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. 2025 Jan 16;15(1):ibaf030.
doi: 10.1093/tbm/ibaf030.

Clinical effectiveness of best-evidence cancer distress management in a real-world practice setting

Shawna L Ehlers  1 , Janae L Kirsch  1 , Elizabeth L Kacel  1 , Lisa M Gudenkauf  1 , Sherrie M Hanna  1 , Eleshia J Morrison  1 , Jill Snuggerud  1 , Jeffrey P Staab  1 , Katharine A R Price  2 , Andrea E Wahner Hendrickson  2 , Carrie Bronars  1 , Kristine A Donovan  1 , Deanna Hofschulte  1 , Holly C Edwards  1 , Kathryn J Ruddy  2
Affiliations

Clinical effectiveness of best-evidence cancer distress management in a real-world practice setting

Shawna L Ehlers et al. Transl Behav Med. .

Abstract

Background: Despite 40 years of evidence supporting psychosocial interventions as a component of comprehensive cancer care, patients continue to report vast unmet psychosocial needs and distress. Cognitive behavioral therapies for cancer distress (CBT-C) are the most rigorously tested class of psychosocial interventions for cancer care.

Purpose: To report clinical effectiveness outcomes of cancer-related distress and self-efficacy following implementation of best-evidence CBT-C, adapted for a real-world, billable practice setting.

Methods: Patients who completed group-delivered, CBT-C (10 intervention hours, 5 sessions) in the practice setting were invited to enroll in a research study to document cancer distress across the year following CBT-C. Participants (n = 65) were primarily middle-aged (mean 50.5 years, 17% were young adults ≤40 years), female, and White. Analyses utilized mixed linear models with intent-to-treat procedures. Given group delivery and social skills training content within CBT-C, social self-efficacy was assessed as a potential treatment mechanism.

Results: Distress decreased across the year following CBT-C (mean score change of 20 points for YAs, 6 points for non-YAs), with statistically significant age x time effects. Within-person improvements in social self-efficacy scores were related to reductions in cancer distress, including distress subscales of intrusive thoughts, avoidant coping, and hyperarousal. The model explained 76.6% of the total variance in cancer distress.

Conclusions: This study demonstrates the effective translation of CBT-C from controlled research trials to the practice setting. CBT-C effectiveness within a mixed-cancer population and relatively rural region of the US is also supported. CBT-C can be effectively translated to the practice settings for which it is intended.

Keywords: behavioral intervention; cancer; cancer distress; cognitive behavioral therapy; oncology; young adult.

Plain language summary

Despite over 40 years of evidence supporting psychosocial interventions as an effective component of comprehensive cancer care, cancer populations generally continue to report vast unmet needs and significant emotional distress. Unmet needs and emotional distress reflect unnecessary suffering and are associated with needing more healthcare. Cognitive behavioral therapies for cancer distress (CBT-C) are the most rigorously tested class of psychosocial interventions for cancer care. CBT-C has been found to be effective in reducing distress through practice and implementation of cognitive behavioral strategies such as relaxation and thought restructuring in clinical trials. In this study, we sought to translate best-evidence CBT-C from research settings into a real-world clinical setting. Patients who completed group-delivered, CBT-C (10 intervention hours, 5 sessions) in the practice setting were invited to enroll in a research study to document cancer distress across the year following CBT-C. Participants (n = 65) were primarily middle-aged (mean 50.5 years, 17% were young adults ≤40 years), female, and White. Cancer distress significantly decreased across the year following CBT-C, especially for patients under 40 years of age. This study demonstrates the effective translation of CBT-C from controlled research trials to the practice setting where most patients receive cancer care.

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