interpretability that was conceptually meaningful.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the current sample, the 5-item Acting with Awareness and Nonjudging subscales were highly correlated (r=.61, p<.01), whereas Nonreactivity showed small correlations with these subscales.

    “For the current analysis, we combined the 5-item Acting with Awareness and Nonjudging subscales to assess mindfulness, as they were highly correlated in our sample (r=.61, p<.01), whereas Nonreactivity showed small correlations with these subscales.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    ACT aims to minimize the negative impact of symptoms on functioning rather than focusing on symptom reduction.

    “Rather than focusing on symptom reduction, these interventions, such as acceptance and commitment therapy (ACT), aim to minimize the negative impact of symptoms on functioning [7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Hulbert-Williams NJ, Storey L (2016) Psychological flexibility correlates with patient-reported outcomes independent of clinical or sociodemographic characteristics. Support Care Cancer 24:2513–2521. https://doi.org/10.1007/s00520-015-3050-9 source

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

    Study design and conductcitation

    In research on the AAQ-II in adults with cancer, alphas have ranged from 0.78 to 0.87.

    “Additionally, in research on the AAQ-II in adults with cancer, alphas have ranged from 0.78 to 0.87 [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] 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 22:459–464. https://doi.org/10.1002/pon.2083 source

  • May combine two claims.

    Premisecitation

    In a pilot RCT with post-treatment survivors, both ACT and Behavioral Activation groups were superior to a waitlist control group and showed comparable post-intervention reductions in anxiety and depressive symptoms.

    “In a pilot randomized controlled trial (RCT) with post-treatment survivors, both ACT and Behavioral Activation groups were superior to a waitlist control group and showed comparable post-intervention reductions in anxiety and depressive symptoms [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] González-Fernández S, Fernández-Rodríguez C, Paz-Caballero MD, Pérez-Álvarez M (2018) Treating anxiety and depression of cancer survivors: behavioral activation versus acceptance and commitment therapy. Psicothema 30:14–20. https://doi.org/10.7334/psicothema2017.396 source

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

    Study design and conductcitation

    The CFQ has demonstrated strong internal consistency, test-retest reliability, and ability to predict anxiety in cancer survivors.

    “The CFQ has demonstrated strong internal consistency, test-retest reliability, and ability to predict anxiety in cancer survivors [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Gillanders DT, Sinclair AK, MacLean M, Jardine K (2015) Illness cognitions, cognitive fusion, avoidance and self-compassion as predictors of distress and quality of life in a heterogeneous sample of adults, after cancer. J Contextual Behav Sci 4:300–311. https://doi.org/10.1016/j.jcbs.2015.07.003 source

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

    Study design and conductcitation

    The PEACE Peaceful Acceptance subscale has shown good internal consistency (α=0.78) and criterion validity in adults with cancer.

    “This subscale has shown good internal consistency (α=0.78) and criterion validity in adults with cancer [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Mack JW, Nilsson M, Balboni T, Friedlander RJ, Block SD, Trice E, Prigerson HG (2008) Peace, Equanimity, and Acceptance in the cancer experience (PEACE). Cancer 112:2509–2517. https://doi.org/10.1002/cncr.23476 source

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

    Study design and conductcitation

    Both VQ subscales have shown good internal consistency (obstruction α=0.79; progress α=0.81) and concurrent validity with measures of ACT constructs in healthy samples.

    “Both VQ subscales have shown good internal consistency (obstruction, α=0.79; progress, α=0.81) and concurrent validity with measures of ACT constructs in healthy samples [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Smout M, Davies M, Burns N, Christie A (2014) Development of the Valuing Questionnaire (VQ). J Contextual Behav Sci 3:164–172. https://doi.org/10.1016/j.jcbs.2014.06.001 source

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

    Premisecitation

    Entropy above .80 indicates a good-fitting model.

    “Entropy above .80 also indicates a good-fitting model [40, 41].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [40] Celeux G, Soromenho G (1996) An entropy criterion for assessing the number of clusters in a mixture model. J Classif 13:195–212. https://doi.org/10.1007/BF01246098 source
    • cites [41] Clark S, Muthén BO (2009) Relating latent class analysis results to variables not included in the analysis. https://statisticalInnovations.com. Accessed 25 May 2020

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

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

    Study design and conductown data

    All measures had good to excellent internal consistency reliability (α range = 0.82-0.95).

    “All measures had good to excellent internal consistency reliability (α range = 0.82–0.95).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Lower values for information criterion (BIC, AIC) and statistical significance of the VLMR LRT indicate better model fit.

    “Lower values for information criterion [38], such as the Bayesian Information Criterion (BIC) and Akaike Information Criterion (AIC), and statistical significance (p<.05) of the Vuong-Lo-Mendell-Rubin likelihood ratio test (VLMR LRT) [39] indicate better model fit.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [38] Nylund KL, Asparouhov T, Muthén BO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Modeling 14:535–569. https://doi.org/10.1080/10705510701575396 source
    • cites [39] Lo Y, Mendell NR, Rubin DB (2001) Testing the number of components in a normal mixture. Biometrika 88:767–778. https://doi.org/10.1093/biomet/88.3.767 source

  • May combine two claims.

    Premisecitation

    One prior study with disease-free breast cancer survivors found that greater psychological inflexibility was associated with higher levels of distress, and other studies have found this association in patients of mixed cancer types and stages.

    “One prior study with disease-free breast cancer survivors found that greater psychological inflexibility, or avoidance of unwanted experiences, was associated with higher levels of distress [13], and other studies have found this association in patients of mixed cancer types and stages [7, 43].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [13] González-Fernández S, Fernández-Rodríguez C, Mota-Alonso MJ, García-Teijido P, Pedrosa I, Pérez-Álvarez M (2017) Emotional state and psychological flexibility in breast cancer survivors. Eur J Oncol Nurs 30:75–83. https://doi.org/10.1016/j.ejon.2017.08.006 source
    • cites [7] Hulbert-Williams NJ, Storey L (2016) Psychological flexibility correlates with patient-reported outcomes independent of clinical or sociodemographic characteristics. Support Care Cancer 24:2513–2521. https://doi.org/10.1007/s00520-015-3050-9 source
    • cites [43] Ciarrochi J, Fisher D, Lane L (2011) The link between value motives, value success, and well-being among people diagnosed with cancer. Psychooncology 20:1184–1192. https://doi.org/10.1002/pon.1832 source

  • May combine two claims.

    Interpretationown data

    Our results suggest that symptoms may interfere with purposeful attention to the present moment, acceptance of one's experiences, and living according to personal values.

    “Our results suggest that symptoms may interfere with purposeful attention to the present moment, acceptance of one’s experiences, and living according to personal values.”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    Because of the exploratory nature of latent class analysis, findings warrant replication.

    “Finally, because of the exploratory nature of latent class analysis, findings warrant replication.”
    Quote in the paperNot a substantial claim
29 of 29

  • The paper relies on this without support.

    The common symptoms in cancer survivors include fatigue, sleep disturbance, pain, anxiety, and depressive symptoms.

    “Common symptoms include fatigue, sleep disturbance, pain, anxiety, and depressive symptoms.”
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?

  • ACT as a therapeutic treatment modality for survivors has a growing evidence base, supporting survivors in cultivating present-moment awareness and disentangling from rigid thoughts about themselves and their cancer.

    “ACT as a therapeutic treatment modality for survivors has a growing evidence base [37,57-59], supporting survivors in cultivating present-moment awareness and disentangling from rigid thoughts about themselves and their cancer [60].”

    From Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach (2024) · cites this paper as [58]

    The Introduction (page not supplied) describes ACT’s focus on present-moment attention and psychological flexibility, including reducing the influence of thoughts on behavior. But this paper’s own findings are cross-sectional associations, and its Conclusion calls for further trials; it does not establish that ACT treatment cultivates these capacities in survivors. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(2) = 12.88reported p = .002 · recomputed p = .002

    “χ2(2, N=203)=12.88, p = .002”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cites

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Related

Authors
Lewson, A. B., Johns, S. A., Krueger, E., Chinh, K., Kidwell, K. M., & Mosher, C. E.
Affiliations
  • Indiana University – Purdue University Indianapolis (US)
  • Regenstrief Institute (US)
  • University of Michigan (US)
Corresponding author
Lewson, Ashley B.
ORCID
Venue
Supportive Care in Cancer
Publisher
Springer Science and Business Media LLC
Published
2020-11-02
Volume
29
Issue
7
Pages
3487-3495
ISSN
  • 0941-4355 (ISSN-L)
  • 1433-7339
DOI
10.1007/s00520-020-05854-7
PMC
PMC8088450
OpenAlex
W3095511790
Cited by
29
References
43
Citations by year
2025: 3 · 2024: 6 · 2023: 4 · 2022: 12 · 2021: 1
FWCI
1.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Supportive Care in Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • PubMed Central (submittedVersion)
Funders
  • National Cancer Institute (K07CA168883, K05CA175048, T32CA117865)
  • Walther Cancer Foundation (0175)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
cancer survivors, acceptance and commitment therapy, symptom severity, fatigue, sleep disorders, pain, anxiety, depressive symptoms
MeSH terms
Cancer Survivors, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Quality of Life

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.

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