A study demonstrates the effectiveness of telephone-delivered acceptance and commitment therapy (ACT) in reducing fatigue’s interference with functioning and improving the quality of life for survivors of metastatic breast cancer. ACT is a behavioral intervention that has shown promise in pilot studies in advanced cancer. Rather than aiming to reduce symptoms, the goal of ACT is to promote psychological flexibility, consisting of mindfulness/acceptance and commitment/behavior change processes.

Researchers also found that the remote ACT intervention has shown evidence of feasibility and promise in reducing sleep interference with functioning of the patients. Cancer-related fatigue is often exacerbated by the physiological consequences of inadequate sleep.

“The women I worked with in the study often reported that their sleep quality had improved because they were practicing mindfulness at bedtime and that was allowing them to feel a greater sense of peace in their life,” said Regenstrief Institute Research Scientist Shelley Johns, PsyD, an associate professor of medicine at the Indiana University School of Medicine and a clinician-scientist at the IU Melvin and Bren Simon Comprehensive Cancer Center.

“The ACT intervention helped participants to fall asleep with greater ease. We think that the sleep quality improved for some participants because they were practicing mindfulness, which has been shown to support enhanced sleep.”

During the clinical trial, 250 survivors living with metastatic breast cancer were randomly assigned to six weekly telephone sessions of ACT or education/support. The results of the telephone-delivered ACT intervention suggest that brief remote conversations with a therapist help encourage the survivors to practice mindfulness in their daily lives, which leads to reduced fatigue interference with functioning.

“Breast cancer is one of the most common cancers affecting women throughout the world. We don’t have effective medications for fatigue in advanced cancer,” said Regenstrief Institute Affiliate Scientist and first author Catherine Mosher, PhD. “I was drawn to acceptance and commitment therapy as a potential behavioral intervention to help reduce the negative impact of fatigue on functioning because it has shown evidence of effectiveness for patients with chronic pain as well as people with mental health conditions.

“Mindfulness involves focused attention on the present moment, including symptoms that one may be experiencing and thoughts and feelings, and having an attitude of compassionate acceptance of those experiences,” said Dr. Mosher, also a behavioral scientist in the Department of Psychology, Indiana University Indianapolis School of Science. “We hypothesized that this would interrupt more maladaptive reactions to fatigue, such as ruminating about the fatigue or catastrophizing, and also by being more in tune with one’s body, more aware of what one is experiencing, one can make choices that enrich quality of life.”

This study informs clinical care by demonstrating that a novel, telephone-delivered ACT intervention can reduce fatigue interference with functioning in patients with metastatic breast cancer and shows promise in reducing sleep interference. Training in ACT is accessible to clinicians from various disciplines. Next steps include testing the intervention in culturally diverse cancer populations and disseminating the intervention.