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The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: A randomized trial
Abstract
The aim of this study was determine the effectiveness of a mindfulness-based stress-reduction (MBSR) program on quality of life (QOL) and psychosocial outcomes in women with early-stage breast cancer, using a three-arm randomized controlled clinical trial (RCT). This RCT consisting of 172 women, aged 20-65 with stage I or II breast cancer consisted of the 8-week MBSR, which was compared to a nutrition education program (NEP) and usual supportive care (UC). Follow-up was performed at three post-intervention points: 4 months, 1, and 2 years. Standardized, validated self-administered questionnaires were adopted to assess psychosocial variables. Statistical analysis included descriptive and regression analyses incorporating both intention-to-treat and post hoc multivariable approaches of the 163 women with complete data at baseline, those who were randomized to MBSR experienced a significant improvement in the primary measures of QOL and coping outcomes compared to the NEP, UC, or both, including the spirituality subscale of the FACT-B as well as dealing with illness scale increases in active behavioral coping and active cognitive coping. Secondary outcome improvements resulting in significant between-group contrasts favoring the MBSR group at 4 months included meaningfulness, depression, paranoid ideation, hostility, anxiety, unhappiness, and emotional control. Results tended to decline at 12 months and even more at 24 months, though at all times, they were as robust in women with lower expectation of effect as in those with higher expectation. The MBSR intervention appears to benefit psychosocial adjustment in cancer patients, over and above the effects of usual care or a credible control condition. The universality of effects across levels of expectation indicates a potential to utilize this stress reduction approach as complementary therapy in oncologic practice.
Supplementary resource (1)
Data
January 2012
... A total of 3,135 women were included, 1,148 in the intervention groups and 1,717 in the control groups. Women considered survivors were included because they had already completed the prescribed cancer treatment and were disease-free 29,33,40,[44][45][46]48 , after diagnosis of breast cancer 42 , before radiotherapy cycle 43 , during radiotherapy 38,47 , undergoing chemotherapy 32,35,39,41,49 , in hormone therapy 30 , undergoing surgery and scheduled to receive radiotherapy 31 , during radiotherapy, chemotherapy, or mastectomy treatment 36 , before mastectomy 37 , and two studies did not present the duration of the treatment during the interventions 28,34 . ...
... The participants were in stages 0 to III 31,38,40,43,46,48 , from I to III 28,[32][33][34]39,41,[44][45][46] , I to IV 35 , I and II 36 , and four studies did not provide this information 29,30,37,42 . ...
... The oldest studies included are those by Molassiotis et al. 44 , Monti et al. 30 e Henderson et al. 34 and the most recent is Araújo et al. 35 . ...
Introduction: Body practices can bring physical, psychological benefits and social rehabilitation and may be an alternative treatment for breast cancer. Objective: To analyze the evidence of the results of body practices over the psychological aspects of survivors women undergoing treatment for breast cancer. Method: Systematic blind and independent review from September to December 2021 following the PRISMA guidelines, carried out in the databases: Embase Elsevier; PubMed Central; ScienceDirect; Scopus Elsevier and Web of Science – Core Collection. Results: Of 1,372 studies identified, 22 were included in this systematic review. Among the practices that stood out are meditation and Yoga, with anxiety being the most investigated variable by the studies. It is clear that body practices are options for non-pharmacological clinical treatments utilized in clinical practice by different health professionals in women who have survived breast cancer. Conclusion: Body practices proved to be beneficial in the treatment and psychological health of women who survived breast cancer. This evidence may help to implement body practices as a therapeutic resource to be used in the clinical practice of health professionals. However, more randomized clinical trials that follow study protocols more rigorously are suggested, so that the effectiveness of this approach can be evaluated in different clinical outcomes.
... The characteristics of the included studies are summarised in online supplemental table 1. Ten were performed in the USA, [22][23][24][25][26][27][28][29][30][31] four in China, 32-35 three in Canada [36][37][38] and in the Netherlands, 39-41 two in Denmark, 42 43 Sweden 44 45 and Iran, 46 47 and one in each of the following countries: Australia, 48 the UK, 49 Mexico 50 and Japan. 51 The combined sample size across all studies was 4208 participants, of which 44 were relatives and the remaining were patients with cancer. ...
... 26 31 32 36 38 40 41 48 Patients with I-II stage of disease were included in two studies. 24 50 Seven studies did not report any information about this. 25 30 39 44-47 Type of intervention and control condition ...
... With reference to the type of intervention evaluated, most studies used MBSR or a modified MBSR and most of the selected studies used a waiting list or the usual care as a control group. In our opinion, the implementation of research on the efficacy of MBCT could provide us with new insights, given its focus on cognitive components of psychological distress of cancer patients; furthermore, studies with an active control Lengacher, 2009 23 Bränström, 2010 44 Foley, 2010 48 Henderson, 2012 24 Würtzen, 2013 42 Hoffman, 2012 49 Lerman, 2012 25 van der Lee, 2012 39 Monti, 2013 26 Carlson, 2013 38 Garland, 2014 37 Lengacher, 2014 27 Bower, 2015 28 Lengacher, 2016 29 Johannsen, 2016 43 Blaes In our review, we chose not to select studies concerning online MBT programmes, as we consider both in-person interaction with facilitator and the group setting as core components of mindfulness interventions. Anyway, we do not exclude that online MBTs might be beneficial when in-person interaction is not possible because of limitations due to illness, distance from the services or to the actual pandemic. ...
Background
Mindfulness-based therapies (MBTs) addressed to patients with cancer have been widely studied in the last two decades, and their efficacy has been systematically reviewed and meta-analysed. Although findings from literature highlight benefits of MBTs on several patients’ health outcomes, these should be appraised taking into consideration the characteristics of the selected studies. In this systematic review, we summarised the current evidence of the efficacy of MBTs in improving the quality of life of both patients with cancer and their relatives, with a focus on the methodological quality, type of MBT evaluated and population involved in existing randomised controlled trials (RCTs).
Methods
We searched English language articles published until February 2021. Couples of authors independently applied inclusion criteria and extracted findings. Thirty RCTs were included.
Results
Nearly half of the studies were performed in English-speaking countries outside of Europe, with females diagnosed with breast cancer. Most considered heterogeneous phases of illness; one study only was performed on relatives. In most cases, different measures were employed to evaluate the same outcome. The efficacy of MBTs has been demonstrated in 25 of the 30 included articles. The methodological quality of RCTs was acceptable.
Conclusion
The heterogeneity of studies’ characteristics makes findings on the efficacy of MBTs poorly informative with reference to different clinical and cancer-related psychological conditions. Studies on more homogeneous samples by cancer site and phase, as well as performed in different cultural contexts, could provide a basis for better evaluating and targeting MBTs’ protocols for the specific needs of patients with cancer and their relatives.
... Non-RCT studies were predominant (n = 14). Five studies [18][19][20][21][22] included active control groups. Majority of the studies included women with breast cancer. ...
... [21,26] Planned home practice time ranged from 20 to 60 minutes, and 13 studies did not report the duration of the planned home practice time. [18,[21][22][23]26,27,34,35,[38][39][40][41][42] A silent retreat was delivered in 11 studies, [18,19,[22][23][24]26,28,30,32,36,41] with a duration varying from 4.5 to 8 hours. In 3 studies, a silent retreat was not delivered, [31,37] or a 6-hour optional silent retreat was provided. ...
... [21,26] Planned home practice time ranged from 20 to 60 minutes, and 13 studies did not report the duration of the planned home practice time. [18,[21][22][23]26,27,34,35,[38][39][40][41][42] A silent retreat was delivered in 11 studies, [18,19,[22][23][24]26,28,30,32,36,41] with a duration varying from 4.5 to 8 hours. In 3 studies, a silent retreat was not delivered, [31,37] or a 6-hour optional silent retreat was provided. ...
Participant adherence to standardized 8-week mindfulness-based interventions (MBIs) may be challenging, and adaptations from intervention protocols have been reported in mindfulness research. We conducted a scoping review to determine how women with breast or gynecological cancer adhered to standardized 8-week MBIs delivered in intervention studies. Searches were conducted for articles published till February 2020 in PubMed, Embase, CINAHL EBSCO, PsycINFO Ovid SP, and Cochrane Library Wiley. The following outcomes were investigated: class and silent retreat attendance, intervention completion rate (ICR), adherence to home practice, and reasons for dropping out from an MBI study. Among the 25 included MBI studies, mindfulness-based stress reduction was the most often delivered intervention and mostly women with stage I–III breast cancer were represented. The duration of classes varied from 1.5 to 3.5 hours. Planned home practice varied from 20 to 60 min/day, and silent retreat varied from 4.5 to 8 hours. Due to heterogeneity in the reporting of class attendance, the data could not be pooled. Six studies reported an average class attendance ranging from 5 to 8.2 classes. Overall, intervention completion rate (the proportion who completed all classes) varied from 26.3% to 100%; however, discontinuations were not systematically reported. Home practice time was reported in 20% of the studies and ranged from 17 to 24 min/day. The main reasons for dropping out from an MBI study were health-related problems, organizational challenges, travel distance, and lack of motivation/commitment. About 70% of the studies reported some data on participant adherence, revealing a relatively high overall frequency of class attendance. However, the monitoring and reporting of participant adherence should be improved in future studies to increase our knowledge on the required amount of participant engagement to improve health outcomes and facilitate the implementation of effective interventions on a larger scale.
... It was observed that a wide range of cancer-related variables, such as quality of life, coping skills, sleep, fatigue and pain, were examined as outcome variables. The Functional Assessment of Breast Cancer -Quality of Life tool (FACT-B) [36,37,40] was used in three studies to assess the quality of life of patients with breast cancer. One study used the European Cancer Quality of Life Survey Research and Treatment Organization -Breast Cancer Module (EORTC QLQ-BR23), [38] and another study used the quality of life scale (QLQ C30). ...
... Henderson et al. [36] (2012) compared the effect of MBSR on quality of life and psychosocial variables (depression, coping ways, emotional control, spiritual well-being) in patients diagnosed with breast cancer with nutritional education and standard therapy. Nutrition education is not only a group intervention, but also an intervention that aims to provide cooking and diet change. ...
... Seven studies involving 640 participants with a diagnosis of breast cancer noted a positive effect of MBSR interventions on quality of life. [35][36][37][38][39]41] The intervention applied to the participants is the original MBSR program. The MBSR program consists of 8 sessions and was implemented once or twice a week. ...
... The results showed that the efficacy of the MTCC programme on the PTG level of breast cancer survivors lasted for 1 year, while the PTG level of participants in the waitlist control group decreased in the follow-up period. In line with most studies (Schell, Monsef, Weckel, & Skoetz, 2019;Henderson et al., 2012) that suggest that mindfulness is beneficial to the psychological health of breast cancer survivors, the results also revealed the positive impacts of a modified mindfulness programme on negative emotions. ...
... This study reinforces the findings of previous studies that mindfulness is an effective method for decreasing stress and anxiety (Henderson et al., 2012). The results showed that the MTCC group participants significantly alleviated stress and anxiety compared with the waitlist group. ...
Background:
With the development of positive psychology, posttraumatic growth research on cancer patients has attracted increasing attention from researchers. It is immensely important to effectively increase the posttraumatic growth level of cancer patients and improve their quality of life.
Objectives:
To investigate the effectiveness of a nurse-led mindfulness-based Tai Chi Chuan (MTCC) programme for increasing posttraumatic growth (PTG) and decreasing the perceived stress and anxiety of breast cancer survivors.
Methods:
A RCT was conducted. Participants were randomly assigned to either the MTCC group or the control group. The programme included 59 women with stage I-III breast cancer. Participants in the intervention group participated in a nurse-led 8-week, twice a week, one-hour per day mindfulness-based exercise programme. The effectiveness of the intervention was measured three times (T1 - before intervention; T2 - after intervention; T3 - one year after intervention) using validated scales, including the PTG inventory (PTGI), Perceived Stress Scale (PSS), and Self-rating Anxiety Scale (SAS). A repeated-measure analysis of variance model was used to analyse the data.
Results:
Compared with the wait-list control group, the PTG level in the MTCC group was much higher after the 8-week intervention and the follow-up (F = 374.98, P < .000). The results showed that MTCC increased the level of PTG, and the effect persisted 1 year after intervention. In addition, PSS (F = 55.22, P < .000) and SAS (F = 148.92, P < .000) scores were significantly decreased at T2 and T3.
Conclusion:
The research preliminarily revealed that the MTCC programme was simple, effective, and more suitable to clinical nurses which should be recommended to cancer survivors to promote their recovery.
... Due to full-text unavailability, three studies were excluded. Full-text examination of 38 studies revealed that 25 studies did not meet criteria, for example, few of the studies measured depression but did not measured anxiety [37][38][39], some measured anxiety but did not measured depression [40][41][42], few studies did not mention the mean of both the groups at baseline and post-intervention [40,43]. Reference list scanning led to identification of one study [44]. ...
... Due to full-text unavailability, three studies were excluded. Full-text examination of 38 studies revealed that 25 studies did not meet criteria, for example, few of the studies measured depression but did not measured anxiety [37][38][39], some measured anxiety but did not measured depression [40][41][42], few studies did not mention the mean of both the groups at baseline and post-intervention [40,43]. Reference list scanning led to identification of one study [44]. ...
Evidence suggested that mindfulness-based techniques have been effective in increasing psychological well-being. The present meta-analytic study aimed to examine the effects of mindfulness-based programmes on anxiety, and depression in cancer infected and survivors. Improvement in mindfulness across groups were also studied. Using various search items (e.g., MBCT, MBSR, Cancer). A systematic search of the electronic databases, reference list, and journal content lists were conducted from June 2011 to June 2020. Fourteen randomized controlled trials (N = 1831) evaluating effect of mindfulness in reducing anxiety and depression in cancer, measuring at pre-and-post interventions were included in this study. Random effects model was utilized for effect-size calculation. Interventions were between 5-8 weeks, with majority of participants been female (98.79%). Significant medium effect was observed for anxiety (g = 0.34) and depression (g = 0.32) with moderate heterogeneity and higher for mindfulness (g = 1.061) with high heterogeneity. Publication bias was not observed. Mindfulness has substantial effects in reducing anxiety and depression in cancer infected and survivors.
... Increased mindfulness has been associated with improved mental health (Grossman, Niemann, Schmidt, & Walach, 2004). Researchers have found that breast cancer patients who participated in mindfulness-based meditation for stress reduction experienced improved quality of life (Carlson, Speca, Patel & Goodey, 2003;Lengacher et al., 2009;Witek-Janusek et al., 2008;Hoffman et al., 2012;Henderson et al., 2012). However, researchers have defined mindfulness differently, making it difficult to compare across studies (Coffey, Hartman, & Fredrickson, 2010). ...
... The results of the present study indicated that higher levels of mindfulness predicted lower quality of life. This finding differs from those of previous researchers who have found that increased mindfulness was associated with improved mental health and that the use of mindfulness-based stress reduction meditation led to enhanced quality of life among patients (Grossman et al., 2004;Coffey et al., 2010;Carlson et al., 2003;Lengacher et al., 2009;Witek-Janusek, 2008;Hoffman et al., 2012;Henderson et al., 2012). A possible explanation for this discrepancy is that all measures used in the present study were taken at baseline and participants had not received any mindfulnessbased education or training. ...
Over 3.1 million women living in the U.S. have been diagnosed with breast cancer. The purpose of the present study was to determine whether stage of cancer, psychological distress, cognitive fusion (fusion of one’s thoughts and emotions), mindfulness, and resilience were related to quality of life among breast cancer patients. Participants were 24 women, aged 41-71, diagnosed with stage 0-3 breast cancer, recruited to participate in a pilot intervention study. All data for this study were collected at the baseline assessment. A multiple linear regression analysis explained 79.1% of the total variance in quality of life, F(5, 14) = 15.400, p < .001, Adjusted R2 = .791. Higher resilience significantly predicted higher quality of life (b = 2.392, p = .002), whereas higher stage of cancer (b = -8.068, p = .030) and higher levels of psychological distress (b = -1.737, p < .001) significantly predicted lower quality of life. Contrary to the hypotheses, higher levels of mindfulness significantly predicted lower quality of life (b = -0.612, p = .022). Cognitive fusion did not significantly predict quality of life (p > .05). More research is needed to determine how various factors predict quality of life among breast cancer patients.
... All studies (excepting Carson et al. 2004) had more female than male participants. Understandably, two studies whose intervention was focused on patients/survivors of breast cancer (Carlson et al. 2016;Henderson et al. 2012) only had female participants. No substantive demographic data of participants was provided by one study (Pang & Ruch, 2019). ...
... Ten studies employed passive controls (treatment as usual (TAU), waitlist, or non-intervention). Of the remaining five studies that included active controls, two had both active and passive controls (Henderson et al. 2012;Jain et al. 2007). The active control groups were roughly matched in time duration and group-based nature to the MBP under study (see Table 1 for further details). ...
Objectives
Spirituality has historically been a neglected aspect of people’s lives within a healthcare context. Previous meta-analyses of the effect of Mindfulness-Based Programs (MBPs) on spirituality have been limited by the small number of includable studies that were available at the time, by not comparing MBPs to active controls, and by not investigating whether effects continue to be observed at follow-up. Therefore, the current systematic review and meta-analysis aimed to more comprehensively examine whether, and to what extent, secular MBPs increase spirituality, and to identify moderators of any observed effects.
Methods
Random effects meta-analyses were conducted on 13 controlled trials of MBPs measuring spirituality that were identified by a systematic search of PsycInfo and Medline.
Results
At post-intervention, MBPs increased spirituality compared to both passive and active controls (passive: g = 0.52, 95% C.I.: 0.35 to 0.68; active: g = 0.34, 95% C.I.: 0.14 to 0.54), and effects continued to be observed at follow-up (passive: g = 0.32, 95% C.I.: 0.09 to 0.55; active: g = 0.44, 95% C.I.: 0.18 to 0.71). For passive controls at post-intervention, cancer samples showed a significantly larger pooled effect than the non-cancer ones (cancer: g = 0.75, 95% C.I.: 0.52 to 0.98; non-cancer: g = 0.38, 95% C.I.: 0.20 to 0.56; χ²(1) = 6.14, p = 0.01), but moderation analysis was not possible at follow-up or for active controls. Study quality was not significantly associated with effect size.
Conclusions
Secular MBPs appear to increase spirituality; these effects endure beyond the end of the MBP and they cannot wholly be attributed to non-specific therapeutic factors. Limitations are discussed.
... Mohabbat-Bahar et al. (2015) showed that group training based on acceptance and commitment therapy is an effective method in reducing anxiety and depression. Henderson et al. (2012) investigated the effectiveness of a mindfulness-based stressreduction (MBSR) program on quality of life (QOL) and psychosocial outcomes in women with earlystage breast cancer, using a three-arm randomized controlled clinical trial (RCT). The MBSR intervention appears to benefit psychosocial adjustment in cancer patients, over and above the effects of usual care or a credible control condition. ...
... Although chemotherapy remains one of the major treatment modalities for women with BC, various side effects have been found among women diagnosed with BC receiving chemotherapy, which adversely affects their psychological state [6,7]. Similarly, educational needs have also been reported [8,9]. ...
Background
Women diagnosed with breast cancer (BC) receiving chemotherapy have reported various side effects, which adversely affect their psychological state. Evidence suggests that psychoeducational interventions (PEIs) delivered through mobile phones might effectively provide psychoeducational support for this population. However, there is a lack of evidence on Nigerian women’s perception of mobile health (mHealth) PEI, which prompted this study.
Method
A qualitative study was conducted among women with BC who had completed chemotherapy at two tertiary hospitals in Nigeria. Face-to-face focus group discussions were conducted at the oncology clinics. Data were collected using focus groups until data saturation was reached. Data were analyzed using thematic analysis.
Results
In total, 32 women were recruited, with seven focus group discussions conducted. The participants were between 22 and 75 years old and mostly diagnosed with Stage III BC. Four main themes emerged from the data analysis, including experiences of BC diagnosis and treatment phase, patients’ needs during chemotherapy, coping with chemotherapy, and perception of mHealth intervention for psychoeducational support. BC diagnosis was devastating, and psychological disturbances were experienced while receiving chemotherapy, but the participants indicated that mHealth intervention was acceptable as it could provide psychological and informational support. The suggested contents include information on chemotherapy, how to deal with the fear of chemotherapy, nutritious diet locally available, and information on exercise.
Conclusion
This study has shown that the participants perceived a mHealth PEI is feasible and acceptable in providing psychoeducational support for Nigerian women diagnosed with BC receiving chemotherapy. It is hoped that the unmet needs of this population will be addressed while receiving chemotherapy.
... Geary and Rosenthal (2011) found that MBSR improved health care workers' spirituality and well-being, and Garland et al. (2007) found cancer patients who received MBSR improved more in spirituality than controls. A study on coping with early-stage cancer (Henderson et al., 2012) found MBSR superior to both nutritional and usualcare controls in terms of quality of life, spiritual well-being, and meaningfulness. Kristeller and Jordan (2018) found participation in a mindfulness-based eating intervention resulted in marked improvement in spiritual well-being that explained mindfulness's impact on eating regulation. ...
... Even in the follow-up, better coping strategies oriented to the problem (instrumental support, active coping, and planning) and to emotions (acceptance, positive reprogramming, and use of emotional support) emerged. These data appear relevant as the first type of coping is to operate actively on the causes of stress, while the second type supports people's self-reflection and the expression and processing of their emotions [40][41][42]. ...
In the last decade, Mindfulness-based interventions have been increasingly used in health care settings, particularly in the context of cancer. Research documents the efficacy of these interventions for decreasing the burdens of stress, anxiety, depression, fatigue, sleep disorders, and other symptoms. This article describes the case report of a patient with breast cancer, highlighting her personality, defense mechanisms, and traumatization connected with the disease. General information about the patient’s personal and medical history is presented in addition to the trajectory of psychoncological support, focusing on objectives, intervention strategies based on Mindfulness, and outcomes. The intervention is a combination of individual and group therapies, with particular reference to the use of Mindfulness in a group setting. The goal is to provide the patient with both a peer sharing experience as well as the tools to manage psychoemotional reactions through the development of awareness and a better relationship with herself. The main hypothesized consequences are an increase in self-esteem and coping strategies, which are necessary for a successful adaptation to cancer. The objective of the Mindfulness intervention is to promote the maintenance of an adequate Quality of Life (QoL) and psychological well-being, during and after treatment, transferring these skills into daily life.
... Women faced with the diagnosis of cancer predominantly have lower QoL. Furthermore, depression and anxiety also negatively affect QoL [44]. Our investigation showed that all aspects of QoL were improved significantly among participants in both groups. ...
Breast cancer (BC) can negatively influence multiple facets of survivors’ lives including mental health, quality of life (QoL), and dietary behavior. Logotherapy as a psycho-education program may help breast cancer survivors (BCSs) discover their meaning of life throughout distressful events. The present study aimed to determine the effects of logotherapy along with nutrition counseling on psychological status, QoL, and dietary intake among BCSs who were diagnosed with depression.
This randomized clinical trial was conducted on 90 BCSs who scored ≥ 14 on Beck’s depression test. Participants were randomly assigned into two groups to receive nutrition counseling plus logotherapy (n = 46) or nutrition counseling alone (n = 44) for 8 weeks. Primary outcomes (depression, anxiety, and QoL) and secondary outcomes (anthropometric indices, dietary intake, and eating disorder status) were measured at baseline and after 8 weeks.
All dimensions of QoL, anthropometric measurements, and the compulsive eating scale improved significantly in both groups after 8 weeks. A combination of nutrition counseling and logotherapy resulted in a significant reduction in anxiety (P < 0.001) and depression (P < 0.001) scores compared with the nutrition counseling alone. In addition, participants who received logotherapy plus nutrition counseling significantly consumed less energy, carbohydrate, and fat intake after 8 weeks compared with the control group (P < 0.001).
It can be concluded that logotherapy along with nutrition education would be an important step in improving anxiety, depression, and QoL of patients with BC who had depressive symptoms.
Trial registration number: (IR.ACECR.IBCRC.REC.1396.17).
... There is limited understanding of the effects of meditation on sleep-related outcomes in patients with cancer, with no research to date examining these outcomes in hematological cancers (1.9 million in the United States) [28,57]. Existing research using apps has focused on emotional measures or cancer-specific biological changes as outcomes but not sleep disturbance [90][91][92][93][94] in survivors of solid tumors with minimal residual disease or those with short survival times (eg, patients with metastatic solid tumors). The different and distinct long-term disease courses of patients with chronic hematological cancer and the associated maintenance therapy toxicities and symptoms warrant innovative interventions that support the self-management of symptoms [3]. ...
Background:
To address the need for long-term, accessible, nonpharmacologic interventions targeting sleep in patients with chronic hematological cancer, we propose the first randomized controlled trial to determine the effects of a consumer-based mobile meditation app, Calm, on sleep disturbance in this population.
Objective:
This study aims to test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group in improving the primary outcome of self-reported sleep disturbance, as well as secondary sleep outcomes, including sleep impairment and sleep efficiency; test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group on inflammatory markers, fatigue, and emotional distress; and explore free-living use during a 12-week follow-up period and the sustained effects of Calm in patients with chronic hematological cancer.
Methods:
In a double-blinded randomized controlled trial, we will recruit 276 patients with chronic hematological cancer to an 8-week app-based wellness intervention-the active, daily, app-based meditation intervention or the health education podcast app control group, followed by a 12-week follow-up period. Participants will be asked to use their assigned app for at least 10 minutes per day during the 8-week intervention period; complete web-based surveys assessing self-reported sleep disturbance, fatigue, and emotional distress at baseline, 8 weeks, and 20 weeks; complete sleep diaries and wear an actigraphy device during the 8-week intervention period and at 20 weeks; and complete blood draws to assess inflammatory markers (tumor necrosis factor-α, interleukin-6, interleukin-8, and C-reactive protein) at baseline, 8 weeks, and 20 weeks.
Results:
This project was funded by the National Institutes of Health National Cancer Institute (R01CA262041). The projects began in April 2022, and study recruitment is scheduled to begin in October 2022, with a total project duration of 5 years. We anticipate that we will be able to achieve our enrollment goal of 276 patients with chronic hematological cancers within the allotted project time frame.
Conclusions:
This research will contribute to broader public health efforts by providing researchers and clinicians with an evidence-based commercial product to improve sleep in the long term in an underserved and understudied cancer population with a high incidence of sleep disturbance.
Trial registration:
ClinicalTrials.gov NCT05294991; https://clinicaltrials.gov/ct2/show/NCT05294991.
International registered report identifier (irrid):
PRR1-10.2196/39007.
... Geary and Rosenthal (2011) found that MBSR improved health care workers' spirituality and well-being, and Garland et al. (2007) found cancer patients who received MBSR improved more in spirituality than controls. A study on coping with early-stage cancer (Henderson et al., 2012) found MBSR superior to both a nutritional and usual-care control in terms of quality of life, spiritual well-being, and meaningfulness. Kristeller and Jordan (2018) found participation in a mindfulness-based eating intervention resulted in marked improvement in spiritual well-being that explained mindfulness's impact on eating regulation. ...
... After mastectomy, the damage to the body becomes the main source of pressure diminishing the QOL of patients. After surgery, patients experience constant anxiety, depression, fear, and other negative emotions after surgery, which will not only affect their own condition, but also impact the mood of their family members and reduces their happiness (32). If nursing staff can understand the psychological activities of patients after surgery and promptly adopt different psychological treatments according to the individual differences and psychological capacities of patients, breast cancer patients may correctly and comprehensively understand the disease. ...
Background:
With the increasing incidence of breast cancer, breast cancer patients suffered from psychological problems in different degrees. There was no unified conclusion on whether psychological intervention nursing can improve the quality of life (QOL) of breast cancer patients. This meta-analysis aimed to explore the impact of psychological nursing interventions on the quality of life of breast cancer patients.
Methods:
We retrieved related articles from both English databases (including PubMed, Medline, and Embase) and Chinese databases [including China Biology Medicine DISC (CBMdisc), China National Knowledge Network (CNKI), Wanfang, and China Science and Technology Journal Database (VIP]. All of the databases were searched using a combination of the following search terms: psychological intervention nursing, psychological nursing, psychotherapy, breast loss, radical mastectomy, modified radical mastectomy, and quality of life. The quality of the included literature was assessed using RevMan 5.3 provided by the Cochrane system.
Results:
A total of 12 articles were included, and the meta-analysis results showed that the quality of life questionnaire core 30 (QLQ-C 30) was evaluated, and there was heterogeneity among the studies (P<0.00001, I2=92%). There was no statistical difference between the intervention group and the control group [standardized mean difference (SMD) =0.58, 95% confidence interval (CI): -0.11-1.27, P=0.10]. Short Form 36 Questionnaire (SF-36) was evaluated, and there was no heterogeneity among the studies (P=0.40, I2=0%). The fixed effect model was used for Meta-analysis. There were statistical differences between the intervention group and the control group [mean difference (MD) =6.12, 95% CI: 5.17-7.06, P<0.00001]. According to the evaluation of functional assessment of cancer therapy (FACT), there is heterogeneity among the studies (P=0.003, I2=83%). There were statistical differences between the intervention group and the control group (MD =12.74, 95% CI: 6.34-19.14, P<0.0001).
Discussion:
Psychological nursing intervention can significantly improve the quality of life of patients with missing breasts undergoing radical mastectomy, which has certain guiding significance for the formulation of clinically effective nursing measures.
... Mood states were assessed using a 35-item short form of POMS Second Edition (POMS-2) (Henderson et al. 2012). The instruments are a collection of self-rating tools that allow for the assessment of transient, fluctuating feelings, and enduring affect states. ...
Objectives
As mindfulness practices become mainstream, it is increasingly common for participants in mindfulness-based interventions (MBI) to have previous meditation experience. The primary aim of this study was to assess whether the impacts of a mindfulness-based stress reduction (MBSR) program on a variety of self-report measures differed for novice meditators (NM) and regular meditators (RM).
Methods
A total of 158 Japanese participants in 10 cohorts completed questionnaires before and after an 8-week community-based MBSR program. The questionnaire consisted of Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Total Mood Disturbance (TMD) from Profile of Mood States 2, Mental Component Summary (MCS) and Physical Component Summary (PCS) of the 12-Item Short Form Health Survey (2nd version), and Perceived Stress Scale (PSS). Baseline scores and pre-post change scores were compared for RM (participants who had reported meditating ≥ 45 min/week prior to MBSR) and NM (< 45 min/week).
Results
At baseline, RM (38.0% of the sample) had significantly higher scores than NM on FFMQ, SCS, and MCS, and lower scores on TMD and PSS (i.e., less mood disturbance and less stress). Post-program, both groups showed significant improvements in all measures except PCS, with NM’s post-MBSR scores comparable to RM’s baseline scores. A significant Group (NM vs. RM) × Time (pre- vs. post-) interaction was observed only for FFMQ.
Conclusions
Regular meditators, who show greater self-compassion and better mental health than novice meditators at baseline, can benefit from MBSR to a similar extent in measures of self-compassion and other aspects of well-being.
... The interventions included 14 studies of the MBSR program and 4 of the MBCT program. Nine studies consisted of women with breast cancer (Henderson et al., 2012;Hoffman et al., 2012;Johannsen et al., 2016;Kenne Sarenmalm et al., 2017;Lengacher et al., 2014;Reich et al., 2014Reich et al., , 2017 most included RCTs were categorized as being at low risk of bias regarding the domains of follow-up compared with others. The risk of bias was high or unclear for performance, measurement, and reporting in a majority of studies. ...
This meta-analysis was a systematic review of evidence on the effects of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on quality of life (QOL), pain, fatigue, anxiety, and depression in cancer patients. Until July 2020, PubMed, Cochrane Library, and Embase were searched for randomized controlled trials (RCTs). The study included 18 RCTs. The MBSR/MBCT intervention resulted in a significant effect on QOL (SMD 0.80, CI 0.28, 1.32, I² = 94%). In subgroup analysis, MBSR/MBCT interventions had a significant effect in the early cancer stage on anxiety (SMD − 3.48, CI − 4.07, − 2.88), and QOL (SMD 4.30, CI 3.62, 4.99); in alleviating decreasing pain (SMD − 0.42, CI − 0.70, − 0.14) within 4 weeks after the end of intervention, and alleviating fatigue in younger participants (SMD − 0.64, CI − 1.09, − 0.19). MBSR/MBCT has short-term effects on cancer patients, especially in younger patients and early cancer stages.
... Although chemotherapy remains one of the major treatment modalities for women with BC, various side effects have been found among women diagnosed with BC receiving chemotherapy, which adversely affects their psychological state [6,7]. Similarly, educational needs have also been reported [8,9]. ...
Background
Women diagnosed with BC receiving chemotherapy have reported various side effects, which adversely affect their psychological state. Evidence suggests that psychoeducational interventions (PEIs) delivered through mobile phones might effectively provide psychosocial support for this population. However, there is a lack of evidence on Nigerian women's perception of mHealth PEI, which prompted this study.
Method
A multi-centre exploratory qualitative study was conducted among women with BC who had completed chemotherapy at two tertiary hospitals in Nigeria. Face-to-face focus group interviews were conducted at the oncology clinics. Data were collected using a semi-structured interview guide until data saturation was reached. Data were analysed using thematic analysis.
Results
Thirty-two women were recruited, with seven focus group interviews conducted. The participants were between 22 and 75 years old and mostly diagnosed with Stage III BC. Four main themes emerged from the data analysis, including experiences of BC diagnosis and treatment phase, patients’ needs during chemotherapy, coping with chemotherapy and perception of mHealth intervention for psychoeducational support. The participants found that mHealth intervention is acceptable, and the suggested contents include information on chemotherapy, how to deal with the fear of chemotherapy, nutritious diet locally available and information on exercise.
Conclusion
BC diagnosis was devastating, and psychological disturbances were experienced while receiving chemotherapy, but the participants perceived that mHealth intervention could provide psychological and informational support. This study will help design a culturally appropriate mHealth PEI for this population.
... For example, MBIs for cancer patients have focused on reducing pain and distress and improving general functioning by increasing awareness and acceptance of side effects [23][24][25]. In studies among cancer patients, including those with breast cancer, participation in MBIs was associated with reduced side effects (e. g., pain, hot flashes), stress, and depressive symptoms, as well as improved health-related quality of life (HRQoL) [26][27][28][29][30][31]. Recent work has also demonstrated the efficacy of MBIs when delivered via web-based platforms [32], which may be particularly important for patients with chronic illnesses who might prefer to access interventions from the convenience of their homes. ...
Background
Approximately 80% of breast cancer survivors are prescribed oral endocrine therapy (ET) medication for 5–10 years following primary treatment, making adherence to ET a critical aspect of cancer survivorship care. Despite the benefits of ET, non-adherence is problematic, and more than half of breast cancer survivors discontinue ET early. Our team developed My Journey, an online, mindfulness-based program designed to improve adherence to ET. This manuscript describes the usability testing of My Journey and the protocol development for the My Journey randomized feasibility trial.
Methods
Usability participants were women (N = 15) with a diagnosis of hormone receptor-positive non-metastatic breast cancer who had initiated ET. Participant impressions and feedback were collected qualitatively and quantitatively using items on usefulness, satisfaction, and ease of use. Participants in the 8-week feasibility trial (N = 80) will be randomized to receive the web-based My Journey intervention or a health education comparison condition.
Results
Quantitative feedback on the usability trial was favorable, with a mean overall usability score of 106.29 (SD = 7.65; Range: 83–115) indicating above average usability. Qualitative data showed that participants found several strengths in the initial design of the My Journey online tool and that participants liked the layout of My Journey.
Conclusions
Findings indicate that the My Journey online tool is useable. The program's feasibility is being evaluated in a randomized trial.
... The number of weeks of MBSR execution may result in different outcomes. Traditional MBSR courses last for 8 weeks and can effectively improve quality of life [36][37][38] and anxiety [34]. However, some studies have indicated that 6 weeks of intervention can also improve quality of life and reduce depression [13]. ...
Purpose
There have been few studies using mindfulness-based stress reduction (MBSR) to improve sexual function in Asian women with breast cancer. This study aimed to evaluate the impact of mindfulness intervention on female sexual function, mental health, and quality of life in patients with breast cancer.
Methods
Fifty-one women with breast cancer were allocated into 6-week MBSR (n=26) sessions or usual care (n=25), without differences in group characteristics. The research tools included the Female Sexual Function Index (FSFI), the Depression Anxiety Stress Scales-21 (DASS-21), and the EuroQol instrument (EQ-5D). The Greene Climacteric Scale (GCS) was used to verify the foregoing scale. The effects of MBSR were evaluated by the differences between the post- and pre-intervention scores in each scale. Statistical analyses consisted of the descriptive dataset and Mann-Whitney ranked-pairs test.
Results
Although MBSR did not significantly improve sexual desire and depression in patients with breast cancer, MBSR could improve parts of female sexual function [i.e., Δarousal: 5.73 vs. -5.96, Δlubrication: 3.35 vs. -3.48, and Δsatisfaction: 8.48 vs. 1.76; all p <.005], with a range from small to medium effect sizes. A significantly benefits were found on mental health [Δanxiety: -10.92 vs.11.36 and Δstress: -10.96 vs.11.40; both p <.001], with large effect sizes, ranging from 0.75 to 0.87.
Conclusion
Our study revealed that MBSR can improve female sexual function and mental health except for sexual desire and depression in women with breast cancer. Medical staff can incorporate MBSR into clinical health education for patients with breast cancer to promote their overall quality of life.
... 20 Mindfulness can be defined as directing attention to the present moment, including all internal and external thoughts, feelings, and bodily sensations, and encountering those with openness, curiosity, and acceptance without valuating them. 23,24 Clinical studies in BC patients have revealed positive effects of Mindfulness-Based Stress Reduction Interventions (MBSR) on stress reduction, [25][26][27] improving health-related quality of life, 27,28 and alleviating anxiety and depression 25,27,29 as well as cancer-related fatigue. 26,27,29 In systematic reviews and meta-analyses, MBSR was positively evaluated and recommended for BC patients. ...
Introduction:
Breast cancer (BC) survivors often suffer from disease- and therapy-related long-term side-effects. The study aim was to explore the feasibility, adherence, and individual experiences as well as possible effects of 2 different walking interventions in BC patients.
Methods:
This randomized controlled, pragmatic pilot trial included a qualitative study component. BC patients were randomized to either mindful walking (MFW) with mindfulness exercises and walking or moderate walking (MW) alone in weekly group sessions over 8 weeks. After 8 and 16 weeks, satisfaction, and self-perceived effectiveness as well as different health-related outcomes including health-related (WHOQOL-BREF) and disease-specific quality of life (FACT-G), perceived stress (PSQ) and cancer-related fatigue (CFS-D) were assessed. ANCOVA was used to evaluate differences in study outcomes. Qualitative data included 4 focus group interviews including 20 patients and were analyzed using a directed qualitative content analysis approach.
Results:
Altogether, 51 women (mean age 55.8 years (SD 10.9)) were randomized (n = 24 MFW; n = 27 MW). Both groups would recommend the course to other BC patients (MFW 88.9%; MW 95.2%) and showed possible improvements from baseline to week 8, without statistically significant difference between groups: WHOQOL-BREF (MFW: adjusted mean 65.4 (95% confidence interval (CI), 57.1-73.7); MW: 61.6 (53.6-69.6)); FACT-G (MFW: 76.0 (71.5-80.5); MW: 73.0 (68.5-77.4)); PSQ (MFW: 45.3 (40.5-50.1); MW: 45.4 (40.8-50.0)); CFS-D (MFW: 24.3 (20.8-27.8); MW: 25.5 (22.1-28.8)). Improvements lasted until the 16-weeks follow-up. The qualitative analysis suggested that MFW primarily promoted mindfulness, self-care, and acceptability in BC patients, whereas MW activated and empowered the patients as a result of the physical exercise.
Conclusion:
Both study interventions were positively evaluated by patients and showed possible pre-post effects in disease-specific health-related outcomes without differences between groups. The qualitative analysis results indicate that different resources and coping strategies were addressed by the 2 study interventions.
Trial registration:
DKRS00011521; prospectively registered 21.12.2016; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011521.
... Recent studies have revealed that mindfulness-based interventions (MBIs) are effective in the treatment of various mental health disorders, and they may improve psychological symptoms and reduce stress in persons with a mental illness [11,12]. Moreover, studies have shown that MBIs are effective at reducing cardiovascular disease, depression [13,14], anxiety [15], and stress [16,17], as well as improving mindfulness, positive affect, negative affect, emotion regulation, wellbeing [18], and quality of life [19]. Mindfulness can be understood as a specific form of meditation that seeks to augment various psychological functions by means of a synergic effort between attention regulation, self-awareness, and emotion regulation, thereby increasing psychological resilience and self-regulation [20]. ...
Mindfulness-based stress reduction programs have been found to be effective in reducing the stress response and improving the psychological wellbeing of various populations. We aimed to confirm the effects of a mindfulness-based stress reduction program on perceived stress, heart rate variability, positive and negative affect, and subjective wellbeing of community-dwelling people with schizophrenia. The participants in this study were 26 people with schizophrenia (experimental group: 14, control group: 12) enrolled in two community mental health centers located in Gyeonggi Province in South Korea. In the experimental group, the mindfulness-based stress reduction program was applied once a week for 60 min over 8 weeks. The experimental group showed a significantly greater decrease in perceived stress and negative affect, as well as significantly greater improvement in heart rate variability than the control group. The mindfulness-based stress reduction program was an effective nursing intervention to reduce stress and negative affect in people with schizophrenia.
... 184,185 It also improves sleep, quality of life, and psychosocial adjustment in this population. 184,186,187 Mindfulness-based stress reduction-a program developed to bring active awareness into daily activities, relationships, and communications-also demonstrated large effect sizes in stress, depression, and anxiety in a meta-analysis of 9 studies of patients with breast cancer. 188 In addition, in a large RCT among breast cancer survivors (N = 322), mindfulness-based stress reduction improved symptoms of anxiety, reduced fear of recurrence, and improved fatigue; however, the effect sizes were generally small to moderate. ...
The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low‐ and middle‐income countries (LMICs) when it comes to receiving evidence‐based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence‐based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence‐informed, patient‐centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment‐related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence‐based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence‐informed, and culturally sensitive cancer care.
... Mindfulness-based stress reduction (MBSR) techniques, through the development of a nonjudgmental awareness of the present moment, have been shown to reduce distress, improve psychological well-being, and positively impact sleep quality and quantity in cancer patients. [42][43][44][45][46][47][48] In randomized trials, MBSR techniques showed also benefits in decreasing fatigue, depression, anxiety, fear of cancer recurrence, and improved health related quality of life. [49][50][51][52][53] In addition, evidence is emerging that mindfulness meditation is effective for chronic pain. ...
Background
Breast cancer (BC) survivors have physical and psychological needs that require convincing responses by health care providers. The quality of life issue and clinical unmet needs are among the main reasons pushing a number of patients toward “natural” therapies that are often misleading and alternative to mainstream cancer care. Integrative Oncology (IO) tries to respond to many of those needs, by combining lifestyle counseling, body-mind activities, and complementary evidence-informed therapies with anticancer standard treatments.
Methods
In our model at Fondazione Policlinico Gemelli (FPG), every woman diagnosed with a BC waiting for surgery or candidate to neoadjuvant chemotherapy undergoes a preliminary psycho-oncological distress evaluation and a brief lifestyle interview. Anthropometric measurements, body composition analysis, and individual levels of physical activity are recorded. Patients are given evidence based recommendations about the advisable diet and physical activity in a prehabilitation setting. A physician provides patients with information about integrative care plans to treat symptoms related to the disease or its treatments. Therapeutic approaches include acupuncture, mindfulness-based protocols, qigong, massage therapy, and classes of music/art therapy.
Results
Between September 2018 and February 2020, the Center for Integrative Oncology at FPG has carried out 1249 lifestyle counseling sessions, 1780 acupuncture treatments, 1340 physiotherapy sessions, 3261 psycho-oncological consultations, 218 herbal medicine counseling sessions. Moreover, 90 BC patients completed the mindfulness based stress reduction (MBSR) protocol and 970 patients participated in qigong, art therapy, and music therapy classes.
Conclusions
Our integrative approach aims to achieve a person-centered medicine by improving symptoms management, adherence to oncological protocols, and eventually overall quality of life.
... Traditional MBSR courses last for 8 weeks and can effectively improve quality of life [27][28][29] and anxiety counterpart can yield improvements in depression, anxiety, and cognition. Therefore, improvements in perceived pain are achievable with short-term MBSR intervention, but depression and anxiety may require long-term MBSR [31]. ...
PurposeThere have been few studies using mindfulness-based stress reduction (MBSR) to improve sexual function in Asian women with breast cancer. This study aimed to evaluate the impact of mindfulness intervention on female sexual function, mental health and quality of life in patients with breast cancer.Methods
Fifty-one women with breast cancer were allocated into 6-week MBSR (n=26) session or usual care (n=25), without differences in group characteristics. The research tools included the Female Sexual Function Index (FSFI), the Depression Anxiety Stress Scales-21 (DASS-21), and the EuroQol instrument (EQ-5D). The Greene Climacteric Scale (GCS) was used to verify the foregoing scale. The effects of MBSR were evaluated by the differences between the post- and pre-intervention score in each scale. Statistical analyses consisted of descriptive dataset and Mann-Whitney ranked-pairs test.ResultsAlthough MBSR did not significantly improve sexual desire and depression in patients with breast cancer, MBSR could improve parts of female sexual function [i.e. Δarousal: 5.73 vs. -5.96, Δlubrication: 3.35 vs. -3.48, and Δsatisfaction: 8.48 vs. 1.76; all p <.005] assessed by the FSFI, and mental health [Δanxiety: -10.92 vs.11.36 and Δstress: -10.96 vs.11.40; both p <.001] assessed by the DASS-21.ConclusionOur study revealed that MBSR can improve female sexual function and mental health except sexual desire and depression in women with breast cancer. Medical staffs can incorporate MBSR into clinical health education for patients with breast cancer to promote their overall quality of life.
... Mindfulness is defined as present-moment nonjudgmental awareness, and its practice can take the form of formal meditation, or more informal practices, such as simply remembering to be present as one undertakes day-to-day tasks. Mindfulness-based stress reduction (MBSR) has been shown to reduce distress and improve psychological well-being in patients with cancer [65][66][67]. Preliminary evidence suggests that MBSR may produce effects comparable to pharmacologic treatment for primary insomnia [68] and positively impact sleep quality and quantity in patients with cancer [69][70][71]. ...
Neoadjuvant chemotherapy is increasingly being employed in the management of breast cancer patients. Efforts and resources have been devoted over the years to the search for an optimal strategy that can improve outcomes in the neoadjuvant setting. Today, a multidisciplinary approach with the application of evidence-based medicine is considered the gold standard for the improvement of oncological results and patient satisfaction. However, several clinical complications and psychological issues due to various factors can arise during neoadjuvant therapy and undermine outcomes. To ensure that health care needs are adequately addressed, clinicians must consider that women with breast cancer have a high risk of developing “unmet needs” during treatment, and often require a clinical intervention or additional care resources to limit possible complications and psychological issues that can occur during neoadjuvant treatment. This work describes a multidisciplinary model developed at “Fondazione Policlinico Universitario Agostino Gemelli” (FPG) in Rome in an effort to optimize treatment, ease the application of evidence-based medicine, and improve patient quality of life in the neoadjuvant setting. In developing our model, our main goal was to adequately meet patient needs while preventing high levels of distress.
... The findings reviewed in the preceding paragraphs are in line with the results of a number of preceding studies. Longitudinal follow-up of MBSR courses has shown a gradual decline in effects (e.g., Henderson et al., 2012) and those that demonstrate greater durability appear to include additional contact (e.g., Gross et al., 2011). The degree of exposure to mindfulness instruction and amount of home practice have been positively linked to the improvement of clinical symptoms (Carmody & Baer, 2009;Parsons et al., 2017); and the value of longer interventions for vulnerable populations noted (Koszycki et al., 2007;Mackenzie et al., 2007). ...
While a considerable research base demonstrates the positive effects of 8-week secular mindfulness courses, it remains unclear to what degree their participants continue to engage with mindfulness practices; and there is a dearth of published reports on longer-term mindfulness interventions. Studies have also tended to focus on clinical “effectiveness,” with less attention given to participants’ own construal and expectations of mindfulness. To address these gaps, the study reported here implemented a year-long mindfulness program for a group of 20 individuals with long-standing health conditions who gradually transitioned to self-guiding. Their experiences, expectations, and understanding of mindfulness were investigated through the lens of descriptive phenomenology. The findings revealed that mindfulness practice did bring therapeutic improvement but that it was a multi-faceted process where an individual’s intentionality toward practice was key, with a clear division between those pursuing an “embodied integrated” mindfulness and those viewing it as a stress management tool.
... Alternatively, mindfulness-based interventions may have promise for promoting emotion regulation in BCSs, as they have been found to improve related constructs such as positive affect (Bower et al., 2015), coping (Matousek & Dobkin, 2010), avoidance (Dodds et al., 2015), emotional wellbeing (Hoffman et al., 2012) and emotional control (Henderson et al., 2012) in these populations. Such mindfulness-based interventions improve emotional wellbeing in BCSs by increasing self-compassion (Boyle et al., 2017), finding that self-kindness, but not mindfulness, accounted for the positive impact of the intervention on emotional distress. ...
... The significant interaction effect and difference between groups on non-organizational (private) religiosity at postintervention can be attributed to the possibility that many participants considered mindfulness meditation a private religious activity and/or MT led participants to increase private religious activities such as other types of meditation, prayer, etc. MBHP, such as MBSR, is a secular behavioral medicine intervention that teaches skills addressed to reduce universal human suffering where spiritual themes are not explicitly explored. That being said, MBIs can enhance transcendence and awareness of interconnectedness in which oneself is not seen as separate from everyday activities, other people, or the world (123); thus, studies consistently have been suggesting that it might lead to increments in spirituality/religiosity (56,(124)(125)(126). MBHP components of values clarification and compassion/loving-kindness practices for oneself and others potentially contributed to this finding. ...
Background: Police officers' high-stress levels and its deleterious consequences are raising awareness to an epidemic of mental health problems and quality of life (QoL) impairment. There is a growing evidence that mindfulness-based interventions are efficacious to promote mental health and well-being among high-stress occupations.
Methods: The POLICE study is a multicenter randomized controlled trial (RCT) with three assessment points (baseline, post-intervention, and 6-month follow-up) where police officers were randomized to mindfulness-based health promotion (MBHP) ( n = 88) or a waiting list ( n = 82). This article focuses on QoL, depression and anxiety symptoms, and religiosity outcomes. Mechanisms of change and MBHP feasibility were evaluated.
Results: Significant group × time interaction was found for QoL, depression and anxiety symptoms, and non-organizational religiosity. Between-group analysis showed that MBHP group exhibited greater improvements in QoL, and depression and anxiety symptoms at both post-intervention (QoL d = 0.69 to 1.01; depression d = 0.97; anxiety d = 0.73) and 6-month follow-up (QoL d = 0.41 to 0.74; depression d = 0.60; anxiety d = 0.51), in addition to increasing non-organizational religiosity at post-intervention ( d = 0.31). Changes on self-compassion mediated the relationship between group and pre-to-post changes for all QoL domains and facets. Group effect on QoL overall health facet at post-intervention was moderated by mindfulness trait and spirituality changes.
Conclusion: MBHP is feasible and efficacious to improve QoL, and depression and anxiety symptoms among Brazilian officers. Results were maintained after 6 months. MBHP increased non-organizational religiosity, although the effect was not sustained 6 months later. To our knowledge, this is the first mindfulness-based intervention RCT to empirically demonstrate these effects among police officers. Self-compassion, mindfulness trait, and spirituality mechanisms of change are examined.
Clinical Trial Registration: www.ClinicalTrials.gov . identifier: NCT03114605.
... MBSR has been proven to reduce distress and improve psychological well-being. Preliminary evidence suggests that MBSR may produce effects comparable to pharmacologic treatment for primary insomnia and positively impacts sleep quality and quantity in patients with cancer (15)(16)(17)(18)(19)(20). ...
Introduction
This study aims to evaluate the efficacy and effectiveness of a mindfulness-based stress reduction (MBSR) program in improving sleep in cancer survivors.
Methods
Four electronic databases (Cochrane Library, EMBASE, PubMed, and PsycARTICLES) were searched for randomized controlled trials evaluating the effects of MBSR on the sleep of cancer survivors from their inception to May 2020. The primary outcome was sleep quality measured by validated questionnaires such as the Insomnia Severity Index and Pittsburgh Sleep Quality Index. The secondary outcome was sleep parameters obtained from a sleep diary, polysomnography, and actigraphy. The included studies were critically appraised by the Cochrane risk of bias tool and meta-analyzed.
Results
Ten studies were included, and nine studies were analyzed quantitatively. MBSR significantly improved sleep quality compared to usual care (standardized mean difference -0.29, 95% confidence interval -0.55 to -0.04, I² = 58%). However, there were no favorable results with sleep parameters. Compared to active controls, MBSR presented mixed results with sleep quality according to the outcomes and negative results with sleep parameters.
Conclusion
This review suggests that MBSR helps cancer survivors improve sleep quality. Our results support the possibility of using MBSR for cancer survivors. However, its efficacy and effectiveness in improving sleep quality and sleep parameters are inconclusive because the number of included studies was few with inconsistent results. Further studies with high methodological quality are required to establish conclusive evidence about the efficacy and effectiveness of MBSR in improving sleep quality and sleep parameters in cancer survivors.
... In patients with cancer, traditional mindfulness-based interventions have been associated with numerous positive mental health effects. They have also been shown to improve HRQoL in patients with cancer (Carlson et al., 2016;Henderson et al., 2012). Regarding mindfulness mHealth interventions, the three RCTs (Kubo et al., 2019;Rosen et al., 2018;Urech et al., 2018) in our systematic review demonstrated results in favor of the these tools compared to the controls. ...
mHealth can be used to deliver interventions to optimize Health-related quality of life (HRQoL) of cancer patients. In this systematic-review and meta-analysis, we explored the possible impact of health interventions delivered via mHealth tools on HRQoL of cancer patients. The systematic literature search was performed on July 20, 2019, to identify studies that evaluated the impact of mHealth intervention on HRQoL of cancer patients. We identified 25 studies (17 randomized controlled trials and 8 pre-post design studies; 957 patients) that evaluated mHealth interventions. The most commonly studied mHealth interventions included physical activity/ fitness interventions (9 studies), cognitive behavioral therapy (6 studies), mindfulness/ stress management (3 studies). In the majority of studies, mHealth interventions were associated with an improved HRQoL of cancer patients. The meta-analysis of the identified studies supported the positive effect of mHealth interventions for HRQoL of cancer patients. mHealth interventions are promising for improving HRQoL of cancer patients.
... The present study is part of the NIH Science of Behavior Change initiative to examine the ways in which MBIs impact self-regulation in order to improve health-related outcomes. Following recent proposals on the mechanisms of mindfulness by our group (Hölzel et al. 2011;Loucks et al. 2015) and others (Gallego et al. 2014;Henderson et al. 2012;Jensen et al. 2012;Koszycki et al. 2007;Polusny et al. 2015), the present review is one of a series that will systematically evaluate evidence for the engagement of mechanistic targets by MBIs in three broad self-regulation domains: cognitive processes, emotion regulation, and self-related processes. Of note, in this present review of emotional factors, we will consider anxiety and depression as mechanistic emotionrelated constructs, rather than as clinical outcomes. ...
Objectives
Mindfulness-based interventions (MBIs) have been widely implemented to improve self-regulation behaviors, often by targeting emotion-related constructs to facilitate change. Yet the degree to which MBIs engage specific measures of emotion-related constructs has not been systematically examined.
Methods
Using advanced meta-analytic techniques, this review examines construct and measurement engagement in trials of adults that used standardized applications of the two most established MBIs: Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), or modified variations of these interventions that met defined criteria.
Results
Seventy-two studies (N = 7,378) were included (MBSR k = 47, MBCT k = 21, modified k = 4). MBIs led to significant improvement in emotion-related processing overall, compared to inactive controls (d = 0.58; k = 36), and in all constructs assessed: depression (d = 0.66; k = 26), anxiety (d = 0.63; k = 19), combined mental health (d = 0.75; k = 7), and stress (d = 0.44; k = 11). Reactions to pain, mood states, emotion regulation, and biological measures lacked sufficient data for analysis. MBIs did not outperform active controls in any analyses. Measurement tool and population type did not moderate results, but MBI type did, in that MBCT showed stronger effects than MBSR, although these effects were driven by a small number of studies.
Conclusions
This review is the first to examine the full scope of emotion-related measures relevant to self-regulation, to determine which measures are most influenced by MBCT/MBSR. Compared to extant reviews, which typically focused on MBI outcomes, this work examined mechanistic processes based on measurement domains and tools. While effect sizes were similar among measurement tools, this review also includes a descriptive evaluation of measures and points of caution, providing guidance to MBI researchers and clinicians for selection of emotion-related measurement tools.
... Each study contributed between 1 and 8 effect size estimates, with a median of 2 effect sizes per study and a total of 88 effect size estimates. Studies contributing multiple effects involved multiple active intervention arms 40,42,48,53 or assessed SpWb at multiple follow-up times. 35 ...
Objective
Spiritual well‐being (SpWb) is an important dimension of health‐related quality of life for many cancer patients. Accordingly, an increasing number of psychosocial intervention studies have included SpWb as a study endpoint, and may improve SpWb even if not designed explicitly to do so. This meta‐analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on SpWb in adults with cancer and tested potential moderators of intervention effects.
Methods
Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which SpWb was an outcome. Doctoral‐level rater pairs extracted data using Covidence following Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. Standard meta‐analytic techniques were applied, including meta‐regression with robust variance estimation and risk‐of‐bias sensitivity analysis.
Results
Forty‐one RCTs were identified, encompassing 88 treatment effects among 3883 survivors. Interventions were associated with significant improvements in SpWb (g = 0.22, 95% CI [0.14, 0.29], p < 0.0001). Studies assessing the FACIT‐Sp demonstrated larger effect sizes than did those using other measures of SpWb (g = 0.25, 95% CI [0.17, 0.34], vs. g = 0.10, 95% CI [−0.02, 0.23], p = 0.03]. No other intervention, clinical, or demographic characteristics significantly moderated effect size.
Conclusions
Psychosocial interventions are associated with small‐to‐medium‐sized effects on SpWb among cancer survivors. Future research should focus on conceptually coherent interventions explicitly targeting SpWb and evaluate interventions in samples that are diverse with respect to race and ethnicity, sex and cancer type.
... The non-judgmental practices of the MBP may have helped women to develop the ability of mindful eating and self-control, including self-monitoring of food intake, which may have contributed to adherence to the food plan. The benefit of MBP to QoL has been noted in other populations apart from overweight and infertile women and derives from physical as well as psychosocial adjustments [55,56]. In addition, we speculate that the MBP group might have further improved their QoL by gaining self-confidence as they succeeded in the diet plan. ...
Objective:
We evaluated the short-term effects of a mindfulness-based program (MBP) on weight loss through lifestyle modification in infertile women who were overweight or obese.
Methods:
The participants were randomly assigned to 8 consecutive weekly sessions of MBP plus diet or diet alone. Both groups received a customized dietary plan. Body measures were taken and a questionnaire was applied to evaluate dietary habits at baseline and three months later.
Results:
The study was completed by 28 women in the MBP group and 24 in the control group. Body weight decreased 1.8 kg (2.1%) in the MBP group (p = 0.001, follow-up vs. baseline) and 1.7 kg (1.9%) in the control group (p = 0.035). There was an average reduction of 2.9 cm of waist circumference in the MBP group (p = 0.008) and 0.3 cm in the control group (p = 0.633). There was a significant reduction in the daily energy intake of the women attending the MBP (mean difference -430 Kcal/day, p=0.010) whereas no significant change was observed in the control group.
Conclusion:
In the short term, this MBP did not affect weight loss in infertile women, but the MBP intervention contributed to reduce waist circumference, possibly due to a significant decrease in food energy intake.
Trial registration number:
RBR-7by76r.
... Stress management and spirituality are identified as effective health promotion practices. It was found that stress reduction was effective in treating depression, hostility, unhappiness and emotional distress (Henderson et al., 2012). Spirituality and religious practices are important issues that influence individuals' health and coping (Braxton, Lang, Sales, Wingood, & DiClemente, 2007;Lozi, 2013). ...
Aim: To assess the health promotion practices of Syrian refugees in the north of
Jordan and to determine their correlation with some socio-demographic variables.
Design: Cross-sectional descriptive correlational.
Methods: Health-Promotion Lifestyle Profile II (HPLP-II) was used to measure health
promotion practices of Syrian refugees. Data were collected from a convenient sample
of 250 Syrian refugees who lived in the North of Jordan. Descriptive and inferential
statistics were used to analyse data.
Results: The results showed that Syrian refugees in Jordan had low scores of total
health promotion scale (mean = 2.28) with a cut score of 2.5, which indicated that
they minimally adopted health promotion practices in general. The higher score was
found on the interpersonal relation domain (mean = 2.89, SD 0.52). While the stress
management domain (mean = 2.48, SD 0.43), spiritual growth domain (mean = 2.38,
SD 0.39) and nutrition domain (mean = 2.34, SD 0.37) were lower than 2.5, the scores
on responsibility and physical activity domains (mean = 2.20, SD 0.62), (mean = 1.35,
SD 0.18) respectively, were the lowest. Women, married and unemployed, have more
healthy behaviours than their counterparts.
... Most of the study participants completed the treatment by their third or fourth visit. This was reflected in the observed increase in emotional functioning, which has also been reported previously [7,17]. We found a significant decrease in daily life limitations 12 months after surgery. ...
Background
This study investigated the impact of curative breast cancer surgery on patient satisfaction concerning cosmetic results and quality of life (QoL).
Methods
In this study 61 participants completed questionnaires to evaluate their QoL and patient satisfaction with cosmetic results following breast cancer surgery. Cosmetic outcomes were evaluated by the breast surgeon and an independent breast specialist using the Harris scale and the breast analyzing tool (BAT).
Results
Of the participants 71% completed all 4 follow-up visits, 38 (62%) patients received breast-conserving therapy (BCT) and 23 (38%) received a mastectomy. Surgery-associated complications arose in 2.6% of the patients who received BCT and 17.4% of patients who received a mastectomy. No significant differences in QoL between BCT patients and mastectomy patients were observed immediately after surgery, or after 6 and 12 months. Breast asymmetry, measured using the BAT score, and QoL scores were worst immediately after surgery. The surgeon rated the cosmetic results as better compared to the independent breast expert ( p = 0.001). Furthermore, patients aged over 60 years old were less satisfied with the cosmetic outcome compared to younger patients at the time of discharge ( p = 0.024). Patients who received a mastectomy were less satisfied when the resected volume was higher.
Conclusion
Patient satisfaction was lowest immediately after surgery but improved during the following months, despite continued breast asymmetry. For mastectomy patients, a lower resected volume led to a higher satisfaction with cosmetic results. Satisfaction is subjective and cannot be determined from the esthetic satisfaction of the surgeon or using an objective tool measuring breast asymmetry.
Background
Mindfulness-based stress reduction (MBSR) has been suggested as an effective mind-body approach for relieving stress in patients with chronic diseases. As of yet, there is no conclusive research on MBSR’s role in reducing affective disorders among cancer patients. A systematic review and meta-analysis was conducted to determine whether MBSR has an impact on loneliness, anxiety, and depression in cancer patients.
Methods
Systematic searches were conducted in PubMed, Embase, and the Cochrane Library from the start of these databases to January 2nd, 2022 to identify relevant randomized controlled trials. Two authors independently conducted the literature search, collected the data, and performed the statistical analysis. In order to account for potential between-study heterogeneity, a random-effect model was used in the meta-analysis.
Results
The meta-analysis included 16 studies with 2072 cancer patients. Among the 16 studies, 13 included patients with breast cancer, and the follow-up duration ranged from 6 to 53 weeks. Compared to controls receiving standard cancer care, interventions of MBSR with sessions for 6 to 8 weeks significantly improved loneliness (standard mean difference [SMD]: −0.35, 95% confidence interval [CI]: −0.59 to −0.12, P = .003, I ² = 46%), anxiety (SMD: −0.51, 95% CI: −0.73 to −0.30, P < .001, I ² = 77%), and depression (SMD: −0.61, 95% CI: −1.02 to −0.20, P = .004, I ² = 94%) in patients with cancer.
Conclusion
According to recent research, MBSR may be beneficial to patients diagnosed with cancer who are feeling lonely, anxious, or depressed.
Background: Breast cancer is the most common cancer among women, affecting their mental and social health and quality of life. Objectives: This study aims to evaluate the effectiveness of acceptance and commitment-based therapy (ACT) on the severity of pain and quality of life in patients with breast cancer. Methods: This research had a semi-experimental pre-test and post-test design with a control group, which, using the convenience sampling method, selected 30 patients with breast cancer and randomly assigned them to the experimental and control groups. During the two months, the experimental group underwent eight 90-minute sessions of ACT-based group therapy. The scores of Cleeland's severity of pain and Arenson’s quality of life questionnaires before and after the intervention were collected from two experimental and control groups and analyzed using SPSS 20. Results: The findings showed that treatment based on ACT significantly reduced pain and increased quality of life in the experimental group compared to the control group in the postoperative stage. Conclusions: Considering the findings and observed efficacy, this method can effectively reduce pain and improve the quality of life of patients with breast cancer. Therefore, it is advisable to use this method along with medical therapies by establishing counseling centers in specialty hospitals and cancer clinics.
Purpose:
To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer.
Methods:
The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations.
Results:
The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline.
Recommendations:
Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment.
Discussion:
Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.
Purpose: Breast cancer is a challenging process that affects the diagnosed people and their social environment psychologically, physiologically, socially,and economically. The main purpose of this study is to investigate the effectiveness of the Online Cognitive Behavioral Stress Management (CBSM) for Cancer program, which is prepared for people diagnosed with cancer to develop coping methods that will enable them to cope with the stress they experience in a healthy and active way. The research question is, whether attending the CBSM program is effective on psychological well- being of breast cancer patients.
Material and Method: The study was completed with a total of 35 people, 17 in the experimental group and 18 in the control group. The pretest-posttest results of the experimental and control groups formed according to cancer type and stages were analyzed. The independent sample t-test was used in the comparison of the two groups of experimental and control groups. Paired sample t-test was used to compare the pretest-posttest scores.
Results: There was no significant difference in the pre-test and post-test scores of the experimental and control groups in terms of mental adjustment to cancer. There was a significant difference observed between the experimental ,and control groups in the post-test measurements in terms of psychosocial adjustment to illness, assessment of coping attitudes, depression, hope, state and trait anxiety (p<.001).
Conclusion: It can be stated that the Online CBSM program for breast cancer patients can enable them to cope with the stress they experience in a healthy and active way.
The aim of this study is to determine how mindfulness-based stress reduction (MBSR) training affects levels of anxiety, depression, and hopelessness in menopausal women. This experimental study was conducted as a pretest-posttest, control group design in two family health centers. The sample consisted of 100 (50 in the control group, 50 in the experimental group) menopausal women, determined on basis of power analysis. Data were collected using the Descriptive Characteristics Form, the State-Trait Anxiety Inventory, the Hamilton Depression Rating Scale, and the Beck Hopelessness Scale. Whereas women in the experimental group received eight sessions of MBSR training, the women in the control group did not receive any intervention. There was a posttraining decrease in the mean anxiety, depression, and hopelessness scores of the experimental group, compared with the control group, and the difference was statistically significant (P < .05). We found that MBSR training effectively reduced anxiety, depression, and hopelessness in menopausal women. [ Psychiatr Ann 2023;53(2):83–94.]
Background:
Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015.
Objectives:
To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles.
Selection criteria:
Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer.
Data collection and analysis:
Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes.
Main results:
We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies.
Authors' conclusions:
Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
Patients with cancer and their caregivers are exposed to various disease- and treatment-related challenges along the illness and recovery continuum that elicit anxiety, emotional distress, and a depressed mood. Mindfulness-based practices facilitate the individual’s adjustment to stress by downregulating biological and behavioral stress response systems and by attenuating emotional reactivity to stressors. Regular practice may also gently shift the mind toward living fully in the present rather than in a fearful future or a mourned past. Mindful practices are particularly well suited to individuals with chronic illnesses such as cancer. The relaxation response technique is an expedient and effective mindfulness strategy that may be carried out with the patient or caregiver at the bedside or in clinic one on one or in a group workshop. The clinical benefits of other mindful practices such as the manualized 6–8-weekly mindfulness-based cancer recovery program offered in workshops are particularly suited for cancer survivors. MM is part of a comprehensive multimodal, multi-targeted approach that facilitates healing and resilience.KeywordsCancer careThe relaxation response techniqueMindful meditation practicesHealing and resilient technique
Background:
Breast cancer (BC) survivors frequently report changes in cognition after chemotherapy. Mindfulness may benefit survivors by mitigating cancer-related cognitive impairment. As part of a larger study investigating the effects of mindfulness-based stress reduction (MBSR) for BC survivors living with neuropathic pain, the authors assessed whether MBSR would have an effect on cognitive outcomes.
Methods:
Participants were randomized to an MBSR intervention group (n = 30) or a waitlist control group (n = 30). Cognitive assessments were administered at 3 time points: at baseline, 2 weeks, and 3 months post-MBSR in the intervention group and at equivalent time intervals for the control group. Multilevel models were used to assess whether MBSR significantly improved task performance at each time point.
Results:
MBSR participants showed a significantly greater reduction in prospective and retrospective memory failures at 2 weeks postintervention. No effects of MBSR were noted for objective assessments.
Conclusions:
These results suggest that MBSR training reduces subjective (but not objective) memory-related impairments in BC survivors who receive treatment with chemotherapy. This study provides insight into a noninvasive intervention to ameliorate memory difficulties in BC survivors.
Purpose of review:
Depression is a prevalent comorbidity in cancer that significantly increases the risk for numerous negative health outcomes. This review updates the current evidence base for management of depression in cancer, highlighting new research directions based on the inflammatory hypothesis of depression.
Recent findings:
Research on pharmacotherapy and psychotherapy for depression in cancer has shown mixed efficacy partly because of methodological issues arising from the phenomenology of depression in cancer. After decades of stagnancy, more recent high-quality clinical trials are beginning to provide an evidence base to guide treatment. Inflammatory cytokine-associated depression is a subtype of depression that may have particular relevance in cancer, opening new avenues to explore therapeutic targets and biobehavioral impacts of interventions, which may improve cancer outcomes.
Summary:
The continuum of severity in cancer-related depression is important to consider in management approaches. Choice of treatment should be personalized to the patient and their symptom profile as there is currently insufficient evidence to recommend any particular medication or psychotherapy over another. Psychological interventions should be considered first line for mild-to-moderate depression, and pharmacological treatment added for more severe depression, which can be optimally delivered within a collaborative care model.
Video abstract:
http://links.lww.com/YCO/A62.
Objective:
To map the scientific evidence published in the literature about nursing strategies and intervention programs directed at supporting psychological adaptation in adult cancer patients.
Method:
A scoping review based on Joanna Briggs Institute Reviewers’ Manual 2015 Methodology for JBI Scoping Reviews was conducted. Twelve databases were searched between 1 January 2012 and 31 January 2019.
Results:
From 2203 studies, 32 were included. Evidence was grouped in five subjects: procedures, outcome assessment measures, nursing feasibility, effectiveness and cost-effectiveness. The cognitive-behavioral therapy was most frequent intervention. These interventions were developed between 5 to 10 weeks, included 3 to 6 sessions and lasted up to 60 minutes. Despite a wide range of outcome measures employed, three main areas were identified, adjustment and coping; stress, anxiety and fear of recurrence; and quality of life.
Conclusion:
This review allowed to identify nursing strategies to support psychological adaptation in adult cancer patients, to assess vulnerabilities and difficulties related to nurse interventions and to recognize the need for further insights into the effectiveness and cost-effectiveness.
Background:
Patients with breast cancer usually experience depression, anxiety, stress, fatigue, pain, poor sleep quality, and low quality of life after their cancer treatment. Some studies used mindfulness-based stress reduction (MBSR) interventions for reducing these symptoms; however, the results are conflicting.
Objective:
This study evaluated the clinical efficacy of MBSR interventions in the short term.
Methods:
Five databases were searched from their inception to April 2020. We included only randomized controlled trials (RCTs) comparing MBSR intervention and control groups for symptom reduction in women with breast cancer. Pooled mean difference (MD), standardized MD, and 95% confidence intervals (CIs) were calculated using random-effects models. We used the Cochrane risk-of-bias assessment tool to assess the included RCTs.
Results:
Nineteen RCTs with 36 to 336 participants were included, of which 11 studies with a total of 1687 participants (mean age, 53.3 years) were eligible for the meta-analysis. The pooled meta-analysis results indicated that, at the end of the MBSR interventions, participants' depression (standardized MD, -1.32; 95% CI, -2.18 to -0.46; I2 = 97%) and fatigue (MD, -0.47; 95% CI, -0.59 to -0.34; I2 = 0%) levels had significantly decreased; moreover, up to 3 months after baseline, their stress levels had significantly decreased (MD, -0.79; 95% CI, -1.34 to -0.24; I2 = 0%).
Conclusion:
Mindfulness-based stress reduction interventions are highly beneficial for reducing depression, fatigue, and stress in the short term.
Implications for practice:
Mindfulness-based stress reduction interventions are cost-effective and practical. Breast cancer survivors are recommended to practice MBSR as part of their daily care routine.
Most patients with breast cancer receive psycho-educational procedures. The feasibility of these interventions has not yet been established, however. We performed a systematic review and meta-analysis to identify the psycho-social (psychoeducational and other) supporting experimental studies with breast cancer patients. Articles have been searched in electronic scientific databases. Independently assessed and collected data from eligible studies by two review authors. Discussion resolved any disagreement. The data extracted included participant information, methods, intervention and outcome. Twelve papers that meet the inclusion criteria are subjected to review. The research included a total of 1834 breast cancer participants. Significant improvement was reported after psychoeducational intervention in multiple psycho-social factors. Meta-analysis found that a significant amount of heterogenicity with high evidence-3.96 (95% CI:-4.39 to-3.83; P = <0.00001; I2 = 92%; Chi2 test P < 0.00001). Our study strengthens the evidence of psychosocial support's efficacy in improving symptoms of breast cancer and psychoeducational intervention in promoting psychological well-being.
The development of an adequate assessment instrument is a necessary prerequisite for social psychological research on loneliness. Two studies provide methodological refinement in the measurement of loneliness. Study 1 presents a revised version of the self-report UCLA (University of California, Los Angeles) Loneliness Scale, designed to counter the possible effects of response bias in the original scale, and reports concurrent validity evidence for the revised measure. Study 2 demonstrates that although loneliness is correlated with measures of negative affect, social risk taking, and affiliative tendencies, it is nonetheless a distinct psychological experience.
To investigate prevalence and severity of symptoms and symptom clustering in breast cancer survivors who attended MBSR(BC). Women were randomly assigned into MBSR(BC) or Usual Care (UC). Eligible women were ≥ 21 years, had been diagnosed with breast cancer and completed treatment within 18 months of enrollment. Symptoms and interference with daily living were measured pre- and post-MBSR(BC) using the M.D. Anderson Symptom Inventory. Symptoms were reported as highly prevalent but severity was low. Fatigue was the most frequently reported and severe symptom among groups. Symptoms clustered into 3 groups and improved in both groups. At baseline, both MBSR(BC) and the control groups showed similar mean symptom severity and interference; however, after the 6-week post-intervention, the MBSR(BC) group showed statistically-significant reduction for fatigue and disturbed sleep (P < 0.01) and improved symptom interference items, compared to the control group. For the between-group comparisons, 11 of 13 symptoms and 5 of 6 interference items had lower means in the MBSR(BC) condition than the control condition. These results suggest that MBSR(BC) modestly decreases fatigue and sleep disturbances, but has a greater effect on the degree to which symptoms interfere with many facets of life. Although these results are preliminary, MBSR intervention post-treatment may effectively reduce fatigue and related interference in QOL of breast cancer survivors.
Conducting rigorous psychosocial intervention research with cancer patients has many challenges including encouraging them to join studies, asking them to engage in interventions or be part of control conditions, and to provide data over follow-up assessments. Here, we highlight valuable insights regarding such challenges provided by investigators studying psychosocial interventions for cancer patients. Handling these skillfully has important implications for the internal and external validity of this research and the ethical treatment of participants. Challenges noted in research reports included in a systematic review of 25 years of research (comprising 488 unique projects) investigating interventions designed to enhance cancer patients' quality of life were compiled. Among the difficulties mentioned was the fact that patients may not feel the need for psychosocial interventions and thus may not be interested in joining an intervention study. Patients who do feel the need for such interventions may be deterred from joining trials by the prospect of being randomized to a nonpreferred group; if they do join a trial, participants may be disappointed, drop out, or seek compensatory additional assistance when they are assigned to a control group. Apart from randomization, other aspects of research may be off-putting to participants or potential participants, such as the language of consent forms or the intrusiveness of questions being asked. Potential remedies, such as research awareness interventions, monetary incentives, partnering with cancer support organizations, and using designs that take preferences into account merit consideration and further research inquiry.
Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period.
We conducted a randomized controlled trial of 84 female BC survivors (Stages 0-III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6-week Mindfulness-Based Stress Reduction (MBSR) program designed to self-regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF-36).
Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two-sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning.
Among BC survivors within 18 months of treatment completion, a 6-week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care.
This meta-analysis was conducted to investigate the effects of mindfulness-based stress reduction (MBSR) on the mental and physical health status of various cancer patients.
Ten studies (randomized-controlled trials and observational studies) were found to be eligible for meta-analysis. Individual study results were categorized into mental and physical variables and Cohen's effect size d was computed for each category.
MBSR may indeed be helpful for the mental health of cancer patients (Cohen's effect size d=0.48); however, more research is needed to show convincing evidence of the effect on physical health (Cohen's effect size d=0.18).
The results suggest that MBSR may improve cancer patients' psychosocial adjustment to their disease.
Quality of life in patients with breast cancer is an important outcome. This paper presents an extensive overview on the topic ranging from descriptive findings to clinical trials.
This was a bibliographic review of the literature covering all full publications that appeared in English language biomedical journals between 1974 and 2007. The search strategy included a combination of key words 'quality of life' and 'breast cancer' or 'breast carcinoma' in titles. A total of 971 citations were identified and after exclusion of duplicates, the abstracts of 606 citations were reviewed. Of these, meetings abstracts, editorials, brief commentaries, letters, errata and dissertation abstracts and papers that appeared online and were indexed ahead of publication were also excluded. The remaining 477 papers were examined. The major findings are summarized and presented under several headings: instruments used, validation studies, measurement issues, surgical treatment, systemic therapies, quality of life as predictor of survival, psychological distress, supportive care, symptoms and sexual functioning.
Instruments-Several valid instruments were used to measure quality of life in breast cancer patients. The European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer specific complementary measure (EORTC QLQ-BR23) and the Functional Assessment Chronic Illness Therapy General questionnaire (FACIT-G) and its breast cancer module (FACIT-B) were found to be the most common and well developed instruments to measure quality of life in breast cancer patients. Surgery-different surgical procedures led to relatively similar results in terms of quality of life assessments, although mastectomy patients compared to conserving surgery patients usually reported a lower body image and sexual functioning. Systemic therapies-almost all studies indicated that breast cancer patients receiving chemotherapy might experience several side-effects and symptoms that negatively affect their quality of life. Adjuvant hormonal therapies also were found to have similar negative impact on quality of life, although in general they were associated with improved survival. Quality of life as predictor of survival-similar to known medical factors, quality of life data in metastatic breast cancer patients was found to be prognostic and predictive of survival time. Psychological distress-anxiety and depression were found to be common among breast cancer patients even years after the disease diagnosis and treatment. Psychological factors also were found to predict subsequent quality of life or even overall survival in breast cancer patients. Supportive care-clinical treatments to control emesis, or interventions such as counseling, providing social support and exercise could improve quality of life. Symptoms-Pain, fatigue, arm morbidity and postmenopausal symptoms were among the most common symptoms reported by breast cancer patients. As recommended, recognition and management of these symptoms is an important issue since such symptoms impair health-related quality of life. Sexual functioning-breast cancer patients especially younger patients suffer from poor sexual functioning that negatively affect quality of life.
There was quite an extensive body of the literature on quality of life in breast cancer patients. These papers have made a considerable contribution to improving breast cancer care, although their exact benefit was hard to define. However, quality of life data provided scientific evidence for clinical decision-making and conveyed helpful information concerning breast cancer patients' experiences during the course of the disease diagnosis, treatment, disease-free survival time, and recurrences; otherwise finding patient-centered solutions for evidence-based selection of optimal treatments, psychosocial interventions, patient-physician communications, allocation of resources, and indicating research priorities were impossible. It seems that more qualitative research is needed for a better understanding of the topic. In addition, issues related to the disease, its treatment side effects and symptoms, and sexual functioning should receive more attention when studying quality of life in breast cancer patients.
This study was designed to determine the effectiveness of a group stress reduction program based on mindfulness meditation for patients with anxiety disorders.
The 22 study participants were screened with a structured clinical interview and found to meet the DSM-III-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia. Assessments, including self-ratings and therapists' ratings, were obtained weekly before and during the meditation-based stress reduction and relaxation program and monthly during the 3-month follow-up period.
Repeated measures analyses of variance documented significant reductions in anxiety and depression scores after treatment for 20 of the subjects--changes that were maintained at follow-up. The number of subjects experiencing panic symptoms was also substantially reduced. A comparison of the study subjects with a group of nonstudy participants in the program who met the initial screening criteria for entry into the study showed that both groups achieved similar reductions in anxiety scores on the SCL-90-R and on the Medical Symptom Checklist, suggesting generalizability of the study findings.
A group mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia.
While it is recognized that quality of life is ultimately as important as quantity of life, efforts to implement quality of life measurement often fail. Two basic reasons for that failure include: 1) definitional differences, where different investigators attribute different meaning to the term and, as a result, are measuring different endpoints; and 2) insufficient information about available measures, which can lead to improper test selection and unnecessary regeneration of new items. Included in this paper is a table that reviews many available quality of life measures that have been designed for, or frequently used with, people with cancer. Proper selection of measures and supplementary questions is an important first step toward a successful evaluation of quality of life.
We developed and validated a brief, yet sensitive, 33-item general cancer quality-of-life (QL) measure for evaluating patients receiving cancer treatment, called the Functional Assessment of Cancer Therapy (FACT) scale.
The five-phase validation process involved 854 patients with cancer and 15 oncology specialists. The initial pool of 370 overlapping items for breast, lung, and colorectal cancer was generated by open-ended interview with patients experienced with the symptoms of cancer and oncology professionals. Using preselected criteria, items were reduced to a 38-item general version. Factor and scaling analyses of these 38 items on 545 patients with mixed cancer diagnoses resulted in the 28-item FACT-general (FACT-G, version 2). In addition to a total score, this version produces subscale scores for physical, functional, social, and emotional well-being, as well as satisfaction with the treatment relationship. Coefficients of reliability and validity were uniformly high. The scale's ability to discriminate patients on the basis of stage of disease, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time. Finally, the validity of measuring separate areas, or dimensions, of QL was supported by the differential responsiveness of subscales when applied to groups known to differ along the dimensions of physical, functional, social, and emotional well-being.
The FACT-G meets or exceeds all requirements for use in oncology clinical trials, including ease of administration, brevity, reliability, validity, and responsiveness to clinical change. Selecting it for a clinical trial adds the capability to assess the relative weight of various aspects of QL from the patient's perspective.
The findings of two meta-analyses of trials of psychological interventions in patients with cancer are presented: the first using anxiety and the second depression, as a main outcome measure. The majority of the trials were preventative, selecting subjects on the basis of a cancer diagnosis rather than on psychological criteria. For anxiety, 25 trials were identified and six were excluded because of missing data. The remaining 19 trials (including five unpublished) had a combined effect size of 0.42 standard deviations in favour of treatment against no-treatment controls (95% confidence interval (CI) 0.08-0.74, total sample size 1023). A most robust estimate is 0.36 which is based on a subset of trials which were randomized, scored well on a rating of study quality, had a sample size > 40 and in which the effect of trials with very large effects were cancelled out. For depression, 30 trials were identified, but ten were excluded because of missing data. The remaining 20 trials (including six unpublished) had a combined effect size of 0.36 standard deviations in favour of treatment against no-treatment controls (95% CI 0.06-0.66, sample size 1101). This estimate was robust for publication bias, but not study quality, and was inflated by three trials with very large effects. A more robust estimate of mean effect is the clinically weak to negligible value of 0.19. Group therapy is at least as effective as individual. Only four trials targeted interventions at those identified as at risk of, or suffering significant psychological distress, these were associated with clinically powerful effects (trend) relative to unscreened subjects. The findings suggest that preventative psychological interventions in cancer patients may have a moderate clinical effect upon anxiety but not depression. There are indications that interventions targeted at those at risk of or suffering significant psychological distress have strong clinical effects. Evidence on the effectiveness of such targeted interventions and of the feasibility and effects of group therapy in a European context is required.
The authors tested effects of a 10-week group cognitive-behavioral stress management intervention among 100 women newly treated for Stage 0-II breast cancer. The intervention reduced prevalence of moderate depression (which remained relatively stable in the control condition) but did not affect other measures of emotional distress. The intervention also increased participants' reports that having breast cancer had made positive contributions to their lives, and it increased generalized optimism. Both remained significantly elevated at a 3-month follow-up of the intervention. Further analysis revealed that the intervention had its greatest impact on these 2 variables among women who were lowest in optimism at baseline. Discussion centers on the importance of examining positive responses to traumatic events--growth, appreciation of life, shift in priorities, and positive affect-as well as negative responses.
PURPOSE
We developed and validated a brief, yet sensitive, 33-item general cancer quality-of-life (QL) measure for evaluating patients receiving cancer treatment, called the Functional Assessment of Cancer Therapy (FACT) scale.
METHODS AND RESULTS
The five-phase validation process involved 854 patients with cancer and 15 oncology specialists. The initial pool of 370 overlapping items for breast, lung, and colorectal cancer was generated by open-ended interview with patients experienced with the symptoms of cancer and oncology professionals. Using preselected criteria, items were reduced to a 38-item general version. Factor and scaling analyses of these 38 items on 545 patients with mixed cancer diagnoses resulted in the 28-item FACT-general (FACT-G, version 2). In addition to a total score, this version produces subscale scores for physical, functional, social, and emotional well-being, as well as satisfaction with the treatment relationship. Coefficients of reliability and validity were uniformly high. The scale's ability to discriminate patients on the basis of stage of disease, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time. Finally, the validity of measuring separate areas, or dimensions, of QL was supported by the differential responsiveness of subscales when applied to groups known to differ along the dimensions of physical, functional, social, and emotional well-being.
CONCLUSION
The FACT-G meets or exceeds all requirements for use in oncology clinical trials, including ease of administration, brevity, reliability, validity, and responsiveness to clinical change. Selecting it for a clinical trial adds the capability to assess the relative weight of various aspects of QL from the patient's perspective.
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
Many cancer patients use psychological therapies because they expect them to cure their cancer or to improve their recovery.
Despite these high expectations, both patients and oncologists report being moderately to very satisfied with the results
of psychological therapies. Previous reviews of the literature have concluded that psychological therapies may help cancer
patients in various ways, ranging from reducing the side effects of cancer treatments to improving patients' immune function
and longevity. However, because those reviews lacked methodologic rigor, we critically and systematically reviewed all identifiable
publications about psychological therapies used by cancer patients to provide an objective and scientific evaluation of nontraditional
therapies. We identified 627 relevant papers that reported on 329 intervention trials by searching MEDLINE™, Healthplan™,
Psychlit™, and Allied and Complementary Medicine™ databases and in the bibliographies of the papers identified. Despite increased
use of randomized, controlled trial designs over time, the methodologic quality of the intervention trials, on 10 internal
validity indicators, was generally suboptimal, with only one trial achieving a quality rating of “good” for its methodology.
Using effectiveness results from 34 trials with psychosocial outcomes, 28 trials with side effect outcomes, 10 trials with
conditioned side-effect outcomes, and 10 trials with survival or immune outcomes, we make only tentative recommendations about
the effectiveness of psychological therapies for improving cancer patients' outcomes. Nevertheless, by exploring the relative
effectiveness of the different intervention strategies for each outcome and follow-up period, we suggest the specific therapies
that should be considered for further investigation. In addition, we suggest how future trials can maximize their internal
validity by describing the minimal reporting standards that should be required in this field.
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
Objective:
In a review of the literature from 1980 to 1994 on psychological and psychiatric problems in patients with cancer, the prevalence, severity, and the course of these problems (i.e., depression, anxiety, and general psychological distress) were studied with the help of meta-analyses and qualitative analyses. Apart from this, qualitative analyses were also applied with respect to other relevant variables.
Method:
A literature search in MEDLINE was conducted and cross-references of articles identified via MEDLINE. Meta-analysis was applied when possible.
Results:
There seemed to be a wide variation across studies in psychological and psychiatric problems. Meta-analysis showed no significant differences between cancer patients and the normal population with respect to anxiety and psychological distress. However, cancer patients seemed to be significantly more depressed than normals. Compared with psychiatric patients, cancer patients were significantly less depressed, anxious, or distressed. Compared with a sample of other medical patients, cancer patients showed significantly less anxiety. With respect to course, a significant decrease was found in the meta-analysis for anxiety, but not for depression. Further meta-analyses showed significant differences among groups of cancer patients with regard to tumor site, sex, age, design of the study, and year of publication. From the qualitative analyses, it seemed that medical, sociodemographic, and psychological variables were related inconsistently to psychological and psychiatric problems.
Conclusion:
With the exception of depression, the amount of psychological and psychiatric problems in patients with cancer does not differ from the normal population. The amount of psychological and psychiatric problems is significantly less in cancer patients than in psychiatric patients. The amount of anxiety is significantly less in cancer patients than in other groups of medical patients with mixed diagnoses, whereas depression is not. Future studies should aim at exploring possible causes for the sometimes impressive differences in psychological or psychiatric problems among patients with cancer.
Replies to comments offered by J. C. Coyne and A. Kagee (see record 2001-05135-009 ) on the M. H. Antoni et al (see record 2000-14051-003 ) study on cognitive-behavioral stress management intervention's role in decreasing the prevalence of depression among women being treated for breast cancer. The authors of this article dispute the claim that patients in need cannot access interventions.
Recent data indicate that the patient-centered counseling model enhances long-term dietary adherence. This model facilitates change by assessing patient needs and subsequently tailoring the intervention to the patient’s stage in the process of change, personal goals, and unique challenges. This article describes this model, including its theoretical foundations, a 4step counseling process, and applications. This behavioral counseling model can help nutrition professionals enhance patient adherence to nutrition care plans and dietary guidelines. J Am Diet Assoc. 2001;101:332-338,341.
Antonovsky's approach—first presented in his groundbreaking book, "Health, Stress, and Coping"—is to uncover the psychological, social, and cultural resources that people can and do use successfully in resisting illness. In that earlier book, Antonovsky showed how a "sense of coherence," or way of making sense of the world, is a major factor in determining how well a person manages stress and stays healthy. Now in this new book, Antonovsky builds on the ideas outlined in "Health, Stress, and Coping," explaining in greater detail how the sense of coherence affects health. He brings together recent studies on health and illness and shows their relationships to the sense of coherence concept. He presents a complete questionnaire that professionals can use to measure the sense of coherence and discusses the evidence for its validity. And he explores the neurophysiological, endocrinological, and immunological pathways through which the sense of coherence influences health outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
start with a formal definition of the SOC [sense of coherence concept] and its three components: comprehensibility, manageability, and meaningfulness / focus on the pathways through which the SOC and health are related
after identifying the dual issue involved in coping with stressful life events, instrumental problem solving and the regulation of emotion, a three-stage primary appraisal process is delineated, which then takes us to the selection of an appropriate coping strategy, action, and feedback evaluation / GRRs [generalized resistance resources] are defined as potential resources, which the person with a strong SOC can mobilize and then apply
the subsequent section focuses on the ways in which the strength of the SOC is central to regulation of the emotional tension generated by confrontation with stressors / in the last section, I turn directly . . . to neurophysiological, endocrinological, and immunological mechanisms through which the SOC influences health outcome (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Two hundred twenty-five chronic pain patients were studied following training in mindfulness meditation. Large and significant overall improvements were recorded post-intervention in physical and psychological status. These gains were maintained at follow-up in the majority of subjects. Follow-up times ranged from 2.5-48 months. Status on the McUill Melzack Fain Rating Index (PRI). however, tended to revert to preintervention levels following the intervention. Most subjects reported a high degree of adherence with the meditation techniques, maintenance of improved status over time, and a high degree of importance attributed to the training program. We conclude that such training can have long-term benefit for chronic pain patients.
(C) Lippincott-Raven Publishers.
Two hundred twenty-five chronic pain patients were studied following training in mindfulness meditation. Large and significant overall improvements were recorded post-intervention in physical and psychological status. These gains were maintained at follow-up in the majority of subjects. Follow-up times ranged from 2.5-48 months. Status on the McGill Melzack Pain Rating Index (PRI), however, tended to revert to preintervention levels following the intervention. Most subjects reported a high degree of adherence with the meditation techniques, maintenance of improved status over time, and a high degree of importance attributed to the training program. We conclude that such training can have long-term benefit for chronic pain patients.
The current study explored the relationship of coping to both psychological and health parameters in 50 gay men recently (within three months) diagnosed with AIDS. Three methods of coping (active behavioral, active cognitive, and avoidance) and eight different coping strategies (positive involvement, expressive/ information seeking, reliance on others, positive understanding/create meaning, passive/ruminative, distraction, passive resignation, and solitary/passive behaviors) were assessed. Findings indicate that avoidance coping is not protecting these people from distressful feelings, mood disturbance, and concerns. The three coping methods evidenced distinctly different associations with measures of psychological and health variables. Active-behavioral coping was related to lower total mood disturbance and higher self-esteem, while avoidance coping was inversely related to self-esteem and positively correlated with depression. The frequencies of specific coping strategies indicate men in this study were using cognitive strategies most frequently. Suggestions for interventions to help people cope with AIDS are given.
The development of a 21-item self-report inventory for measuring the severity of anxiety in psychiatric populations is described. The initial item pool of 86 items was drawn from three preexisting scales: the Anxiety Checklist, the Physician’s Desk Reference Checklist, and the Situational Anxiety Checklist. A series of analyses was used to reduce the item pool. The resulting Beck Anxiety Inventory (BAI) is a 21-item scale that showed high internal consistency (α = .92) and test—retest reliability over 1 week, r (81) = .75. The BAI discriminated anxious diagnostic groups (panic disorder, generalized anxiety disorder, etc.) from nonanxious diagnostic groups (major depression, dysthymic disorder, etc). In addition, the BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale, r (150) = .51, and was only mildly correlated with the revised Hamilton Depression Rating Scale, r (153) = .25.