Living Well With Uncertainty in Advanced, Metastatic or Incurable Cancers: A Pragmatic Feasibility Study of the Adapting to Life With Cancer Cognitive ExisteNtial Therapy (ACCENT).

BACKGROUND

New treatments are contributing to individuals living longer with advanced, metastatic, or incurable (AMI) cancers. The impact of these treatments is unpredictable, resulting in considerable uncertainty for these patients. Currently, there are no interventions that effectively address uncertainty in AMI cancers. To fill this gap, we designed the Adapting to life with Cancer Cognitive ExisteNtial Therapy (ACCENT) intervention.

AIM: To evaluate the feasibility, acceptability, and preliminary efficacy of ACCENT in AMI cancers.

METHODS

ACCENT was delivered online for 6 consecutive weekly sessions of 1.5 hours to five groups of six to seven patients. Thirty-two patients were interested in participating, but 2 did not complete the assessments pre- or post-intervention. A pragmatic feasibility study was conducted using data collected in routine clinical practice. Participants completed the Intolerance of Uncertainty Scale-Short Form, the Generalized Anxiety Disorder scale, and the Impact of Events Scale before and after the intervention. Post-intervention, participants answered open-ended questions to assess acceptability, rated their perceptions of improvement and usefulness, and completed the Satisfaction with Therapy and Therapist Scale.

RESULTS

ACCENT appears feasible with participants completing the intervention and all assessments between January 2022 and November 2023. It appears acceptable with an attrition rate of 12.5%, and a high degree of attendance and satisfaction. There was a non-significant decrease in intolerance of uncertainty, and a significant decrease in anxiety, and cancer-specific distress post-intervention.

CONCLUSION

A randomized controlled pilot study is warranted to further evaluate ACCENT in patients with AMI cancers.