Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer

Abstract

This investigation used a non-randomized controlled design to evaluate the effect and feasibility of a mindfulness based stress reduction (MBSR) program on immune function, quality of life (QOL), and coping in women recently diagnosed with breast cancer. Early stage breast cancer patients, who did not receive chemotherapy, self-selected into an 8-week MBSR program or into an assessment only, control group. Outcomes were evaluated over time. The first assessment was at least 10 days after surgery and prior to adjuvant therapy, as well as before the MBSR start-up. Further assessments were mid-MBSR, at completion of MBSR, and at 4-week post-MBSR completion. Women with breast cancer enrolled in the control group (Non-MBSR) were assessed at similar times. At the first assessment (i.e., before MBSR start), reductions in peripheral blood mononuclear cell NK cell activity (NKCA) and IFN-gamma production with increases in IL-4, IL-6, and IL-10 production and plasma cortisol levels were observed for both the MBSR and Non-MBSR groups of breast cancer patients. Over time women in the MBSR group re-established their NKCA and cytokine production levels. In contrast, breast cancer patients in the Non-MBSR group exhibited continued reductions in NKCA and IFN-gamma production with increased IL-4, IL-6, and IL-10 production. Moreover, women enrolled in the MBSR program had reduced cortisol levels, improved QOL, and increased coping effectiveness compared to the Non-MBSR group. In summary, MBSR is a program that is feasible for women recently diagnosed with early stage breast cancer and the results provide preliminary evidence for beneficial effects of MBSR; on immune function, QOL, and coping.

Figures

Figure 1

The experimental design and study flow diagram is illustrated.

Figure 2

a. NKCA, expressed as lytic units at 20%, is illustrated for the MBSR and Non-MBSR groups, and for women without cancer (Cancer-Free). Peripheral blood was collected and NKCA was measured using K562 tumor cells as the target. ANOVA: Time effect p=0.035, Treatment effect p=0.010, Interaction of Treatment × Time p=0.018. b. PBMC production of IFN gamma is depicted for MBSR and Non-MBSR groups and for women without cancer (Cancer-Free). Peripheral blood was collected, PBMC were activated with PMA/PHA and culture supernatants were collected at 48 hr. Cytokine concentration was determined by ELISA. Repeated measures ANOVA; Treatment effect, p=0.001 and Interaction of Treatment × Time p=0.043. Bars represent the mean values +/− SEM.

Figure 3

a. PBMC production of IL-4 is depicted for the MBSR and Non-MBSR groups, and for women without cancer (Cancer-Free). Repeated measures ANOVA: Time effect p=0.039, Treatment effect p=0.001, Interaction of Treatment × Time p=0.024. b. PBMC production of IL-6 is depicted for the MBSR and Non-MBSR groups, and for women without cancer (Cancer-Free). Repeated measures ANOVA: Treatment effect p=0.031. c. PBMC production of IL-10 is depicted for women in the MBSR and Non-MBSR groups, and in comparison to women without cancer (Cancer-Free). Repeated measures ANOVA: Treatment effect p=0.035. For a.-c. Peripheral blood was collected, PBMC were activated with PMA/PHA and culture supernatants were collected at 48 hr. Cytokine concentration was determined by ELISA. d. Circulating cortisol levels (PM values) are shown for women in the MBSR and Non-MBSR groups, and in comparison to women without cancer (Cancer-Free). Repeated measures ANOVA: Treatment effect p=0.024. Cortisol concentration was determined by ELISA. Bars represent the mean values +/− SEM.

Figure 4

a. Total quality of life is depicted for women in the MBSR and Non-MBSR groups. Quality of life was measured using the Ferrans Quality of Life Index and absolute change from T1 is depicted. Repeated measures ANOVA; Treatment effect p=0.023. b. The Psychological/Spiritual subscale of the Ferrans Quality of Life Index is depicted for women in the MBSR and Non-MBSR groups. Quality of life was measured using the Ferrans Quality of Life Index and absolute change from T1 is depicted. Repeated measures ANOVA; Treatment effect p=0.001, Interaction of Treatment × Time p=0.009. c. The Family subscale of the Ferrans Quality of Life Index is depicted for women in the MBSR and Non-MBSR groups. Quality of life was measured using the Ferrans Quality of Life Index and absolute change from T1 is depicted. Repeated measures ANOVA: Treatment effect p=0.046.

Figure 5

a. The Optimistic Effectiveness subscale of the Jalowiec Coping Scale is depicted for women in the MBSR and Non-MBSR groups. Absolute change from T1 is depicted. Repeated measures ANOVA; Time effect p=0.08, Treatment effect p=0.001 and Treatment × Time effect p=0.034. b. The Supportant Effectiveness subscale of the Jalowiec Coping Scale is depicted for women in the MBSR and Non-MBSR groups. Absolute change from T1 is depicted. Repeated measures ANOVA: Treatment effect p=0.04.