Managing cancer and living meaningfully (CALM) in adults with malignant glioma: a proof-of-concept phase IIa trial
Open accessAbstract
Background Managing Cancer and Living Meaningfully (CALM) is an evidence-based, brief, semi-structured psychotherapy designed to help patients with advanced cancer cope with the practical and profound challenges of their illness. However, no study to date has investigated its feasibility, acceptability, and preliminary effectiveness in adults with malignant glioma, despite the well-documented incidence of psychological distress in this vulnerable and underserved population.Methods Fourteen patients with glioma and elevated symptoms of depression and/or death anxiety enrolled in the trial: 83% glioblastoma, 75% female, M age = 56 years (SD = 15.1; range = 27-81). Feasibility was assessed based on established metrics. Acceptability was measured by post-session surveys and post-intervention interviews. Preliminary intervention effects were explored using paired t-tests, comparing psychological distress at baseline and post-intervention.Results Of the 14 enrolled patients, 12 were evaluable. Nine completed the study (75% retention rate). Three patients withdrew due to substantial disease progression which affected their ability to participate. Participants reported high perceived benefit, and all recommended the program to others. Baseline to post-intervention assessments indicated reductions in death anxiety, generalized anxiety, and depression, and increases in spirituality. Quality of life and fear of cancer recurrence remained stable throughout the study period.Conclusions CALM appears feasible for use with adults with malignant glioma. Enrollment and retention rates were high and comparable to psychotherapy trials for patients with advanced cancer. High perceived benefit and reductions in symptoms of death anxiety, generalized anxiety, and depression were reported by participants. These findings are extremely encouraging and support further study of CALM in neuro-oncology.Trial registration number NCT04646213 registered on 11/27/2020.
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Committed action, related to work on personal values, has been seen positively correlated with psychological well-being and negatively with experiential avoidance and cancer-related distress.
“Concretamente, la acción comprometida, relacionada con el trabajo en valores personales, se ha visto correlacionada positivamente con el bienestar psicológico y negativamente con la evitación experiencial y el distrés relacionado con el cáncer (79) .”
From AVANZACT: protocolo e intervención psicoterapéutica en cáncer avanzado basados en Terapia de Aceptación y Compromiso. (2025) · cites this paper as [79]
The Methods (Measures) and Discussion report distress and well-being outcomes following CALM, and the Results (Acceptability of CALM intervention) mention meaning and purpose as an intervention domain. None reports committed action, experiential avoidance, or the claimed correlations; searches for those terms found no matching passage. Page numbers were not available in our copy. (LLM, conf=0.76)
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“%) studies [53,54,108,109,151] evaluated the effect of an intervention named the Managing Cancer and Living Meaningfully intervention.”
Leo, K., Porter, L. S., Lisenbee, J., & Ramos, K. (2025) · Palliative & Supportive Care · doi:10.1017/s1478951525100436 · Cited by 1 · see citing works
“There have also been patient-focused interventions that encourage but do not require caregiver participation (e.g., Loughan et al. 2022; Ownsworth et al. 2023), yet outcomes have been primarily focused on the patients or found no positive benefits for the caregiver, perhaps because their…”
Spirituality in neuro-oncology
Miran, D. M., Kearns, J. P., & Peteet, J. R. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-15663-2.00022-5
Psychotherapeutic interventions in neuro-oncology
Acquaye, A., & Loughan, A. R. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-15663-2.00006-7
Self-citationMaatouk, I., & Fleischer, A. (2024) · Springer eBooks · doi:10.1007/978-3-662-68436-8_34
Acquaye, A., Rodin, G., Managoli, M. V., Robins, K. R., Stockdill, M., Leeper, H. E., Vera, E., Mendoza, T. R., King, A. L., Cassidy, M. L., et al. (2026) · medRxiv · doi:10.64898/2026.01.07.26343618
Self-citationLoughan, A. R., Lanoye, A. M., Davies, A., Fox, A. M., & Zarrella, G. V. (2026) · Neuro-Oncology Advances · doi:10.1093/noajnl/vdag087
Self-citationEngström, A. H., Guldager, A. M., Strandh, M. R., Kuylenstierna, A., Stålberg, K., Viirman, F., Eklund, R., Ljungman, L., & Wikman, A. (2026) · Journal of Health Psychology · doi:10.1177/13591053261438035
Wang, G., Li, J., Xiao, J., Qi, Y., Tang, S., Liu, J., Han, Y., Kuang, J., & Xu, W. (2026) · BMC Psychology · doi:10.1186/s40359-026-04901-y
“Spiritual care and CALM components are suggested to be implemented as active, structured, and dose-controlled elements, with dedicated sessions focused on death-related concerns, legacy, and end-of-life preparation [27, 32].”
Willis, K. D., Thumma, L., Fox, A. M., Reid, M. P., Rybarczyk, B. D., Mazzeo, S. E., Keeley, J. W., Rodin, G., & Loughan, A. R. (2026) · Palliative & Supportive Care · doi:10.1017/s1478951526103460
“Findings from a recent proof-of-concept trial of CALM in PwMG suggest CALM is feasible and acceptable, with preliminary reductions in death anxiety (Loughan et al. 2022b).”
Self-citationDeath anxiety in advanced cancer patients and family caregivers: A scoping review
Sun, Q., Yorke, J., Loong, H. H. F., Luo, H., Xuexun, X. I. A. O., Liu, Q., Mao, T., & Ho, K. Y. (2026) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2026.103334
Abdi, A., Imani, B., Zandi, S., & Zamani, M. R. (2026) · Journal of Qualitative Research in Health Sciences · doi:10.34172/jqr.1565
“The search for meaning in life typically leads to priorities shifting from attaining material and professional success to putting family, relationships, and enjoyable moments first (37).”
- Authors
- Loughan, A. R., Willis, K. D., Braun, S. E., Rodin, G., Lanoye, A., Davies, A. E., Svikis, D., Mazzeo, S., Malkin, M., & Thacker, L.
- Affiliations
- Virginia Commonwealth University (US)
- Princess Margaret Cancer Centre (CA)
- Corresponding author
- Loughan, Ashlee R.
- ORCID
- Venue
- Journal of Neuro-Oncology
- Published
- 2022-04-18
- Volume
- 157
- Issue
- 3
- Pages
- 447-456
- ISSN
- 0167-594X (ISSN-L)
- 1573-7373
- PMC
- PMC9909556
- OpenAlex
- W4224239303
- Cited by
- 29
- References
- 52
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 7 · 2023: 5 · 2022: 1
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Neuro-Oncology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Cancer Society - Institutional Research Grant (IRG-18-159-43)
- National Center for Advancing Translational Sciences (KL2TR002648)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Keywords
- high-grade glioma, psychotherapy, psychological distress, fear of death, generalized anxiety disorder, depression, spirituality, quality of life, fear of cancer recurrence, feasibility, acceptability, neuro-oncology, advanced cancer
- MeSH terms
- Adult, Anxiety, Depression, Feasibility Studies, Female, Glioma, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Psychotherapy, Brief, Quality of Life
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