Artikel: Acceptance and Commitment Therapy for Breast Cancer Survivors With Fear of Cancer Recurrence: A 3-Arm Pilot Randomized Controlled Trial

BACKGROUND: Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors.
Breast cancersurvivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors’ knowl-
edge, evidence-based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological
flexibility in managing life’s stressors. The current study examined the feasibility and preliminary efficacy of group-based ACT for FCR
in BCS.

METHODS: Post-treatment BCS (91 patients with stage I-III disease) with clinical FCR randomly were assigned to ACT (6weekly
2-hour group sessions), survivorship education (SE; 6 weekly 2-hour group sessions), or enhanced usual care (EUC; one 30-minute
group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post-traumatic stress,
depression, QOL, and other FCR-related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2),
1 month after the intervention (T3), and 6 months after the intervention (T4) using intent-to-treat analysis.

RESULTS: Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within-group reductions
in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between-group
differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P<.001) and EUC (Cohen d, 0.61; P<.01). For 10 of 12
secondary outcomes, only ACT produced significant within-group reductions across all time points. By T4, significant moderate to large
between-group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR-related
psychological distress.

CONCLUSIONS: Group-based ACT is a feasible and promising treatment for FCR and associated outcomes in
BCS that warrants testing in larger, fully powered trials. Cancer 2020;126:211-218. © 2019 American Cancer Society