A Mindfulness-Based Lifestyle Intervention for Obese, Inactive Endometrial Cancer Survivors: A Feasibility Study

Alexander R Lucas, Brian C Focht, David E Cohn, Janet Buckworth, Maryanna D Klatt, Alexander R Lucas, Brian C Focht, David E Cohn, Janet Buckworth, Maryanna D Klatt

Abstract

Background: Mindfulness-based interventions (MBIs) to address self-regulation and lifestyle behaviors (diet, physical activity) may benefit endometrial cancer survivors (ECS), who are at increased risk for morbidity and mortality associated with obesity. However, the acceptability of mindfulness training and whether it can augment behavior change in ECS is unknown. We aimed to examine; 1) the feasibility of the Mindfulness in Motion + Diet (MIM+D) intervention and 2) the preliminary efficacy of MIM+D for improving mindfulness, diet, PA and health-related quality of life (HRQL).

Methods: ECS (Mage=62.4, ±5yrs from diagnosis) completed assessments at baseline, 8 and 14 weeks. Feasibility was determined by intervention completion surveys, attendance and adherence data. We used repeated measures ANOVA's (SPSS 22.0) and effect size estimates (Cohen's d) to examine changes in mindfulness, diet, PA, and HRQL over time.

Results: Thirteen ECS (76%) completed the MIM+D program and attendance (≥6/8 sessions) was 90%. Women reported favorably on the overall quality (mean of 4.75/5) and benefits of the MIM+D program; however, would have preferred receiving MIM+D closer to diagnosis. Intention to treat analyses found MIM+D did not significantly improve any outcomes. However, an intervention completers analysis showed significant change in mindfulness (p=.0039) and small to moderate estimates for change in fruits and vegetable intake (d=.23), MVPA (d=.45), RAND SF-36: MCS (d=.46), and sleep quality (d=.68).

Conclusions: Integrating mindfulness training into behavioral interventions is feasible and ECS that adhere to these lifestyle programs may benefit. However, to future research should examine the-long term effects of mindfulness-based behavioral lifestyle interventions.

Keywords: diet; endometrial cancer; lifestyle behaviors; mindfulness; physical activity; survivorship.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
CONSORT diagram for participant flow.
Figure 2.
Figure 2.
Completion surveys of the MIM+Diet intervention.

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J. Clin. 2016;66:7-30.
    1. Reeves GK, Pirie K, Beral V, et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ. 2007;335:1134.
    1. Friberg E, Orsini N, Mantzoros CS, Wolk A. Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia. 2007;50:1365-1374.
    1. Secord AA, Hasselblad V, Von Gruenigen VE, et al. Body mass index and mortality in endometrial cancer: a systematic review and meta-analysis. Gynecol Oncol. 2016;140:184-190.
    1. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625-1638.
    1. Ward KK, Shah NR, Saenz CC, McHale MT, Alvarez EA, Plaxe SC. Cardiovascular disease is the leading cause of death among endometrial cancer patients. Gynecol Oncol. 2012;126:176-179.
    1. von Gruenigen VE, Waggoner SE, Frasure HE, et al. Lifestyle challenges in endometrial cancer survivorship. Obstet Gynecol. 2011;117:93-100.
    1. Laskey RA, McCarroll ML, von Gruenigen VE. Obesity-related endometrial cancer: an update on survivorship approaches to reducing cardiovascular death. BJOG. 2016;123:293-298.
    1. Allison DB, Downey M, Atkinson RL, et al. Obesity as a disease: a white paper on evidence and arguments commissioned by the Council of the Obesity Society. Obesity (Silver Spring). 2008;16:1161-1177.
    1. Kabat-Zinn J. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York, NY: Hyperion; 1994.
    1. Shennan C, Payne S, Fenlon D. What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psychooncology. 2011;20:681-697.
    1. Olson KL, Emery CF. Mindfulness and weight loss: a systematic review. Psychosom Med. 2015;77:59-67.
    1. Godsey J. The role of mindfulness based interventions in the treatment of obesity and eating disorders: an integrative review. Complement Ther Med. 2013;21:430-439.
    1. Forman EM, Shaw JA, Goldstein SP, et al. Mindful decision making and inhibitory control training as complementary means to decrease snack consumption. Appetite. 2016;103:176-183.
    1. Kearney DJ, Milton ML, Malte CA, McDermott KA, Martinez M, Simpson TL. Participation in mindfulness-based stress reduction is not associated with reductions in emotional eating or uncontrolled eating. Nutr Res. 2012;32:413-420.
    1. Wing RR. Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. 1999;31(11 suppl):S547-S552.
    1. Blanchard CM, Courneya KS, Stein K; American Cancer Society’s SCS-II. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol. 2008;26:2198-2204.
    1. McCarroll ML, Armbruster S, Frasure HE, et al. Self-efficacy, quality of life, and weight loss in overweight/obese endometrial cancer survivors (SUCCEED): a randomized controlled trial. Gynecol Oncol. 2014;132:397-402.
    1. McCarroll ML, Armbruster S, Pohle-Krauza RJ, et al. Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application. Gynecol Oncol. 2015;137:508-515.
    1. Koutoukidis DA, Knobf MT, Lanceley A. Obesity, diet, physical activity, and health-related quality of life in endometrial cancer survivors. Nutr Rev. 2015;73:399-408.
    1. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30:975-991.
    1. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55:305-312.
    1. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. New York, NY: Guilford Press; 2012.
    1. Klatt MD, Buckworth J, Malarkey WB. Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults. Health Educ Behav. 2009;36:601-614.
    1. Klatt M, Steinberg B, Duchemin AM. Mindfulness in Motion (MIM): an onsite mindfulness based intervention (MBI) for chronically high stress work environments to increase resiliency and work engagement. J Vis Exp. 2015;(101):e52359.
    1. Malarkey WB, Jarjoura D, Klatt M. Workplace based mindfulness practice and inflammation: a randomized trial. Brain Behav Immun. 2013;27:145-154.
    1. Klatt M. Mind-body wellness and integrative medicine. Personalized approach to cancer survivorship. In: Lester J, Schmidt P. eds. Cancer Rehabilitation and Survivorship: Transdisciplinary Approaches to Personalized Care. Pittsburg, PA: Oncology Nursing Society; 2011:317-323.
    1. Campbell MK, Carr C, Devellis B, et al. A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control. Ann Behav Med. 2009;38:71-85.
    1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.
    1. World Cancer Research Fund. Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: American Institute for Cancer Research; 2007.
    1. Carels RA, Darby L, Cacciapaglia HM, et al. Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach. Health Psychol. 2007;26:369-374.
    1. Rejeski WJ, Brawley LR, Ambrosius WT, et al. Older adults with chronic disease: benefits of group-mediated counseling in the promotion of physically active lifestyles. Health Psychol. 2003;22:414-423.
    1. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13:27-45.
    1. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84:822-848.
    1. Baer RA, Smith GT, Lykins E, et al. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15:329-342.
    1. Carlson LE, Brown KW. Validation of the Mindful Attention Awareness Scale in a cancer population. J Psychosom Res. 2005;58(1):29-33.
    1. Silverstein L, Scott B, Zahrt H. Dietary quality: the Food Habits Questionnaire. In: Jeor S., St ed. Obesity Assessment: Tools, Methods, Interpretations. New York, NY: Chapman & Hall; 1997:281-291.
    1. Paffenbarger RS, Jr, Blair SN, Lee IM, Hyde RT. Measurement of physical activity to assess health effects in free-living populations. Med Sci Sports Exerc. 1993;25:60-70.
    1. Kumahara H, Schutz Y, Ayabe M, et al. The use of uniaxial accelerometry for the assessment of physical-activity-related energy expenditure: a validation study against whole-body indirect calorimetry. Br J Nutr. 2004;91:235-243.
    1. Ayabe M, Brubaker PH, Mori Y, et al. Self-monitoring moderate-vigorous physical activity versus steps/day is more effective in chronic disease exercise programs. J Cardiopulm Rehabil Prev. 2010;30:111-115.
    1. McClain JJ, Craig CL, Sisson SB, Tudor-Locke C. Comparison of Lifecorder EX and ActiGraph accelerometers under free-living conditions. Appl Physiol Nutr Metab. 2007;32:753-761.
    1. Resnicow K, McCarty F, Blissett D, Wang T, Heitzler C, Lee RE. Validity of a modified CHAMPS physical activity questionnaire among African-Americans. Med Sci Sports Exerc. 2003;35:1537-1545.
    1. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85-M94.
    1. Peters C, Lotzerich H, Niemeier B, Schule K, Uhlenbruck G. Influence of a moderate exercise training on natural killer cytotoxicity and personality traits in cancer patients. Anticancer Res. 1994;14:1033-1036.
    1. Peters C, Lotzerich H, Niemeir B, Schule K, Uhlenbruck G. Exercise, cancer and the immune response of monocytes. Anticancer Res. 1995;15:175-179.
    1. Reboussin BA, Rejeski WJ, Martin KA, et al. Correlates of satisfaction with body function and body appearance in middle- and older aged adults: the Activity Counseling Trial (ACT). Psychol Health. 2000;15:239-254.
    1. Rejeski WJ, Ettinger WH, Jr, Schumaker S, James P, Burns R, Elam JT. Assessing performance-related disability in patients with knee osteoarthritis. Osteoarthritis Cartilage. 1995;3:157-167.
    1. Diener E, Emmons RA, Larsen RJ, Griffin S. The Satisfaction With Life Scale. J Pers Assess. 1985;49:71-75.
    1. Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med. 2001;33:350-357.
    1. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193-213.
    1. Fader AN, Arriba LN, Frasure HE, von Gruenigen VE. Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol. 2009;114:121-127.
    1. von Gruenigen VE, Tian C, Frasure H, Waggoner S, Keys H, Barakat RR. Treatment effects, disease recurrence, and survival in obese women with early endometrial carcinoma: a Gynecologic Oncology Group study. Cancer. 2006;107:2786-2791.
    1. Chia VM, Newcomb PA, Trentham-Dietz A, Hampton JM. Obesity, diabetes, and other factors in relation to survival after endometrial cancer diagnosis. Int J Gynecol Cancer. 2007;17:441-446.
    1. Cook LS, Nelson HE, Cockburn M, Olson SH, Muller CY, Wiggins CL. Comorbidities and endometrial cancer survival in Hispanics and non-Hispanic whites. Cancer Causes Control. 2013;24:61-69.
    1. von Gruenigen VE, Courneya KS, Gibbons HE, Kavanagh MB, Waggoner SE, Lerner E. Feasibility and effectiveness of a lifestyle intervention program in obese endometrial cancer patients: a randomized trial. Gynecol Oncol. 2008;109:19-26.
    1. von Gruenigen VE, Gibbons HE, Kavanagh MB, Janata JW, Lerner E, Courneya KS. A randomized trial of a lifestyle intervention in obese endometrial cancer survivors: quality of life outcomes and mediators of behavior change. Health Qual Life Outcomes. 2009;7:17.
    1. von Gruenigen V, Frasure H, Kavanagh MB, et al. Survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED): a randomized controlled trial. Gynecol Oncol. 2012;125:699-704.
    1. Basen-Engquist K, Carmack C, Brown J, et al. Response to an exercise intervention after endometrial cancer: differences between obese and non-obese survivors. Gynecol Oncol. 2014;133:48-55.
    1. Soliman PT, Bassett RL J., Wilson EB, et al. Limited public knowledge of obesity and endometrial cancer risk: what women know. Obstet Gynecol. 2008;112(4):835-842.
    1. Park JH, Lee J, Oh M, et al. The effect of oncologists’ exercise recommendations on the level of exercise and quality of life in survivors of breast and colorectal cancer: a randomized controlled trial. Cancer. 2015;121:2740-2748.
    1. Jernigan AM, Tergas AI, Satin AJ, Fader AN. Obesity management in gynecologic cancer survivors: provider practices and attitudes. Am J Obstet Gynecol. 2013;208:e401-e408.
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5-29.
    1. Rejeski WJ, Mihalko SL, Ambrosius WT, Bearon LB, McClelland JW. Weight loss and self-regulatory eating efficacy in older adults: the cooperative lifestyle intervention program. J Gerontol B Psychol Sci Soc Sci. 2011;66:279-286.
    1. Luberto CM, Cotton S, McLeish AC, Mingione CJ, O’Bryan EM. Mindfulness skills and emotion regulation: the mediating role of coping self-efficacy. Mindfulness. 2014;5:373-380.
    1. Soysa CK, Wilcomb CJ. Mindfulness, self-compassion, self-efficacy, and gender as predictors of depression, anxiety, stress, and well-being. Mindfulness. 2013;6:217-226.
    1. Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, van den Berg JF, Verschuren WM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep. 2011;34:1487-1492.
    1. Lehrer S, Green S, Ramanathan L, Rosenzweig KE. Obesity and deranged sleep are independently associated with increased cancer mortality in 50 US states and the District of Columbia. Sleep Breath. 2013;17:1117-1118.
    1. Focht BC, Lucas AR, Grainger E, Simpson C, Thomas-Ahner JM, Clinton SK. The Individualized Diet and Exercise Adherence Pilot Trial (IDEA-P) in prostate cancer patients undergoing androgen deprivation therapy: study protocol for a randomized controlled trial. Trials. 2014;15:354.
    1. Zhang X, Haggerty AF, Brown JC, et al. The prescription or proscription of exercise in endometrial cancer care. Gynecol Oncol. 2015;139:155-159.

Source: PubMed

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