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Post-chemo cancer survivors have less cognitive impairment after mindfulness training

Posted 08.26.2020 | by AMRA

Up to 78% of women undergoing chemotherapy for cancer report impairment in cognitive functioning, commonly referred to as “chemo fog.” These complaints are accompanied by functional connectivity changes in regions of the brain involved in attention and executive functioning. Functional connectivity is a measure of the degree to which different brain regions act in tandem. While the efficacy of mindfulness training for cancer-related emotional difficulties is supported, the effect on cognitive impairment remains unknown.

Gucht et al. [Cancer] tested mindfulness training against a wait-list control on cancer survivors’ subjective and objective cognitive impairment, psychological symptoms, and brain connectivity.

The researchers randomly assigned 33 Belgian female breast cancer survivors (average age = 45 years) with self-reported subjective cognitive impairment to either mindfulness training or a wait-list control. Mindfulness training was based on Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), and delivered in four group-based sessions, each lasting three hours. Home practice was encouraged and brief between-session telephone calls for encouragement and support were offered over an 8-week period.

Participants were assessed at baseline, one week after the intervention, and at 3 months after on a subjective measure of cognitive functioning and an objective battery of attention, concentration, memory, executive functioning, and processing speed. Other subjective measures were used to assess emotional distress, fatigue, and mindfulness (Comprehensive Inventory of Mindfulness Experiences).

Participants also underwent resting-state fMRI brain scans at all three assessment points. Six mindfulness participants and one control did not complete the study.

Results showed the mindfulness training group had significantly greater improvement in subjective cognitive impairment at post-treatment (Hedge’s g=0.99) and follow-up (g=0.95) than controls. The mindfulness group also had significantly greater decreases in […]

August 26th, 2020|News|

Insomnia relieved by mindfulness program for breast cancer survivors

Posted 06.25.2020 | by AMRA

The diagnosis and treatment of breast cancer is a major stressor, and many breast cancer survivors (24-46%) suffer from insomnia with persistent difficulty in falling and staying asleep. Mindfulness training may help insomnia by promoting relaxation and by enhancing present-moment focusing, which can reduce sleep-interfering thoughts and emotions.

Mindfulness-Based Therapy for Insomnia (MBTI) is an integrated therapeutic intervention that offers mindfulness training along with cognitive-behavioral strategies for stress management and sleep hygiene. Zhao et al. [European Journal of Cancer Care] tested the effectiveness of MBTI compared to a wait-list control for improving sleep quality in a large sample of breast cancer survivors.

The researchers randomly assigned 136 Chinese women (average age = 53 years) diagnosed with breast cancer who had completed surgery, adjuvant chemotherapy and radiotherapy, and who met the American Academy of Sleep Medicine criteria for insomnia to an MBTI program or a wait-list control.

The six-week MBTI program was delivered in weekly, 90-minute group sessions, with instructions for 20-40 minutes of daily home mindfulness practice. Seventy percent of group session time was devoted to meditation practice using the body scan, yoga, sitting and walking meditations. The remainder of the time involved didactic material on stress management, sleep hygiene, and cognitive strategies to change one’s thinking.

Participants kept sleep diaries and meditation practice logs and were assessed at baseline, post intervention, and at 3- and 6-month follow-up on self-report measures of insomnia and mindfulness using the Five Facet Mindfulness Questionnaire.

They also donned wrist-worn actigraphs for three consecutive nights during each of the four assessment periods to measure their nighttime movement activity. Actigraphic data yielded measures of sleep latency, sleep awakenings, total time asleep, and […]

June 25th, 2020|News|

Chemotherapy patients in mindful relaxation report less nausea

Posted 02.26.2020 | by AMRA

Chemotherapy treatment for cancer can cause a variety of unpleasant side effects including nausea and vomiting. As many as 30% of chemotherapy patients may develop what is diagnosed as anticipatory nausea and vomiting. That is, nausea and vomiting become conditioned responses, and the patients suffer these symptoms just anticipating a drug infusion.

Patients’ anticipatory symptoms commonly manifest by the third chemotherapy session. Once anticipatory nausea and vomiting is conditioned, it tends to persist throughout treatment and may prove unresponsive to anti-emetic medication. An ideal intervention would prevent anticipatory symptoms before they start and could be easily administered by existing nursing personnel.

Hunter et al. [Cancer Medicine] investigated the relative efficacy of a brief nurse-administered mindfulness intervention compared to relaxing music or standard care in preventing anticipatory nausea and vomiting in chemotherapy patients.

The researchers randomly assigned 474 chemotherapy patients (92% female; 86% Caucasian; 85% diagnosed with breast cancer) to mindful relaxation, relaxing music, and standard care conditions. For the mindful relaxation group, nurses individually taught patients a 20-minute exercise involving mindfulness, imagery, and relaxation prior to their first chemotherapy treatment. Patients were also given a recording to use for daily home practice, and at the start of each chemotherapy session.

In the relaxing music group, participants listened to relaxing music (nature sounds, vocal tracks) for 20 minutes prior to the start of their first chemotherapy treatment, and were given a recording of the music to relax with at home daily, and to listen to at the beginning of each new chemotherapy session. In the standard care group, participants met with a nurse for 20 minutes before their first chemotherapy session and were given general information about […]

February 26th, 2020|News|

MBSR supports immune health among breast cancer survivors

Posted 05.28.2019 | by AMRA

Newly diagnosed breast cancer patients often experience significant psychological distress including symptoms of depression, sleep disturbance, and fatigue. They can also exhibit stress-induced immune system compromises that have the potential to accelerate tumor growth and metastasis. Interventions that restore psycho-immunological balance may also help improve cancer treatment outcomes.

Witek-Janusek et al. [Brain, Behavior, and Immunity] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on psychological and immunological functioning in newly diagnosed breast cancer patients in an experimental trial.

The researchers randomly assigned 164 women (average age = 55 years; 77% Caucasian) recently diagnosed with early stage breast cancer who had undergone surgery to either a standard MBSR or an active control condition. The active control consisted of eight 2.5 hour group sessions providing information on breast cancer, cancer treatment, communication with health providers, and other health-related topics. Attendance in both programs was fairly good, with 68% of MBSR and 78% of control participants attending at least 7 of the group sessions.

Each participant’s psychological status was assessed pre-intervention, mid-intervention, post-intervention, and at 1- and 6-month follow-ups for perceived stress, depression, sleep quality, fatigue, and mindfulness (Five Facet Mindfulness Questionnaire).

The researchers also measured natural killer cell anti-tumor activity (NKCA), monocyte production of Interleukin-6 (IL-6) and Interferon-gamma (INF-ɣ), and the amount of IL-6 and Tumor Necrosis Factor-alpha (TNF-α) present in blood plasma. NKCA prevents tumor growth and metastasis, and is thus associated with longer cancer-free periods. NK cells produce INF-ɣ, an anti-tumor cytokine which is a key immune system activator. IL-6 and TNF-α are pro-inflammatory cytokines that promote tumor progression and aggressiveness.

The results showed that the MBSR group had significantly greater increases in two protective immunological factors […]

May 28th, 2019|News|

Mindfulness coach supports women undergoing breast biopsy

Posted 11.26.2018 | by AMRA

About one in eight U.S. women will be diagnosed with breast cancer at some point in their lives. Cancer is often diagnosed by a stereotactic breast biopsy that uses a mammography-guided needle to extract suspicious tissue. The procedure requires women to remain immobile for 15-30 minutes while undergoing breast compression, which can be an uncomfortable, anxiety provoking experience.

Patients can take prescription drugs to reduce anxiety, but this requires them to be driven to and from the procedure and can delay their return to work. As a result, there is interest in non-drug interventions to reduce biopsy discomfort and anxiety.

Ratcliff et al. [Journal of the American College of Radiology] compared the effect of mindfulness meditation or focused breathing to a control group on breast biopsy pain and anxiety.

The researchers randomly assigned 76 women (average age = 55 years; 74% Caucasian and 20% Hispanic/Latina) preparing to undergo stereotactic breast biopsy to: 1) a 10-minute guided mindfulness meditation, 2) a 10-minute guided period of focused diaphragmatic breathing, or 3) a 10-minute period of listening to a neutral audio clip.

Mindfulness meditation emphasized nonjudgmental observation of the breath, sensations, thoughts, and feelings with reminders to refocus whenever the mind wandered. The meditation was guided in-person by a mind-body medicine specialist. The specialist also accompanied the patient to the biopsy, coaching them in meditation during the procedure. Focused breathing was taught and coached similarly. Audio clip patients were not accompanied or coached during the biopsy.

Measures of anxiety and pain were taken after the training interventions, every four minutes during the biopsy, and immediately following the biopsy. Additionally, an electroencephalogram (EEG) measured patient brain wave activity in regions of […]

November 26th, 2018|News|

Cost savings of Mindfulness Based Cognitive Therapy in cancer care

Posted 06.22.2017 | by AMRA

One in five breast cancer survivors report significant pain that persists years after the conclusion of medical treatment. Persistent post-treatment pain reduces cancer survivors’ quality of life and contributes to greater health care costs due to increased medical visits and medication usage. While mindfulness-based interventions have been shown to reduce pain in cancer survivors, little is known about the overall cost effectiveness of these interventions.

Johannsen et al. [Psycho-Oncology] analyzed data from a previously published randomized, controlled trial of Mindfulness-Based Cognitive Therapy (MBCT) to reduce pain in breast cancer survivors, in order to explore its cost effectiveness.

The researchers randomly assigned 129 Danish female breast cancer patients who had completed treatment and reported persistent pain to either an 8-week trial of MBCT or a wait-list control group. Health care utilization and cost analyses were performed only for a subset of 84 patients for whom there was no missing data. The MBCT intervention followed the standard weekly two-hour group protocol. Subjective pain ratings were collected from the patients at baseline, immediately at the end of the intervention, and at 3 and 6-month follow-up.

The treatment was deemed a success if a patient decreased her pain by at least two points on a 10-point rating scale, which was deemed to be the minimal clinically meaningful difference. A Danish national health registry was the source of information about healthcare utilization and prescription medication usage and costs during the 6-month follow-up period.

As previously reported, 53% of the MBCT patients reduced their pain by at least two points, whereas only 29% of the wait list controls did. MBCT patients made significantly fewer visits to general practitioners, medical specialists, physical therapists […]

June 22nd, 2017|News|

Body scan meditation during chemotherapy changes stress

Posted 05.18.2017 | by AMRA

Being diagnosed and treated for cancer can be highly stressful, and prolonged stress often alters the body’s normal stress response. For example, the amount of cortisol (a stress hormone) secreted by the adrenal gland typically varies over the course of the day, peaking upon morning awakening and gradually diminishing throughout the day. Prolonged stress blunts this biological response so that the difference between morning and afternoon cortisol levels is much smaller.

Cancer survivors often show this kind of blunted cortisol response—reduced daily variation and reduced reactivity to stress. This blunting of stress reactivity is associated with greater disease progression and shorter survival times for many types of cancers. It’s possible that somehow preventing this blunting may improve patient outcomes. Prior research shows that mindfulness-based interventions (MBIs) can limit cortisol blunting across the day in breast and prostate cancer patients.

Black et al. [Cancer] conducted a randomized, controlled test of whether a brief mindfulness activity could reduce the blunting of acute cortisol reactivity in colorectal cancer patients undergoing chemotherapy infusion.

The researchers randomly assigned 57 adults with colorectal cancer (average age = 54 years; 51% Male; 66% non-Hispanic, 33% Hispanic/Latino) who were undergoing chemotherapy infusion to one of three conditions: 1) a standard chemotherapy control group, 2) a chemotherapy + cancer education attention control group, and 3) a mindfulness meditation + cancer education group.

Saliva samples (to assess cortisol levels) were drawn four times during the hour-long chemotherapy infusion: at the start of infusion and at three 20-minute intervals thereafter. The patients also completed self-report measures of stress, anxiety, depression, and fatigue during the past week, as well as general levels of mindfulness (using a short form […]

May 18th, 2017|News|

Distress not lowered by MBCT in men with advanced stage cancer

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 […]

December 22nd, 2016|News|

Breast cancer survivors find pain and pill relief with MBCT

Posted 07.25.2016 | by AMRA

cancer_bandana_170

Up to one-in-five breast cancer survivors experience persistent moderate-to-severe pain five years after treatment. Pain may result from surgery, radiation, or chemotherapy-induced tissue and nerve damage. Since pain can be both exacerbated and modulated by psychological factors, breast cancer survivors with persistent pain may potentially benefit from psychosocial interventions to lessen pain and improve quality of life.

Johannsen et al. [Journal of Clinical Oncology] conducted a randomized, controlled trial to test the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) on reducing pain and improving quality of life in breast cancer survivors who reported persistent pain.

One hundred and twenty-nine Danish breast cancer survivors (average age = 57) who were at least 3 months post-surgery and had continuing pain ratings ≥ 3 on a 0-10 numerical rating scale were randomly assigned to either MBCT or a wait-list control. Self-report measures of pain, quality of life, and psychological distress were completed at baseline, after intervention, and at 3- and 6-month follow-up.

The MBCT protocol was the standard 8-week protocol used in treating recurrent depression, but modified to meet the needs of breast cancer survivors: session lengths were cut to 2 hours each, meditations were shortened to ≤ 30 minutes each, the yoga was “gentler,” and the all-day session was omitted.

MBCT participants showed significantly greater reductions than controls in pain intensity (Cohen’s d = .61) on a 0-10 numerical rating scale. Average pain intensity ratings decreased from 5.5 at baseline to 4.0 post-intervention, then dropped further to 3.6 at 3-month follow-up. In contrast, wait-list control pain intensity remained essentially unchanged (5.3 at baseline, 5.3 at post-intervention, 5.0 at 3-month follow-up).

MBCT participants improved significantly more on quality of life (d […]

July 25th, 2016|News|

Long-term controlled trial of mindfulness for cancer survivors shows promise

Posted 06.24.2016 | by AMRA

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Every year nearly 250,000 American women are diagnosed with breast cancer. Diagnosis and treatment can be frightening and arduous, and the interval following active treatment is often fraught with anxiety and uncertainty. Prior studies show that breast cancer survivors can benefit from psychological interventions, but little is known about which interventions yield the best outcomes.

Carlson et al. [Psycho-Oncology] conducted a randomized, controlled trial comparing two evidence-supported programs, Mindfulness-Based Cancer Recovery (MBCR) and supportive expressive group therapy (SET), in reducing stress and improving the quality of life of distressed breast cancer survivors.

The researchers randomly assigned 271 distressed Canadian breast cancer survivors (average age = 55 years) to either MBCR or SET. MBCR is an 8-week group mindfulness-based intervention modeled after Mindfulness Based Stress Reduction. SET is a 12-week group treatment developed at Stanford University that aims to mobilize social support, facilitate emotional openness and expressiveness, and strengthen coping skills.

All participating survivors had been diagnosed with Stage I-III breast cancer, completed surgical, chemotherapy, and/or radiation treatment, and scored ≥ 4 on a 10-point distress scale. Participants completed self-report measures of mood, stress, quality-of-life, perceived social support, spiritual well-being and post-traumatic growth before treatment, immediately after treatment, and at 6 month and 12 month follow-up.

Dropout rates during treatment were relatively high (MBCR=32%, SET=28%), with additional attrition (MBCR=28%, SET=23%) prior to post-treatment and follow-up assessments. The results included data from all the participants who enrolled in the trial.

Both groups improved on all of the mood subscales, but the improvement was significantly greater for MBCR participants, especially on measures of fatigue, anxiety, and confusion (average Cohen’s d = 0.37). Both groups also significantly improved on most of […]

June 24th, 2016|News|