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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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“For example, Managing Cancer and Living Meaningfully (CALM) is a 3- to 8-session intervention grounded in “relational, attachment and existential theory” (p 236).(7) A pilot study of CALM provided some support for this intervention, but only 24 of 50 patients completed the treatment, and only 16 patients completed a f…”
BackgroundRodin, G., Lo, C., Rydall, A., Shnall, J., Malfitano, C., Chiu, A., Panday, T., Watt, S., An, E., Nissim, R., et al. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2017.77.1097 · Cited by 338
“provement in depression, death anxiety, spiritual well-being, and attachment security.(18,19) In qualitative interviews, participants reported that CALM provides a “safe place” that helped them to “be seen as a whole person by the medical system,” “grow as a person,” and “be able to handle death in a peaceful way.”
BackgroundSelf-citation
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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