Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials

Linda Cillessen, Maja Johannsen, Anne E M Speckens, Robert Zachariae, Linda Cillessen, Maja Johannsen, Anne E M Speckens, Robert Zachariae

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's 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.

Keywords: cancer; meta-analysis; mindfulness; mindfulness-based cognitive therapy; mindfulness-based stress reduction; oncology; systematic review.

Conflict of interest statement

The authors have no conflict of interest to disclose.

© 2019 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Flowchart of study selection
Figure 2
Figure 2
Forest plot of effect sizes for combined psychological distress outcomes at post‐intervention

References

    1. De Moor JS, Mariotto AB, Parry C, et al. Cancer survivors in the United States: Prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Prevent Biomarkers. 2013;22(4):561‐570.
    1. Noone A, Howlader N, Krapcho M, et al. SEER Cancer Statistics Review, 1975‐2015. Bethesda, MD: National Cancer Institute; 2018.
    1. Bosetti C, Bertuccio P, Malvezzi M, et al. Cancer mortality in Europe, 2005–2009, and an overview of trends since 1980. Ann Oncol. 2013;24(10):2657‐2671.
    1. Carlson LE, Angen M, Cullum J, et al. High levels of untreated distress and fatigue in cancer patients. Br J Cancer. 2004;90(12):2297‐2304.
    1. National Comprehensive Cancer Network . Distress management. Clinical practice guidelines. Version 2.2018. NCCN Guidelines. 2018.
    1. Nayak MG, George A, Vidyasagar MS, et al. Quality of life among cancer patients. Indian J Palliat Care. 2017;23(4):445‐450.
    1. Weis J. Psychosocial care for cancer patients. Breast Care. 2015;10(2):84‐86.
    1. Piet J, Wurtzen 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;80(6):1007‐1020.
    1. Zhang M‐F, Wen Y‐S, Liu W‐Y, Peng L‐F, Wu X‐D, Liu Q‐W. Effectiveness of mindfulness‐based therapy for reducing anxiety and depression in patients with cancer: A meta‐analysis. Medicine. 2015;94(45):e0897‐e0890.
    1. Zhang J, Xu R, Wang B, Wang J. Effects of mindfulness‐based therapy for patients with breast cancer: A systematic review and meta‐analysis. Complement Ther Med. 2016;26:1‐10.
    1. Cramer H, Lauche R, Paul A, Dobos G. Mindfulness‐based stress reduction for breast cancer—A systematic review and meta‐analysis. Current Oncology. 2012;19(5):e343.
    1. Haller H, Winkler MM, Klose P, Dobos G, Kümmel S, Cramer H. Mindfulness‐based interventions for women with breast cancer: An updated systematic review and meta‐analysis. Acta Oncol. 2017;56(12):1665‐1676.
    1. Huang H‐p, He M, Wang H‐y, Zhou M. A meta‐analysis of the benefits of mindfulness‐based stress reduction (MBSR) on psychological function among breast cancer (BC) survivors. Breast Cancer. 2016;23(4):568‐576.
    1. Hall DL, Luberto CM, Philpotts LL, Song R, Park ER, Yeh GY. Mind‐body interventions for fear of cancer recurrence: A systematic review and meta‐analysis. Psychooncology. 2018;27(11):2546‐2558.
    1. Zainal NZ, Booth S, Huppert FA. The efficacy of mindfulness‐based stress reduction on mental health of breast cancer patients: A meta‐analysis. Psychooncology. 2013;22(7):1457‐1465.
    1. Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long‐term and late effects of cancer. Cancer. 2008;112(S11):2577‐2592.
    1. Carlson LE, Speca M, Segal Z. Mindfulness‐based cancer recovery. Oakland, CA: New Harbinger; 2010.
    1. Kazdin AE. Mediators and mechanisms of change in psychotherapy research. Annu Rev Clin Psychol. 2007;3(1):1‐27.
    1. Reich RR, Lengacher CA, Alinat CB, et al. Mindfulness‐based stress reduction in post‐treatment breast cancer patients: Immediate and sustained effects across multiple symptom clusters. J Pain Symptom Manage. 2017;53(1):85‐95.
    1. Booth A, Clarke M, Dooley G, et al. The nuts and bolts of PROSPERO: An international prospective register of systematic reviews. Syst Rev. 2012;1(1):2.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P . Preferred reporting items for systematic reviews and meta‐analyses: The PRISMA statement. PLoS Med. 2009;6(7):e1000097 10.1371/journal.pmed.1000097
    1. Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta‐analysis protocols (PRISMA‐P) 2015 statement. Syst Rev. 2015;4(1):1.
    1. Sackett DL. Evidence‐based medicine: How to practice and teach EBM: WB Saunders Company; 1997.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361‐370.
    1. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343(oct18 2):d5928.
    1. Shaw JM, Sekelja N, Frasca D, Dhillon HM, Price MA. Being mindful of mindfulness interventions in cancer: A systematic review of intervention reporting and study methodology. Psychooncology. 2018;27(4):1162‐1171.
    1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed). 2008;336(7650):924‐926.
    1. Biostat inc . Comprehensive meta‐analysis. version 3 2018.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: erlbaum; 1988.
    1. Hedges L, Olkin I. Statistical methods for meta‐analysis. New York: Academic Press; 1985.
    1. Copas J, Shi JQ. Meta‐analysis, funnel plots and sensitivity analysis. Biostatistics. 2000;1(3):247‐262.
    1. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882‐893.
    1. Duval S, Tweedie R. Trim and fill: A simple funnel‐plot–based method of testing and adjusting for publication bias in meta‐analysis. Biometrics. 2000;56(2):455‐463.
    1. Rosenthal R. The file drawer problem and tolerance for null results. Psychol Bull. 1979;86(3):638‐641.
    1. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to meta‐analysis. Chichester: John Wiley & Sons; 2011.
    1. Lipsey MW, Wilson DB. Practical meta‐analysis. Thousand Oaks, CA, US: Sage Publications, Inc; 2001.
    1. Blaes AH, Fenner D, Bachanova V, et al. Mindfulness‐based cancer recovery in survivors recovering from chemotherapy and radiation. J Commun Supportive Oncol. 2016;14(8):351‐358.
    1. Bower JE, Crosswell AD, Stanton AL, et al. Mindfulness meditation for younger breast cancer survivors: A randomized controlled trial. Cancer. 2015;121(8):1231‐1240.
    1. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397‐402.
    1. Bränström R, Kvillemo P, Brandberg Y, Moskowitz JT. Self‐report mindfulness as a mediator of psychological well‐being in a stress reduction intervention for cancer patients—A randomized study. Ann Behav Med. 2010;39(2):151‐161.
    1. Bränström R, Kvillemo P, Moskowitz JT. 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. Int J Behav Med. 2012;19(4):535‐542.
    1. Bruggeman‐Everts FZ, Wolvers MD, van de Schoot R, Vollenbroek‐Hutten MM, Van der Lee ML. Effectiveness of two web‐based interventions for chronic cancer‐related fatigue compared to an active control condition: Results of the “Fitter na kanker” randomized controlled trial. J Med Internet Res. 2017;19(10):e336 10.2196/jmir.7180
    1. Carlson LE, Doll R, Stephen J, et al. Randomized controlled trial of mindfulness‐based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer. J Clin Oncol. 2013;31(25):3119‐3126.
    1. Schellekens MP, Tamagawa R, Labelle LE, et al. 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;40(3):414‐422.
    1. Chambers SK, Occhipinti S, Foley E, et al. Mindfulness‐based cognitive therapy in advanced prostate cancer: A randomized controlled trial. J Clin Oncol. 2017;35(3):291‐297.
    1. Compen F, Bisseling E, Schellekens M, et al. Face‐to‐face and internet‐based mindfulness‐based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: A multicenter randomized controlled trial. J Clin Oncol. 2018;36(23):2413‐2421.
    1. Foley E, Baillie A, Huxter M, Price M, Sinclair E. Mindfulness‐based cognitive therapy for individuals whose lives have been affected by cancer: A randomized controlled trial. J Consult Clin Psychol. 2010;78(1):72‐79.
    1. Garland SN, Carlson LE, Stephens AJ, Antle MC, Samuels C, Campbell TS. Mindfulness‐based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: A randomized, partially blinded, noninferiority trial. J Clin Oncol. 2014;32(5):449‐457.
    1. Garland SN, Rouleau CR, Campbell T, Samuels C, Carlson LE. The comparative impact of mindfulness‐based cancer recovery (MBCR) and cognitive behavior therapy for insomnia (CBT‐I) on sleep and mindfulness in cancer patients. Explore: J Sci Healing. 2015;11(6):445‐454.
    1. Henderson VP, Clemow L, Massion AO, Hurley TG, Druker S, Hébert JR. 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 Res Treat. 2012;131(1):99‐109.
    1. Hoffman CJ, Ersser SJ, Hopkinson JB, Nicholls PG, Harrington JE, Thomas PW. 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. J Clin Oncol. 2012;30(12):1335‐1342.
    1. Jang S‐H, Kang S‐Y, Lee H‐J, Lee S‐Y. Beneficial effect of mindfulness‐based art therapy in patients with breast cancer—A randomized controlled trial. Explore: J Sci Healing. 2016;12(5):333‐340.
    1. Johannsen M, O'Connor M, O'Toole MS, Jensen AB, Højris I, Zachariae R. Efficacy of mindfulness‐based cognitive therapy on late post‐treatment pain in women treated for primary breast cancer: A randomized controlled trial. J Clin Oncol. 2016;34(28):3390‐3399.
    1. Johannsen M, O'Connor M, O'Toole MS, Jensen AB, Zachariae R. Mindfulness‐based cognitive therapy and persistent pain in women treated for primary breast cancer: Exploring possible statistical mediators results from a randomized controlled trial. Clin J Pain. 2018;34(1):59‐67.
    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;24(8):885‐893.
    1. Johns SA, Brown LF, Beck‐Coon K, et al. Randomized controlled pilot trial of mindfulness‐based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors. Support Care Cancer. 2016;24(10):4085‐4096.
    1. Johns SA, Von Ah D, Brown LF, et al. Randomized controlled pilot trial of mindfulness‐based stress reduction for breast and colorectal cancer survivors: Effects on cancer‐related cognitive impairment. J Cancer Surviv. 2016;10(3):437‐448.
    1. Kenne Sarenmalm E, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108‐1122.
    1. Kingston T, Collier S, Hevey D, et al. Mindfulness‐based cognitive therapy for psycho‐oncology patients: An exploratory study. Irish J Psychol Med. 2015;32(3):265‐274.
    1. Lengacher CA, Reich RR, Paterson CL, et al. Examination of broad symptom improvement resulting from mindfulness‐based stress reduction in breast cancer survivors: A randomized controlled trial. J Clin Oncol. 2016;34(24):2827‐2834.
    1. Lengacher CA, Johnson‐Mallard V, Post‐White J, et al. Randomized controlled trial of mindfulness‐based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261‐1272.
    1. Lerman R, Jarski R, Rea H, Gellish R, Vicini F. Improving symptoms and quality of life of female cancer survivors: A randomized controlled study. Ann Surg Oncol. 2012;19(2):373‐378.
    1. Monti DA, Peterson C, Kunkel EJS, et al. A randomized, controlled trial of mindfulness‐based art therapy (MBAT) for women with cancer. Psycho‐Oncol: J Psychol, Social Behav Dimensions Cancer. 2006;15(5):363‐373.
    1. Monti DA, Kash KM, Kunkel EJ, et al. Psychosocial benefits of a novel mindfulness intervention versus standard support in distressed women with breast cancer. Psychooncology. 2013;22(11):2565‐2575.
    1. Nakamura Y, Lipschitz DL, Kuhn R, Kinney AY, Donaldson GW. Investigating efficacy of two brief mind–body intervention programs for managing sleep disturbance in cancer survivors: A pilot randomized controlled trial. J Cancer Surviv. 2013;7(2):165‐182.
    1. Reynolds LM, Bissett IP, Porter D, Consedine NS. A brief mindfulness intervention is associated with negative outcomes in a randomised controlled trial among chemotherapy patients. Mind. 2017;8(5):1291‐1303.
    1. Schellekens MPJ, Hurk DGM, Prins JB, et al. Mindfulness‐based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial. Psychooncology. 2017;26(12):2118‐2126.
    1. Speca M, Carlson LE, Goodey E, Angen M. 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. Psychosom Med. 2000;62(5):613‐622.
    1. Würtzen H, Dalton SO, Elsass P, et al. 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. Eur J Cancer. 2013;49(6):1365‐1373.
    1. Würtzen H, Dalton SO, Christensen J, et al. 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 Oncol. 2015;54(5):712‐719.
    1. Andersen SR, Würtzen H, Steding‐Jessen M, et al. Effect of mindfulness‐based stress reduction on sleep quality: Results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336‐344.
    1. Zernicke KA, Campbell TS, Speca M, McCabe‐Ruff K, Flowers S, Carlson LE. A randomized wait‐list controlled trial of feasibility and efficacy of an online mindfulness‐based cancer recovery program: The eTherapy for cancer applying mindfulness trial. Psychosom Med. 2014;76(4):257‐267.
    1. Zhang J‐Y, Zhou Y‐Q, Feng Z‐W, Fan Y‐N, Zeng G‐C, Wei L. Randomized controlled trial of mindfulness‐based stress reduction (MBSR) on posttraumatic growth of Chinese breast cancer survivors. Psychol Health Med. 2017;22(1):94‐109.
    1. Kabat‐Zinn J, Hanh TN. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Delta; 2009.
    1. Segal ZV, Williams JMG, Teasdale JD. Mindfulness‐based cognitive therapy for depression. New York: Guilford Press; 2013.
    1. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health‐related quality of life: The remarkable universality of half a standard deviation. Med Care. 2003;41(5):582‐592.
    1. Rosenkranz MA, Dunne JD, Davidson RJ. The next generation of mindfulness‐based intervention research: What have we learned and where are we headed? Current Opinion in Psychology. 2019.
    1. Compen FR, Adang EMM, Bisseling EM, Van der Lee ML, Speckens AEM. Cost‐effectiveness of individual internet‐based and face‐to‐face mindfulness‐based cognitive therapy compared to treatment as usual in reducing psychological distress in cancer patients. Submitted
    1. Monteiro LM, Compson JF, Musten F. Practitioner's guide to ethics and mindfulness‐based interventions. Cham, Switzerland: Springer; 2017.
    1. Ludwig DS, Kabat‐Zinn J. Mindfulness in medicine. JAMA. 2008;v300(11):1350‐1352.
    1. Tatrow K, Montgomery GH. Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: A meta‐analysis. J Behav Med. 2006;29(1):17‐27.
    1. Bisseling EM, Schellekens MP, Jansen ET, van Laarhoven HW, Prins JB, Speckens AE. Mindfulness‐based stress reduction for breast cancer patients: A mixed method study on what patients experience as a suitable stage to participate. Support Care Cancer. 2017;25(10):3067‐3074.
    1. Thewes B, Rietjens JA, van den Berg SW, et al. One way or another: The opportunities and pitfalls of self‐referral and consecutive sampling as recruitment strategies for psycho‐oncology intervention trials. Psychooncology. 2018;27(8):2056‐2059.
    1. Carlson LE, Tamagawa R, Stephen J, et al. Tailoring mind‐body therapies to individual needs: Patients' program preference and psychological traits as moderators of the effects of mindfulness‐based cancer recovery and supportive‐expressive therapy in distressed breast cancer survivors. J Natl Cancer Inst Monogr. 2014;2014(50):308‐314.
    1. Crane RS, Eames C, Kuyken W, et al. Development and validation of the mindfulness‐based interventions–teaching assessment criteria (MBI: TAC). Assessment. 2013;20(6):681‐688.
    1. Baer R, Crane C, Miller E, Kuyken W. Doing no harm in mindfulness‐based programs: Conceptual issues and empirical findings. Clin Psychol Rev. 2019;71:101‐114.
    1. Gu J, Strauss C, Bond R, Cavanagh K. How do mindfulness‐based cognitive therapy and mindfulness‐based stress reduction improve mental health and wellbeing? A systematic review and meta‐analysis of mediation studies. Clin Psychol Rev. 2015;37:1‐12.

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