Acceptance and Commitment Therapy for Addressing Chronic Cancer Pain: A Narrative Review with Considerations for Utilization in Primary Care

Background: Chronic pain is common among cancer survivors and may reflect interacting physical, psychological, social, and existential factors. Acceptance and Commitment Therapy (ACT) is a behavioral intervention that emphasizes psychological flexibility, acceptance, present-moment awareness, and values-guided action. As cancer survivorship care increasingly involves primary care, scalable behavioral approaches may be needed to complement medical pain management, particularly where specialty behavioral health resources are limited. Methods: This narrative review examined evidence for ACT in chronic cancer-related pain and its potential applicability to primary care and resource-constrained healthcare settings. Searches were conducted in PubMed, PsycINFO, and CINAHL Ultimate, supplemented by Google Scholar and the Association for Contextual Behavioral Science database. Fifteen studies met criteria for inclusion. Results: ACT showed promising effects on outcomes including psychological flexibility, pain acceptance, emotional distress, quality of life, pain coping, and pain-related functioning, whereas findings for pain intensity were less consistent. The evidence was limited by heterogeneous study designs and populations and generally small experimental samples. None of the included studies directly evaluated ACT for cancer-related pain in primary care, although studies in other chronic pain and mental health populations provide indirect support for the feasibility of ACT in primary care and community settings. Discussion: Although direct evidence for the utilization of ACT in primary care is lacking, studies on ACT interventions for chronic pain and mental illness in these settings suggest that brief ACT interventions for cancer pain may help to address the need for behavioral health support. Future research should include pragmatic trials to determine whether brief ACT-informed interventions can be feasibly integrated into multidisciplinary primary care teams and delivered through digital or hybrid models.