Advanced Lung Cancer: Therapy for Fatigue, Depression, and Quality of Life

Targeted and immunotherapies appear to be opening a new frontier in the management of elderly patien
Targeted and immunotherapies appear to be opening a new frontier in the management of elderly patien
A clinical trial of patients with advanced lung cancer assessed the efficacy and feasibility of ACT, a behavioral therapy, for reducing cancer-related fatigue and depression.

In patients with advanced lung cancer, Acceptance and Commitment Therapy (ACT) – a mindfulness-based behavioral therapy — significantly improved depression, anxiety, fatigue, and quality of life, and showed a high rate of patient retention. These were among clinical trial findings published in the Asia-Pacific Journal of Oncology Nursing.

Cancer-related fatigue (CRF), a non-objective feeling of emotional and/or physical exhaustion linked with cancer and treatment that can be severely disruptive to daily living, is experienced most among patients with lung cancer. Patients experiencing CRF are often resistant to non-pharmacological interventions such as physical exercise and psychological seminars, and the use of acupuncture for relief has shown uneven results. Researchers sought to investigate the feasibility and acceptability of ACT and its effect on fatigue interference and health-related quality of life among patients with advanced lung cancer. The primary outcomes were feasibility and acceptability.

The researchers initiated a prospective, single-blinded, parallel-group randomized controlled trial ( Identifier: NCT04869267) from March 2021 to May 2021. The trial included 40 patients (≥18 years of age) with advanced lung cancer experiencing CRF or unexplained fatigue, with a reliable internet connection and a mobile smartphone, who were randomized to the intervention or control group (n=20 for each group). Individuals in the control group received usual care; patients in the intervention group received usual care and individual ACT (face-to-face and virtual conferencing), with 1 session per week for 4 weeks. Intervention attendance was 88.75%, with retention of 75%, and self-reported satisfaction with the intervention of 95%. There were no adverse events.

Intervention showed insignificant effects on fatigue interference but statistically significant effects for anxiety (P <.001), symptoms of depression (P <.001), cancer-related fatigue (P <.001), health-related quality of life (P =.001), and distress (P =.003).

Study limitations include underpowered sample size, limited generalizability, and selection bias.

Researchers said their study showed the feasibility of ACT intervention for health-related quality of life and fatigue in patients with advanced lung cancer. “The findings showed that the intervention is potentially effective in remitting depressive symptoms, anxiety, distress and fatigue and improving health-related quality of life in this population.”


Li H, Jin X, Ng MSN, Mann KF, Wang N, Wong CL. Effects of Acceptance and Commitment Therapy on fatigue interference and health-related quality of life amongst patients with advanced lung cancer: a pilot randomised controlled trial. Asia Pac J Oncol Nurs. Published online June 8, 2022. doi:10.1016/j.apjon.2022.100102