Top

Published in:

01-06-2016

Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal cancer survivors: effects on cancer-related cognitive impairment

Authors: Shelley A. Johns, Diane Von Ah, Linda F. Brown, Kathleen Beck-Coon, Tasneem L. Talib, Jennifer M. Alyea, Patrick O. Monahan, Yan Tong, Laura Wilhelm, R. Brian Giesler

Published in: Journal of Cancer Survivorship | Issue 3/2016

Abstract

Purpose

Cancer-related cognitive impairment (CRCI) is a common, fatigue-related symptom that disrupts cancer survivors’ quality of life. Few interventions for CRCI exist. As part of a randomized pilot study targeting cancer-related fatigue, the effects of mindfulness-based stress reduction (MBSR) on survivors’ cognitive outcomes were investigated.

Methods

Breast and colorectal cancer survivors (n = 71) with moderate-to-severe fatigue were randomized to MBSR (n = 35) or a fatigue education and support (ES; n = 36) condition. The Attentional Function Index (AFI) and the Stroop test were used to assess survivors’ cognitive function at baseline (T1), after the 8-week intervention period (T2), and 6 months later (T3) using intent-to-treat analysis. Mediation analyses were performed to explore mechanisms of intervention effects on cognitive functioning.

Results

MBSR participants reported significantly greater improvement on the AFI total score compared to ES participants at T2 (d = 0.83, p = 0.001) and T3 (d = 0.55, p = 0.021). MBSR also significantly outperformed ES on most AFI subscales, although both groups improved over time. MBSR produced greater Stroop accuracy rates relative to ES at T2 (r = 0.340, p = 0.005) and T3 (r = 0.280, p = 0.030), with improved accuracy over time only for the MBSR group. There were no significant differences in Stroop reaction time between groups. Improvements in mindfulness mediated the effect of group (e.g., MBSR vs. ES) on AFI total score at T2 and T3.

Conclusions

Additional randomized trials with more comprehensive cognitive measures are warranted to definitively assess the efficacy of MBSR for CRCI.

Implications for Cancer Survivors

This pilot study has important implications for all cancer survivors as it is the first published trial to show that MBSR offers robust and durable improvements in CRCI.

Bender CM, Thelen BD. Cancer and cognitive changes: the complexity of the problem. Semin Oncol Nurs. 2013;29(4):232–7. doi:10.1016/j.soncn.2013.08.003.CrossRefPubMed

Vardy J, Rourke S, Tannock IF. Evaluation of cognitive function associated with chemotherapy: a review of published studies and recommendations for future research. J Clin Oncol. 2007;25(17):2455–63. doi:10.1200/JCO.2006.08.1604.CrossRefPubMed

Wefel JS, Schagen SB. Chemotherapy-related cognitive dysfunction. Curr Neurol Neurosci Rep. 2012;12(3):267–75.CrossRefPubMed

Cruzado JA, Lopez-Santiago S, Martinez-Marin V, Jose-Moreno G, Custodio AB, Feliu J. Longitudinal study of cognitive dysfunctions induced by adjuvant chemotherapy in colon cancer patients. Support Care Cancer. 2014;22(7):1815–23. doi:10.1007/s00520-014-2147-x.CrossRefPubMed

Hodgson KD, Hutchinson AD, Wilson CJ, Nettelbeck T. A meta-analysis of the effects of chemotherapy on cognition in patients with cancer. Cancer Treat Rev. 2013;39(3):297–304. doi:10.1016/j.ctrv.2012.11.001.CrossRefPubMed

Lindner OC, Phillips B, McCabe MG, et al. A meta-analysis of cognitive impairment following adult cancer chemotherapy. Neuropsychology. 2014;28(5):726–40. doi:10.1037/neu0000064.CrossRefPubMedPubMedCentral

Bender CM, Ergyn FS, Rosenzweig MQ, Cohen SM, Sereika SM. Symptom clusters in breast cancer across 3 phases of the disease. Cancer Nurs. 2005;28(3):219–25.CrossRefPubMed

Koppelmans V, Breteler MM, Boogerd W, Seynaeve C, Gundy C, Schagen SB. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol. 2012;30(10):1080–6. doi:10.1200/jco.2011.37.0189.CrossRefPubMed

Von Ah D, Habermann B, Carpenter J, Schneider B. Impact of perceived cognitive impairment in breast cancer survivors. Eur J Oncol Nurs. 2013;17(2):236–41. doi:10.1016/j.ejon.2012.06.002.CrossRef

10.

Myers JS. Cancer- and chemotherapy-related cognitive changes: the patient experience. Semin Oncol Nurs. 2013;29(4):300–7.CrossRefPubMed

11.

Feuerstein M, Hansen JA, Calvio LC, Johnson L, Ronquillo JG. Work productivity in brain tumor survivors. J Occup Environ Med. 2007;49(7):803–11. doi:10.1097/JOM.0b013e318095a458.CrossRefPubMed

12.

Von Ah D, Russell KM, Storniolo AM, Carpenter JS. Cognitive dysfunction and its relationship to quality of life in breast cancer survivors. Oncol Nurs Forum. 2009;36(3):326–36.CrossRef

13.

Von Ah D, Jansen CE, Allen DH. Evidence-based interventions for cancer- and treatment-related cognitive impairment: putting evidence into practice. Clin J Oncol Nurs. 2014;18(Suppl):17–25. doi:10.1188/14.CJON.S3.17-25.

14.

Cullen M. Mindfulness-based interventions: an emerging phenomenon. Mindfulness. 2011;2(3):186–93.CrossRef

15.

Lutz A, Slagter HA, Dunne JD, Davidson RJ. Attention regulation and monitoring in meditation. Trends Cogn Sci. 2008;12(4):163–9.CrossRefPubMedPubMedCentral

16.

Carmody J. Evolving conceptions of mindfulness in clinical settings. J Cogn Psychother. 2009;23(3):270–80.CrossRef

17.

Gu J, Strauss C, Bond R, Cavanagh K. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? a systematic review and meta-analysis of mediation studies. Clin Psychol Rev. 2015;37:1–12. doi:10.1016/j.cpr.2015.01.006.CrossRefPubMed

18.

Chiesa A, Calati R, Serretti A. Does mindfulness training improve cognitive abilities? a systematic review of neuropsychological findings. Clin Psychol Rev. 2011;31(3):449–64. doi:10.1016/j.cpr.2010.11.003.CrossRefPubMed

19.

Hoffman CJ, Ersser SJ, Hopkinson JB, Nicholls PG, Harrington JE, Thomas PW. Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. J Clin Oncol. 2012;30(12):1335–42. doi:10.1200/JCO.2010.34.0331.CrossRefPubMed

20.

Lengacher CA, Johnson-Mallard V, Post-White J, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261–72. doi:10.1002/pon.1529.CrossRefPubMed

21.

Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2014. doi:10.1002/pon.3648.PubMed

22.

Zainal NZ, Booth S, Huppert FA. The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis. Psychooncology. 2013;22(7):1457–65. doi:10.1002/pon.3171.CrossRefPubMed

23.

Von Ah D, Storey S, Jansen C, Allen D. Coping strategies and interventions for cognitive changes associated with cancer and cancer therapy. Semin Oncol Nurs. 2013;29(4):288–99.CrossRef

24.

Speca M, Carlson LE, Goodey E, Angen M. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med. 2000;62(5):613–22.CrossRefPubMed

25.

Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M. The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Support Care Cancer. 2001;9(2):112–23.CrossRefPubMed

26.

Johns SA, Talib TL, Brown LF, et al. Randomized controlled trial of mindfulness-based stress reduction compared to education/support for persistently fatigued breast and colorectal cancer survivors. Transforming Cancer Survivorship Through Research and Best Practice. 2015; Cincinnati, OH.

27.

Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It's not over when it's over: long-term symptoms in cancer survivors--a systematic review. Int J Psychiatry Med. 2010;40(2):163–81.CrossRefPubMed

28.

Donovan KA, Jacobsen PB, Small BJ, Munster PN, Andrykowski MA. Identifying clinically meaningful fatigue with the fatigue symptom inventory. J Pain Symptom Manag. 2008;36(5):480–7. doi:10.1016/j.jpainsymman.2007.11.013.CrossRef

29.

Kroenke K, Spitzer RL, Williams JBW. The patient health questionnaire-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.CrossRefPubMedPubMedCentral

30.

Santorelli S, Kabat-Zinn J. Mindfulness-based stress reduction professional education and training resource manual: MBSR standards of practice, curriculum, and supporting materials. Worcester: Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School; 2011.

31.

Hutchinson AD, Hosking JR, Kichenadasse G, Mattiske JK, Wilson C. Objective and subjective cognitive impairment following chemotherapy for cancer: a systematic review. Cancer Treat Rev. 2012;38(7):926–34. doi:10.1016/j.ctrv.2012.05.002.CrossRefPubMed

32.

Cimprich B, Visovatti M, Ronis DL. The attentional function index--a self-report cognitive measure. Psychooncology. 2011;20(2):194–202. doi:10.1002/pon.1729.CrossRefPubMed

33.

Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol. 1935;18:643–22.CrossRef

34.

MacLeod CM. The stroop task in cognitive research. In: Wenzel A, Rubin DC, editors. Cognitive methods and their application to clinical research. Washington, D. C.: Merican Psychological Association; 2005. p. 17–40.CrossRef

35.

Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13(1):27–45. doi:10.1177/1073191105283504.CrossRefPubMed

36.

Baer RA, Smith GT, Lykins E, et al. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15(3):329–42. doi:10.1177/1073191107313003.CrossRefPubMed

37.

Senn S. Testing for baseline balance in clinical trials. Stat Med. 1994;13(17):1715–26.CrossRefPubMed

38.

Johnson SE, Richeson JA, Finkel EJ. Middle class and marginal? socioeconomic status, stigma, and self-regulation at an elite university. J Pers Soc Psychol. 2011;100(5):838–52. doi:10.1037/a0021956.CrossRefPubMed

39.

Richeson JA, Trawalter S. Why do interracial interactions impair executive function? a resource depletion account. J Pers Soc Psychol. 2005;88(6):934–47. doi:10.1037/0022-3514.88.6.934.CrossRefPubMed

40.

Josefsson T, Borberg A. Mediators and non-mediators on sustained and executive attentional performance. c. 2011;14(3):291–309.

41.

Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91.CrossRefPubMed

42.

Cimprich B, So H, Ronis DL, Trask C. Pre-treatment factors related to cognitive functioning in women newly diagnosed with breast cancer. Psychooncology. 2005;14(1):70–8. doi:10.1002/pon.821.CrossRefPubMed

43.

de Raaf PJ, de Klerk C, van der Rijt CCD. Elucidating the behavior of physical fatigue and mental fatigue in cancer patients: a review of the literature. Psycho-Oncology. 2013;22(9):1919–29. doi:10.1002/pon.3225.CrossRefPubMed

44.

Lengacher C, Reich R, Post-White J, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86–94. doi:10.1007/s10865-011-9346-4.CrossRefPubMed

45.

Denlinger CS. National Comprehensive National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Survivorship, version 1.2015. 2015. http://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf. Accessed 20 March 2015.

46.

Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hebert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404–13. doi:10.1177/1534735412473640.CrossRefPubMedPubMedCentral

Title: Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal cancer survivors: effects on cancer-related cognitive impairment
Authors: Shelley A. Johns
Diane Von Ah
Linda F. Brown
Kathleen Beck-Coon
Tasneem L. Talib
Jennifer M. Alyea
Patrick O. Monahan
Yan Tong
Laura Wilhelm
R. Brian Giesler
Publication date: 01-06-2016
Publisher: Springer US
Published in: Journal of Cancer Survivorship / Issue 3/2016
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-015-0494-3

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors

Please log in to get access to this content

Other articles of this Issue 3/2016

Changes in importance of work and vocational satisfaction during the 2 years after breast cancer surgery and factors associated with this

Sexual health problems in French cancer survivors 2 years after diagnosis—the national VICAN survey

Medicaid expansion and access to care among cancer survivors: a baseline overview

The influence of high-intensity compared with moderate-intensity exercise training on cardiorespiratory fitness and body composition in colorectal cancer survivors: a randomised controlled trial

Prevalence and predictors of human papillomavirus (HPV) vaccination among young women surviving childhood cancer

Improving an electronic system for measuring PROs in routine oncology practice

Keynote webinar | Spotlight on antibody–drug conjugates in cancer