Supportive Care in Cancer

, Volume 26, Issue 6, pp 1993–2004 | Cite as

Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial

  • Catherine E. MosherEmail author
  • Ekin Secinti
  • Ruohong Li
  • Adam T. Hirsh
  • Jonathan Bricker
  • Kathy D. Miller
  • Bryan Schneider
  • Anna Maria Storniolo
  • Lida Mina
  • Erin V. Newton
  • Victoria L. Champion
  • Shelley A. Johns
Original Article



Breast cancer is the leading cause of cancer mortality in women worldwide. With medical advances, metastatic breast cancer (MBC) patients often live for years with many symptoms that interfere with activities. However, there is a paucity of efficacious interventions to address symptom-related suffering and functional interference. Thus, this study examined the feasibility and preliminary efficacy of telephone-based acceptance and commitment therapy (ACT) for symptom interference with functioning in MBC patients.


Symptomatic MBC patients (N = 47) were randomly assigned to six telephone sessions of ACT or six telephone sessions of education/support. Patients completed measures of symptom interference and measures assessing the severity of pain, fatigue, sleep disturbance, depressive symptoms, and anxiety.


The eligibility screening rate (64%) and high retention (83% at 8 weeks post-baseline) demonstrated feasibility. When examining within-group change, ACT participants showed decreases in symptom interference (i.e., fatigue interference and sleep-related impairment; Cohen’s d range = − 0.23 to − 0.31) at 8 and 12 weeks post-baseline, whereas education/support participants showed minimal change in these outcomes (d range = − 0.03 to 0.07). Additionally, at 12 weeks post-baseline, ACT participants showed moderate decreases in fatigue and sleep disturbance (both ds = − 0.43), whereas education/support participants showed small decreases in these outcomes (ds = − 0.24 and − 0.18 for fatigue and sleep disturbance, respectively). Both the ACT and education/support groups showed reductions in depressive symptoms (ds = − 0.27 and − 0.28) at 12 weeks post-baseline. Group differences in all outcomes were not statistically significant.


ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients and warrants further investigation.


Metastatic breast cancer Acceptance and commitment therapy Psychosocial interventions Symptom interference Fatigue Sleep 



The authors thank Susan Daily, B.S., RT (T), Kelly Chinh, B.S., Lauren Hall, LCSW, and Danielle B. Tometich, M.S., for their assistance with this study and the study participants for their time and effort. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or Walther Cancer Foundation.

Funding information

This study was supported by a grant from the Walther Cancer Foundation. Catherine Mosher was supported by the National Cancer Institute (K07CA168883 and K05CA175048). Shelley Johns was supported by the National Cancer Institute (K05CA175048) and Walther Cancer Foundation (0175.01). Victoria Champion was supported by the National Cancer Institute (K05CA175048).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Catherine E. Mosher
    • 1
    Email author
  • Ekin Secinti
    • 1
  • Ruohong Li
    • 2
  • Adam T. Hirsh
    • 1
  • Jonathan Bricker
    • 3
    • 4
  • Kathy D. Miller
    • 5
  • Bryan Schneider
    • 5
  • Anna Maria Storniolo
    • 5
  • Lida Mina
    • 6
  • Erin V. Newton
    • 5
  • Victoria L. Champion
    • 7
  • Shelley A. Johns
    • 8
  1. 1.Department of PsychologyIndiana University-Purdue University IndianapolisIndianapolisUSA
  2. 2.Department of BiostatisticsIndiana University Fairbanks School of Public HealthIndianapolisUSA
  3. 3.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
  4. 4.Department of PsychologyUniversity of WashingtonSeattleUSA
  5. 5.Indiana University School of MedicineIndiana University Melvin and Bren Simon Cancer CenterIndianapolisUSA
  6. 6.Banner MD Anderson Cancer CenterGilbertUSA
  7. 7.School of NursingIndiana UniversityIndianapolisUSA
  8. 8.Indiana University School of MedicineCenter for Health Services Research, Regenstrief InstituteIndianapolisUSA

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