Effects of acceptance and commitment therapy-based intervention on fatigue interference and health-related quality of life in patients with advanced lung cancer: A randomised controlled trial

Cancer-related fatigue is common in patients with advanced lung cancer, persistently interfering with their health-related quality of life. Acceptance and Commitment Therapy (ACT) may effectively reduce fatigue interference and improve health-related quality of life in the advanced lung cancer population. This study aimed to evaluate the effects of an ACT-based intervention on fatigue interference and health-related quality of life in patients with advanced lung cancer. An assessor-blinded, two-arm randomised controlled trial with 160 patients with advanced lung cancer was conducted. Participants were randomly allocated into either a four-week ACT-based intervention group (n = 80) or usual care control group (n = 80). The intervention consisted of a face-to-face session and three video-conferencing-based sessions and was delivered on an individual basis. The primary outcomes were fatigue interference and health-related quality of life. The secondary outcomes included cancer-related fatigue, depression and anxiety, cancer-specific distress, and activity level. Changes in psychological flexibility (PF), experiential avoidance, and cognitive fusion were also evaluated. Outcomes were measured at baselines (T0), one-week post-intervention (T1), and 3-month follow-up (T2). The intervention effects were assessed using generalised estimating equation models. Compared with the control group, the intervention group demonstrated significant improvements in fatigue interference (T1: β = −0.50, p < 0.001; T2: β = −0.16, p = 0.007), health-related quality of life (T1: β = 16.01, p < 0.001; T2: β = 11.21, p < 0.001), depression (T1: β = −0.32, p < 0.001) and anxiety (T1: β = −0.20, p < 0.001), cancer-specific distress (T1: β = −7.37, p < 0.001; T2: β = −8.00, p < 0.001), activity level (intensity, T1: β = 3.24, p = 0.004; T2: β = 2.61, p = 0.02; frequency, T1: β = 2.44, p < 0.001; T2: β = 1.96, p < 0.001; duration, T1: β = 1.36, p < 0.001), PF (T1: β = 5.54, p < 0.001; T2: β = 8.63, p < 0.001), experiential avoidance (T1: β = −7.70, p < 0.001; T2: β = −10.07, p < 0.001), and cognitive fusion (T2: β = −3.31, p = 0.007). The changes in experiential avoidance at one-week post-intervention mediated the effects of ACT on reducing cancer-specific distress (β = −7.40, p < 0.001; β = −3.68, 95%CI, −5.77 to −1.58) and promoting HRQoL (β = 11.15, p < 0.001; β = 5.49, 95%CI, 3.09 to 8.31) at three-month follow-up. The changes in PF at one-week post-intervention mediated the effect of ACT on HRQoL (β = 11.15, p < 0.001; β = 2.25, 95%CI, 0.66 to 4.19) at three-month follow-up. ACT-based intervention can effectively reduce fatigue interference and improve health-related quality of life in patients with advanced lung cancer. The intervention can be integrated into palliative care within the cancer system to contribute to the well-being of patients with advanced cancer.