Tailoring cognitive-behavioral therapy to treat anxiety comorbid with advanced cancer
Open accessAbstract
Patients with advanced cancer often experience debilitating anxiety symptoms that interfere with quality of life and relate to worse medical outcomes. Although cognitive behavioral therapy (CBT) is an empirically-validated, first-line treatment for anxiety disorders, clinical trials of CBT for anxiety typically exclude patients with medical comorbidities in general, and those with terminal illnesses, such as advanced cancer, in particular. Moreover, CBT has generally targeted unrealistic fears and worries in otherwise healthy individuals with clinically significant anxiety symptoms. Consequently, traditional CBT does not sufficiently address the cognitive components of anxiety in patients with cancer, especially negative thought patterns that are rational but nonetheless intrusive and distressing, such as concerns about pain, disability and death, as well as management of multiple stressors, changes in functional status and burdensome medical treatments. In this paper, we describe a treatment approach for tailoring CBT to the needs of this population. Three case examples of patients diagnosed with terminal lung cancer are presented to demonstrate the treatment methods along with outcome measures for anxiety and quality of life.
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Prior reviews identified that face-to-face CBT provided some benefit in decreasing depressive and anxiety symptoms in advanced cancer.
“First, prior reviews identified that face-to-face CBT (individual (Moorey et al., 2009, Anderson et al., 2008) and group (Edelman et al., 1999)) provided some benefit in assisting those living with advanced cancer by decreasing depressive and anxiety symptoms (Greer et al., 2010; Moorey et al., 2009; Horne and Watson, 2011).”
From A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy (iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety (2021) · cites this paper as Greer et al., 2010
The Introduction’s ‘Psychosocial Interventions for Anxiety Comorbid with Cancer’ section reports benefits for anxiety or distress in broader cancer populations. But it says a systematic review found no consistent evidence for CBT’s efficacy against anxiety in cancer, and only 15% of reviewed studies included people with advanced disease. It does not establish that face-to-face CBT decreased both depressive and anxiety symptoms in advanced cancer. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAttempts at cognitive restructuring would be inappropriate for patients with advanced disease and/or those approaching the end of life, given that their intrusive thoughts and ruminations are realistic and inevitable.
“Accordingly, attempts at cognitive restructuring would be inappropriate for patients with advanced disease and/or those approaching the end of life, given that their intrusive thoughts and ruminations are realistic and inevitable [52].”
From Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness (2022) · cites this paper as [52]
The Introduction says cognitive restructuring may be inadequate or inappropriate for realistic cancer fears, particularly in advanced disease or with shortened life expectancy. But Module 3 says it remains valid for worries involving cognitive errors, and the case examples show it being used; the source does not say all intrusive thoughts are realistic and inevitable or that restructuring is categorically inappropriate for these patients. (LLM, conf=0.88)
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References 56 · Cited by 96
Research works printed but not linked: 13
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- Authors
- Greer, J. A., Park, E. R., Prigerson, H. G., & Safren, S. A.
- Affiliations
- Harvard University (US)
- Venue
- Journal of Cognitive Psychotherapy
- Publisher
- Springer Publishing Company
- Published
- 2010-11
- Volume
- 24
- Issue
- 4
- Pages
- 294-313
- ISSN
- 0889-8391 (ISSN-L)
- 1938-887X
- PMC
- PMC3018827
- OpenAlex
- W1985938816
- Cited by
- 96
- References
- 56
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 9 · 2023: 8 · 2022: 10 · 2021: 9 · 2020: 5 · 2019: 8 · 2018: 11 · 2017: 4 · 2016: 8 · 2015: 4 · 2014: 4 · 2013: 1 · 2012: 4
- FWCI
- 1.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Cognitive Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Comprehensive Cancer Network
- National Cancer Institute (R03CA128478)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- cognitive behavioral therapy, anxiety, advanced cancer, terminal illness, treatment adaptation, terminal lung cancer, quality of life, death concerns, stressors, case examples
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