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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|