Acceptance and Commitment Therapy for Children, Adolescents, and Young Adults With Cancer and Their Parents and for Children, Adolescents, and Young Adults Affected by Parental Cancer: A Population-Stratified Systematic Review

AI Summary

Moderate-certainty evidence indicates ACT reduces parental distress, anxiety, and depression and increases psychological flexibility (effect sizes d = 0.61 to 0.83).
Evidence for adolescents and young adults is of very low certainty, methodologically heterogeneous, and insufficient to support definitive efficacy conclusions.
No studies included children; the review calls for developmentally tailored, rigorous randomised trials to test ACT across CAYA populations and parental contexts.

TL;DR (AI Generated)

OBJECTIVE: Cancer profoundly affects the entire family system; evidence for acceptance and commitment therapy (ACT) remains fragmented within three distinct cohorts: (1) children, adolescents, and young adults (CAYAs) with cancer or cancer survivors, (2) CAYAs impacted by parental cancer, and (3) parents of CAYAs with cancer.

For AYA populations (both with cancer or cancer survivors and affected by parental cancer), evidence was of very low certainty; psychological flexibility emerged as a plausible mediator of quality-of-life improvements in a single mixed sample study of distressed AYAs affected by their own or a family member's cancer.

Moderate-certainty evidence for parents of CAYAs with cancer showed reductions in distress, anxiety, and depressive symptoms (d = 0.61-0.83), and increased psychological flexibility (d = 0.63).

Basic summary

Brain Behav. 2026 Nov;16(11):e71902. doi: 10.1002/brb3.71902.

ABSTRACT

METHODS: Adhering to Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, 12 databases (including MEDLINE, PsycINFO, and Embase) and gray literature were searched from inception to October 2025. Quantitative studies evaluating ACT-based interventions were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality using JBI tools and the Risk of Bias in N-of-1 Trials (RoBiNT) Scale. Data were synthesized narratively by outcome within population strata following synthesis without meta-analysis (SWiM), with effectiveness appraised for certainty of evidence using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).

RESULTS: Nine studies (N = 573) were included (one RCT, one single case experimental design [SCED], four quasi-experimental trials, and three single-group pilot/feasibility studies). No studies targeted children. For AYA populations (both with cancer or cancer survivors and affected by parental cancer), evidence was of very low certainty; psychological flexibility emerged as a plausible mediator of quality-of-life improvements in a single mixed sample study of distressed AYAs affected by their own or a family member’s cancer. Moderate-certainty evidence for parents of CAYAs with cancer showed reductions in distress, anxiety, and depressive symptoms (d = 0.61-0.83), and increased psychological flexibility (d = 0.63).

CONCLUSIONS: ACT shows promise for improving mental health outcomes in parents of CAYAs with cancer. Evidence for both AYAs populations remains limited by methodological heterogeneity, highlighting a need for developmentally tailored, rigorous trials.

PMID:43002142 | DOI:10.1002/brb3.71902

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