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Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model

Journal of Cancer Survivorship volume 15, pages 427–451 (2021)Cite this article

Abstract

Purpose

People with cancer experience significant physical and psychological symptoms, during as well as after primary treatment. Acceptance and Commitment Therapy (ACT), a psychological intervention, reduces both types of symptoms among individuals with chronic pain and emotional distress. Due to the unique challenges of cancer survivorship, this systematic review critically evaluates and synthesizes the literature on the context, mechanisms, and effect of ACT among adult cancer survivors.

Methods

Articles were retrieved from the CINAHL, MEDLINE via Ovid, Web of Science, PsycInfo, Scopus, Embase, Google Scholar, and Cochrane databases. Selected grey literature portals, clinical trial registries, and conference proceedings were also searched. The NIH tools were used to assess study quality and the revised Cochrane Risk-of-Bias tool to assess risk of bias

Results

Thirteen articles, reporting on 537 cancer survivors with various cancer types, were included. ACT significantly reduced anxiety, depression, and fear of cancer recurrence and improved psychological flexibility and quality of life. Outcomes such as pain and insomnia were understudied. Lack of participant blinding and non-random assignment were the most common methodological issues. A conceptual model is proposed that describes the possible influencing factors of an ACT-based intervention in cancer survivors.

Conclusion

Review findings suggest that ACT is an effective intervention to improve some of the common concerns among cancer survivors. While all the studies in the review were recent (published 2015–2019), they examined only a limited number of outcomes. Hence, more methodologically rigorous studies which examine the effect of ACT on other troubling symptoms among cancer survivors are warranted.

Implications for Cancer Survivors

Incorporating ACT into comprehensive post-treatment survivorship care can enhance psychological flexibility and reduce anxiety, depression, and fear.

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Acknowledgments

The authors acknowledge health sciences librarian, Rebecca Raszewski, for her expertise and guidance regarding article search and retrieval strategies.

Funding

This article was supported by the National Institute of Nursing Research of the National Institutes of Health under award number #K24NR015340. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois, 845 S. Damen Ave. Room 1024, Chicago, IL, 60612, USA

    Asha Mathew, Ardith Z. Doorenbos, Min Kyeong Jang & Patricia E. Hershberger

  2. College of Nursing, Christian Medical College, Vellore, India

    Asha Mathew

  3. University of Illinois Cancer Center, Chicago, IL, USA

    Ardith Z. Doorenbos & Min Kyeong Jang

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  1. Asha Mathew
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Contributions

AM contributed to the review conception, data collection/screening/interpretation/analysis, quality assessment, and writing the manuscript. PEH and AZD contributed to review conception, methodological and domain expertise, advice on data analysis/synthesis, and critical revision of the manuscript. AZD additionally contributed to data screening and critical revision of the conceptual framework. MKJ contributed to quality assessment. All authors critically reviewed and edited drafts and approved the final version for submission.

Corresponding author

Correspondence to Asha Mathew.

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The authors declare that they have no conflict of interest.

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Mathew, A., Doorenbos, A.Z., Jang, M.K. et al. Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model. J Cancer Surviv 15, 427–451 (2021). https://doi.org/10.1007/s11764-020-00938-z

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