Symptom experiences in post-treatment cancer survivors: associations with acceptance and commitment therapy constructs
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ORIGINAL ARTICLE
Symptom experiences in post-treatment cancer survivors: associations with acceptance and commitment therapy constructs Ashley B. Lewson 1 & Shelley A. Johns 1,2,3 & Ellen Krueger 1 & Kelly Chinh 1 & Kelley M. Kidwell 4 & Catherine E. Mosher 1 Received: 12 July 2020 / Accepted: 22 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Acceptance and Commitment Therapy (ACT) has improved symptom and quality-of-life outcomes in pilot research with post-treatment cancer survivors. To further test the ACT model, the present study examined relationships between ACT constructs and subgroups of post-treatment survivors based on the severity of common symptoms. Methods Survivors who had completed primary treatment for stage I or II cancer (N = 203) participated in this one-time survey. Latent class analysis (LCA) was used to identify subgroups of survivors based on the severity of fatigue, sleep disturbance, pain, anxiety, and depressive symptoms. Multinomial logistic regressions employing Vermunt’s 3-step approach were used to examine ACT constructs (e.g., mindfulness, acceptance, values progress) as correlates of survivor subgroups based on symptoms. Results The LCA showed three survivor classes: (1) mild-to-moderate levels of all symptoms except for normal pain intensity; (2) mild anxiety, moderate fatigue, and normal levels of all other symptoms; and (3) normal levels of all symptoms. Lower mindfulness, acceptance, and values progress and higher cognitive fusion, psychological inflexibility, and values obstruction were associated with a greater likelihood of being in class 1 or 2 than in class 3. Conclusion Findings are consistent with the ACT model. Survivors with greater symptom burden reported greater withdrawal from personally meaningful activities and less acceptance of their cancer diagnosis and internal experiences (e.g., thoughts, feelings, symptoms). Findings provide strong justification for further testing of ACT to reduce symptom-related suffering in cancer survivors. Keywords Latent class analysis . Symptoms . Cancer survivors . Acceptance and commitment therapy . Mindfulness . Psychological flexibility
Introduction Many cancer survivors experience persistent, debilitating symptoms for months or years after cancer treatment [1]. Common symptoms include fatigue, sleep disturbance, pain,
* Ashley B. Lewson [email protected] 1
Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
2
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
3
Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
4
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
anxiety, and depressive symptoms. These symptoms tend to co-occur, with survivors showing heterogeneous clustering and severity of symptoms [2, 3]. Survivors’ heightened symptoms have a substantial negative impact on their daily activities, functional status, and qua
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