Addressing Existential Distress Through Compassion: Feasibility and Preliminary Effects of Compassion With You (COMwithU), a Compassion‐Based Intervention for Patients With Cancer

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ABSTRACT Background Cancer‐related distress extends beyond anxiety and depression to existential suffering, including loss of meaning, helplessness, uncertainty, and relational strain. Compassion‐based interventions in psycho‐oncology are promising, but existential outcomes such as demoralization and spiritual well‐being have rarely been examined. Compassion With You (COMwithU) is a brief, five‐session compassion‐based intervention that centers on cultivating self‐compassion, supported by the therapist's compassionate presence and by practices of extending compassion toward others. Methods This single‐arm feasibility study evaluated COMwithU in adult patients with cancer using a pre‐post‐1‐month follow‐up design. The intervention comprised five individual 60‐min sessions delivered in person or via videoconferencing. Primary outcomes were feasibility and acceptability. Secondary outcomes included anxiety, depression, spiritual well‐being, demoralization, self‐compassion, and intolerance of uncertainty. Linear mixed models examined changes across baseline, post‐intervention, and follow‐up. Results Of 44 participants who started the intervention, 37 attended at least 3 of 5 sessions, yielding a completion rate of 84.1%. Among 34 full completers, 31 (91.2%) completed the post‐intervention assessment, and 30 (88.2%) completed the follow‐up. Helpfulness was rated highly (mean 4.63/5). Anxiety, depression, spiritual well‐being, demoralization, and self‐compassion improved significantly, whereas intolerance of uncertainty did not change significantly. Among participants above the demoralization cutoff at baseline, 68.0% showed reliable improvement, and 56.0% achieved clinically significant change by follow‐up. Conclusions COMwithU demonstrated good feasibility, high acceptability, and promising preliminary effects in patients with cancer. The strongest effects were observed for demoralization and spiritual well‐being. Further randomized controlled trials should directly assess self‐compassion, relational compassion processes, and existential outcomes. Trial registration This study was registered at the Clinical Research Information Service (CRIS), Republic of Korea (Registration number: KCT0010315)