Acceptance and commitment therapy (ACT) shows promise for treating fear of cancer recurrence in women who have survived breast cancer. The first of its kind study by researchers from Regenstrief Institute, Indiana University, Butler University and West Virginia University School of Medicine, published in Cancer, found that cancer survivors who received ACT showed significantly larger improvements when compared to the other treatment approaches in the study.

Fear that cancer may come back or progress is one of the most prevalent, persistent and disruptive problems that people who survive the disease face. It is especially common in breast cancer survivors, with up to 70 percent reporting that the fear affects their daily life. That fear can cause anxiety, depression and overall diminished quality of life.

In the pilot randomized controlled trial described in Cancer, 91 breast cancer survivors were assigned to one of three different groups. One group received ACT for six weeks. The second group was provided survivorship education for six weeks. And the third received enhanced usual care, which included standard care from their healthcare providers, a survivorship booklet and lists of supplemental resources along with one 30-minute group coaching session.

Researchers assessed the participants' fear of recurrence at the beginning of the study, immediately after the intervention, one month after, and then six months after. Each group showed reductions in the severity of their fear, but only ACT provided significant improvements at each evaluation, and the effect continued to grow as time went on.

"There is no way to erase the understandable concern that one's cancer may recur, yet ACT allows cancer survivors to focus more on living their lives as meaningfully as possible and less on the fear they feel. We want them to be the driver of their own lives, not be driven by the fear," said Shelley Johns, PsyD, Regenstrief Institute scientist and first author on the paper. "In my clinical practice, I found that ACT really resonated with my patients. It teaches them skills they can use throughout their life."

The success of recruitment and retention rates in the study demonstrated that this treatment is feasible.

What is ACT?

Acceptance and commitment therapy supports individuals in coping adaptively with unwanted or difficult thoughts, feelings and circumstances. Therapists work with survivors to practice mindfulness, helping them pay attention to the present moment without letting fears about the future interfere with their quality of life. Survivors are also guided in clarifying their core values. This helps them set goals and focus on their life's purpose rather than the fear.

"We conducted this study because evidence supporting group-based ACT for cancer survivors with fear of recurrence is extremely limited," Dr. Johns continued. "There are nearly 17 million cancer survivors in the U.S., but there are not enough healthcare providers who specialize in fear of recurrence to treat them. Many community therapists practice ACT, so providing evidence that the therapy works, particularly in a group format, offers both survivors and therapists more options for treatment."

In addition to her role at Regenstrief, Dr. Johns is an assistant professor at Indiana University School of Medicine and a clinical health psychologist in the Eskenazi Health Palliative Care Program. She is a member of the Indiana University Melvin and Bren Simon Cancer Center.

"Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial" was published online September 20 in Cancer, ahead of the print edition.

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Other authors on the paper are: Patrick V. Stutz, B.A. from IU School of Medicine; Tasneem L. Talib, PhD, formerly of Regenstrief Institute; Andrea A. Cohee, PhD from Indiana University School of Nursing; Kathleen A. Beck-Coon, M.D. from IU School of Medicine and IU School of Nursing; Linda F. Brown, PhD from IU School of Medicine; Laura R. Wilhelm, PhD from West Virginia University School of Medicine; Patrick O. Monahan, PhD from IU School of Medicine; Michelle L. LaPradd, M.S. from IU School of Medicine; Victoria L. Champion, PhD from IU School of Nursing; Kathy D. Miller, M.D. from IU School of Medicine and Indiana University Simon Cancer Center; and R. Brian Giesler, PhD from Butler University.

This study was funded by Indiana University Health Values Grant (grant 0952) and the Walther Cancer Foundation (0175.01).