Grant funds novel approach to reducing symptom-related suffering of advanced cancer patients

INDIANAPOLIS -- IUPUI psychologist Catherine Mosher has been awarded $1.7 million from the National Cancer Institute to investigate a novel acceptance-based approach to reducing the negative impact of fatigue and other symptoms on functioning in late-stage cancer patients, ultimately enriching their quality of life through therapist-guided exercises conducted over the phone.

"Every palliative care physician and oncologist will tell you that improving quality of life is central to their care of advanced cancer patients," said Mosher, an associate professor of psychology in the Purdue School of Science and a member of the Cancer Prevention and Control research program at the Indiana University Melvin and Bren Simon Cancer Center. "Until we find a cure, the hope is that they can still have a strong sense of quality of life because they're engaged in what's meaningful to them, even in the last months or years of life."

Patient lying in bedView print quality image
Improving quality of life is central to the care of advanced cancer patients by palliative care physicians and oncologists. Photo by Getty Images

For this study, metastatic breast cancer patients will participate in Acceptance and Commitment Therapy, or ACT, which aims to increase their mindfulness or present-moment acceptance of thoughts, feelings and symptoms. Initial studies have suggested that ACT has the potential to reduce symptom-related suffering in cancer patients while helping them set goals consistent with personal values.

While ACT is widely available and used by therapists to treat other conditions, Mosher aims to provide the evidence base for its effectiveness in the cancer community.

"Clinicians have long believed that acceptance is central to coping with illness in general, especially serious illness, and research suggests that reaching a state of acceptance is challenging for many patients," Mosher said. "We help patients identify what's most important to them -- whether it's being an engaged parent or their spirituality -- and then to set specific action steps rooted in those values."

"We find when patients reflect on what's most important to them and set goals, they help break the cycle of symptoms interfering with functioning," Mosher said. "A lot of patients withdraw from meaningful social activities when they're fatigued; we're trying to get them back in touch with their values and consider 'Is there a piece of this social activity that I can still do?'"

For example, a patient in the study had described feeling tired much of the time. When her family planned to go bowling, she recalled her conversation with a therapist and realized she could still participate. While she wouldn't be able to bowl all night, she could cheer on her family and engage in quality time.

"That's the heart of ACT -- getting in touch with your values, what's important to you and, in the case of an advanced cancer patient, engaging in a feasible aspect of that valued activity," Mosher said.

In addition to this project, Mosher is exploring Acceptance and Commitment Therapy for advanced gastrointestinal cancer patients and their family caregivers. She was awarded a nearly $400,000 exploratory grant from the National Cancer Institute to examine whether ACT is a promising approach to addressing the negative impact of patient symptoms on functioning and caregiver burden.

Additional researchers on these National Cancer Institute grants include Victoria Champion, Adam Hirsh, Shelley Johns, Deborah Kashy, Kurt Kroenke, Marianne Matthias, Dr. Kathy Miller, Dr. Bert O'Neil and Wanzhu Tu.

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