Managing Anxiety from Cancer (MAC): A pilot randomized controlled trial of an anxiety intervention for older adults with cancer and their caregivers
Open accessAbstract
Objective: Anxiety is common in older adults with cancer (OACs) and their caregivers and is associated with poor outcomes including worse physical symptoms, poor treatment adherence and response, and longer hospitalizations. This study examined the feasibility, acceptability, adherence, and preliminary efficacy of a cognitive-behavioral therapy (CBT) intervention for OACs and their caregivers. Method: Patients with active cancer age 65 years and older and their caregivers were randomized to Managing Anxiety from Cancer (MAC), a seven-session CBT-based psychotherapy intervention delivered over the telephone or usual care. Patients and caregivers completed the intervention separately with licensed social workers. Self-report measures of anxiety, depression, and quality of life were administered after randomization and following intervention completion. Analyses were conducted separately for patients and caregivers and at the dyad level. Hierarchical Linear Modeling accounted for the within-dyad intraclass correlation coefficients (ICCs) by random intercepts associated with the dyads. Results: Twenty-nine dyads were randomized; 28 (96.6%) patients and 26 (89.7%) caregivers completed all study procedures. Of dyads randomized to MAC, 85.7% (n = 12) of patients and caregivers completed all seven sessions. Most patients (≥50%) and over 80% of caregivers rated the overall intervention and intervention components as “moderately” to “very” helpful. MAC was associated with a greater reduction in anxiety among dyads than usual care, the effect of MAC was greater in caregivers than in patients, and improvement in patient anxiety was associated with the reduction in caregiver anxiety. However, these results did not reach statistical significance. Significance of results: This pilot study demonstrates the feasibility of MAC and suggests strategies for improving acceptability, with a focus on adherence. Furthermore, these results indicate that MAC is promising for the reduction of anxiety in OAC–caregiver dyads and may be particularly beneficial for OAC caregivers. Larger randomized controlled trials are needed to evaluate the efficacy of MAC.
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MAC aims to teach older adults with cancer and caregivers CBT, ACT, and PST techniques to manage anxiety associated with cancer and aging.
“The goal of MAC is to teach OACs and their caregivers various techniques from Cognitive-Behavioral Therapy, Acceptance and Commitment Therapy and Problem-Solving Therapy to manage the anxiety associated with cancer and aging.”
From Utilizing a Manualized Therapy to Provide Parallel Treatment to Older Adults With Cancer and Their Caregivers: A Case Study (2022) · cites this paper as Trevino et al., 2021
Methods > Treatment conditions (page not provided) describes MAC as a CBT-based intervention that teaches older adults with cancer and their caregivers skills for managing anxiety, including acceptance-based coping strategies. The Introduction and Discussion link the intervention to the dual stressors of cancer and aging. Our copy does not identify Acceptance and Commitment Therapy or Problem-Solving Therapy as sources of MAC techniques. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe 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 [30]
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 [23]
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Self-citation
- Authors
- Trevino, K. M., Stern, A., Hershkowitz, R., Kim, S. Y., Li, Y., Lachs, M., & Prigerson, H. G.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- NewYork–Presbyterian Hospital (US)
- Corresponding author
- Trevino, Kelly M.
- ORCID
- Venue
- Palliative and Supportive Care
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021-04
- Volume
- 19
- Issue
- 2
- Pages
- 135-145
- ISSN
- 1478-9515 (ISSN-L)
- 1478-9523
- PMC
- PMC8085071
- OpenAlex
- W3146323950
- Cited by
- 23
- References
- 76
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 2
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Palliative & Supportive Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- Funders
- National Institute on Aging (K23AG048632)
- National Cancer Institute (P30CA008748)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- cancer-related anxiety, elderly cancer patients, cancer caregivers, cognitive behavioral therapy, intervention feasibility and acceptability, dyadic intervention, caregiver anxiety, depression, quality of life, medication adherence
- MeSH terms
- Aged, Anxiety, Female, Humans, Male, Neoplasms, Pilot Projects, Quality of Life, Caregivers
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