Research Update — February 2021

Cillessen, L., Johannsen, M., Speckens, A.E.M., et al.
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 (2019), 28(12), 2257-2269.

ABSTRACT

Objective: Mindfulness-based interventions (MBIs) are increasingly used within psycho-oncology. Since the publication of the most recent comprehensive meta-analysis on MBIs in cancer in 2012, the number of published trials has more than doubled. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), testing the efficacy of MBIs on measures of psychological distress (primary outcome) and other health outcomes in cancer patients and survivors.

Methods: Two authors conducted independent literature searches in electronic databases from first available date to 10 October 2018, selected eligible studies, extracted data for meta-analysis and evaluated risk of bias.

Results: Twenty-nine independent RCTs (reported in 38 papers) with 3274 participants were included. Small and statistically significant pooled effects of MBIs on combined measures of psychological distress were found at post-intervention (Hedges’ g = 0.32; 95%CI: 0.22-0.41; P < .001) and follow-up (g = 0.19; 95%CI: 0.07-0.30; P < .002). Statistically significant effects were also found at either post-intervention or follow-up for a range of self-reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances and pain (g: 0.20 to 0.51; p: <.001 to.047). Larger effects of MBIs on psychological distress were found in studies (a) adhering to the original MBI manuals, (b) with younger patients, (c) with passive control conditions and (d) shorter time to follow-up. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post-intervention.

Conclusions: MBIs appear efficacious in reducing psychological distress and other symptoms in cancer patients and survivors. However, many of the effects were of small magnitude, suggesting a need for intervention optimization research.

INSPIREHEALTH’S INTERPRETATION

Interest in the long-term wellbeing of cancer survivors continues to grow. Awareness of the psychological impact of a cancer diagnosis and increasing numbers of cancer survivors, drive important research into developing strategies to reduce psychological distress. One widely studied method of supporting psychological distress is the use of Mindfulness-Based Interventions (MBIs). Jon Kabat-Zinn, a pioneer in MBIs and the creator of Mindfulness-Based Stress Reduction (MBSR) programs, defines mindfulness as “the awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally”. Examples of MBIs include meditation, breath practices, practicing gratitude, awareness of the senses, practicing self-compassion, among others. Some programs are more formalized and structured than others.

This research paper focused on reviewing the current literature (which included 29 randomized controlled trials totaling data for 3274 participants) related to the effects MBIs for cancer patients on factors of psychological distress, such as anxiety, depression and fear of cancer recurrence as well as the role of MBIs in symptom management of pain, fatigue and sleep disturbance.

Several types of MBIs were studied including Mindfulness Awareness Practices, Mindfulness-Based Art Therapy, Mindfulness-Based Cancer Recovery, Mindfulness-Based Cognitive Therapy (MBCT), and MBSR. Of these, MBCT and MBSR had the most well-developed protocols. Results indicated that MBIs were modestly to moderately effective at lessening psychological distress and physical symptoms such as pain, fatigue and poor sleep. Although those participants under 65 years of age seemed to benefit more from MBIs than those participants over 65, time since diagnosis, type and stage of cancer were unrelated to intervention gain, suggesting that benefits could be achieved at any time. Furthermore, benefits seemed greater in those studies adhering more closely to the standardized protocols of MBCT and MBSR. Importantly, MBIs have not shown any negative effects. Given the variety of MBIs available and the ease of creating a home practice, MBIs can be fairly easily incorporated into a healing and/or wellness plan. InspireHealth clinicians are always available to help explore the MBI that may be most supportive for you through both individual and group programming.