Posted 12.22.2016 | by AMRA

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Prostate cancer is the second most frequently diagnosed cancer in men, and one-fifth of those diagnosed go on to develop either metastatic or incurable progressive forms of the disease. Men with advanced prostate cancer have higher rates of depression, anxiety, PTSD, and suicide risk than the general population, and may be able to benefit from group treatments to reduce the psychological suffering associated with both the illness and the unintended effects of treatment.

Mindfulness-Based Cognitive Therapy (MBCT) has been shown to be an effective treatment for preventing relapse in recurrent depression, and Chambers et al. [Journal of Clinical Oncology] conducted a randomized, controlled study to see whether it could also be of benefit to advanced prostate cancer patients.

The researchers randomly assigned 189 Australian men (average age = 71 years) with advanced prostate cancer to either an 8-week MBCT group intervention delivered by teleconferencing, or a minimally enhanced treatment-as-usual condition. Teleconferencing allowed patients who lived in rural/remote areas or who were too ill to travel to participate.

MBCT telephone sessions were held once a week, lasted for 1.25 hours, included short 15-minute meditation periods, and encouraged daily home practice. The enhanced treatment-as-usual condition provided patients with a consumer guide to advanced prostate cancer, a relaxation CD, coping-with-cancer booklets, and similar information.

Outcome measures included self-report measures of general psychological distress, cancer-specific distress, anxiety concerning prostate-specific antigen (PSA) tests, quality of life, posttraumatic growth, and mindfulness (using the Five Facet Mindfulness Questionnaire or FFMQ). Measures were obtained at baseline and at 3, 6, and 9 month follow-ups.

There were no significant differences between the MBCT group and the control group on any of the self-reported outcome variables, including any of the FFMQ sub-scales. Of the 94 men assigned to the MBCT group, only 52% participated in 4 or more of the 8 group sessions. When statistical analyses were performed using the 49% of the MBCT participants who completed four or more sessions, there were again no significant improvement in outcomes, except for MBCT participants earning higher FFMQ Observing scores. Despite the lack of change in outcomes assessed, of the 61% of the MBCT sample who completed satisfaction questionnaires, 73% rated the intervention as “very helpful.”

MBCT was not effective in reducing distress in this sample of men with advanced prostate cancer. There are many possible reasons for this finding. First, a psychotherapeutic MBCT may not be for everybody. This was an older male population, and it’s possible that either mindfulness skills in the context of cognitive therapy weren’t consonant with their preferred masculine coping styles, or that their attentional styles weren’t sufficiently modifiable.

Second, this was a largely non-distressed population (60% scored below the cut-off for significant distress) so there might not have been that much room for improvement. The high non-attendance rate may be a clue that patients either didn’t think the treatment was necessary, or that this treatment wasn’t what they wanted.

Third, the high non-attendance rate lowered this study’s statistical power, affecting its ability to detect an actual effect. Fourth, teleconferencing may not have been an effective medium for MBCT treatment delivery, especially considering most MBIs were developed for in-person group-based administration. Further studies are needed to clarify which populations and conditions MBCT may be best suited for, and which forms of delivery may be most effective for male patients with advanced cancer.

Reference:

Chambers, S. K., Occhipinti, S., Foley, E., Clutton, S., Legg, M., Berry, M., . . . Smith, D. P. (2016). Mindfulness-Based cognitive therapy in advanced prostate cancer: A randomized controlled trial. Journal of Clinical Oncology.

[Link to abstract]