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Cited by 14Mindfulness and Compassion InterventionsCancer survivorship and carePalliative Care and End-of-Life Issues

Impact of acceptance and commitment therapy on physical and psychological symptoms in advanced gastrointestinal cancer patients and caregivers: Secondary results of a pilot randomized trial

Open access
Burns, Marcia F., Secinti, Ekin, Johns, Shelley A., Wu, Wei, Helft, Paul R., Turk, Anita A., Loehrer, Patrick J., Sehdev, Amikar +2 more·2023·Journal of Contextual Behavioral Science
DOI 10.1016/j.jcbs.2023.01.001PMC PMC10100868
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Abstract

Patients with advanced gastrointestinal cancer often experience high symptom burden, which is associated with heightened distress in both patients and their family caregivers. Few interventions have been tested to jointly address patient and caregiver symptoms in advanced gastrointestinal cancer. In a randomized pilot trial, telephone-based, dyadic acceptance and commitment therapy (ACT) was found to be feasible in this population. The present secondary analyses examined the impact of this intervention on patient and caregiver physical and psychological symptoms. Patients and caregivers (N = 40 dyads) were recruited from clinics in Indianapolis, Indiana and randomized to either six weeks of telephone-based ACT or education/support, an attention control condition. Outcomes were assessed at baseline and at 2 weeks and 3 months post-intervention. Study group differences in outcomes were not statistically significant. However, when examining within-group change, only ACT patients experienced moderate reductions in pain severity and interference at 2 weeks post-intervention (effect size [ES]=-0.47; -0.51) as well as moderate reductions in depressive symptoms at 2 weeks (ES=-0.42) and 3 months (ES=-0.41) post-intervention. ACT caregivers experienced moderate reductions in sleep disturbance (ES=-0.56; -0.49) and cognitive concerns (ES=-0.61; -0.85) across follow-ups. Additionally, caregivers in both conditions experienced moderate reductions in fatigue (ES=-0.38 to -0.70) and anxiety (ES=-0.40 to -0.49) across follow-ups. Findings suggest that ACT may improve certain symptoms in dyads coping with advanced gastrointestinal cancer and warrant replication in a larger trial. © 2023 Association for Contextual Behavioral Science

Integrity signals

Registry

Crossref · 10.1016/j.jcbs.2023.01.001

Cites

62 of 62 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 9 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Preliminary evidence suggests that ACT may improve symptom and quality-of-life outcomes in advanced cancer patients.

    “Preliminary evidence suggests that acceptance and commitment therapy (ACT) may improve symptom and QoL outcomes in advanced cancer patients (Arch et al., 2020; Li et al., 2021; Mosher et al., 2018; Rost et al., 2012).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Arch et al., 2020 source
    • cites Li et al., 2021

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

    • cites Mosher et al., 2018 source
  • Premisecitation

    Few interventions have been tested to jointly address patient and caregiver symptoms in advanced GI cancer.

    “Few interventions have been tested to jointly address patient and caregiver symptoms in advanced GI cancer (Mosher et al., 2018; Porter et al., 2017).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Mosher et al., 2018 source

      The Introduction and Methods describe interventions for symptoms in metastatic breast cancer patients, not advanced GI cancer patients and their caregivers. Searches for caregiver, GI cancer, and joint patient–caregiver interventions found no passage addressing how many such interventions have been tested. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites Porter et al., 2017 source

      The Background (page not available) says most couple-based cancer intervention studies involved early-stage disease, and this paper tests an intervention with patients with advanced GI cancer and their partners. That supports the claim that relatively few interventions had been tested in this setting. But the intervention focused on communication and relationship functioning, not explicitly on jointly addressing patient and caregiver symptoms. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Findingown data

    Among survey completers, caregivers in both conditions had moderate reductions in fatigue and anxiety across follow-ups.

    “Caregivers in both groups showed moderate decreases in fatigue across follow-ups (ds=−0.38 to −0.70).”
    • Also stated in: § Preliminary efficacy: supplemental analyses of survey completers · plain
      “Across follow-ups, ACT and education/support caregivers showed moderate decreases in anxiety symptoms (ds=−0.40 to −0.49) and small to moderate decreases in depressive symptoms (ds=−0.17 to −0.67).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Within-group effect sizes among survey completers reflect intervention effects rather than natural recovery or regression to the mean.
  • Study design and conductown data

    Intervention fidelity was high, with a mean rating of 98% across conditions.

    “Across study conditions, the mean fidelity rating was 98% (number of required topics and exercises covered in each session/total number of fidelity criteria).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 4
  • May combine two claims. 7

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

    Study design and conductcitation

    Analyses used an intent-to-treat approach and multiple imputation with 50 datasets.

    “Data analyses were performed using an intent-to-treat approach.”
    • Also stated in: § Statistical analyses · plain
      “Missing data were addressed through multiple imputation with 50 imputed datasets (Jakobsen et al., 2017).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Jakobsen et al., 2017 source

      The Background (page unavailable) says randomised trials are routinely analysed according to the intention-to-treat principle. ‘When and how to use multiple imputations’ (page unavailable) says 50 imputed datasets or more seem preferable. These passages support the methodological choices, but they do not establish that the citing authors actually used either approach in their analyses. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • Rests on an assumption: Missing data are missing at random, as required for multiple imputation.

  • May combine two claims.

    Findingown data

    Among survey completers, ACT caregivers had moderate reductions in sleep disturbance and cognitive concerns at both follow-ups, whereas education/support caregivers showed minimal improvement.

    “ACT caregivers also showed moderate decline in sleep disturbance (ds=−0.56, −0.49) and cognitive concerns (ds=−0.61, −0.85) at both follow-ups, whereas education/support caregivers showed minimal improvement in these outcomes (ds=−0.24 to −0.02).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Within-group effect sizes among survey completers reflect intervention effects rather than natural recovery or regression to the mean.

  • May combine two claims.

    Findingown data

    In this pilot trial, no statistically significant group-by-time interactions were found for patient pain severity or interference, or for dyadic fatigue, sleep disturbance, cognitive concerns, anxiety, or depressive symptoms.

    “Results showed no significant group-by-time interaction effects on patient pain severity or interference.”
    • Also stated in: § Preliminary efficacy: linear mixed model results · plain
      “Regarding dyadic outcomes, results showed no significant two-way or three-way interaction effects among group, time, and role for fatigue severity, sleep disturbance, cognitive concerns, anxiety, or depressive symptoms.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Missing data are missing at random, as required for multiple imputation.

  • May combine two claims.

    Findingown data

    Among survey completers, ACT patients had moderate reductions in depressive symptoms at both 2 weeks and 3 months post-intervention, while education/support patients did not improve.

    “ACT patients showed moderate decreases in depressive symptoms at both follow-ups (ds=−0.42, −0.41), whereas education/support patients showed no improvement in these symptoms (ds=−0.10, 0.11).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Within-group effect sizes among survey completers reflect intervention effects rather than natural recovery or regression to the mean.

  • May combine two claims.

    Findingown data

    Among survey completers, ACT patients had moderate reductions in pain severity and interference at 2 weeks post-intervention, but these were not sustained at 3 months.

    “ACT patients showed moderate decline in pain severity and interference at 2 weeks (ds=−0.47, −0.51) that was not sustained at 3 months (ds=0.32, 0.20).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Within-group effect sizes among survey completers reflect intervention effects rather than natural recovery or regression to the mean.

  • May combine two claims.

    Study design and conductown data

    Baseline demographics, medical factors, and outcomes did not differ by study group.

    “Demographics, medical factors, and outcomes did not vary by study group at baseline.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The trial was pre-registered at ClinicalTrials.gov (NCT04010227).

    “The study was pre-registered at ClinicalTrials.gov (NCT04010227).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Research assistants blind to study condition conducted follow-up assessments.

    “Research assistants blind to study condition conducted individual phone assessments at 2 weeks and 3 months post-intervention.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    Randomization used a stratified block scheme balanced by patient ECOG performance status.

    “The statistician produced a stratified block randomization scheme balanced by patient performance status (ECOG scores 0 or 1 vs. 2) (Bauer et al., 2002) in R (Snow, 2013; R Core Team, 2013).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Bauer et al., 2002 source
    • cites Snow, 2013

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

    • cites R Core Team, 2013

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

  • May combine two claims.

    Interpretationown data

    The findings suggest that ACT may improve certain symptoms in dyads coping with advanced GI cancer and warrant replication in a larger trial.

    “Findings suggest that ACT may improve certain symptoms in dyads coping with advanced gastrointestinal cancer and warrant replication in a larger trial.”
    Quote in the paperSubstantial claim
10 of 10

  • The paper relies on this without support.

    Missing data are missing at random, as required for multiple imputation.

    “Missing data were addressed through multiple imputation with 50 imputed datasets (Jakobsen et al., 2017).”
    “nearly all attrition was due to patient death or severe medical issues.”

  • The paper relies on this without support.

    Within-group effect sizes among survey completers reflect intervention effects rather than natural recovery or regression to the mean.

    “For survey completers, we computed mean changes in study outcomes from baseline to 2 weeks and 3 months and their corresponding effect sizes within and between study groups”
    “ACT patients showed moderate decline in pain severity and interference at 2 weeks”
2 of 2

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Related

Authors
Burns, M. F., Secinti, E., Johns, S. A., Wu, W., Helft, P. R., Turk, A. A., Loehrer, P. J., Sehdev, A., Al-Hader, A. A., & Mosher, C. E.
Affiliations
  • Indiana University – Purdue University Indianapolis (US)
  • Regenstrief Institute (US)
  • Indiana University Melvin and Bren Simon Comprehensive Cancer Center (US)
Corresponding author
Burns, Marcia F.
ORCID
Venue
Journal of Contextual Behavioral Science
Publisher
Elsevier BV
Published
2023-01
Volume
27
Pages
107-115
ISSN
2212-1447 (ISSN-L)
DOI
10.1016/j.jcbs.2023.01.001
PMC
PMC10100868
OpenAlex
W4313648750
Semantic Scholar
7f34ade0b9f028041431e985a93d2bac21e4f0a7
Cited by
14
References
65
Citations by year
2026: 7 · 2025: 3 · 2024: 2 · 2023: 2
FWCI
4.07
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Contextual Behavioral Science (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
National Cancer Institute (R21CA235788)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords
acceptance and commitment therapy, advanced gastrointestinal cancer, family caregivers, dyadic intervention, telephone-delivered intervention, symptom burden, pain, depressive symptoms, sleep disorders, cognitive concerns, fatigue, anxiety, caregiver distress, patient-caregiver dyads

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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.

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