A Randomized Controlled Trial of Brief Behavioral Activation for Older Adult Cancer Survivors

/Abstract: By 2040, 73% of cancer survivors will be ≥65 years old, with up to 35% of them developing clinically significant depression. Depression is problematic for many reasons, including its potential to interfere with the ability to engage in preventive and follow-up healthcare. National Comprehensive Cancer Network guidelines strongly recommend the management of depression among cancer survivors. However, older adults are the least likely age group to utilize mental health services, and Hispanic older adults are even less likely, despite being at higher risk for depression. Older adult cancer survivors (OACs; ≥65, post-cancer treatment) also have unique challenges relative to their peers without cancer (e.g., fatigue, cognitive changes, mobility issues, pain, social distancing and isolation). These issues often create additional barriers to benefitting from existing evidence-based depression treatment, which is ineffective for many OACs. Brief Behavioral Activation (BBA) is an evidence-based psychotherapy for healthy adults that has a strong theoretical rationale for use with OACs and the potential to overcome the limitations of conventional psychotherapies in this age group. It is adaptable for a range of functional statuses, and thus may be especially helpful for OACs given their typically faster rate of functional decline. Moreover, in OACs, BBA has the potential to promote cancer survivorship self-efficacy and improve health behaviors. We developed a BBA manual for OACs (BBA-OACs) with cancer-specific psychoeducation and modified worksheets with a focus on cancer survivorship, self-efficacy, and American Cancer Society (ACS)-recommended preventive health behaviors (i.e., healthy weight, exercise, healthy eating, avoiding alcohol and tobacco). In a fully remote (i.e., recruitment, intervention, and assessment) pilot RCT of telehealth BBA-OACs (N=81) we demonstrated its excellent feasibility, acceptability, and initial superiority to an active control, Supportive Psychotherapy, for improving OACs’ depression, anxiety, and coping. While this demonstrates the promise of BBA-OACs for reducing depression in this medically vulnerable group, we need to ensure its efficacy in a fully powered trial with a diverse sample that will have the ability to identify mediators and moderators of change. For this NIH Stage II RCT of telehealth BBA-OACs (N=502) with 4-month follow-up, we will partner with Cancer Support Community to recruit a diverse nationwide sample of English- and Spanish-speaking OACs with three aims: 1) Determine the efficacy of BBA-OACs for improving depressive symptoms; 2) Determine the efficacy of BBA- OACs for improving anxiety, loneliness, coping, and cancer-related health behaviors; 3) Determine the extent to which behavioral activation, general self-efficacy, and cancer-survivorship self-efficacy mediate the relationship between BBA-OACs and depressive symptoms. By expanding viable, evidence-based telehealth treatment options for depression, these results will ultimately improve the quality of life and cancer survivorship trajectories of OACs. Project Number: 1R01CA309492-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: Rebecca Saracino | Institution: SLOAN-KETTERING INST CAN RESEARCH, NEW YORK, NY | Award Amount: $731,503 | Activity Code: R01 | Study Section: Biobehavioral Medicine and Health Outcomes Study Section[BMHO] View on NIH RePORTER: https://reporter.nih.gov/project-details/11375557