Effects of Acceptance and Commitment Therapy on Death Anxiety in Cancer Survivors: A Randomized Controlled Trial

Given that cancer survivors often face psychological problems, this study explores the effect of acceptance and commitment therapy (ACT) to improve death anxiety (DA), experiential avoidance (EA), meaning in life (MIL), and quality of life (QoL).

The study was conducted from June to November 2023, encompassing recruitment, an 8-week intervention (July-August 2023), and follow-up to 3 months post-intervention at a tertiary cancer hospital in China. A total of 50 cancer survivors were randomized (25 per group). The weekly intervention was delivered through in-person, one-on-one sessions over 8 weeks. Each session (approximately 35-45 min) was structured to cover distinct thematic modules of ACT. The primary outcome was DA and other secondary outcomes included EA, MIL, as well as QoL. Data were collected at T0 (pre-intervention), T1 (post-intervention), T2 (1 month post-intervention), and T3 (3 months post-intervention). The intervention effects were estimated using generalized estimating equation models.

Participants had various cancer types, primarily head and neck (28%), lung (28%), and breast (24%). Cancer stages included I-II (54%), III (44%), and IV (2%). Participants in the ACT group revealed significantly greater reductions on DA than those in the wait-list control group at T1 (95% CI: -3.449 to -2.631), T2 (95% CI: -4.899 to -3.821), and T3 (95% CI: -5.311 to -3.969), as well as on EA and the symptom domain of quality of life at three time points. In addition, the intervention demonstrated significantly greater improvements on MIL, the functional domain and global health status of quality of life at T1, T2, and T3.

In this study with a wait-list control group rather than an active comparator, the in-person ACT-based intervention reduced death anxiety, experiential avoidance, and symptom-related quality of life impairments while enhancing meaning in life, functional quality of life, and global health status in cancer survivors. These benefits were sustained for up to 3 months post-intervention, though generalizability may be limited by the sample's cancer types and stages.

Chinese Clinical Trial Registry (ChiCTR2300074472). https://www.chictr.org.cn/.