Effectiveness of acceptance and commitment therapy on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer: A meta-analysis of randomized controlled trials
Open accessAbstract
BACKGROUND: Current studies have revealed that acceptance and commitment therapy (ACT) can alleviate the adverse effects of cancer; however, its effectiveness on the psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer remains unclear. AIMS: The aims of this study were to identify the effectiveness of ACT on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer, and to explore moderators. METHODS: PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL, CNKI, VIP, and Wanfang electronic databases were searched from inception to September 29, 2022. The Cochrane Collaboration's risk-of-bias assessment tool II and the Grading of Recommendations Assessment, Development, and Evaluation approach were used to evaluate evidence certainty. The data were analyzed using R Studio. The study protocol was registered with PROSPERO (CRD42022361185). RESULTS: The study included 19 relevant studies (1643 patients) published between 2012 and 2022. The pooled results showed that ACT significantly improved psychological flexibility (mean difference [MD] = -4.22, 95% CI [-7.86, -0.58], p = .02) and quality of life (Hedges' g = 0.94, 95% CI [0.59, 1.29], Z = 5.31, p < .01) but did not significantly improve fatigue (Hedges' g = -0.03, 95% CI [-0.24, 0.18], p = .75) or sleep disturbance (Hedges' g = -0.26, 95% CI [-0.82, 0.30], p = .37) in patients with cancer. Additional analyses revealed a 3-month sustainable effect on psychological flexibility (MD = -4.36, 95% CI [-8.67, -0.05], p < .05), and moderation analysis showed that intervention duration (β = -1.39, p < .01) and age (β = 0.15, p = .04) moderated the effects of ACT on psychological flexibility and sleep disturbance, respectively. LINKING EVIDENCE TO ACTION: Acceptance and commitment therapy demonstrates effectiveness for psychological flexibility and quality of life of patients with cancer, but there is a lack of evidence regarding its effects on fatigue and sleep disturbance. In clinical practice, ACT should be designed in more detail and rounded to achieve better results.
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The non-significant result of fatigue is consistent with Zhang et al. but in contradiction to Fang et al. and Maunick et al.
“the non-significant result of fatigue is consistent with Zhang et al. (Zhang et al., 2023) but in contradiction to Fang et al. (2023) and Maunick et al. (2023)”
From Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials (2024) · cites this paper as Zhang et al., 2023
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- Authors
- Zhang, Y., Ding, Y., Chen, X., Li, Y., Li, J., & Hu, X.
- Affiliations
- Sichuan University (CN)
- Corresponding author
- Hu, Xiaolin
- Venue
- Worldviews on Evidence-Based Nursing
- Publisher
- Wiley
- Published
- 2023-05-16
- Volume
- 20
- Issue
- 6
- Pages
- 582-592
- ISSN
- 1545-102X (ISSN-L)
- 1741-6787
- OpenAlex
- W4376872829
- Cited by
- 26
- References
- 39
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 6 · 2023: 1
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Worldviews on Evidence-Based Nursing (publishedVersion)
- PubMed (publishedVersion)
- Funders
- China Medical Board (Grant#22‐482)
- National Key Research and Development Program of China (2021YFE0206600)
- 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 and Oncologic Care
- Keywords
- acceptance and commitment therapy, psychological flexibility, cancer patients, cancer-related fatigue, sleep disorders, quality of life, intervention duration, age as moderator, treatment moderators, cancer-related anxiety, cancer-related depression, cancer-related distress
- MeSH terms
- Depression, Fatigue, Humans, Neoplasms, Quality of Life, Sleep, Sleep Wake Disorders, Randomized Controlled Trials as Topic, Acceptance and Commitment Therapy
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