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Managing Cancer And Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer
Open accessAbstract
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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“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
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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. 21”
From Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer (2019) · cites this paper as [21]
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“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]
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“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]
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“Palliative care research has developed personally tailored, individually delivered interventions requiring significant resources (e.g., [14, 23, 38])”
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Items 101–166 of 166
Psychotherapeutic Interventions Near the End of Life: Theory, Evidence, and Future Directions
Rodin, G. (2017) · Australian Psychologist · doi:10.1111/ap.12307 · Cited by 6
Self-citationDwyer, J. L., Johnston, R. B., O’Callaghan, C. C., & Ross, M. (2025) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2025.12.002 · Cited by 5
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“16 Acceptability was defined as (1) < 15% drop out rate due to the intervention, (2) < 15% rate of elevated ( > 14) hospital anxiety and depression scores (HADS) attributed to the intervention, and (3) qualitative summative feedback on the intervention measured at six to nine months (Supplementary…”
Cai, Y., Zhao, J., Li, W., Yu, S., Tang, L., Yao, S., & Cheng, H. (2023) · Future Oncology · doi:10.2217/fon-2023-0311 · Cited by 5
Will Ihr Patient wirklich sterben?
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Psychosocial Interventions for End‐of‐Life Care: An Invited Commentary
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“Similarly large-scale RCTs of CALM are undertaken around the world (Lo et al., 2014; Scheffold et al., 2015).”
BackgroundRelationship between Spirituality and Death Anxiety in Patients with Cancer Undergoing Chemotherapy
Hedayatizadeh‐Omran, A., Janbabaei, G., Emafti, M. F., Noroozi, A., Kolagari, S., & Modanloo, M. (2018) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 5
Psicooncología en cáncer avanzado. Terapia CALM, una intervención canadiense
Paulina Troncoso, G., Rydall, A. C., & Rodin, G. (2019) · Revista chilena de neuro-psiquiatría · doi:10.4067/s0717-92272019000300238 · Cited by 5
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“, and trust and satisfaction in the relationship between patients and healthcare providers, such as physicians (Hinnen et al., 2014; Holwerda et al., 2013), nurses (Harding, Beesley, Holcombe, Fisher, & Salmon, 2015; Hawkins, Howard, & Oyebode, 2007) and social workers (Lo et al., 2014).”
BackgroundPsychotherapeutisches Arbeiten in Palliative Care
Gramm, J., Trachsel, M., & Berthold, D. (2019) · Verhaltenstherapie · doi:10.1159/000504455 · Cited by 5
Integrative Oncology and Palliative Care in Iran: Mind, Body, Religion, and Spirituality
Rassouli, M., Farzin, H., Kehinde, A., & Ashrafizadeh, H. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01640-6 · Cited by 4
Psychoonkologische Unterstützung für Patienten mit begrenzter Lebenserwartung
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Ghazipoor, G., Ahmadian, H., Goudarzi, M., & Amirifard, N. (2021) · Journal of Clinical Research in Paramedical Sciences · doi:10.5812/jcrps.119923 · Cited by 4
“The results of Lo et al.’s (2014) research also show that finding the meaning of lifeandspiritualityhasaneffectonreducingthedeathanx-iety of cancer patients (37).”
A scoping review of psychosocial oncology interventions promoting posttraumatic growth
Wong, K. L., McClure, K. S., & Psillos, D. E. (2022) · Journal of Psychosocial Oncology Research and Practice · doi:10.1097/or9.0000000000000071 · Cited by 5
“Lo et al, 2014([30]) Recruitment occurred at Princess”
BackgroundShapiro, G. K., Mah, K., de Vries, F. E., Zimmermann, C., Li, M., Hales, S., & Rodin, G. (2022) · Journal of Psychosocial Oncology Research and Practice · doi:10.1097/or9.0000000000000076 · Cited by 4
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Gautama, M. S. N., Huang, T., Haryani, H., Khalish, G., Liu, A.-I., & Wibawa, Y. A. (2025) · Journal of Clinical Nursing · doi:10.1111/jocn.17754 · Cited by 4
Connery, T., Riotto, G. D., Macdonald, D., & Menzies, R. E. (2025) · PLoS ONE · doi:10.1371/journal.pone.0325176 · Cited by 4
“Further, other psychological interventions, particularly those focusing on creating meaning, have been shown to significantly alleviate death anxiety in patients with advanced cancer [28,29].”
Beasley, E., WHITE, V. M., Ugalde, A., Brooker, J., Skvarc, D., & Mikocka‐Walus, A. A. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112106 · Cited by 3
L’acceptabilité de l’intervention Revie ⊕ : perception et vécu des infirmières
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The desire for hastened death in patients in palliative care
Nissim, R. S., Lo, C., & Rodin, G. (2015) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780198713982.003.0007 · Cited by 2
Self-citationYoung clinicians dealing with death: Problems and opportunities
Nissen, K. G. (2015) · Palliative & Supportive Care · doi:10.1017/s1478951515001303 · Cited by 2
“Previous studies have employed existential therapy in the field of death and dying (see Lo et al., 2014).”
BackgroundGlobal and regional partnerships to build evidence and capacity in supportive care
Kaasa, S., Mwangi-Powell, F. N., Lam, W. S., & Rodin, G. (2018) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30094-9 · Cited by 2
Self-citationExistenzielles Leiden und sinnbezogene Interventionen
Schulz‐Kindermann, F. (2018) · Onkologische Welt · doi:10.1055/s-0038-1670946 · Cited by 1
Trachsel, M., Chochinov, H. M., & Irwin, S. A. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-84702-5.00026-9 · Cited by 1
Bertolucci, I. (2023) · Journal of Psychology and Psychotherapy Research · doi:10.12974/2313-1047.2023.10.07 · Cited by 1
“CALM therapy is a psychotherapeutic intervention developed for oncology patients in advanced care by doctors at the Global Institute of Psychosocial, Palliative & End-of-Life Care (GIPPEC; Lo et al ., 2014) at the Princess Margaret Cancer Centre in Toronto.”
Loughan, A. R., Lanoye, A. M., Willis, K. D., Braun, S. E., Davies, A., Rodin, G., Thacker, L. R., Fox, A. M., Kleva, C. S., Zarrella, G. V., et al. (2024) · Neuro-Oncology Practice · doi:10.1093/nop/npae097 · Cited by 1
Self-citationRamos, K. (2016) · Current Geriatrics Reports · doi:10.1007/s13670-016-0180-y · Cited by 1
Existenzielles Leiden und sinnbezogene Interventionen
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Jia, Y., Gan, C., Chai, J., Huang, R., Li, A., Ge, H., Zheng, X., Liu, L., Xu, J., Cheng, L. J., et al. (2025) · Clinical Breast Cancer · doi:10.1016/j.clbc.2025.01.007 · Cited by 1
Interventions psychologiques centrées sur la spiritualité : revue de la question
Bernard, M., Hayek, A.-S., Spring, G., Borasio, G. D., & Diawara, F. (2017) · Psycho-Oncologie · doi:10.1007/s11839-017-0641-3 · Cited by 1
Medical Family Therapy in Palliative and Hospice Care
Williams‐Reade, J., & Trudeau, S. (2018) · Focused issues in family therapy · doi:10.1007/978-3-319-68834-3_10 · Cited by 1
Enacting embodied memory theater in an intuitive inquiry study of therapeutic space for the dying.
Kelly, D. (2018) · The Humanistic Psychologist · doi:10.1037/hum0000116 · Cited by 1
(2021) · Iranian Red Crescent Medical Journal · doi:10.32592/ircmj.2021.23.7.661 · Cited by 2
“Therefore, reducing the anxiety of thinking about death and psychological disturbances in the case of COVID-19 is an important aspect of care like other fatal diseases (33).”
Interventionen zur Stützung der Sinnhaftigkeit
Schnell, T. (2020) · Springer eBooks · doi:10.1007/978-3-662-61120-3_12 · Cited by 1
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Death-related Distress in Advanced Cancer
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Schnell, T. (2016) · Springer eBooks · doi:10.1007/978-3-662-48922-2_11
Searching for wisdom in oncology care: A scoping review
Butlin, H., Kinsella, E. A., Garcia, C., & Bauman, G. S. (2016) · Palliative & Supportive Care · doi:10.1017/s1478951516000675
“…such as meaning-making therapy (Breitbart et al., 2010; 2012, 2015; Greenstein & Breitbart, 2000; Vos, 2014); dignity therapy (Chochinov, 2006; Chochinov et al., 2011; Hack et al., 2010; McClement et al., 2007) and Managing Cancer and Living Meaningfully (Lo et al., 2014; Rodin et al., 2007).”
BackgroundThe Quality of Dying and Death of Long-term Care Residents
Fernandes, S. (2016) · TSpace (University of Toronto)
Konzepte und Befunde zu psychotherapeutischen Interventionen am Lebensende
Wenzel, C. (2017) · Vandenhoeck & Ruprecht eBooks · doi:10.13109/9783666402883.41
From Our Clinic, Across the Globe
Rodin, G., & Hales, S. (2021) · doi:10.1093/med/9780190236427.003.0013
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Abordando o Sofrimento Existencial na Pessoa com Cancro
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Psychosoziale Unterstützungskonzepte
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Managing Cancer and Living Meaningfully (CALM) Therapy
Malfitano, C., Hales, S., & Rodin, G. (2022) · Oxford University Press eBooks · doi:10.1093/med/9780197583838.003.0037
Self-citationKapfhammer, H. (2023) · Springer eBooks · doi:10.1007/978-3-662-68309-5_1
Sinn und Existenz in der Praxis
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Psychosocial distress in rural palliative care: Preliminary longitudinal findings using the DADDS
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“Specifically, Lo et al. reported that individualized psychotherapy interventions reduced depressive symptoms and increased spiritual well-being in advanced cancer patients (Lo et al. 2014).”
Xu, S., Wang, J., Zhao, W., & Wu, W. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1682149
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“With the exception of Breitbart et al. (2012) [12] and Lo et al. (2014) [13], other existential interventions tend to focus on the here‐and‐now.”
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“The module “living meaningfully” is based on the CALM therapy and is aimed at patients at high risk for death anxiety and distress [20, 22, 60].”
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“In RCTs erreichte MCGP gegenüber der Kontrollgruppe signifikant höhere Verbesserungen des spirituellen Wohlbefindens sowie eine Verringerung der psychischen Belastung (Breitbart et al. 2015).”
InfluentialDeath anxiety in advanced cancer patients and family caregivers: A scoping review
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Metadata
- 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)
- Venue
- Palliative Medicine
- Publisher
- SAGE Publications
- Published
- 2013-10-29
- Volume
- 28
- Issue
- 3
- Pages
- 234-242
- ISSN
- 0269-2163 (ISSN-L)
- 1477-030X
- 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
- green
- hdl.handle.net
- 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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