Investigation of Three Approaches to Address Fear of Recurrence Among Breast Cancer Survivors

NCT ID: NCT02611544

Last Updated: 2019-06-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

91 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-12-31

Study Completion Date

2016-12-01

Brief Summary

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Fear of cancer recurrence (FCR) is one of the most prevalent, persistent, and disruptive sources of distress for adult cancer survivors. Prevalence rates for FCR have been estimated at up to 89%, with approximately half of cancer survivors reporting clinically significant levels of FCR. Despite the recognized prevalence, persistence, and suffering associated with FCR, effective and accessible treatments for FCR are lacking and urgently needed. Our long-term goal is to develop, evaluate, and implement effective behavioral interventions for cancer survivors suffering with FCR.

Detailed Description

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The proposed randomized pilot study will assess the effects of a novel therapeutic intervention-Acceptance and Commitment Therapy (ACT)-for breast cancer survivors (BCS) with clinically-significant FCR. ACT is a spiritually-sensitive behavioral therapy that has shown efficacy in the treatment of anxiety in non-cancer populations, and preliminary efficacy in improving a variety of outcomes among adults with cancer. ACT uses mindfulness and acceptance processes, along with committed behavior change in service of an individual's deeply held values to enhance psychological flexibility and encourage adaptive coping with life challenges, such as cancer.

The primary objective of the proposed 3-arm randomized controlled pilot trial is to assess the feasibility/acceptability and determine preliminary effect size estimates of ACT in preparation for a fully-powered efficacy trial. To allow for potential drop out (15% attrition) and ensure we have a minimum of 78 completers through the end of the trial, we will enroll approximately 91 BCS with clinically significant FCR (defined by score ≥ 13 on Fears of Cancer Recurrence Inventory-Short Form). Participants will be randomized to one of three groups: (1) a 6-week ACT intervention group (n=26); (2) a 6-week survivorship education group (SE; n=26); or (3) enhanced usual care (EUC; n=26). The impact of ACT, SE, and EUC on survivors' FCR and associated psychological, spiritual, and biological (telomere length) outcomes will be examined at baseline (T1), post-intervention (T2), and at 1-month (T3) and 6-month follow-up (T4) with the following specific aims:

Aim 1: Evaluate feasibility and acceptability of ACT, SE, and EUC according to the:

1. Percentage of eligible BCS who consent to participate in the trial;
2. Attendance rate across 6 sessions of ACT and SE;
3. Retention rate through T4 in the ACT, SE, and EUC arms;
4. Mean ratings across groups for intervention satisfaction and helpfulness for managing FCR.

Aim 2: Determine pairwise effect size estimates of ACT, SE, and EUC effects at each time point (T2, T3, T4) adjusted for T1 on the:

1. Primary outcome: reducing FCR;
2. Secondary psychological outcomes: cancer-related experiential avoidance, cognitive avoidance, anxiety, depression, post-traumatic stress symptoms, vitality, breast cancer self-efficacy, and quality of life;
3. Secondary spiritual outcomes: spiritual well-being and mindfulness;
4. Secondary biological outcome: telomere length.

Conditions

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Breast Neoplasms Breast Cancer Breast Carcinoma Malignant Neoplasm of Breast Cancer of Breast Mammary Neoplasm, Human Human Mammary Carcinoma Malignant Tumor of Breast Mammary Cancer Mammary Carcinoma Anxiety Fear Neoplasm Remission, Spontaneous Spontaneous Neoplasm Regression Regression, Spontaneous Neoplasm Remission, Spontaneous Neoplasm Spontaneous Neoplasm Remission

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Participants were blinded to study hypotheses.

Study Groups

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Acceptance and Commitment Therapy

6 weeks, the ACT group will meet weekly for 2 hours at one of three facilities.

Group Type ACTIVE_COMPARATOR

Acceptance and Commitment Therapy

Intervention Type BEHAVIORAL

6-week ACT intervention group (n=33)

Survivorship Education

6 weeks, SE group will meet weekly for 2 hours at one of three facilities.

Group Type ACTIVE_COMPARATOR

Survivorship Education

Intervention Type BEHAVIORAL

6-week survivorship education group (SE; n=32)

Enhanced Usual Care

Continue to meet with their health care team + receive a variety of readings at each data collection point on coping with common survivorship concerns, including a booklet from the National Cancer Institute entitled "Facing Forward: Life After Cancer Treatment."

Group Type ACTIVE_COMPARATOR

Enhanced Usual Care

Intervention Type BEHAVIORAL

enhanced usual care (EUC; n=26)

Interventions

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Acceptance and Commitment Therapy

6-week ACT intervention group (n=33)

Intervention Type BEHAVIORAL

Survivorship Education

6-week survivorship education group (SE; n=32)

Intervention Type BEHAVIORAL

Enhanced Usual Care

enhanced usual care (EUC; n=26)

Intervention Type BEHAVIORAL

Other Intervention Names

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ACT SE EUC

Eligibility Criteria

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Inclusion Criteria

1. ≥18 years old,
2. have been diagnosed with non-metastatic breast cancer (stages I-III),
3. have completed curative treatment for breast cancer,
4. have not experienced a cancer recurrence, and
5. report a clinically significant level of FCR (Fear of Cancer Recurrence Inventory-Short Form score of ≥ 13)

Exclusion Criteria

1. severe depression (PHQ-8 score of ≥ 20),
2. past participation in ACT or formal mindfulness training, and
3. limited English proficiency.
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Indiana University Health

OTHER

Sponsor Role collaborator

Indiana University

OTHER

Sponsor Role lead

Responsible Party

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Shelley Johns

Assistant Professor of Medicine, Research Scientist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Shelley A Johns, PsyD

Role: PRINCIPAL_INVESTIGATOR

Indiana University School of Medicine; Regenstrief Institute, Inc.

Locations

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Indiana University

Indianapolis, Indiana, United States

Site Status

Countries

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United States

References

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Other Identifiers

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IUSCC-0563

Identifier Type: -

Identifier Source: org_study_id

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