title: Symptom experiences in metastatic breast cancer patients: relationships to activity engagement, value-based living, and psychological inflexibility.
abstract: OBJECTIVE
  This study examined symptom-based subgroups of metastatic breast cancer (MBC) patients and the extent to which they differed across key constructs of acceptance and commitment therapy (ACT).
  
  
  METHODS
  Eighty women with MBC completed self-report surveys assessing 10 common symptoms and several ACT variables (ie, activity engagement, psychological inflexibility, value obstruction, and value progress) during a single time point.
  
  
  RESULTS
  A cluster analysis yielded 3 patient subgroups: low symptoms, low-moderate symptoms, and moderate-high symptoms. Relative to the subgroup with low symptoms, the other subgroups reported less activity engagement. In addition, compared with patients with low symptoms, the subgroup with moderate-high symptoms reported greater psychological inflexibility (ie, avoidance of unwanted internal experiences) and greater difficulty living consistently with their values.
  
  
  CONCLUSIONS
  Women with MBC show heterogeneity in their symptom profiles, and those with higher symptom burden are more likely to disengage from valued activities and avoid unwanted experiences (eg, thoughts, feelings, and bodily sensations). Findings are largely consistent with the ACT model and provide strong justification for testing ACT to address symptom interference in MBC patients.
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Mosher
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Danielle B
authors.initials: DB
authors.lastname: Tometich
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Hirsh
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Rand
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.|Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.
authors.forename: Shelley A
authors.identifier: http://orcid.org/0000-0001-5730-1822
authors.initials: SA
authors.lastname: Johns
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.|Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.|VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.|Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.|Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.|VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.|Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Samantha D
authors.initials: SD
authors.lastname: Outcalt
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Psychology, University of Washington, Seattle, WA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bricker
authors.affiliation: Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Schneider
authors.affiliation: Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA.
authors.forename: Lida
authors.initials: L
authors.lastname: Mina
authors.affiliation: Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Storniolo
authors.affiliation: Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Newton
authors.affiliation: Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Miller
mesh_terms: D064869:Acceptance and Commitment Therapy; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications* / Q000473:pathology* / Q000523:psychology; D000066498:Emotional Adjustment; D004644:Emotions; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D057566:Self Report; D011795:Surveys and Questionnaires
keywords: acceptance and commitment therapy; activity engagement; metastatic breast cancer; oncology; psychological flexibility; symptoms