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

The DOI matches its Crossref record; 126 of the 126 references it cites were found in a registry or an index; none of the 51 sources its claims cite is checked for support yet.

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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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Results > Mean Effect Sizes
Load-bearingStrength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
In the paper
“Based on stem-and-leaf plots, one study (Lyons et al., 2015) was identified as an outlier for the association between acceptance of cancer and depressive symptoms.”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Results > Mean Effect Sizes
What the sources say
- Not checked yetcites Lyons et al., 2015 source
Strength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes

Show all 57 claims

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Probably not a substantial claim. 26

A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Results > Moderator Analyses
Strength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Results > Moderator Analyses
Load-bearingStrength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Results > Moderator Analyses
Load-bearingStrength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Method > Meta-analytic Method
What the sources say
- Not checked yetcites Hunter & Schimdt, 2004
- Not checked yetcites Sharma & Yetton, 2007
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Introduction > Present Study: Acceptance of Cancer and Distress
What the sources say
- Not checked yetcites Dasch et al., 2010 source
- Not checked yetcites Mack et al., 2008 source
- Not checked yetcites Peters et al., 2014 source
Load-bearingStrength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
In the paper
“by accepting the illness to a greater degree, patients are empowered to engage in value-based actions, which might subsequently improve psychological well-being.”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Introduction > Acceptance of Cancer
What the sources say
- Not checked yetcites Hayes et al., 2006 source
Load-bearingStrength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
In the paper
“The quality of study reporting was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (von Elm, Altman, & Egger, 2008).”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Method > Quality Assessment
What the sources say
- Not checked yetcites von Elm, Altman, & Egger, 2008 source
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement (Moher, Liberati, Tetzlaff, & Altman, 2009).”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Method > Literature Search
What the sources say
- Not checked yetcites Moher, Liberati, Tetzlaff, & Altman, 2009 source
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Introduction > Present Study: Acceptance of Cancer and Distress
What the sources say
- Not checked yetcites Fashler et al., 2018 source
- Not checked yetcites Graham, Gouick, Krahé, & Gillanders, 2016 source
- Not checked yetcites Haller et al., 2017 source
Strength:hedged· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“In accordance with Hunter and Schmidt (2004), meta-analyses were conducted with raw correlations (r) and correlations corrected for measurement reliability (ρ).”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Method > Meta-analytic Method
What the sources say
- Not checked yetcites Hunter and Schmidt (2004)
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Results > Mean Effect Sizes
What the sources say
- Not checked yetcites Lipsey & Wilson, 2001
Load-bearingStrength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Introduction > Present Study: Acceptance of Cancer and Distress
What the sources say
- Not checked yetcites Fashler et al., 2018 source
- Not checked yetcites Graham, Gouick, Krahé, & Gillanders, 2016 source
- Not checked yetcites Haller et al., 2017 source
Strength:hedged· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Discussion > Moderators of the acceptance of cancer and distress relationship
What the sources say
- Not checked yetcites Holland & Holahan, 2003 source
- Not checked yetcites Kim, Han, Shaw, McTavish, & Gustafson, 2010
Strength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Discussion > Implications for Clinical Practice and Intervention Research
What the sources say
- Not checked yetcites Alsubaie et al., 2017 source
- Not checked yetcites Gu, Strauss, Bond, & Cavanagh, 2015 source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Discussion > Moderators of the acceptance of cancer and distress relationship
What the sources say
- Not checked yetcites Thomas, Liu, & Umberson, 2017
- Not checked yetcites K. Williams, 2003 source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“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.”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Discussion > Moderators of the acceptance of cancer and distress relationship
What the sources say
- Not checked yetcites Applebaum et al., 2014 source
Load-bearingStrength:hedged· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
In the paper
“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).”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Discussion
What the sources say
- Not checked yetcites Abbey et al., 2015 source
Load-bearingStrength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Discussion > Implications for Clinical Practice and Intervention Research
What the sources say
- Not checked yetcites Fashler et al., 2018 source
- Not checked yetcites Hulbert-Williams et al., 2015 source
Strength:hedged· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ The Relationship between Acceptance of Cancer and Distress: A Meta-Analytic Review > Discussion > Conclusion
What the sources say
- Not checked yetcites Lazarus & Folkman, 1984
- Not checked yetcites Hayes et al., 1999
- Not checked yetcites Kabat-Zinn, 1990
Load-bearingStrength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.

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.”

5 of 5

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“Additionally, acceptance and commitment therapy (ACT), one of the third-wave cognitive behavioral therapies, is considered potentially helpful in facilitating meaning-making after traumatic events (Secinti et al., 2019).”
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“Furthermore, disease acceptance—the willingness to embrace thoughts and feelings without judgment—has been linked to lower levels of anxiety and depressive symptoms in breast cancer patients (Secinti et al., 2019).”
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“Acceptance of one’s disease has been described as positively associated with finding meaning in life and negatively associated with distress, depression, and anxiety symptoms in people with cancer (Quinto et al., 2022; Secinti et al., 2019).”
Assimilating breast cancer experience: a contrasting case study
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The mediating role of partner support in the relationship between reproductive health concerns and psychological distress among cancer survivors
Amin, S. M., Abdelaliem, S. M. F., Alabdullah, A. A. S., Alasqah, I., El-Feshawy, N. I., Ali, H. S. I., Khedr, M. A., El-Kholy, E. A., Atta, M. H. R., El‐Monshed, A. H., et al. (2026) · Scientific Reports · doi:10.1038/s41598-026-53124-z
“Previous studies have shown that acceptance can play a role in coping with cancer, but its effect may not be as immediate or measurable in terms of psychological distress as health problems 47 .”
Application Effect of Mindfulness Meditation Relaxation Training in Postoperative Breast Cancer Patients Undergoing Chemotherapy at a Day Chemotherapy Center
秦, 晴. (2026) · Advances in Clinical Medicine · doi:10.12677/acm.2026.1662251
Psychological (in)flexibility as a mediator between resilience and psychological outcomes in patients with cancer
Sauer, C., Sajjad, T., Zinndorf, L., & Weißflog, G. (2026) · Scientific Reports · doi:10.21203/rs.3.rs-9994953/v1
Acceptance and Commitment Therapy (ACT) in End-of-Life Care: A Meta-Analysis of Efficacy and Process of Change
Macías, J., Lara-Merín, L., & López-Pinar, C. (2026) · Psicothema · doi:10.70478/psicothema.2026.38.12
Psychological Resources in Adults with Cancer: A Systematic Review of Quantitative Studies
Bridou, M., & Robieux, L. (2026) · Cancers · doi:10.3390/cancers18152525
“…meaning in life, and self-acceptance could reduce this negative impact by enabling cancer patients to reinterpret the adverse situation [145–147], but a lack of research on these resources’ salutogenic potential means that more evidence of their positive effects is needed before…”
Beyond ‘just accepting it’: Existential postures in relating to illness realities in metastatic breast cancer
Ng, A., Yeo, S., Neo, S., & Menzies, R. E. (2026) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2026.100863
Early post-operative changes in quality of life and psychological symptoms after breast cancer surgery: the role of perceived pain, upper limb disability, and disease acceptance
Lai, C., Giraldi, E., Paolucci, T., Cichelli, A., Mazzani, S., Pizzi, S. D., Veneziani, G., Unit, B. C., Cicalini, I., Liotti, V., et al. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-11278-6
“…thoughts, emotions, and bodily sensations without excessive avoidance or struggle, seems to promote patients’ mental and physical well-being, as it allows them to engage in meaningful daily activities despite experiencing stressful and painful inner experiences related to the disease [27–30].”
Influential
Psychological Distress Among Oncology Nurses and Their Attitudes Toward Seeking Professional Psychological Help
Andargeery, S. Y., Alenazi, D. F., AlOthman, N. O., Mutairi, R. A. A., AlShahrani, R. A., Alqahtani, S. A., Aldhafeeri, N. S., Alshomrani, R. M., & Alwesmi, M. B. (2026) · Behavioral Sciences · doi:10.3390/bs16111968

Authors: Secinti, E., Tometich, D. B., Johns, S. A., & Mosher, C. E.
Affiliations: Indiana University – Purdue University Indianapolis (US)
Regenstrief Institute (US)
ORCID: Secinti, Ekin
Tometich, Danielle B.
Johns, Shelley A.
Mosher, Catherine E.
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: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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

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

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