A new form of psychotherapy overcomes the fear of cancer recurrence

A pilot randomised clinical trial demonstrates that acceptance and commitment therapy (ACT) is a feasible and promising treatment for fear of cancer recurrence (FCR), a very disruptive condition affecting cancer survivors. Since the number of cancer survivors is expected to increase in the coming years, this treatment may be beneficial to a large number of people.

FCR, characterized by maladaptive coping, intrusive thoughts, and excessive distress, negatively impacts on quality of life. It is very common, especially in breast cancer (BC) patients: up to 70% of BC survivors report clinically significant FCR. ACT is a new form of psychotherapy aimed to produce a radical change of perspective in cancer survivors; it emphasizes acceptance and the importance of living mindfully according to one’s values.

The first randomized trial assessing the efficacy of ACT, whose results were published by Cancer journal, enrolled 91 BC patients with clinically significant FCR who had completed curative treatments. Participants were randomised toACT(6 weekly 2-hour group sessions), survivorship education (6 weekly 2-hour group sessions covering relevant survivorship topics) or enhanced usual care (one 30-minute group coaching session with survivorship readings). The severity of FCR decreased in each group, however only ACT produced significant reductions at each time point compared with baseline. At 6 months, between-group comparisons favored ACT over the other interventions.

Shelley A. Johns, clinical health psychologist and researcher at the Regenstrief Institute (Indianapolis, IN, USA), who supervised the trial, underlines two potential strengths of ACT: “First, ACT can be delivered efficaciously to a group, thereby potentially reducing costs and increasing the number of those served compared to individually delivered interventions. Second, it appears that targeting FCR while reducing maladaptive coping may promote concomitant reductions in distress outcomes. Although avoidant coping allows survivors to escape anxiety-provoking thoughts about cancer in the short term, rebound effects produce sustained, elevated levels of FCR over time. This may explain why the impact of ACT was greatest at 6 months. As more time passed, ACT became more efficacious.”