Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors

Abstract

Objective: Cancer-related fatigue (CRF) is one of the most common, persistent, and disabling symptoms associated with cancer and its treatment. Evidence-based treatments that are acceptable to patients are critically needed. This study examined the efficacy of mindfulness-based stress reduction (MBSR) for CRF and related symptoms.

Method: A sample of 35 cancer survivors with clinically significant CRF was randomly assigned to a 7-week MBSR-based intervention or wait-list control group. The intervention group received training in mindfulness meditation, yoga, and self-regulatory responses to stress. Fatigue interference (primary outcome) and a variety of secondary outcomes (e.g., fatigue severity, vitality, disability, depression, anxiety, and sleep disturbance) were assessed at baseline, post-intervention, and 1-month follow-up. Bonferroni correction was employed to account for multiple comparisons. Controls received the intervention after the 1-month follow-up. Participants in both groups were followed for 6 months after completing their respective MBSR courses to assess maintenance of effects.

Results: Compared to controls, the MBSR group reported large post-intervention reductions as assessed by effect sizes (d) in the primary outcome, fatigue interference (d = -1.43, p < 0.001), along with fatigue severity (d = -1.55, p < 0.001), vitality (d = 1.29, p < 0.001), depression (d = -1.30, p < 0.001), and sleep disturbance (d = -0.74, p = 0.001). Results were maintained or strengthened at 1-month follow-up, the point at which significant improvements in disability (d = -1.22, p < 0.002) and anxiety (d = -0.98, p = 0.002) occurred. Improvements in all outcomes were maintained 6 months after completing the course. MBSR adherence was high, with 90% attendance across groups and high rates of participant-reported home practice of mindfulness.

Conclusions: Mindfulness-based stress reduction is a promising treatment for CRF and associated symptoms.

Keywords: MBSR; cancer; cancer-related fatigue; meditation; mindfulness; oncology.

Copyright © 2014 John Wiley & Sons, Ltd.

Figures

Figure 1

CONSORT Diagram

Figure 2

Figure 2(a) represents the randomized portion of the trial, comparing MBSR to wait-list control at two time points adjusted for baseline differences. Figure 2(b) represents the non-randomized portion of the trial in which the wait-list controls received the MBSR training at the end of the 1-month follow-up. MBSR 1 represents the intervention group, and MBSR 2 represents the wait-list control group. Each group's FSI fatigue interference score immediately before they began the MBSR course represents their baseline score, and the baseline score for each group is compared to their respective post-MBSR and 6-month follow-up scores.