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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

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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|

Mindfulness integrated in supportive cancer care

Posted 04.24.2015 | by AMRA

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Cancer survivors often suffer from mental distress, and there is a growing interest in evidence-based integrative approaches that address survivor’s psychological, social, and spiritual needs. Dobos et al. [Supportive Care in Cancer] tracked the emotional well-being of 117 cancer survivors referred to an 11-week Mindfulness-Based Day Care (MBDC) offered at a clinic in Essen, Germany.

Participants were assessed before, immediately after, and three months following treatment on a variety of self-report questionnaires. The clinic, which combined Mindfulness-Based Stress Reduction (MBSR) with relaxation, cognitive restructuring, diet, exercise, and naturopathic interventions, met once weekly for six hours over the 11 week period. Participants were mostly female (91%) and mostly breast cancer survivors (65%) (average age = 54 years).

Over the course of the study, the cancer survivors reported significant improvements in their physical, emotional, role, social, and cognitive quality of life, and significant decreases in their depression, anxiety, fatigue, pain, and insomnia. The magnitude of improvements ranged from an 8% improvement in physical quality of life to a 34% decrease in depression.

They also reported significantly greater life and health satisfaction, greater mindfulness (on the Freiburg Mindfulness Inventory) and improved adaptive coping, including spiritual and religious coping.

The study documented a significant improvement in the quality of life and mental well being of the cancer survivors attending the MBDC clinic.

Since it lacked a control arm, no definitive inference can be made as to whether the improvements were due to participation in the program or confounding factors such as the passage of time. Effect sizes were not reported, so it is challenging to evaluate the clinical significance of the improvements. Lastly, the combination of so many different therapeutic […]

April 24th, 2015|News|

Mindfulness Intervention for Cancer Survivors Shows Superiority

Posted from archive: 10.01.2013 | by AMRA

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Carlson el al. [Journal of Clinical Oncology] studied a large sample (N=271) of distressed breast cancer survivors who were randomly assigned to one of three treatment conditions: (1) Mindfulness-Based Cancer Recovery (MBCR), (2) Supportive-Expressive Group Therapy (SET) or (3) one-day didactic stress management control (SMS).

Participants were survivors of Stage I-III breast cancer who were no longer in the active phase of treatment and who reported moderate or higher levels of distress but who were free from severe mental illness. MBCR and SET are both empirically validated treatments for psychological distress in breast cancer survivors, and this study is the first head-to-head comparison of their efficacy. Outcome measures included quality of life, social support, and stress-related symptomatology, as well as salivary cortisol measured at regular intervals four times a day over the course of three days both prior to and after intervention.

MBCR and SET participants both maintained their initial steep diurnal cortisol slope after treatment (a desirable stress response), whereas SMS controls showed a flattening in their slope (a dysregulated stress response). These results suggest that MBCR and SET both exert a protective effect against stress-related biological disruption. MBCR participants showed a significantly greater reduction in self-reported stress symptoms than either SET or SMS participants, and a significantly greater improvement in quality of life than SMS participants.

The MBCR group also showed a significantly greater improvement in perceived social support than SET participants, which was a surprise given that SET emphasizes social support. The authors interpret the findings as evidence for MBCR’s superiority as a treatment for psychological distress in breast cancer survivors.

Reference:

Carlson, L. E., Doll, R., Stephen, J., Faris, P., Tamagawa, […]

January 10th, 2014|News|

MBSR and Long-Term Active Coping in People with Breast Cancer

Posted from archive: 02.21.2013 | by AMRA

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Henderson et al. [Integrative Cancer Therapies] compared MBSR to nutrition education (NEP) and treatment as usual (TAU) in 40 breast cancer patients actively undergoing radiation therapy.

MBSR participants outperformed both control groups on 16 variables four months after the intervention. These variables reflected improved quality of life and adaptive coping, reduced avoidance coping, increased meaningfulness and spirituality, and decreased psychopathology.

Group differences tended to diminish over time, so that by the end of two-year follow-up, MBSR participants only showed superior scores on meaningfulness, active cognitive coping, and less anxious preoccupation.

Reference:

Henderson, V. P., Massion, A. O., Clemow, L., Hurley, T. G., Druker, S., & Hébert, J. R. (2013). A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integrative Cancer Therapies, 12(5):404-13. [PMID: 23362338]

[Link to abstract]

December 27th, 2013|News|

Mindfulness Meditation Superior to Sleep Hygiene for Cancer Survivors

Posted from archive: 02.07.2013 | by AMRA

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Nakamura et al [Journal of Cancer Survivorship] compared three interventions in 57 cancer survivors with self-reported problems sleeping. Participants were randomly assigned to sleep hygiene education (SHE), mindfulness meditation (MM), or mind, body bridging (MBB). All interventions were delivered in three 2-hour group sessions, with home practice left to the participants’ discretion.

MM was a shortened version of MBSR that included sitting and walking meditation, the body scan, and a forgiveness meditation. MBB shares features with MM (sensory awareness, non, judgmental attitude, decontextualization of thought) but doesn’t include formal meditation practice. It trains participants to “rest” their “identify systems” through sensory awareness, identify the irrational demands the system places on reality and on oneself, and disengage from those demands in a friendly manner, thus loosening an identification with a false sense of self, and getting in touch with an undamaged sense of wholeness.

All three interventions significantly improved self-reported sleep quality, with both MBB and MM proving superior to SHE. MBB participants also showed significant improvement on secondary measures of self-reported depression, mindfulness, and self-compassion when compared with the SHE control group, while MM participants showed a nonsignificant trend in the same direction of benefit.

Reference:

Nakamura, Y., Lipschitz, D. L., Kuhn, R., Kinney, A. Y., & Donaldson, G. W. (2013). Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: A pilot randomized controlled trial. Journal of Cancer Survivorship: Research and Practice, 7(2):165-82. [PMID: 23338490]

[Link to abstract]

December 26th, 2013|News|

Improved Short-Term Sleep Quality from MBSR in Breast Cancer Patients

Posted from archive: 02.01.2013 | by AMRA

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Andersen et al. [Acta Oncologica] studied a cohort of 336 breast cancer patients, randomly assigned to either MBSR or treatment as usual. Self-reported sleep quality improved for both conditions, with a significantly greater improvement noted for MBSR. The effect size was small, however, and the groups no longer differed at 6-, and 12-month follow-up, controls eventually catching up with MBSR participants.

The authors conclude MBSR has a small short-term effect on sleep. MBSR participants maintained their gains at long-term follow-up, suggesting maintenance of their initial improvement over time. Sleep problems were rare in this cohort, perhaps due to the patients being an average of 7-8 months past their diagnosis, placing a ceiling on the magnitude of change scores.

Reference:

Andersen, S. R., Würtzen, H., Steding-Jessen, M., Christensen, J., Andersen, K. K., Flyger, H., . . . Dalton, S. O. (2013). Effect of mindfulness-based stress reduction on sleep quality: Results of a randomized trial among Danish breast cancer patients. Acta Oncologica, 52(2), 336-44. [PMID: 23282113]

[Link to abstract]

December 25th, 2013|News|