Managing Cancer and Living Meaningfully (CALM): Application in Italy of an Innovative Meaning-Centered Intervention for Advanced Cancer Patients

Background: Managing Cancer and Living Meaningfully psychotherapy (CaLM) is an innovative approach aimed at reducing depression and demoralization in advanced cancer patients, while promoting meaning making processes and personal growth. These constructs are considered to be the principal components at the basis of existential distress or vice versa, of a sense of meaning and fulfillment at the end of life. The aim of this research was to investigate the acceptability and feasibility of CaLM within an Italian context, while evaluating its potentiality of reducing depression, demoralization, anxiety and other emotional distress as compared to controls treated with usual care (UC). Materials and Methods: Advanced cancer patients were randomized to be allocated either in the experimental arm to receive a semi-structured intervention of 12 individual sessions delivered over 6 months; or in a control arm to receive UC at the hospital Oncology Service. Usual care included routine oncology clinic visits, during which distress screening was carried out. The primary expected outcomes were greater improvements of depression (at PHQ-9), and demoralization (at Demoralization Scale). Secondary outcomes included greater positive changhes anxiety (at DADDS), spiritual wellbeing (at FACIT), quality of life (at QUAL-EC) and posttraumatic growth (at PTGI).in experimental arm vs controls. At 3 and 6 months CaLM participants were interviewed about their therapy experience and both CaLM and UC patients were administered a questionnaire assessing satisfaction with care. Results: Statistical analysis indicated that experimental group patients had a significant improvement in important clinical aspects of existential distress, including depression, demoralization, and anxiety. Moreover they experienced a higher spiritual well-being and a post-traumatic growth as a result of CaLM therapy. UC patients did not present any statistically significant change. Qualitative analysis of the experimental group comments on the intervention underscored CaLM benefits, including an increased awareness and involvement in life. Conclusions: The findings of our study demonstrated a full acceptability and feasibility of CaLM intervention, while indicating its effectiveness in reducing existential distress and promoting psychological and spiritual growth in advanced cancer patients.