Acceptance and commitment therapy for symptom interference in advanced lung cancer and caregiver distress: a pilot randomized trial.
Open accessAbstract
Context Advanced lung cancer patients typically have a poor prognosis and many symptoms that interfere with functioning, contributing to high rates of emotional distress in both patients and family caregivers. There remains a need for evidence-based interventions to improve functional outcomes and distress in this population.Objectives This pilot trial examined the feasibility and preliminary efficacy of telephone-based Acceptance and Commitment Therapy (ACT) for symptomatic, advanced lung cancer patients and their distressed family caregivers. Primary outcomes were patient symptom interference with functioning and patient and caregiver distress.Methods Symptomatic, advanced lung cancer patients and distressed caregivers (n = 50 dyads) were randomly assigned to six sessions of ACT or an education/support condition. Patients completed measures of symptom interference and measures assessing the severity of fatigue, pain, sleep disturbance, and breathlessness. Patients and caregivers completed measures of distress and illness acceptance and struggle.Results The eligibility screening rate (51%) and retention rate (76% at six weeks postintervention) demonstrated feasibility. No group differences were found with respect to patient and caregiver outcomes. Both groups showed a small, significant decrease in struggle with the illness over the study period, but did not show meaningful change in other outcomes.Conclusion Findings suggest that telephone-based ACT is feasible for many advanced lung cancer patients and caregivers, but may not substantially reduce symptom interference and distress. Low baseline levels of certain symptoms may have contributed to null findings. Next steps include applying ACT to specific, clinically meaningful symptom interference and varying intervention dose and modality.
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The two prior dyad ACT studies had high completion rates and levels of satisfaction among participants.
“high completion rates and levels of satisfaction among the participants in these studies”
From Effectiveness of a videoconferencing group-based dyad acceptance and commitment therapy on the quality of life of chronic heart failure patients and their family caregivers: A study protocol for a randomized controlled trial (2024) · cites this paper as [58]
The Results > Feasibility section (page unavailable) reports that 39 of 50 dyads (78%) completed all six sessions, supporting the completion-rate claim for this trial. The paper does not report participant satisfaction, and this source alone does not establish completion rates for both studies. (LLM, conf=0.84)
Experimental — accuracy not yet measuredNo statistically significant differences were found in QOL, use of health services, and caregiver distress after the intervention when compared to usual care in the two prior dyad ACT studies.
“Although no statistically significant differences were found in QOL, use of health services, and caregiver distress after the intervention when compared to those who received the usual care”
From Effectiveness of a videoconferencing group-based dyad acceptance and commitment therapy on the quality of life of chronic heart failure patients and their family caregivers: A study protocol for a randomized controlled trial (2024) · cites this paper as [58]
The Discussion reports no reduction in caregiver distress with ACT compared with education/support. But it calls this the first ACT trial for cancer patient-caregiver dyads, and explicitly says it had no usual-care condition. The cited trial therefore does not support the claim about two prior dyad ACT studies or a comparison with usual care; the cited passages also do not report the claimed QOL or health-service-use results. Page numbers are unavailable in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredBoth prior dyad ACT studies involved relatively small sample sizes ranging from 40 to 50 dyads.
“Both studies involved relatively small sample sizes ranging from 40 to 50 dyads.”
From Effectiveness of a videoconferencing group-based dyad acceptance and commitment therapy on the quality of life of chronic heart failure patients and their family caregivers: A study protocol for a randomized controlled trial (2024) · cites this paper as [58]
The Results (Feasibility; page unavailable) report that 50 dyads were randomized in this ACT trial, and the Discussion describes its sample size as limiting statistical power. The paper does not establish that the other study enrolled 40 dyads, so it supports only the 50-dyad end of the stated range. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHigh completion rates and levels of satisfaction among participants in the two prior dyad ACT studies provide early support for the use of a remote ACT intervention for patient-FC dyads.
“high completion rates and levels of satisfaction among the participants in these studies provide early support for the use of a remote ACT intervention for patient-FC dyads.”
From Effectiveness of a videoconferencing group-based dyad acceptance and commitment therapy on the quality of life of chronic heart failure patients and their family caregivers: A study protocol for a randomized controlled trial (2024) · cites this paper as [58]
The Results > Feasibility section reports that 39 of 50 dyads (78%) completed all six telephone sessions, and the Discussion describes the intervention as feasible. Our copy does not report participant satisfaction, and this trial alone cannot establish completion rates across the two studies mentioned in the claim. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn people with advanced cancer, a high rate of treatment rejection and abandonment is common.
“dado que en personas con cáncer avanzado es habitual una alta tasa de rechazo y abandono del tratamiento (13,48,72)”
From AVANZACT: protocolo e intervención psicoterapéutica en cáncer avanzado basados en Terapia de Aceptación y Compromiso. (2025) · cites this paper as [72]
The Results (Feasibility; page not provided) report that 134 of 331 approached patients with advanced lung cancer declined participation in this trial. They do not establish a generally high rate of rejection or abandonment of cancer treatment: 78% of randomized patient–caregiver pairs completed all six intervention sessions. The Discussion describes recruitment and retention as strong. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Weak effects for pain interference were found, with half of the papers assessing pain showing no change post intervention.
“Weak effects for pain interference were found, with half of the papers assessing pain showed no change post intervention.16,48,49”
From Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. (2023) · cites this paper as [48]
The Results (Preliminary Efficacy) report a small effect size and no group-by-time effect for pain interference in this trial. The paper does not establish that half of the papers assessing pain showed no post-intervention change. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn this scoping review, short or flexibly delivered interventions resulted in greater participant retention.
“In this scoping review, short or flexibly delivered interventions resulted in greater participant retention.16,48,49”
From Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. (2023) · cites this paper as [48]
The Methods describe six weekly telephone sessions, and Results > Feasibility reports 76% retention at six-week follow-up. This supports the cited trial as an example of a relatively brief, remotely delivered intervention with substantial retention. It does not show that brevity or flexible delivery resulted in greater retention than other approaches. (LLM, conf=0.85)
Experimental — accuracy not yet measuredTo date, only two studies have adopted an ACT intervention for dyads, and in both cases the interventions were delivered via telephone in an individual/dyad format for specific cancer conditions, such as lung cancer or gastrointestinal cancer.
“To date, only two studies have adopted an ACT intervention for dyads, and in both cases the interventions were delivered via telephone in an individual/dyad format for specific cancer conditions, such as lung cancer [58] or gastrointestinal cancer [59].”
Eight of the 12 included studies were pilot studies.
“Eight studies were pilot studies [19–26].”
From Third-wave cognitive behavioral therapies for caregivers of cancer patients: a scoping review. (2023) · cites this paper as [19]
The most common method was a weekly session for a total of 6 weeks or 8 weeks with a length of approximately 60 min per session.
“The most common method was a weekly session for a total of 6 weeks [19, 20, 24, 27] or 8 weeks [25, 28, 29] with a length of approximately 60 min per session [21, 22, 27, 29, 30].”
From Third-wave cognitive behavioral therapies for caregivers of cancer patients: a scoping review. (2023) · cites this paper as [19]
Two included studies were conducted with caregivers of lung cancer patients in an advanced stage.
“Two studies were conducted with caregivers of lung cancer patients in an advanced stage [19, 21]”
From Third-wave cognitive behavioral therapies for caregivers of cancer patients: a scoping review. (2023) · cites this paper as [19]
Three studies found no change in pain interference; two RCTs and one pre/post study.
“Three studies found no change; two RCTs48,49, one pre/post study. 46”
From Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. (2023) · cites this paper as [48]
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- Authors
- Mosher, C. E., Secinti, E., Hirsh, A. T., Hanna, N., Einhorn, L. H., Jalal, S. I., Durm, G., Champion, V. L., & Johns, S. A.
- Affiliations
- Indiana University – Purdue University Indianapolis (US)
- Indiana University School of Medicine (US)
- Richard L. Roudebush VA Medical Center (US)
- Indiana University Indianapolis (US)
- Regenstrief Institute (US)
- Corresponding author
- Mosher, Catherine E.
- ORCID
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 58
- Issue
- 4
- Pages
- 632-644
- ISSN
- 0885-3924 (ISSN-L)
- PMC
- PMC6754796
- OpenAlex
- W2953657786
- Cited by
- 98
- References
- 66
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 14 · 2023: 20 · 2022: 12 · 2021: 20 · 2020: 11
- FWCI
- 12.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- Funders
- National Cancer Institute (0175.01)
- Walther Cancer Foundation (0172.01)
- 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 lung cancer, symptom interference, caregiver distress, telephone-delivered intervention, feasibility, fatigue, pain, sleep disorders, dyspnea, acceptance of illness, family caregivers
- MeSH terms
- Psychological Distress, Adult, Aged, Aged, 80 and over, Family, Feasibility Studies, Female, Humans, Lung Neoplasms, Male, Middle Aged, Pilot Projects, Telephone, Caregivers, Young Adult, Symptom Assessment, Acceptance and Commitment Therapy
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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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