Mindfulness -based interventions: Do you reduce fear among cancer patients?

This article is part of our special edition October 2020. Download the full edition here.

reference

Oberoi S., Yang J., Woodgate RL, et al. Association of mindfulness -based interventions with the severity of fear in adults with cancer: a systematic review and meta -analysis. Jama network open . 2020; 3 (8): E2012598.

Study goal

The goal of this review was to determine whether mindfulness -based interventions (MBIS) improve fear in cancer patients.

study design

The researchers carried out a systematic review and meta -analysis of clinical studies that were taken from Medline, Embase, Cochrane Central Register of Controlled Trials, Cinahl, Psycinfo and Scopus from the beginning of the database by May 2019.

All studies have been randomized for MBI versus control group, which could be a sham treatment, no intervention, participants on the waiting list or usual treatment. Inclusion criteria were adults and children with cancer or who received stem cell treatment for cancer.

The exclusion criteria included "observing, quasi-randomized, crossover or cluster-randomized study designs and studies that have not reported any results relevant to this review". No languages ​​were excluded from data extraction. Interventions that included physical movement, such as yoga, Qigong and Tai Chi, were excluded.

participant

A total of 3,053 people were involved in the 28 studies included in the meta -analysis. All participants were adults because none of the studies with subjects under the age of 18 met the review criteria. The participants could be in active treatment or post -treatment, with some MBIs preserving both during and after their treatments.

study parameters

A first search resulted in 5,686 quotations. After a blind screening and an independent review by 2 of the authors of this publication, 27 studies finally fulfilled the review criteria. The researchers added another study that they had found by hand for a total of 28 studies.

Primary result measurements

The primary endpoint was the severity of short -term fear up to 1 month after MBI. Secondary endpoints were afraid, depression and quality of life in the medium term (1–6 months) and long -term (6–12 months) according to MBI.

important knowledge

The MBI most frequently used in the studies included mindfulness -based stress reduction (MBSR; 13 studies, 46.4 %) and mindfulness -based cognitive therapy (MBCT; 6 studies, 21.4 %). The median duration of the MBIs was 8 weeks. 12 different anxiety scales were used in the studies, whereby Hospital Anxiety and Depression Scale A (Hads-A; 5 studies) and State-Trait Anxiety Inventory (StaI; 5 studies) were most common. Breast cancer was by far the most represented cancer in this review. Twelve studies (42.8 %) dealt exclusively with MBIs and breast cancer. Eleven recruited participants with different types of cancer, and of them were still the most common type of cancer in 10 of the studies.

mbis reduced short -term (0–1 month) fear significant (23 studies; 2,339 participants; SMD, –0.51; 95 % KI, –0.70 to –0.33; I ² = 76 %). A reduction in short-term fear was obvious when Hads-A or the Stai scale were used in an independent statistical analysis of both.

mbis also reduced the severe medium -term (> 1–6 months) anxiety (9 studies; 965 participants; SMD, –0.43; 95 % KI, –0,68 to –0.18; I ² = 66 %).

mbis were not associated with a long -term (> 6 months - 1 year) reduction in fear (2 studies; 403 participants; SMD, –0.02; 95 % KI, –0.38 to 0.34; I ² = 68 %).

Additional results showed a short -term reduction in depression (19 studies; 1,874 participants; SMD, –0.73; 95 % KI, –1.00 to –0.46; I ² = 86 %) and in the medium term; 891 participants; SMD, −0.85; 95 % KI, −1.35 −0.35;

mbis were also with an improvement in the general health-related quality of life (HRQOL) scores both at short notice (9 studies; 1,108 participants; SMD, 0.51; 95 % KI, 0.20 to 0.82; I ² = 82 %) and medium (5 studies; 771 participants; SMD, 0.29; 95 % KI, 0.06 to 052;

practice implications

mindfulness is a concept that goes back to old eastern philosophy thousands of years and is generally associated with the Buddhist tradition. Jon Kabat-Zinn, PhD, one of the pioneers of the modern mindfulness movement, describes mindfulness as "awareness that is deliberately paid attention to when you are in the present moment and without evaluation of the development of moment to moment to moment." ^{1 Kabat-Zinn was one of the first people who examined mindfulness in the context of health and well-being. After graduating from the Massachusetts Institute of Technology (with), he founded a stress reduction clinic at the University of Massachusetts Medical School. In 1979 he created Mindfulness Based Stress Reduction (MBSR), an 8-week group course. The program teaches mindfulness as a meditation practice, but also as a way of life. 2 Then he started researching the role of mindfulness in chronic pain and immunity. Kabat-Zinn examined the effects of the MBSR program for breast and prostate cancer patients, the first research of this kind.}

Although thousands of studies on mindfulness were carried out in cancer patients, most show only a moderate improvement. For example, mindfulness was no longer able to achieve the desired result compared to practice.

Several studies have shown that mindfulness benefits cancer patients. A systematic review that was carried out by Ngamkham, Holden and Smith in 2019 showed that mindfulness interventions can alleviate cancer -related pain and improve the quality of life. ^{3 A Canadian study from 2014 confirmed the results of the Nobel Prize winner and discoverer of the enzyme telomerase, elizabeth blackburn, namely that Mindfulness interventions actually influence the length of the telomer. 4 In the Canadian study, breast cancer survived who participated in a mindfulness-based Cancer Recovery (MBCR) program or group therapy, while those who did not take part in a program, a sign of Cell aging. 5}

The currently checked study is a meta -analysis that provides some indications that MBIs reduce fear in cancer patients and is a valuable contribution due to the larger number of subjects (n = 3.053) and the inclusion of all cancer. Other checks were carried out. A meta -analysis from 2017 with 1,709 breast cancer patients examined how MBSR/MBCT had a significant impact on quality of life, tiredness, sleep, stress, fear and depression. ^{6 A further meta -analysis from 2015 confirmed the effectiveness of MBIs to reduce anxiety and Depression. 7}

Despite the amount of evidence that we now have with regard to the therapeutic effect of mindfulness, there are still critics of mindfulness. Although thousands of studies on cancer patients have been carried out, most show only a moderate improvement. For example, mindfulness was no longer able to achieve the desired result compared to practice. Some include studies with small sampling sizes, lack of diversity in patients and a lack of diversity in types of cancer. Many of the study designs also lack randomized checks and long -term follow -up.

Nevertheless, many oncological centers offer mindfulness, mostly in the form of MBSR or MBCT. The programs usually last 8 weeks, with a weekly group session that covers various aspects of mindfulness, and daily individual exercises that are carried out at home. Usual techniques are non-assessment, patience, friendliness and acceptance.

decades of research provides an argument for the use of mindfulness in cancer patients, but further research is required to broadly accept its application. While the academic debate on the effectiveness of MBIs continues, only a few will deny that the reduction in anxiety and depression and the improvement of the quality of life can change the life of a patient for the better