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Cited by 166Cancer survivorship and carePalliative and Oncologic CarePalliative Care and End-of-Life Issues

Managing Cancer And Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer

Open access
Lo, Chris, Hales, Sarah, Jung, Judy, Chiu, Aubrey, Panday, Tania, Rydall, Anne, Nissim, Rinat, Malfitano, Carmine +3 more·2014·Palliative Medicine
DOI 10.1177/0269216313507757
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Abstract

Background: Advanced cancer brings substantial physical and psychosocial challenges that may contribute to emotional distress and diminish well-being. In this study, we present preliminary data concerning the effectiveness of a new brief individual psychotherapy, Managing Cancer And Living Meaningfully (CALM), designed to help individuals cope with this circumstance. Aim: To test the feasibility and preliminary effectiveness of CALM to reduce emotional distress and promote psychological well-being and growth. Design: CALM is a brief, manualized, semi-structured individual psychotherapy for patients with advanced cancer. This study employed a phase 2 intervention-only design. The primary outcome was depressive symptoms and the secondary outcomes were death anxiety, attachment security, spiritual well-being and psychological growth. These were assessed at 3 months (t1) and 6 months (t2). Multilevel regression was used to model change over time. Setting/participants: A total of 50 patients with advanced or metastatic cancer were recruited from the Princess Margaret Cancer Centre, Toronto, Canada. Results: A total of 39 patients (78%) were assessed at baseline, 24 (48%) at t1, and 16 (32%) at t2. Analyses revealed reductions over time in depressive symptoms: beta = −0.13, confidence interval (CI .95 ) = (−0.23, −0.022) and death anxiety: beta = −0.23, CI .95 (−0.40, −0.061); and an increase in spiritual well-being: beta = 0.14, CI .95 (0.026, 0.26). Conclusions: CALM may be a feasible intervention to benefit patients with advanced cancer. The results are encouraging, despite attrition and small effect sizes, and support further study.

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Crossref · 10.1177/0269216313507757

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56 of 56 references verified0 citation errors · 0 not checkable

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  • Reducing psychological distress and death anxiety is a fundamental element of end-of-life care and treatment.

    “Based on this evidence, reducing psychological distress and death anxiety is a fundamental element of end-of-life care and treatment (Lo, Hales, Jung, Chiu, Panday, Rydall, et al., 2014;Lo, Hales, Zimmermann, Gagliese, Rydall and Rodin, 2011;Sherman et al., 2010).”

    From Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct (2014) · cites this paper as Lo, Hales, Jung, Chiu, Panday, Rydall, et al., 2014

    The Introduction (page unavailable) describes distress related to dying and death in advanced cancer as harmful and calls for effective interventions after distress is detected. The Discussion (page unavailable) identifies death anxiety as relevant to patients near the end of life, but the paper concerns advanced cancer and does not establish distress reduction as a fundamental element of end-of-life care generally. (LLM, conf=0.83)

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  • In an intervention-only phase 2a pilot trial of 50 patients with advanced cancer, CALM was associated with reductions in depressive symptoms and death anxiety and an increase in spiritual wellbeing.

    “In an intervention-only phase 2a pilot trial of 50 patients with advanced cancer, CALM was associated with reductions in depressive symptoms and death anxiety and an increase in spiritual wellbeing. 21”

    From Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer (2019) · cites this paper as [21]

  • Non-compliance with intervention was comparable in both pilots, with 37% of participants receiving less than 3 sessions in this trial compared to 42% in the earlier study.

    “Non-compliance with intervention was comparable in both pilots, with 37% of participants receiving less than 3 sessions in this trial, compared to 42% in the earlier study. 21”

    From Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer (2019) · cites this paper as [21]

  • The attrition rate of 25% was substantially less than the attrition rate of 68% observed in the previous intervention-only pilot trial.

    “As a result of recruitment earlier in the course of disease and of more systematic follow-up, the attrition rate of 25%, was substantially less than the attrition rate of 68% observed in our previous intervention-only pilot trial. 21”

    From Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer (2019) · cites this paper as [21]

  • Palliative care research has developed personally tailored, individually delivered interventions requiring significant resources.

    “Palliative care research has developed personally tailored, individually delivered interventions requiring significant resources (e.g., [14, 23, 38])”

    From A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. (2022) · cites this paper as [38]

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Cites

1 retracted

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Research works printed but not linked: 4

  1. [11]11. Lo C, Zimmermann C, Gagliese L, et al. Sources of spiritual well-being in advanced cancer. BMJ Support Palliat Care 2011; 1: 149-153.
  2. [30]30. Edelman S, Bell DR and Kidman AD. A group cognitive behaviour therapy programme with metastatic breast cancer patients. Psychooncology 1999; 8: 295-305.
  3. [38]38. Spiegel D, Morrow GR, Classen C, et al. Group psychotherapy for recently diagnosed breast cancer patients: a multicenter feasibility study. Psychooncology 1999; 8: 482-493.
  4. [46]46. Des Jarlais DC, Lyles C, Crepaz N, and the TREND Group. Nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health 2004; 94: 361-366.

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Authors
Lo, C., Hales, S., Jung, J., Chiu, A., Panday, T., Rydall, A., Nissim, R., Malfitano, C., Petricone-Westwood, D., Zimmermann, C., & Rodin, G.
Affiliations
  • Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
  • University Health Network (CA)
ORCID
Venue
Palliative Medicine
Publisher
SAGE Publications
Published
2013-10-29
Volume
28
Issue
3
Pages
234-242
ISSN
  • 0269-2163 (ISSN-L)
  • 1477-030X
DOI
10.1177/0269216313507757
OpenAlex
W2159372318
Cited by
166
References
56
Citations by year
2026: 11 · 2025: 12 · 2024: 5 · 2023: 14 · 2022: 18 · 2021: 12 · 2020: 14 · 2019: 13 · 2018: 18 · 2017: 20 · 2016: 11 · 2015: 14 · 2014: 4
FWCI
5.17
Type
journal article
Language
en
Open access
Licence
Locations
  • Palliative Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion, public-domain)
Funders
  • Cancer Research Institute
  • Princess Margaret Cancer Foundation
  • University of Toronto
  • Canadian Institutes of Health Research (MOP106473)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords
advanced cancer, metastatic cancer, depressive symptoms, fear of death, spiritual well-being, psychological growth, attachment security, emotional distress, psychological well-being, feasibility
MeSH terms
Attitude to Death, Depressive Disorder, Feasibility Studies, Female, Humans, Interpersonal Relations, Male, Middle Aged, Neoplasms, Palliative Care, Pilot Projects, Psychotherapy, Brief, Regression Analysis, Stress, Psychological, Qualitative Research

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