Acceptance and Commitment Therapy for Fatigue Interference in Metastatic Breast Cancer

项目摘要/摘要 疲劳对活动、情绪和认知的干扰是最普遍和最令人担忧的问题之一 转移性乳腺癌患者的比例。到目前为止，还没有针对减轻疲劳的循证干预措施。 对转移性乳腺癌患者和其他晚期癌症人群的干预。在试点研究中， 接受和承诺疗法(ACT)在减少与症状相关的痛苦方面显示出潜力 癌症患者。我们最近在转移性乳腺癌中进行了一项试点研究，测试了一种新型电话- 基于ACT的干预结合正念练习(例如，冥想，进行更多的活动 意识)，识别个人价值观，并参与与这些价值观一致的活动。 干预措施显示出了减少排放的可行性、可接受性和承诺的有力证据 疲劳干扰活动、情绪和认知。拟议的第二阶段试验旨在更明确地 检查我们基于电话的ACT干预对转移性乳腺癌患者的疗效 正在经历疲劳干扰。在这项试验中，250名妇女将被随机分配到同等数量的 ACT干预或教育/支持控制条件。两种情况下的女性都将参加六次 每周50分钟的电话会议。这项研究的主要目的是测试基于电话的 对疲劳干扰采取行动。次要结果包括睡眠干扰、参与日常活动、 和生活质量。结果将在基线、干预后2周以及干预后3个月和6个月进行评估。 干预。这项试验还将检查是否增加了心理灵活性，定义为完全意识 在坚持与个人价值观一致的行动的同时，考虑到有益的影响 关于疲劳干涉的ACT。在证明了ACT的有效性后，干预可以广泛进行 传播给转移性乳腺癌患者。本次试验也为进一步推广应用奠定了基础 以及对广泛的癌症人群和功能结果进行ACT测试。

Project Summary/Abstract Fatigue interference with activities, mood, and cognition is one of the most prevalent and distressing concerns of metastatic breast cancer patients. To date, there are no evidence-based interventions for reducing fatigue interference in metastatic breast cancer patients and other advanced cancer populations. In pilot studies, Acceptance and Commitment Therapy (ACT) has shown potential for reducing symptom-related suffering in cancer patients. We recently conducted a pilot study in metastatic breast cancer that tested a novel telephone- based ACT intervention combining mindfulness exercises (e.g., meditations, performing activities with greater awareness) with identification of personal values and engagement in activities consistent with these values. The intervention showed strong evidence of feasibility, acceptability, and promise with respect to reducing fatigue interference with activities, mood, and cognition. The proposed Phase II trial seeks to more definitively examine the efficacy of our telephone-based ACT intervention for women with metastatic breast cancer who are experiencing fatigue interference. In this trial, 250 women will be randomly assigned in equal numbers to either the ACT intervention or an education/support control condition. Women in both conditions will attend six weekly 50-minute telephone sessions. The primary aim of this study is to test the effect of telephone-based ACT on fatigue interference. Secondary outcomes include sleep interference, engagement in daily activities, and quality of life. Outcomes will be assessed at baseline, 2 weeks post-intervention, and 3 and 6 months post- intervention. This trial will also examine whether increases in psychological flexibility, defined as full awareness of the present moment while persisting in action aligned with personal values, account for the beneficial effect of ACT on fatigue interference. After demonstrating ACT's efficacy, the intervention can be widely disseminated to metastatic breast cancer patients. This trial will also lay the groundwork for further application and testing of ACT with a wide range of cancer populations and functional outcomes.