Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials

Jennifer Huberty, Ryan Eckert, Linda Larkey, Jonathan Kurka, Sue A Rodríguez De Jesús, Wonsuk Yoo, Ruben Mesa, Jennifer Huberty, Ryan Eckert, Linda Larkey, Jonathan Kurka, Sue A Rodríguez De Jesús, Wonsuk Yoo, Ruben Mesa

Abstract

Background: Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms.

Objective: The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group.

Methods: Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden.

Results: A total of 128 patients were enrolled across all 4 groups, with 73.4% (94/128) patients completing the intervention. Of the participants who completed the 10% Happier app, 61% (46/76) enjoyed it, 66% (50/76) were satisfied with the content, and 77% (59/76) would recommend to others. Of those who completed the Calm app, 83% (56/68) enjoyed it, 84% (57/68) were satisfied with the content, and 97% (66/68) would recommend to others. Of those who completed the educational control, 91% (56/61) read it, 87% (53/61) enjoyed it, and 71% (43/61) learned something. Participants who completed the 10% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10% Happier app participants saw small effects on anxiety (P<.001 d=-0.43), depression (P=.02; d=-0.38), sleep disturbance (P=.01; d=-0.40), total symptom burden (P=.13; d=-0.27), and fatigue (P=.06; d=-0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=-0.22), depression (P=.09; d=-0.29), sleep disturbance (P=.002; d=-0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=-0.27), and fatigue (P=.13; d=-0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77).

Conclusions: Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs.

Trial registration: ClinicalTrials.gov NCT03726944; https://ichgcp.net/clinical-trials-registry/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM).

Keywords: cancer; mHealth; meditation; mindfulness; quality of life; smartphone.

Conflict of interest statement

Conflicts of Interest: RM reports research support by Incyte, Celgene, CTI BioPharma, Abbvie, and Genetech. In addition, RM acts as a consultant for Novartis, La Jolla, and Sierra Oncology. The authors do not report any additional conflicts of interest.

©Jennifer Huberty, Ryan Eckert, Linda Larkey, Jonathan Kurka, Sue A Rodríguez De Jesús, Wonsuk Yoo, Ruben Mesa. Originally published in JMIR Formative Research (http://formative.jmir.org), 29.04.2019.

Figures

Figure 1
Figure 1
Weekly meditation participation.

References

    1. Emanuel RM, Dueck AC, Geyer HL, Kiladjian J, Slot S, Zweegman S, te Boekhorst PA, Commandeur S, Schouten HC, Sackmann F, Kerguelen Fuentes A, Hernández-Maraver D, Pahl HL, Griesshammer M, Stegelmann F, Doehner K, Lehmann T, Bonatz K, Reiter A, Boyer F, Etienne G, Ianotto J, Ranta D, Roy L, Cahn J, Harrison CN, Radia D, Muxi P, Maldonado N, Besses C, Cervantes F, Johansson PL, Barbui T, Barosi G, Vannucchi AM, Passamonti F, Andreasson B, Ferrari ML, Ferarri ML, Rambaldi A, Samuelsson J, Birgegard G, Tefferi A, Mesa RA. Myeloproliferative neoplasm (MPN) symptom assessment form total symptom score: prospective international assessment of an abbreviated symptom burden scoring system among patients with MPNs. J Clin Oncol. 2012 Nov 20;30(33):4098–103. doi: 10.1200/JCO.2012.42.3863. JCO.2012.42.3863
    1. Mesa RA, Niblack J, Wadleigh M, Verstovsek S, Camoriano J, Barnes S, Tan AD, Atherton PJ, Sloan JA, Tefferi A. The burden of fatigue and quality of life in myeloproliferative disorders (MPDs): an international internet-based survey of 1179 MPD patients. Cancer. 2007 Jan 01;109(1):68–76. doi: 10.1002/cncr.22365. doi: 10.1002/cncr.22365.
    1. Mesa R, Miller CB, Thyne M, Mangan J, Goldberger S, Fazal S, Ma X, Wilson W, Paranagama DC, Dubinski DG, Boyle J, Mascarenhas JO. Myeloproliferative neoplasms (MPNs) have a significant impact on patients' overall health and productivity: the MPN Landmark survey. BMC Cancer. 2016 Feb 27;16:167. doi: 10.1186/s12885-016-2208-2. 10.1186/s12885-016-2208-2
    1. Scherber R, Dueck AC, Johansson P, Barbui T, Barosi G, Vannucchi AM, Passamonti F, Andreasson B, Ferarri ML, Rambaldi A, Samuelsson J, Birgegard G, Tefferi A, Harrison CN, Radia D, Mesa RA. The Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF): international prospective validation and reliability trial in 402 patients. Blood. 2011 Jul 14;118(2):401–8. doi: 10.1182/blood-2011-01-328955. blood-2011-01-328955
    1. Hultcrantz M, Kristinsson SY, Andersson TM, Landgren O, Eloranta S, Derolf AR, Dickman PW, Björkholm M. Patterns of survival among patients with myeloproliferative neoplasms diagnosed in Sweden from 1973 to 2008: a population-based study. J Clin Oncol. 2012 Aug 20;30(24):2995–3001. doi: 10.1200/JCO.2012.42.1925. JCO.2012.42.1925
    1. Tefferi A, Guglielmelli P, Larson DR, Finke C, Wassie EA, Pieri L, Gangat N, Fjerza R, Belachew AA, Lasho TL, Ketterling RP, Hanson CA, Rambaldi A, Finazzi G, Thiele J, Barbui T, Pardanani A, Vannucchi AM. Long-term survival and blast transformation in molecularly annotated essential thrombocythemia, polycythemia vera, and myelofibrosis. Blood. 2014 Oct 16;124(16):2507–13. doi: 10.1182/blood-2014-05-579136. blood-2014-05-579136
    1. Mehta J, Wang H, Fryzek JP, Iqbal SU, Mesa R. Health resource utilization and cost associated with myeloproliferative neoplasms in a large United States health plan. Leuk Lymphoma. 2014 Oct;55(10):2368–74. doi: 10.3109/10428194.2013.879127.
    1. Geyer H, Scherber R, Kosiorek H, Dueck AC, Kiladjian J, Xiao Z, Slot S, Zweegman S, Sackmann F, Fuentes AK, Hernández-Maraver D, Döhner K, Harrison CN, Radia D, Muxi P, Besses C, Cervantes F, Johansson PL, Andreasson B, Rambaldi A, Barbui T, Bonatz K, Reiter A, Boyer F, Etienne G, Ianotto J, Ranta D, Roy L, Cahn J, Maldonado N, Barosi G, Ferrari ML, Gale RP, Birgegard G, Xu Z, Zhang Y, Sun X, Xu J, Zhang P, te Boekhorst PA, Commandeur S, Schouten H, Pahl HL, Griesshammer M, Stegelmann F, Lehmann T, Senyak Z, Vannucchi AM, Passamonti F, Samuelsson J, Mesa RA. Symptomatic profiles of patients with polycythemia vera: implications of inadequately controlled disease. J Clin Oncol. 2016 Jan 10;34(2):151–9. doi: 10.1200/JCO.2015.62.9337.JCO.2015.62.9337
    1. Mesa R, Verstovsek S, Kiladjian J, Griesshammer M, Masszi T, Durrant S, Passamonti F, Harrison CN, Pane F, Zachee P, Zhen H, Jones MM, Parasuraman S, Li J, Côté I, Habr D, Vannucchi AM. Changes in quality of life and disease-related symptoms in patients with polycythemia vera receiving ruxolitinib or standard therapy. Eur J Haematol. 2016 Aug;97(2):192–200. doi: 10.1111/ejh.12707.
    1. Scotch A, Scherber R, Bruso M, Kosiorek H, Dueck A, Geyer H, Fauble V, Vannuchi A, Fuentes A, Andersen C, Ejerblad E. Myeloproliferative Neoplasm Quality of Life (MPN-QOL) study group: results from the MPN Experimental Assessment of Symptoms By Utilizing Repetitive Evaluation (MEASURE) trial. Blood. 2017;128(22):1641.
    1. Christodoulou G, Black DS. Mindfulness-based interventions and sleep among cancer survivors: a critical analysis of randomized controlled trials. Curr Oncol Rep. 2017 Sep;19(9):60. doi: 10.1007/s11912-017-0621-6.10.1007/s11912-017-0621-6
    1. Gong H, Ni CX, Liu YZ, Zhang Y, Su WJ, Lian YJ, Peng W, Jiang CL. Mindfulness meditation for insomnia: a meta-analysis of randomized controlled trials. J Psychosom Res. 2016 Dec;89:1–6. doi: 10.1016/j.jpsychores.2016.07.016.S0022-3999(16)30357-9
    1. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010 Apr;78(2):169–83. doi: 10.1037/a0018555. 2010-05835-004
    1. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015 Aug;24(8):885–93. doi: 10.1002/pon.3648.
    1. Ong JC, Manber R, Segal Z, Xia Y, Shapiro S, Wyatt JK. A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep. 2014 Sep 01;37(9):1553–63. doi: 10.5665/sleep.4010. sp-00573-13
    1. Piet J, Würtzen H, Zachariae R. The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis. J Consult Clin Psychol. 2012 Dec;80(6):1007–20. doi: 10.1037/a0028329.2012-12072-001
    1. Musial F, Büssing A, Heusser P, Choi K, Ostermann T. Mindfulness-based stress reduction for integrative cancer care: a summary of evidence. Forsch Komplementmed. 2011;18(4):192–202. doi: 10.1159/000330714. 000330714
    1. Kabat-Zinn J, Hanh T. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York, NY: Delta; 2009.
    1. Salhofer I, Will A, Monsef I, Skoetz N. Meditation for adults with haematological malignancies. Cochrane Database Syst Rev. 2016 Feb 03;2:CD011157. doi: 10.1002/14651858.CD011157.pub2.
    1. Huberty J, Eckert R, Gowin K, Mitchell J, Dueck AC, Ginos BF, Larkey L, Mesa R. Feasibility study of online yoga for symptom management in patients with myeloproliferative neoplasms. Haematologica. 2017 Dec;102(10):e384–8. doi: 10.3324/haematol.2017.168583.haematol.2017.168583
    1. Pew Research Center. 2018. Mobile Fact Sheet
    1. Pew Research Center. 2017. [2018-10-23]. Key Trends in Social and Digital News Media
    1. Pew Research Center. 2015. US Smartphone Use in 2015
    1. van Waart H, van Harten WH, Buffart LM, Sonke GS, Stuiver MM, Aaronson NK. Why do patients choose (not) to participate in an exercise trial during adjuvant chemotherapy for breast cancer? Psychooncology. 2016 Dec;25(8):964–70. doi: 10.1002/pon.3936.
    1. Statista. 2018. Number of apps available in leading app stores as of 3rd quarter
    1. Marlynn W. Psychology Today. 2017. [2018-10-23]. What mindfulness app is right for you? .
    1. Fischer K. Healthline. 2018. [2018-10-23]. Best Meditation Apps of 2018 .
    1. Rabin C, Bock B. Desired features of smartphone applications promoting physical activity. Telemed J E Health. 2011 Dec;17(10):801–3. doi: 10.1089/tmj.2011.0055.
    1. Dennison L, Morrison L, Conway G, Yardley L. Opportunities and challenges for smartphone applications in supporting health behavior change: qualitative study. J Med Internet Res. 2013;15(4):e86. doi: 10.2196/jmir.2583. v15i4e86
    1. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, Fernandez M. How we design feasibility studies. Am J Prev Med. 2009 May;36(5):452–7. doi: 10.1016/j.amepre.2009.02.002. S0749-3797(09)00096-8
    1. de Bruin EI, van der Zwan JE, Bögels SM. A RCT comparing daily mindfulness meditations, biofeedback exercises, and daily physical exercise on attention control, executive functioning, mindful awareness, self-compassion, and worrying in stressed young adults. Mindfulness (N Y) 2016;7(5):1182–92. doi: 10.1007/s12671-016-0561-5. 561
    1. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004 Jul;57(1):35–43. doi: 10.1016/S0022-3999(03)00573-7.S0022399903005737
    1. Moore AW, Gruber T, Derose J, Malinowski P. Regular, brief mindfulness meditation practice improves electrophysiological markers of attentional control. Front Hum Neurosci. 2012;6:18. doi: 10.3389/fnhum.2012.00018. doi: 10.3389/fnhum.2012.00018.
    1. McDonald K. How to Meditate: A Practical Guide. Somerville, MA: Wisdom Publications; 2005.
    1. Chittaro L, Vianello A. Evaluation of a mobile mindfulness app distributed through on-line stores: a 4-week study. Int J Hum Comput Stud. 2016 Feb;86:63–80. doi: 10.1016/j.ijhcs.2015.09.004.
    1. Huberty J, Matthews J, Leiferman J, Cacciatore J, Gold K. A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study) Pilot Feasibility Stud. 2018;4(1):12. doi: 10.1186/s40814-017-0162-7.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. United Kingdom: Routledge; 1988.
    1. Economides M, Martman J, Bell MJ, Sanderson B. Improvements in stress, affect, and irritability following brief use of a mindfulness-based smartphone app: a randomized controlled trial. Mindfulness (N Y) 2018;9(5):1584–93. doi: 10.1007/s12671-018-0905-4. 905
    1. Bostock S, Crosswell AD, Prather AA, Steptoe A. Mindfulness on-the-go: Effects of a mindfulness meditation app on work stress and well-being. J Occup Health Psychol. 2019 Feb;24(1):127–38. doi: 10.1037/ocp0000118.2018-19565-001
    1. Huberty J, Eckert R, Larkey L, Mesa R. Myeloproliferative neoplasm patients experience of using a consumer-based mobile meditation app to improve fatigue: informing future directions. J Med Internet Res. 2019 (forthcoming)(forthcoming)
    1. Bakker D, Kazantzis N, Rickwood D, Rickard N. Mental health smartphone apps: review and evidence-based recommendations for future developments. JMIR Ment Health. 2016;3(1):e7. doi: 10.2196/mental.4984. v3i1e7
    1. Newman M, Lauterbach D, Munson S, Resnick P, Morris M. It's not that i don't have problems, i'm just not putting them on facebook: Challenges and opportunities in using online social networks for health. Proceedings of the ACM 2011 conference on Computer supported cooperative work; Conference on Computer Supported Cooperative Work; March 19-23, 2011; China. 2011. pp. 341–350.
    1. Richardson CR, Buis LR, Janney AW, Goodrich DE, Sen A, Hess ML, Mehari KS, Fortlage LA, Resnick PJ, Zikmund-Fisher BJ, Strecher VJ, Piette JD. An online community improves adherence in an internet-mediated walking program. Part 1: results of a randomized controlled trial. J Med Internet Res. 2010;12(4):e71. doi: 10.2196/jmir.1338. v12i4e71
    1. Ledesma D, Kumano H. Mindfulness-based stress reduction and cancer: a meta-analysis. Psychooncology. 2009 Jun;18(6):571–9. doi: 10.1002/pon.1400.
    1. Carlson LE. Mindfulness-based interventions for coping with cancer. Ann N Y Acad Sci. 2016 Jun;1373(1):5–12. doi: 10.1111/nyas.13029.
    1. Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med. 2010 Jan;16(1):3–12. doi: 10.1089/acm.2009.0044.
    1. Schellekens MP, Tamagawa R, Labelle LE, Speca M, Stephen J, Drysdale E, Sample S, Pickering B, Dirkse D, Savage LL, Carlson LE. Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators. J Behav Med. 2017 Jun;40(3):414–22. doi: 10.1007/s10865-016-9799-6. 10.1007/s10865-016-9799-6
    1. Speca M, Carlson L, Mackenzie M. Mindfulness-based cancer recovery: An adaptation of Mindfulness-Based Stress Reduction (MBSR) for cancer patients. In: Baer R, editor. Mindfulness-Based Treatment Approaches. 2nd Edition. San Diego, CA: Elsevier; 2014. pp. 293–316.
    1. Price GL, Davis KL, Karve S, Pohl G, Walgren RA. Survival patterns in United States (US) medicare enrollees with non-CML myeloproliferative neoplasms (MPN) PLoS One. 2014;9(3):e90299. doi: 10.1371/journal.pone.0090299. PONE-D-13-25718
    1. Hui D, Zhukovsky D, Bruera E. Which treatment is better? Ascertaining patient preferences with crossover randomized controlled trials. J Pain Symptom Manage. 2015;49(3):625–31.
    1. Raghunathan NJ, Korenstein D, Li QS, Tonorezos ES, Mao JJ. Determinants of mobile technology use and smartphone application interest in cancer patients. Cancer Med. 2018 Nov;7(11):5812–9. doi: 10.1002/cam4.1660. doi: 10.1002/cam4.1660.
    1. Girault A, Ferrua M, Lalloué B, Sicotte C, Fourcade A, Yatim F, Hébert G, Di PM, Minvielle E. Internet-based technologies to improve cancer care coordination: current use and attitudes among cancer patients. Eur J Cancer. 2015 Mar;51(4):551–7. doi: 10.1016/j.ejca.2014.12.001.S0959-8049(14)01158-7

Source: PubMed

3
Subscribe