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Cited by 132Cancer survivorship and careMindfulness and Compassion InterventionsPalliative and Oncologic Care

The relationship between acceptance of cancer and distress: A meta-analytic review

Open access
Secinti, Ekin, Tometich, Danielle B., Johns, Shelley A., Mosher, Catherine E.·2019·Clinical Psychology Review
DOI 10.1016/j.cpr.2019.05.001PMC PMC7010402
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Abstract

Acceptance of cancer has long been recognized as playing a critical role in psychological adjustment to the illness, but its associations with distress outcomes have not been quantitatively reviewed. Informed by coping theory and third wave conceptualizations of acceptance, we first propose an integrated model of acceptance of cancer. Then we examine the strength of the relationships between acceptance of cancer and general and cancer-specific distress in cancer patients and potential moderators of these relationships. CINAHL, Embase, MEDLINE, PsycINFO, PsycARTICLES, and Web of Science databases were searched. Random-effects meta-analyses were conducted on 78 records (N=15,448). Small-to-moderate, negative, and significant relationships were found between acceptance of cancer and general distress (r=−.31; 95% CI:−.36 to −.26, k=75); cancer-specific distress (r=−.18; 95% CI:−.21 to −.14, k=13); depressive symptoms (r=−.25; 95% CI:−.31 to −.19, k=41); and anxiety symptoms (r=−.22; 95% CI:−.30 to −.15, k=29). Age, marital status, and stage of cancer were identified as significant moderators. Findings suggest that acceptance of cancer may be important to target in interventions to reduce general and cancer-specific distress in cancer patients. Future research should focus on developing multifaceted measures of acceptance and identifying theory-based psychological and social processes that lead to greater acceptance.

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Crossref · 10.1016/j.cpr.2019.05.001

Cites

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Claims the paper makes

0 of 51 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Acceptance of cancer had a small-to-moderate, negative, statistically significant association with anxiety symptoms (r = −.22, 95% CI −.30 to −.15, k = 29).

    “anxiety symptoms (r=−.22; 95% CI:−.30 to −.15, k=29)”
    Quote in the paperSubstantial claim
  • Findingown data

    Stage of cancer was a significant moderator of the relationship between acceptance of cancer and distress.

    “Age, marital status, and stage of cancer were identified as significant moderators.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Acceptance of cancer had a small-to-moderate, negative, statistically significant association with depressive symptoms (r = −.25, 95% CI −.31 to −.19, k = 41).

    “depressive symptoms (r=−.25; 95% CI:−.31 to −.19, k=41)”
    Quote in the paperSubstantial claim
  • Findingown data

    Acceptance of cancer has a small-to-moderate negative association with depressive symptoms (r = −.25, p < .0001).

    “depressive symptoms (r = −.25, p < .0001)”
    • Also stated in: § Discussion · plain
      “We found significant, small to moderate, negative relationships between acceptance of cancer and general distress, cancer-specific distress, depressive symptoms, and anxiety symptoms.”
    Quote in the paperSubstantial claim
  • Findingown data

    Acceptance of cancer had a small-to-moderate, negative, statistically significant association with cancer-specific distress (r = −.18, 95% CI −.21 to −.14, k = 13).

    “cancer-specific distress (r=−.18; 95% CI:−.21 to −.14, k=13)”
    Quote in the paperSubstantial claim
  • May combine two claims. 35
  • Classified as probably not a substantial claim. 26

  • May combine two claims.

    Findingnone given

    Most included studies were conducted in the United States, and the majority of participants were married middle-aged Caucasian women.

    “First, most of the studies were conducted in the United States, and the majority of participants were married middle-aged Caucasian women.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Publication status, year of data collection, and study reporting quality did not significantly moderate the acceptance-cancer-specific distress association (ps = .279, .748, and .667).

    “cancer-specific distress (ps = .279, .748, and .667, respectively)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Publication status, year of data collection, and study reporting quality did not significantly moderate the acceptance-anxiety association (ps = .335, .322, and .338).

    “or anxiety (ps = .335, .322, and .338, respectively).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Marital status significantly moderated the acceptance-anxiety symptoms relationship (b = .006, SE = .003, z = 2.08, 95% CI .000 to .011; k = 20); each percent increase in married/partnered patients weakened the relationship by 0.006.

    “as well as anxiety symptoms (b = .006, SE = .003, z = 2.08, 95% CI .000 to .011; k = 20)”
    • Also stated in: § Moderator Analyses · plain
      “and the relationship between acceptance of cancer and anxiety symptoms weakened by 0.006.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Acceptance was more strongly correlated with depressive and anxiety symptoms among early-stage cancer patients, but this was not replicated for general distress.

    “Acceptance of cancer was more strongly correlated with depressive and anxiety symptoms among cancer patients with early-stage disease; however, this finding was not replicated when examining general distress.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Cancer stage significantly moderated the acceptance-depressive symptoms relationship (b = .004, SE = .002, z = 2.59, 95% CI .001 to .007; k = 18); each percent increase in advanced-stage patients weakened the association by 0.004.

    “Cancer stage was a significant moderator of the relationships between acceptance of cancer and depressive symptoms (b = .004, SE = .002, z = 2.59, 95% CI .001 to .007; k = 18)”
    • Also stated in: § Moderator Analyses · plain
      “For each percent increase in advanced-stage cancer patients in the sample, associations between acceptance of cancer and both depressive and anxiety symptoms weakened by 0.004.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was minimal heterogeneity in the acceptance-cancer-specific distress relationship (Q = 12.76; I2 = .00; τ2 = .00), so moderation analyses were not conducted for it.

    “However, there was minimal heterogeneity in the relationship between acceptance of cancer and cancer-specific distress (Q = 12.76; I2 = .00; τ2 = .00); therefore, we did not conduct moderation analyses for this association.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Publication status, year of data collection, and study reporting quality did not significantly moderate the acceptance-depressive symptoms association (ps = .235, .773, and .342).

    “depressive symptoms (ps = .235, .773, and .342, respectively)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Publication status, year of data collection, and study reporting quality did not significantly moderate the acceptance-general distress association (ps = .429, .544, and .059).

    “publication status (i.e., published vs. not published), year of data collection, and study reporting quality did not significantly moderate the associations between acceptance of cancer and general distress (ps = .429, .544, and .059, respectively)”
    Quote in the paperSubstantial claim

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

    Findingown data

    A small minority of studies reported how sample size was determined (5.13%, 4/78).

    “a small minority of studies reported how sample size was determined (reported in 5.13%, 4/78)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Marital status significantly moderated the acceptance-depressive symptoms relationship (b = .007, SE = .003, z = 2.43, 95% CI .001 to .012; k = 26); each percent increase in married/partnered patients weakened the relationship by 0.007.

    “Marital status (i.e., percent of patients married/partnered) was a significant moderator of the relationships between acceptance of cancer and depressive symptoms (b = .007, SE = .003, z = 2.43, 95% CI .001 to .012; k = 26)”
    • Also stated in: § Moderator Analyses · plain
      “For each percent increase in married/partnered patients in the sample, the relationship between acceptance of cancer and depressive symptoms weakened by 0.007”
    Quote in the paperSubstantial claim

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

    Findingnone given

    Few authors using the COPE or Brief COPE reported whether instructions were revised to refer to acceptance of cancer-specific stressors.

    “Additionally, few authors using the COPE or Brief COPE reported whether the instructions were revised to refer to acceptance of cancer-specific stressors.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    A minority of studies reported reasons for non-participation (23.08%, 18/78).

    “reasons for non-participation (23.08%, 18/78)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Acceptance had the smallest association with cancer-specific distress, the largest association with general distress, and similar small associations with anxiety and depressive symptoms.

    “Although all of our results were small to moderate effect sizes, acceptance of cancer had the smallest association with cancer-specific distress, the largest association with general distress, and similar small associations with anxiety and depressive symptoms.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    When reliability coefficients were missing, median reliability from the sample was imputed; single-item measures received .60.

    “When reliability coefficients were not reported in the study, the median reliability coefficients of the measures were imputed based on those reported in the sample. For single-item measures, a reliability coefficient of .60 was imputed (Hunter & Schimdt, 2004; Sharma & Yetton, 2007).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hunter & Schimdt, 2004

      Not checked in the free run.

    • cites Sharma & Yetton, 2007

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  • May combine two claims.

    Premisecitation

    Earlier studies found that higher acceptance of cancer was linked to lower cancer-specific distress, depression, and anxiety symptoms.

    “studies have shown that greater acceptance of cancer is related to reduced symptoms of cancer-specific distress, depression, and anxiety; however, effect sizes for these relationships vary from small to large”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Dasch et al., 2010 source

      Not checked in the free run.

    • cites Mack et al., 2008 source

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    • cites Peters et al., 2014 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Greater acceptance of illness enables patients to act on their values, which may in turn improve psychological well-being.

    “by accepting the illness to a greater degree, patients are empowered to engage in value-based actions, which might subsequently improve psychological well-being.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hayes et al., 2006 source

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

    Study design and conductcitation

    Reporting quality was assessed with the STROBE guidelines.

    “The quality of study reporting was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (von Elm, Altman, & Egger, 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites von Elm, Altman, & Egger, 2008 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Statistical significance was set at p < .05.

    “Effect sizes were considered statistically significant for p-values < .05.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The first author screened all titles, abstracts, and eligible full texts; the second author screened 20% of each; disagreements were resolved by consensus.

    “The first author (ES) screened all of the titles and abstracts and, when found eligible, the full-texts; the second author (DBT) screened 20% of the titles and abstracts and 20% of the full-texts. Any discrepancies were resolved through consensus meetings.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    The review followed the PRISMA statement.

    “This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement (Moher, Liberati, Tetzlaff, & Altman, 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher, Liberati, Tetzlaff, & Altman, 2009 source

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

    Premisecitation

    Mindfulness and acceptance-based interventions for cancer patients yield moderate to large decreases in anxiety, depressive symptoms, and traumatic stress responses.

    “Recent reviews suggest that among cancer patients, mindfulness and acceptance-based interventions lead to significant moderate to large improvement in emotional well-being and quality of life as well as moderate to large reductions in anxiety and depressive symptoms and traumatic stress responses”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Fashler et al., 2018 source

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    • cites Graham, Gouick, Krahé, & Gillanders, 2016 source

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    • cites Haller et al., 2017 source

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

    Study design and conductcitation

    Meta-analyses used both uncorrected correlations and correlations adjusted for measurement reliability, following Hunter and Schmidt.

    “In accordance with Hunter and Schmidt (2004), meta-analyses were conducted with raw correlations (r) and correlations corrected for measurement reliability (ρ).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hunter and Schmidt (2004)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Sensitivity analysis excluding the depressive-symptom outlier did not produce statistically significant differences in results, so the study was retained.

    “Sensitivity analyses conducted excluding this study did not yield statistically significant differences in the results; thus, the study was included in the final analyses (Lipsey & Wilson, 2001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lipsey & Wilson, 2001

      Not checked in the free run.

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

    Study design and conductown data

    Interrater agreement for title and abstract screening was 95.3%, with Cohen's kappa .72.

    “A total of 3,507 records were excluded with 95.3% agreement between raters (Cohen’s kappa = .72).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Quality assessment had 91.4% interrater agreement (Cohen's kappa = .81).

    “The interrater agreement for study reporting quality was 91.4% (Cohen’s kappa = .81).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The first author coded all records initially, the second coded 20%, and coding agreement was 94.8% (Cohen's kappa = .89).

    “The first author (ES) conducted the initial coding, and the second author (DBT) coded the information reported in 20% of the selected full-texts. There was 94.8% interrater agreement for coding (Cohen’s kappa = .89).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Validated self-report measures of distress were chosen in advance.

    “Similarly, validated self-report measures of distress were selected a priori, and additional measures found during the database search were included if they had acceptable psychometric properties.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Mindfulness and acceptance-based interventions for cancer patients yield moderate to large gains in emotional well-being and quality of life.

    “Recent reviews suggest that among cancer patients, mindfulness and acceptance-based interventions lead to significant moderate to large improvement in emotional well-being and quality of life as well as moderate to large reductions in anxiety and depressive symptoms and traumatic stress responses”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Fashler et al., 2018 source

      Not checked in the free run.

    • cites Graham, Gouick, Krahé, & Gillanders, 2016 source

      Not checked in the free run.

    • cites Haller et al., 2017 source

      Not checked in the free run.

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

    Study design and conductnone given

    Self-report acceptance measures with validation evidence were chosen before data collection.

    “As part of the inclusion criteria, validated self-report measures of acceptance of cancer were selected a priori.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Full-text screening had 92.6% interrater agreement (Cohen's kappa = .79).

    “There was 92.6% interrater agreement for full-text screening (Cohen’s kappa = .79).”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Extra acceptance measures were included only if they fit the conceptual definition and showed adequate reliability (alpha at least .70) and validity evidence.

    “additional measures were included if they assessed acceptance in line with our conceptual definition (i.e., recognizing and staying present with the reality of the diagnosis rather than engaging in resignation or fatalism), and if they had acceptable psychometric properties, including reliability (i.e., Cronbach’s alpha ≥ .70) and validity evidence”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    For longitudinal and intervention studies, only baseline correlations were extracted to maximize sample size and reduce extraneous effects.

    “For longitudinal and intervention studies, only the initial (or baseline) acceptance of cancer and general and/or cancer-specific distress correlation coefficients were extracted in order to include the largest possible sample and minimize the effects of extraneous factors (e.g., intervention, practice effects).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Advanced-stage cancer patients were underrepresented in the analyses, so the stage moderation results should be interpreted cautiously.

    “As advanced-stage cancer patients were underrepresented in the analyses, the results should be interpreted with caution.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    The null gender moderation findings may be due to limited representation of male cancer patients in the analyses.

    “Alternatively, our null moderation findings for gender may be due to the limited representation of male cancer patients in the analyses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The meta-analytic results may be affected by publication bias, but including unpublished results and publication bias analyses suggested this was not a significant concern.

    “Finally, as in previous reviews, our meta-analytic results may be affected by publication bias (i.e., the file drawer problem). However, we attempted to minimize this limitation by including unpublished results (e.g., dissertations, conference abstracts), and analyses of publication bias suggested that this was not a significant concern.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Both younger and older adults were underrepresented in the included studies, so the age moderation findings should be interpreted cautiously.

    “These findings should be cautiously interpreted, as both younger and older adults were underrepresented in the studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Marital status can be considered a proxy for enhanced social support, which appears to influence patients' choice of coping strategies and in turn distress.

    “Marital status can be considered a proxy variable for enhanced social support, which appears to influence patients’ choice of coping strategies (Holland & Holahan, 2003; Kim, Han, Shaw, McTavish, & Gustafson, 2010) and, in turn, influence distress.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Holland & Holahan, 2003 source

      Not checked in the free run.

    • cites Kim, Han, Shaw, McTavish, & Gustafson, 2010

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  • May combine two claims.

    Study design and conductown data

    The analysis of study reporting quality showed that many researchers did not report sample size determination or reasons for non-participation, lowering reporting quality and limiting evaluation of research procedures.

    “Additionally, as in prior reviews, our analysis of study reporting quality showed that many researchers did not report information such as the determination of sample size or reasons for non-participation, thereby lowering their reporting quality and limiting our ability to evaluate their research procedures.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Current acceptance measures do not assess acceptance of cancer-specific stressors such as the prospect of death, changes in physical appearance, and role changes, which may be more strongly associated with cancer-specific distress.

    “For instance, current measures do not assess acceptance of cancer-specific stressors, such as the prospect of death, changes in physical appearance, and role changes, which may be more strongly associated with cancer-specific distress.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    It is likely that many patients considered their cancer experience when completing these measures, because the original instructions focus on coping with stressful life events.

    “However, it is likely that many patients considered their cancer experience when completing these measures, as the original instructions focus on coping with stressful life events.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Because time since diagnosis did not significantly moderate the relationships, acceptance may be equally important at different phases of the cancer trajectory.

    “Time since diagnosis did not significantly moderate the relationships between acceptance of cancer and general distress, anxiety, or depressive symptoms, suggesting that acceptance may be equally important at different phases of the cancer trajectory.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    When partner support is absent, coping strategies such as acceptance might be more important for reducing distress.

    “When partner support is absent, coping strategies such as acceptance might be more important for reducing distress.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Recent reviews of studies with primarily healthy adults found promising evidence that changes in acceptance, mindfulness, rumination, worry, and self-compassion are potential mechanisms underlying the mental health benefits of mindfulness- and acceptance-based interventions.

    “Recent reviews of studies with primarily healthy adults found promising evidence that changes in acceptance, mindfulness, rumination, worry, and self-compassion are potential mechanisms underlying the mental health benefits of mindfulness- and acceptance-based interventions (Alsubaie et al., 2017; Gu, Strauss, Bond, & Cavanagh, 2015).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Alsubaie et al., 2017 source

      Not checked in the free run.

    • cites Gu, Strauss, Bond, & Cavanagh, 2015 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The mixed marital-status findings might reflect variable quality of marital relationships, as being in an unsatisfying marriage might undermine mental health more than being single or divorced.

    “Our mixed findings might reflect the variable quality of marital relationships, as being in an unsatisfying marriage might undermine mental health to a greater extent than being single or divorced (Thomas, Liu, & Umberson, 2017; K. Williams, 2003).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Thomas, Liu, & Umberson, 2017

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    • cites K. Williams, 2003 source

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  • Classified as probably not a substantial claim.

    Interpretationown data

    Because moderation findings were mixed and limited by small subgroup sample sizes, recommendations about targeting or tailoring acceptance-based interventions to cancer patient subgroups are premature.

    “However, a number of our moderation findings were mixed and limited by the small sample sizes for certain subgroups. Thus, recommendations regarding the targeting or tailoring of acceptance-based interventions to cancer patient subgroups are premature.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Many cancer patients do not have an accurate perception of their disease stage, so stage identified from medical charts might not be an appropriate proxy for patients' understanding of prognosis.

    “Additionally, given that many cancer patients do not have an accurate perception of their disease stage (Applebaum et al., 2014), stage of cancer as identified from medical charts might not be an appropriate proxy variable for patients’ understanding of their prognosis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Applebaum et al., 2014 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    Information on time since diagnosis was limited and long-term cancer survivors were underrepresented in the analyses.

    “Additionally, information regarding time since diagnosis was limited and long-term cancer survivors were underrepresented in our analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Acceptance of cancer may be a multifaceted construct, including acceptance of death, changes in physical appearance, and reduced self-sufficiency.

    “We contend that acceptance of cancer may be a multifaceted construct (e.g., acceptance of death, changes in physical appearance, reduced self-sufficiency).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    All analyses were based on baseline correlational data, so directionality and change over time in the acceptance-distress relationships cannot be inferred.

    “First, in order to maximize the sample sizes and reduce the impact of third variables, all of our analyses were based on baseline correlational data. Thus, we cannot infer directionality and change over time in the acceptance of cancer-distress relationships.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Most included measures of cancer-specific distress assessed cancer-related post-traumatic stress symptoms, which tend to be endorsed at low levels compared with fear of recurrence and general distress.

    “First, most of the included measures of cancer-specific distress assessed cancer-related post-traumatic stress symptoms, which tend to be endorsed at low levels compared to fear of recurrence and general distress (Abbey et al., 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Abbey et al., 2015 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pilot findings suggest that ACT leads to significant improvement in acceptance and reductions in distress outcomes in cancer patients.

    “Additionally, pilot findings suggest that ACT leads to significant improvement in acceptance and reductions in distress outcomes in cancer patients (Fashler et al., 2018; Hulbert-Williams et al., 2015).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Fashler et al., 2018 source

      Not checked in the free run.

    • cites Hulbert-Williams et al., 2015 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The paper's findings combined with trial results suggest that acceptance of cancer-related experiences might be targeted in interventions aiming to improve mental health in cancer patients.

    “Overall, our findings in combination with these trial results suggest that acceptance of cancer-related experiences might be targeted in interventions aiming to improve mental health in cancer patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    There is preliminary evidence that acceptance of cancer might have a greater impact on the mental health of older age groups, singles, and those with early-stage disease.

    “We also found preliminary evidence that acceptance of cancer might have a greater impact on the mental health of older age groups, singles, and those with early-stage disease.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Greater acceptance of cancer was related to reduced distress, consistent with the integrated model of acceptance based on coping theory and third wave theories.

    “Consistent with our integrated model of acceptance based on coping theory (Lazarus & Folkman, 1984) and third wave theories (Hayes et al., 1999; Kabat-Zinn, 1990; Linehan, 1993; Segal et al., 2002), we found that greater acceptance of cancer was related to reduced distress.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Lazarus & Folkman, 1984

      Not checked in the free run.

    • cites Hayes et al., 1999

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    • cites Kabat-Zinn, 1990

      Not checked in the free run.

55 of 55

  • The paper relies on this without support.

    Before this review, the link between acceptance of cancer and distress outcomes had not been quantitatively synthesized.

    “its associations with distress outcomes have not been quantitatively reviewed”

  • The paper relies on this without support.

    Acceptance of cancer has a critical role in psychological adjustment to cancer.

    “Acceptance of cancer has long been recognized as playing a critical role in psychological adjustment to the illness”

  • The paper relies on this without support.

    Variation in effect sizes may come from differences in sample characteristics and acceptance measures across studies.

    “Differences in sample characteristics and measures of acceptance across studies may contribute to this variability in effect sizes.”

  • The paper relies on this without support.

    Some demographic and medical subgroups of cancer patients may benefit more mentally from acceptance.

    “Certain demographic and medical subgroups of cancer patients might experience greater mental health benefits from acceptance.”

  • The authors state this as an assumption.

    Acceptance of cancer is an active process that changes how patients relate to internal experiences, involves a nonjudgmental and compassionate stance, and includes behavioral willingness in response to cancer-related stressors.

    “As stated earlier, we conceptualize acceptance of cancer as an active process that changes how patients relate to their internal experiences of the illness such as appraisals, emotional responses, and bodily sensations.”
    “Specifically, acceptance involves taking a nonjudgmental and compassionate stance toward internal experiences, thereby reducing the struggle with the realities of the illness.”
    “In addition, we conceptualize acceptance as behavioral willingness in response to cancer-related stressors, resulting in action consistent with deeply held values.”
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Authors
Secinti, E., Tometich, D. B., Johns, S. A., & Mosher, C. E.
Affiliations
  • Indiana University – Purdue University Indianapolis (US)
  • Regenstrief Institute (US)
ORCID
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2019-07
Volume
71
Pages
27-38
ISSN
0272-7358 (ISSN-L)
DOI
10.1016/j.cpr.2019.05.001
PMC
PMC7010402
OpenAlex
W2942810090
Semantic Scholar
3d5a1f48681be8854d19a72a4c1bce41703f5716
Cited by
132
References
125
Citations by year
2026: 16 · 2025: 32 · 2024: 15 · 2023: 24 · 2022: 23 · 2021: 15 · 2020: 6 · 2019: 1
FWCI
1.07
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Psychology Review (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • Author eBooks
Funders
  • National Cancer Institute (T32CA117865, F31CA220964, K05CA175048, K07CA168883)
  • 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
psychological distress, cancer-specific distress, depressive symptoms, anxiety symptoms, psychological adjustment to cancer, coping, marital status, tumor stage, moderators
MeSH terms
Psychological Distress, Anxiety, Depression, Humans, Neoplasms, Stress, Psychological

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 by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

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

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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