Phone therapy eases fatigue and improves quality of life for breast cancer survivors

Thanks to medical progress, more than 169,000 people in the U.S. are living with metastatic breast cancer. Combating debilitating symptoms is becoming increasingly important. Fatigue remains a major problem, affecting up to 63 percent of patients and severely impacting daily activities.

A study recently published in the Journal of Clinical Oncology demonstrates the effectiveness of telephone-based acceptance and commitment therapy (ACT) in reducing the impact of fatigue on activities of daily living and improving quality of life for metastatic breast cancer survivors. ACT is a behavioral intervention that has been shown to be effective in pilot studies in advanced cancer. The goal of ACT is not to reduce symptoms, but to develop psychological flexibility consisting of mindfulness/acceptance and responsibility/commitment processes.

The researchers also found that remote ACT intervention has shown feasibility and promise in reducing sleep interference that interferes with patients’ normal activities of daily living. Cancer-related fatigue is often exacerbated by the physiologic effects of insufficient sleep.

“The women I worked with in the study often reported that their sleep quality improved because they practiced mindfulness before going to bed, and it allowed them to feel more peace in their lives,” says Regenstrief Institute researcher Shelley Johns, Ph.D., assistant professor of psychology, associate professor of medicine at Indiana University School of Medicine and clinical research fellow at the Melvin and Bren Simon Comprehensive Cancer Center.

ACT intervention helped participants fall asleep more easily. Researchers believe that some participants’ sleep quality improved because they practiced mindfulness, which has been shown to promote better sleep.

In the clinical trial, 250 people living with metastatic breast cancer were randomly assigned to six weekly telephone ACT or education/support sessions. Results of the telephone ACT intervention suggest that short, remote conversations with a therapist help encourage cancer survivors to practice mindfulness in their daily lives, leading to a reduction in fatigue that interferes with functioning.

Breast cancer is one of the most common cancers affecting women worldwide. There is no effective cure for fatigue in the later stages of cancer. Acceptance and responsibility therapy has interested scientists as a potential behavioral intervention to help reduce the negative impact of fatigue on functioning, as it has demonstrated efficacy for patients with chronic pain as well as for people with psychiatric disorders.

“Mindfulness involves focused attention on the present moment, including symptoms a person may be experiencing, thoughts and feelings, and relating to these experiences with compassion,” says Dr. Mosher, also in the Department of Behavioral Sciences in the Department of Psychology at Indiana University School of Science in Indianapolis. – “We hypothesized that this would interrupt more maladaptive responses to fatigue, particularly ruminating about fatigue or catastrophizing, and through greater harmony with one’s body and awareness of what one is experiencing, one would be able to make choices that would improve quality of life.

This study supports clinical care by demonstrating that a novel telephone-based ACT intervention can reduce the impact of fatigue on the functioning of patients with metastatic breast cancer and shows promise in reducing sleep disturbances. Training in the ACT method is available to clinicians in a variety of specialties. Next steps include trials of this intervention in culturally diverse cancer populations and dissemination.