Experiential Avoidance: Associations With Quality Of Life, Distress, And Fear Of Recurrence Among Early Breast Cancer Survivors Living In Regional Australia

Experiential Avoidance: Associations With Quality Of Life, Distress, And Fear Of Recurrence Among Early Breast Cancer Survivors Living In Regional Australia

Women survivors of early breast cancer living in regional Australia experience unique challenges to their wellbeing starting with treatment choices as patients, to accessibility of practical and psychological services to address unmet needs as survivors. Targeting psychological interventions to the mechanisms of change proposed for quality of life, psychological distress, and fear of cancer recurrence is especially required in regional settings where resources are scarce. Preliminary information suggests that acceptance and commitment therapy (ACT) may be a theoretical and practical fit for improving quality of life in regional breast cancer survivors through targeting of experiential avoidance to increase adaptive coping. Study 1 was a pilot, unblinded, three-arm crossover randomised control trial of 20 women within two years of completing primary treatment for early breast cancer. In this study, experiential avoidance correlated negatively with quality of life, and positively with fear of cancer recurrence. Results indicated that there were individual differences in how ACT intervention impacted distress, fear, and avoidance. Not all improvements could be attributed to a reduction in experiential avoidance. A second study sought to clarify these variables and current quality of life for women in regional Australia. Study 2 was a crosssectional survey of 538 participants that considered the role of experiential avoidance in quality of life for regional women survivors of early breast cancer. The survey included established demographic, social, psychological, and disease characteristic predictors of quality of life. Experiential avoidance was a significant predictor in a model that contained these established and strong predictors, which included chemotherapy, financial strain, exercise, social support, and time since treatment. The practical implications of this research are the improved targeting of variables that improve quality of life outcomes specific to regional breast cancer survivors, in a context where there is health and resource disparity. The main limitations were sampling biases and lack of representativeness of certain marginalised groups such as Aboriginal and Torres Strait Islanders Australians. Strengths of this research were the focus on clinical utility and the understanding of quality of life holistically. Future research directions include targeted recruitment of marginalised groups and the use of measures that capture more processes of ACT to explore avenues other than experiential avoidance through which ACT may improve quality of life for regional breast cancer survivors.

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