Internet-delivered Acceptance and Commitment Therapy for Cancer Patients and Survivors: A Systematic Review

Abstract

Acceptance and commitment therapy (ACT) has proven effective in cancer patients, reducing common psychological symptoms and improving wellbeing. Moreover, the use of eHealth technologies makes support cheaper and easier to provide. The aim of this systematic review was to collect results on the effectiveness of internet-delivered ACT for common symptoms in cancer patients and survivors. The review follows PRISMA guidance and was registered in PROSPERO (CRD42022326543). Searches were conducted using PubMed, Web of Science, Scopus, EBSCOhost, and different web platforms of grey literature. Interventional studies were selected which focused on cancer patients and survivors, were published in English or Spanish, included at least two of the six main ACT components, and were partially or fully delivered through the Internet. The risk of bias was assessed following Cochrane’s recommendations. Eleven records from seven studies met the inclusion criteria. Only one study showed significant reductions in anxiety (reliable change index, RCI [2.32, 3.47]) and depression (RCI [2.00, 4.00]). As regards quality of life, significant improvements were observed in certain domains such as cancer-related quality of life (RCI = 2.43), fatigue (d = 20.33), sleep problems (d = 20.53), physical and functional wellbeing (partial eta-square = .06), and participation in social activities (d = 0.18). ACT processes resulted in significant post-intervention improvements with regard to mindfulness ability and psychological flexibility. Results look promising; however, we believe that limitations such as blinding issues, the heterogeneity of designs and measurement tools, or the use of monetary incentives should be taken into account in future research.

Cancer remains one of the most frequently diagnosed diseases worldwide. People undergoing treatment often experience anxiety, depression, insomnia, and a decline in quality of life, among other things. Currently, various alternatives are being explored to alleviate these issues. One promising option is psychological therapy, such as acceptance and commitment therapy (ACT), which focuses on accepting emotions and taking actions aligned with personal values. Furthermore, given the rise of technology in recent years, it is worth investigating whether digital interventions are beneficial, particularly since attending therapy can be challenging for those suffering from treatment side effects or struggling with the sequelae of their illness. Therefore, a systematic review of research utilizing internet-delivered ACT has been conducted to determine if this remote intervention can effectively improve symptoms. A total of seven studies met the inclusion criteria for this review. The findings are promising but not conclusive enough to assert that this type of intervention significantly improves emotional symptoms, quality of life, fatigue, pain, insomnia, physical function, lifestyle, or social function. Improvements were noted in most studies, but not all of them were significant. These mixed results may be attributed to variations in study designs, the use of inadequate questionnaires, or a lack of control over some variables that could have affected outcomes.