Abstract
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.
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References
Andersen, S. R., Würtzen, H., Steding-Jessen, M., Christensen, J., Andersen, K. K., Flyger, H., Mitchelmore, C., Johansen, C., Mitchelmore, C., Johansen, C., & Dalton, S. O. (2013). Effect of mindfulness-based stress reduction on sleep quality: Results of a randomized trial among Danish breast cancer patients. Acta Oncologica, 52(2), 336–344. https://doi.org/10.3109/0284186X.2012.745948
Blaes, A. H., Fenner, D., Bachanova, V., Torkelson, C., Geller, M., Haddad, T., Shanley, R., & Kreitzer, M. J. (2016). Mindfulness-based cancer recovery in survivors recovering from chemotherapy and radiation. Journal of Community and Supportive Oncology, 14, 351–358.
Bower, J. E. (2014). Cancer-related fatigue–mechanisms, risk factors, and treatments. Nature Reviews: Clinical Oncology, 11(10), 597–609. https://doi.org/10.1038/nrclinonc.2014.127
Branstrom, R., Kvillemo, P., Brandberg, Y., & Moskowitz, J. T. (2010). Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients–a randomized study. Annals of Behavioral Medicine, 39(2), 151–161. https://doi.org/10.1007/s12160-010-9168-6
Branstrom, R., Kvillemo, P., & Moskowitz, J. T. (2012). A randomized study of the effects of mindfulness training on psychological well-being and symptoms of stress in patients treated for cancer at 6-month follow-up. International Journal of Behavioral Medicine, 19(4), 535–542. https://doi.org/10.1007/s12529-011-9192-3
Carlson, L. E., Angen, M., Cullum, J., Goodey, E., Koopmans, J., Lamont, L., MacRae, J. H., Martin, M., Pelletier, G., Robinson, J., Simpson, J. S., Speca, M., Tillotson, L., & Bultz, B. D. (2004). High levels of untreated distress and fatigue in cancer patients. British Journal of Cancer, 90(12), 2297–2304. https://doi.org/10.1038/sj.bjc.6601887
Castanhel, F. D., & Liberali, R. (2018). Mindfulness-Based Stress Reduction on breast cancer symptoms: Systematic review and meta-analysis. Einstein, 16(4), eRW4383-eRW4383. https://doi.org/10.31744/einstein_journal/2018RW4383.
Cillessen, L., Johannsen, M., Speckens, A. E. M., & Zachariae, R. (2019). Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials. Psycho-Oncology. https://doi.org/10.1002/pon.5214
Cochrane. (2019). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Retrieved from http://www.training.cochrane.org/handbook
Foley, E., Baillie, A., Huxter, M., Price, M., & Sinclair, E. (2010). Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 78(1), 72–79. https://doi.org/10.1037/a0017566
Haller, H., Winkler, M. M., Klose, P., Dobos, G., Kummel, S., & Cramer, H. (2017). Mindfulness-based interventions for women with breast cancer: An updated systematic review and meta-analysis. Acta Oncologica, 56(12), 1665–1676. https://doi.org/10.1080/0284186X.2017.1342862
Henderson, V. P., Clemow, L., Massion, A. O., Hurley, T. G., Druker, S., & Hebert, J. R. (2012). The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: A randomized trial. Breast Cancer Research and Treatment, 131(1), 99–109. https://doi.org/10.1007/s10549-011-1738-1
Henderson, V. P., Massion, A. O., Clemow, L., Hurley, T. G., Druker, S., & Hébert, J. R. (2013). A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integrative Cancer Therapies, 12(5), 404–413. https://doi.org/10.1177/1534735412473640
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414), 557–560. https://doi.org/10.1136/bmj.327.7414.557
Hoffman, C. J., Ersser, S. J., Hopkinson, J. B., Nicholls, P. G., Harrington, J. E., & Thomas, P. W. (2012). Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: A randomized, controlled trial. Journal of Clinical Oncology, 30(12), 1335–1342. https://doi.org/10.1200/jco.2010.34.0331
Johannsen, M., O’Connor, M., O’Toole, M. S., Jensen, A. B., Hojris, I., & Zachariae, R. (2016). Efficacy of mindfulness-based cognitive therapy on late post-treatment pain in women treated for primary breast cancer: A randomized controlled trial. Journal of Clinical Oncology, 34(28), 3390–3399. https://doi.org/10.1200/jco.2015.65.0770
Johannsen, M., O’Connor, M., O’Toole, M. S., Jensen, A. B., & Zachariae, R. (2018). Mindfulness-based cognitive therapy and persistent pain in women treated for primary breast cancer: Exploring possible statistical mediators: Results from a randomized controlled trial. The Clinical Journal of Pain, 34(1), 59–67. https://doi.org/10.1097/AJP.0000000000000510
Johannsen, M., O’Toole, M. S., O’Connor, M., Jensen, A. B., & Zachariae, R. (2017). Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer - explorative analyses from a randomized controlled trial. Acta Oncologica, 56(2), 321–328. https://doi.org/10.1080/0284186X.2016.1268713
Johns, S. A., Brown, L. F., Beck-Coon, K., Monahan, P. O., Tong, Y., & Kroenke, K. (2015). Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psycho-Oncology, 24(8), 885–893. https://doi.org/10.1002/pon.3648
Kang, H. (2016). How to understand and conduct evidence-based medicine. Korean Journal Anesthesiol, 69(5), 435–445. https://doi.org/10.4097/kjae.2016.69.5.435
Kenne Sarenmalm, E., Martensson, L. B., Andersson, B. A., Karlsson, P., & Bergh, I. (2017). Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Medicine, 6(5), 1108–1122. https://doi.org/10.1002/cam4.1052
Kingston, T., Collier, S., Hevey, D., McCormick, M. M., Besani, C., Cooney, J., & O’Dwyer, A. M. (2015). Mindfulness-based cognitive therapy for psycho-oncology patients: An exploratory study. Irish Journal of Psychological Medicine, 32(3), 265–274. https://doi.org/10.1017/ipm.2014.81
Lengacher, C. A., Johnson-Mallard, V., Post-White, J., Moscoso, M. S., Jacobsen, P. B., Klein, T. W., Widen, R. H., Fitzgerald, S. G., Shelton, M. M., Barta, M., Goodman, M., & Kip, K. E. (2009). Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology, 18(12), 1261–1272. https://doi.org/10.1002/pon.1529
Lengacher, C. A., Reich, R. R., Paterson, C. L., Ramesar, S., Park, J. Y., Alinat, C., Johnson-Mallard, V., Moscoso, M., Budhrani-Shani, P., Miladinovic, B. Jacobsen, P. B., & Kip, K. E. (2016). Examination of broad symptom improvement resulting from mindfulness-based stress reduction in breast cancer survivors: A randomized controlled trial. Journal of Clinical Oncology, 34(24), 2827–2834. https://doi.org/10.1200/jco.2015.65.7874
Lengacher, C. A., Shelton, M. M., Reich, R. R., Barta, M. K., Johnson-Mallard, V., Moscoso, M. S., Paterson, C., Ramesar, S., Budhrani, P., Carranza, I. and Lucas, J., & Kip, K. E. (2014). Mindfulness based stress reduction (MBSR(BC)) in breast cancer: Evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). Journal of Behavioral Medicine, 37(2), 185–195. https://doi.org/10.1007/s10865-012-9473-6
Lerman, R., Jarski, R., Rea, H., Gellish, R., & Vicini, F. (2012). Improving symptoms and quality of life of female cancer survivors: A randomized controlled study. Annals of Surgical Oncology, 19(2), 373–378. https://doi.org/10.1245/s10434-011-2051-2
Lindsay, E. K., & Creswell, J. D. (2017). Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT). Clinical Psychology Review, 51, 48–59. https://doi.org/10.1016/j.cpr.2016.10.011
Liu, T., Zhang, W., Xiao, S., Xu, L., Wen, Q., Bai, L., Ma, Q., & Ji, B. (2019). Mindfulness-based stress reduction in patients with differentiated thyroid cancer receiving radioactive iodine therapy: A randomized controlled trial. Cancer Management and Research, 11, 467–474. https://doi.org/10.2147/CMAR.S183299
Michaelides, A., & Zis, P. (2019). Depression, anxiety and acute pain: Links and management challenges. Postgraduate Medicine, 131(7), 438–444. https://doi.org/10.1080/00325481.2019.1663705
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery (london, England), 8(5), 336–341. https://doi.org/10.1016/j.ijsu.2010.02.007
Ngamkham, S., Holden, J. E., & Smith, E. L. (2019). A systematic review: Mindfulness intervention for cancer-related pain. Asia-Pacific Journal of Oncology Nursing, 6(2), 161–169. https://doi.org/10.4103/apjon.apjon_67_18
Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M. (2018). SEER Cancer Statistics Review, 1975–2015. Retrieved from https://seer.cancer.gov/csr/1975_2015/
Rahmani, S., & Talepasand, S. (2015). The effect of group mindfulness-based stress reduction program and conscious yoga on the fatigue severity and global and specific life quality in women with breast cancer. Medical Journal of the Islamic Republic of Iran, 29, 175.
Reich, R. R., Lengacher, C. A., Alinat, C. B., Kip, K. E., Paterson, C., Ramesar, S., Han, H. S., Ismail-Khan, R., Johnson-Mallard, V., Moscoso, M., Budhrani-Shani, P., & Park, J. (2017). Mindfulness-based stress reduction in post-treatment breast cancer patients: Immediate and sustained effects across multiple symptom clusters. Journal of Pain and Symptom Management, 53(1), 85–95. https://doi.org/10.1016/j.jpainsymman.2016.08.005
Reich, R. R., Lengacher, C. A., Kip, K. E., Shivers, S. C., Schell, M. J., Shelton, M. M., & Klein, T. W. (2014). Baseline immune biomarkers as predictors of MBSR(BC) treatment success in off-treatment breast cancer patients. Biological Research for Nursing, 16(4), 429–437. https://doi.org/10.1177/1099800413519494
Schell, L. K., Monsef, I., Wöckel, A., & Skoetz, N. (2019). Mindfulness-based stress reduction for women diagnosed with breast cancer. The Cochrane Database of Systematic Reviews, 3(3), CD011518-CD011518. https://doi.org/10.1002/14651858.CD011518.pub2.
Schellekens, M. P. J., van den Hurk, D. G. M., Prins, J. B., Donders, A. R. T., Molema, J., Dekhuijzen, R., van der Drift, M. A., & Speckens, A. E. M. (2017). Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial. Psycho-Oncology, 26(12), 2118–2126. https://doi.org/10.1002/pon.4430
Speca, M., Carlson, L. E., Goodey, E., & Angen, M. (2000). A randomized, wait-list controlled clinical trial: The effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62(5), 613–622. https://doi.org/10.1097/00006842-200009000-00004
Suurmond, R., van Rhee, H., & Hak, T. (2017). Introduction, comparison, and validation of meta-essentials: A free and simple tool for meta-analysis. Research Synthesis Methods, 8(4), 537–553. https://doi.org/10.1002/jrsm.1260
The Nordic Cochrane Centre. (2012). Review Manager (RevMan). (Version 5.3) [Computer program]. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration.
Tiller, J. W. (2013). Depression and anxiety. Medical Journal Australia, 199(S6), S28-31. https://doi.org/10.5694/mja12.10628
Tsaras, K., Papathanasiou, I. V., Mitsi, D., Veneti, A., Kelesi, M., Zyga, S., & Fradelos, E. C. (2018). Assessment of depression and anxiety in breast cancer patients: prevalence and associated Factors. Asian Pacific Journal of Cancer Prevention, 19(6), 1661–1669. https://doi.org/10.22034/apjcp.2018.19.6.1661.
van der Lee, M. L., & Garssen, B. (2012). Mindfulness-based cognitive therapy reduces chronic cancer-related fatigue: A treatment study. Psycho-Oncology, 21(3), 264–272. https://doi.org/10.1002/pon.1890
World Health Organization. (2018). Cancer. Retrieved from https://www.who.int/news-room/fact-sheets/detail/cancer
Würtzen, H., Dalton, S. O., Christensen, J., Andersen, K. K., Elsass, P., Flyger, H. L., & Johansen, C. (2015). Effect of mindfulness-based stress reduction on somatic symptoms, distress, mindfulness and spiritual wellbeing in women with breast cancer: Results of a randomized controlled trial. Acta Oncologica, 54(5), 712–719. https://doi.org/10.3109/0284186X.2014.997371
Wurtzen, H., Dalton, S. O., Elsass, P., Sumbundu, A. D., Steding-Jensen, M., Karlsen, R. V., & Johansen, C. (2013). Mindfulness significantly reduces self-reported levels of anxiety and depression: Results of a randomised controlled trial among 336 Danish women treated for stage I-III breast cancer. European Journal of Cancer, 49(6), 1365–1373. https://doi.org/10.1016/j.ejca.2012.10.030
Zhang, J. Y., Zhou, Y. Q., Feng, Z. W., Fan, Y. N., Zeng, G. C., & Wei, L. (2017). Randomized controlled trial of mindfulness-based stress reduction (MBSR) on posttraumatic growth of Chinese breast cancer survivors. Psychology, Health & Medicine, 22(1), 94–109. https://doi.org/10.1080/13548506.2016.1146405
Zhang, M. F., Wen, Y. S., Liu, W. Y., Peng, L. F., Wu, X. D., & Liu, Q. W. (2015). Effectiveness of mindfulness-based terapy for reducing anxiety and depression in patients with cancer: A meta-analysis. Medicine (baltimore), 94(45), e0897-e1890. https://doi.org/10.1097/md.0000000000000897
Zhang, Q., Zhao, H., & Zheng, Y. (2019). Effectiveness of mindfulness-based stress reduction (MBSR) on symptom variables and health-related quality of life in breast cancer patients—A systematic review and meta-analysis. Supportive Care in Cancer, 27(3), 771–781. https://doi.org/10.1007/s00520-018-4570-x
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We acknowledge Hsiao-Hsuan Cheng and Ya-Ting Hu for their support in the implementation of this project.
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This work was supported by Kaohsiung Veterans General Hospital 429 (VGHKS107-D03-3).
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The authors confirm contribution to the paper as follows: study conception and design: PCL and PLH; data collection: LYL and LHL; analysis and interpretation of results: GLT, YHH, and JFT; draft manuscript preparation: YLC, CJW, and LYL. All authors reviewed the results and approved the final version of the manuscript.
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Lin, LY., Lin, LH., Tzeng, GL. et al. Effects of Mindfulness-Based Therapy for Cancer Patients: A Systematic Review and Meta-analysis. J Clin Psychol Med Settings 29, 432–445 (2022). https://doi.org/10.1007/s10880-022-09862-z
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DOI: https://doi.org/10.1007/s10880-022-09862-z