Skip to main content
Top
Published in: Breast Cancer Research and Treatment 1/2012

01-01-2012 | Clinical Trial

The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial

Authors: Virginia P. Henderson, Lynn Clemow, Ann O. Massion, Thomas G. Hurley, Susan Druker, James R. Hébert

Published in: Breast Cancer Research and Treatment | Issue 1/2012

Login to get access

Abstract

The aim of this study was determine the effectiveness of a mindfulness-based stress-reduction (MBSR) program on quality of life (QOL) and psychosocial outcomes in women with early-stage breast cancer, using a three-arm randomized controlled clinical trial (RCT). This RCT consisting of 172 women, aged 20–65 with stage I or II breast cancer consisted of the 8-week MBSR, which was compared to a nutrition education program (NEP) and usual supportive care (UC). Follow-up was performed at three post-intervention points: 4 months, 1, and 2 years. Standardized, validated self-administered questionnaires were adopted to assess psychosocial variables. Statistical analysis included descriptive and regression analyses incorporating both intention-to-treat and post hoc multivariable approaches of the 163 women with complete data at baseline, those who were randomized to MBSR experienced a significant improvement in the primary measures of QOL and coping outcomes compared to the NEP, UC, or both, including the spirituality subscale of the FACT-B as well as dealing with illness scale increases in active behavioral coping and active cognitive coping. Secondary outcome improvements resulting in significant between-group contrasts favoring the MBSR group at 4 months included meaningfulness, depression, paranoid ideation, hostility, anxiety, unhappiness, and emotional control. Results tended to decline at 12 months and even more at 24 months, though at all times, they were as robust in women with lower expectation of effect as in those with higher expectation. The MBSR intervention appears to benefit psychosocial adjustment in cancer patients, over and above the effects of usual care or a credible control condition. The universality of effects across levels of expectation indicates a potential to utilize this stress reduction approach as complementary therapy in oncologic practice.
Appendix
Available only for authorised users
Literature
1.
go back to reference Montazeri A (2008) Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res 27:32–63PubMedCrossRef Montazeri A (2008) Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res 27:32–63PubMedCrossRef
2.
go back to reference van’t Spijker A, Trijsburg RW, Duivenvoorden HJ (1997) Psychological sequelae of cancer diagnosis: a metaanalytical review of 58 studies after 1980. Psychosom Med 59:280–293PubMed van’t Spijker A, Trijsburg RW, Duivenvoorden HJ (1997) Psychological sequelae of cancer diagnosis: a metaanalytical review of 58 studies after 1980. Psychosom Med 59:280–293PubMed
3.
go back to reference Heim E, Valach L, Sheffner L (1997) Coping and psychosocial adaptation: longitudinal effects overtime and stages in breast cancer. Psychosom Med 59:408–418PubMed Heim E, Valach L, Sheffner L (1997) Coping and psychosocial adaptation: longitudinal effects overtime and stages in breast cancer. Psychosom Med 59:408–418PubMed
4.
go back to reference Teasdale J, Segal Z, Williams J (1995) How does cognitive therapy prevent depressive relapse and why should attentional control (mindfullness) training help? An information-processing analysis. J Behav Res Ther 33:25–39CrossRef Teasdale J, Segal Z, Williams J (1995) How does cognitive therapy prevent depressive relapse and why should attentional control (mindfullness) training help? An information-processing analysis. J Behav Res Ther 33:25–39CrossRef
5.
go back to reference Kabat-Zinn J, Massion AO, Kristeller J, Peterson LG, Fletcher KE, Pbert L, Lenderking WR, Santorelli SF (1992) Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry 149:936–943PubMed Kabat-Zinn J, Massion AO, Kristeller J, Peterson LG, Fletcher KE, Pbert L, Lenderking WR, Santorelli SF (1992) Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry 149:936–943PubMed
6.
go back to reference Kabat-Zinn J, Lipworth L, Burney V (1985) The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med 8:163–189PubMedCrossRef Kabat-Zinn J, Lipworth L, Burney V (1985) The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med 8:163–189PubMedCrossRef
7.
go back to reference Stanton A (2005) How and for whom? Asking questions about the utility of psychosocial interventions for individuals diagnosed with cancer. J Clin Oncol 23(22):4818–4820PubMedCrossRef Stanton A (2005) How and for whom? Asking questions about the utility of psychosocial interventions for individuals diagnosed with cancer. J Clin Oncol 23(22):4818–4820PubMedCrossRef
8.
go back to reference Moyer A, Knapp-Oliver SK, Sohl SJ, Schnieder S, Floyd AH (2009) Lessons to be learned from 25 years of research investigating psychosocial interventions for cancer patients. Cancer J 15(5):345–351PubMedCrossRef Moyer A, Knapp-Oliver SK, Sohl SJ, Schnieder S, Floyd AH (2009) Lessons to be learned from 25 years of research investigating psychosocial interventions for cancer patients. Cancer J 15(5):345–351PubMedCrossRef
9.
go back to reference Moyer A, Sohl SJ, Knapp-Oliver SK, Schneider S (2009) Characteristics and methodological quality of 25 years of research investigating psychosocial interventions for cancer patients. Cancer Treat Rev 35(5):475–484PubMedCrossRef Moyer A, Sohl SJ, Knapp-Oliver SK, Schneider S (2009) Characteristics and methodological quality of 25 years of research investigating psychosocial interventions for cancer patients. Cancer Treat Rev 35(5):475–484PubMedCrossRef
10.
go back to reference Newell SA, Sanson-Fisher RW, Savolainen NJ (2002) Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst 94(8):558–584PubMed Newell SA, Sanson-Fisher RW, Savolainen NJ (2002) Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst 94(8):558–584PubMed
11.
go back to reference Tatrow K, Montgomery GH (2006) Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med 29(1):17–27PubMedCrossRef Tatrow K, Montgomery GH (2006) Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med 29(1):17–27PubMedCrossRef
12.
go back to reference Ledesma D, Kumano H (2009) Mindfulness-based stress reduction and cancer: a meta-analysis. Psycho-oncology 18(6):571–579PubMedCrossRef Ledesma D, Kumano H (2009) Mindfulness-based stress reduction and cancer: a meta-analysis. Psycho-oncology 18(6):571–579PubMedCrossRef
13.
go back to reference Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, Widen RH, Fitzgerald SG, Shelton MM, Barta M et al (2009) Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology 18(12):1261–1272PubMedCrossRef Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, Widen RH, Fitzgerald SG, Shelton MM, Barta M et al (2009) Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology 18(12):1261–1272PubMedCrossRef
15.
go back to reference Shapiro SL, Bootzin RR, Figueredo AJ, Lopez AM, Schwartz GE (2003) The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study. J Psychosom Res 54(1):85–91PubMedCrossRef Shapiro SL, Bootzin RR, Figueredo AJ, Lopez AM, Schwartz GE (2003) The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study. J Psychosom Res 54(1):85–91PubMedCrossRef
16.
go back to reference Antoni MH, Lehman JM, Kilbourn KM, Boyers AE, Culver JL, Alferi SM, Yount SE, McGregor BA, Arena PL, Harris SD et al (2001) Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol 20(1):20–32PubMedCrossRef Antoni MH, Lehman JM, Kilbourn KM, Boyers AE, Culver JL, Alferi SM, Yount SE, McGregor BA, Arena PL, Harris SD et al (2001) Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol 20(1):20–32PubMedCrossRef
17.
go back to reference Antoni MH, Lechner SC, Kazi A, Wimberly SR, Sifre T, Urcuyo KR, Phillips K, Gluck S, Carver CS (2006) How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol 74(6):1143–1152PubMedCrossRef Antoni MH, Lechner SC, Kazi A, Wimberly SR, Sifre T, Urcuyo KR, Phillips K, Gluck S, Carver CS (2006) How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol 74(6):1143–1152PubMedCrossRef
18.
go back to reference Antoni MH, Wimberly SR, Lechner SC, Kazi A, Sifre T, Urcuyo KR, Phillips K, Smith RG, Petronis VM, Guellati S et al (2006) Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. Am J Psychiatry 163(10):1791–1797PubMedCrossRef Antoni MH, Wimberly SR, Lechner SC, Kazi A, Sifre T, Urcuyo KR, Phillips K, Smith RG, Petronis VM, Guellati S et al (2006) Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. Am J Psychiatry 163(10):1791–1797PubMedCrossRef
19.
go back to reference Kabat-Zinn J (1982) An outpatient program in behavioural medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry 4:33–47PubMedCrossRef Kabat-Zinn J (1982) An outpatient program in behavioural medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry 4:33–47PubMedCrossRef
20.
go back to reference Kabat-Zinn J (1990) Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. Delacorte, New York Kabat-Zinn J (1990) Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. Delacorte, New York
21.
go back to reference Kabat-Zinn J, Chapman-Waldrop A (1988) Compliance with an outpatient stress reduction program: rates and predictors of completion. J Behav Med 11:333–352PubMedCrossRef Kabat-Zinn J, Chapman-Waldrop A (1988) Compliance with an outpatient stress reduction program: rates and predictors of completion. J Behav Med 11:333–352PubMedCrossRef
22.
go back to reference Kabat-Zinn J, Lipworth L, Burney R, Sellers W (1987) Four year follow-up of a meditation-based program for the self-regulation of chronic pain: treatment outcomes and compliance. Clin J Pain 2:159–173CrossRef Kabat-Zinn J, Lipworth L, Burney R, Sellers W (1987) Four year follow-up of a meditation-based program for the self-regulation of chronic pain: treatment outcomes and compliance. Clin J Pain 2:159–173CrossRef
23.
go back to reference Bandura A (1986) Social foundation of thought and action: a social cognitive theory. Prentice-Hall, Englewood Cliffs Bandura A (1986) Social foundation of thought and action: a social cognitive theory. Prentice-Hall, Englewood Cliffs
24.
go back to reference Bandura A (1997) Self efficacy: the exercise of control. W. H. Freeman & Co, New York Bandura A (1997) Self efficacy: the exercise of control. W. H. Freeman & Co, New York
25.
26.
go back to reference Bandura A, O’Leary A, Taylor CB, Gauthier J, Gossard D (1987) Perceived self-efficacy and pain control: opioid and nonopioid mechanisms. J Pers Soc Psychol 53:563–571PubMedCrossRef Bandura A, O’Leary A, Taylor CB, Gauthier J, Gossard D (1987) Perceived self-efficacy and pain control: opioid and nonopioid mechanisms. J Pers Soc Psychol 53:563–571PubMedCrossRef
27.
go back to reference Ockene JK, Ockene IS, Quirk ME, Hebert JR, Saperia GM, Luippold RS, Merriam PA, Ellis S (1995) Physician training for patient-centered nutrition counseling in a lipid intervention trial. Prev Med 24:563–570PubMedCrossRef Ockene JK, Ockene IS, Quirk ME, Hebert JR, Saperia GM, Luippold RS, Merriam PA, Ellis S (1995) Physician training for patient-centered nutrition counseling in a lipid intervention trial. Prev Med 24:563–570PubMedCrossRef
28.
go back to reference Rosal MC, Ebbeling CB, Lofgren I, Ockene JK, Ockene IS, Hebert JR (2001) Facilitating dietary change: the patient-centered counseling model. J Am Dietet Assoc 101:332–341CrossRef Rosal MC, Ebbeling CB, Lofgren I, Ockene JK, Ockene IS, Hebert JR (2001) Facilitating dietary change: the patient-centered counseling model. J Am Dietet Assoc 101:332–341CrossRef
29.
go back to reference Cella DF, Lee-Riordan D, Silberman M (1989) Quality of life in advanced cancer: three new disease-specific measures. Proc Am Soc Clin Oncol 8:315 (Abst. 1225) Cella DF, Lee-Riordan D, Silberman M (1989) Quality of life in advanced cancer: three new disease-specific measures. Proc Am Soc Clin Oncol 8:315 (Abst. 1225)
30.
go back to reference Cella DF, Tulsky DS (1990) Measuring quality of life today: methodological aspects. Oncology 4(5):29–38PubMed Cella DF, Tulsky DS (1990) Measuring quality of life today: methodological aspects. Oncology 4(5):29–38PubMed
31.
go back to reference Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) The functional assessment of cancer therapy (FACT) Scale: development and validation of the general measure. J Clin Oncol 11:570–579PubMed Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) The functional assessment of cancer therapy (FACT) Scale: development and validation of the general measure. J Clin Oncol 11:570–579PubMed
32.
go back to reference Cella DF (1992) Manual - functional assessment of cancer therapy (FACT) scales: available from David F. Cella, Ph.D., Division of Psychosocial Oncology, Rush Cancer Center, 1725 W. Harrison, Chicago, I 60612 Cella DF (1992) Manual - functional assessment of cancer therapy (FACT) scales: available from David F. Cella, Ph.D., Division of Psychosocial Oncology, Rush Cancer Center, 1725 W. Harrison, Chicago, I 60612
33.
go back to reference Namir S, Wolcott DL, Fawzy FI, Alumbaugh MJ (1987) Coping with AIDS: psychological and health implications. J Appl Soc Psychol 17:309–328CrossRef Namir S, Wolcott DL, Fawzy FI, Alumbaugh MJ (1987) Coping with AIDS: psychological and health implications. J Appl Soc Psychol 17:309–328CrossRef
34.
go back to reference Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedCrossRef Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedCrossRef
35.
go back to reference Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Clin Consult Psychol 56:893–897CrossRef Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Clin Consult Psychol 56:893–897CrossRef
36.
go back to reference Derogatis LR (1977) SCL-90-R (revised version manual-1). Baltimore Derogatis LR (1977) SCL-90-R (revised version manual-1). Baltimore
37.
go back to reference Rosenberg M (1979) Conceiving the self. Basic Books, New York Rosenberg M (1979) Conceiving the self. Basic Books, New York
38.
go back to reference Russell D, Peplau L, Cutrona C (1980) The revised UCLA loneliness scale: concurrent and discriminative validity evidence. J Pers Soc Psychol 39:472–480PubMedCrossRef Russell D, Peplau L, Cutrona C (1980) The revised UCLA loneliness scale: concurrent and discriminative validity evidence. J Pers Soc Psychol 39:472–480PubMedCrossRef
39.
go back to reference Watson M, Greer S, Young J, Inayat Q, Burgess C, Robertson B (1988) Development of a questionnaire measure of adjustment to cancer: the MAC scale. Psychol Med 18:203–209PubMedCrossRef Watson M, Greer S, Young J, Inayat Q, Burgess C, Robertson B (1988) Development of a questionnaire measure of adjustment to cancer: the MAC scale. Psychol Med 18:203–209PubMedCrossRef
40.
go back to reference Antonovsky A (1987) Unraveling the mystery of health. Jossey-Bass, San Francisco Antonovsky A (1987) Unraveling the mystery of health. Jossey-Bass, San Francisco
41.
go back to reference Antonovsky A (1993) The structure and properties of the sense of coherence scale. Soc Sci Med 36:725–733PubMedCrossRef Antonovsky A (1993) The structure and properties of the sense of coherence scale. Soc Sci Med 36:725–733PubMedCrossRef
42.
go back to reference Antonovsky A (1990) Pathways leading to successful coping and health. In: Rosenbaum M (ed) Learned resourcefulness. Springer, New York, p 31 Antonovsky A (1990) Pathways leading to successful coping and health. In: Rosenbaum M (ed) Learned resourcefulness. Springer, New York, p 31
43.
go back to reference Watson M, Greer S (1983) A manual for the courtauld emotional control scale (CECS). Downs Road, Sutton, Surrey SM2 5PT, England. Cancer Research Campaign Psychological Medicine Research Group, The Royal Marsden Hospital Watson M, Greer S (1983) A manual for the courtauld emotional control scale (CECS). Downs Road, Sutton, Surrey SM2 5PT, England. Cancer Research Campaign Psychological Medicine Research Group, The Royal Marsden Hospital
44.
go back to reference Watson M, Greer S (1983) Development of a questionnaire measure of emotional control. J Psychosom Res 27(4):299–305PubMedCrossRef Watson M, Greer S (1983) Development of a questionnaire measure of emotional control. J Psychosom Res 27(4):299–305PubMedCrossRef
45.
go back to reference Hebert JR, Ebbeling CB, Hurley TG, Ma Y, Clemow L, Olendzki BC, Saal N, Ockene JK (2001) Change in women’s diet and body mass following intensive intervention in early-stage breast cancer. J Am Diet Assoc 101:421–431PubMedCrossRef Hebert JR, Ebbeling CB, Hurley TG, Ma Y, Clemow L, Olendzki BC, Saal N, Ockene JK (2001) Change in women’s diet and body mass following intensive intervention in early-stage breast cancer. J Am Diet Assoc 101:421–431PubMedCrossRef
46.
go back to reference Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36(1):13–34PubMedCrossRef Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36(1):13–34PubMedCrossRef
47.
go back to reference Knobf MT (2011) Clinical update: psychosocial responses in breast cancer survivors. Sem Oncol Nurs 27(3):e1–e14CrossRef Knobf MT (2011) Clinical update: psychosocial responses in breast cancer survivors. Sem Oncol Nurs 27(3):e1–e14CrossRef
48.
go back to reference Coyne JC, Lepore SJ, Palmer SC (2006) Efficacy of psychosocial interventions in cancer care: evidence is weaker than it first looks. Ann Behav Med 32(2):104–110PubMedCrossRef Coyne JC, Lepore SJ, Palmer SC (2006) Efficacy of psychosocial interventions in cancer care: evidence is weaker than it first looks. Ann Behav Med 32(2):104–110PubMedCrossRef
49.
go back to reference Linden W, Satin JR (2007) Avoidable pitfalls in behavioral medicine outcome research. Ann Behav Med 33(2):143–147PubMedCrossRef Linden W, Satin JR (2007) Avoidable pitfalls in behavioral medicine outcome research. Ann Behav Med 33(2):143–147PubMedCrossRef
50.
go back to reference Sheard T, Maguire P (1999) The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br J Cancer 80(11):1770–1780PubMedCrossRef Sheard T, Maguire P (1999) The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br J Cancer 80(11):1770–1780PubMedCrossRef
51.
go back to reference Coyne JC, Palmer SC, Shapiro PJ, Thompson R, DeMichele A (2004) Distress, psychiatric morbidity, and prescriptions for psychotropic medication in a breast cancer waiting room sample. Gen Hospital Psychiatry 26(2):121–128CrossRef Coyne JC, Palmer SC, Shapiro PJ, Thompson R, DeMichele A (2004) Distress, psychiatric morbidity, and prescriptions for psychotropic medication in a breast cancer waiting room sample. Gen Hospital Psychiatry 26(2):121–128CrossRef
52.
go back to reference Gruber BL, Hersh SP, Hall NRS, Waletzky LR, Kunz JF, Carpenter JK, Kverno KS, Weiss SM (1993) Immunological responses of breast cancer patients to behavioral interventions. Biofeedback Self Regul 18(1):1–22PubMedCrossRef Gruber BL, Hersh SP, Hall NRS, Waletzky LR, Kunz JF, Carpenter JK, Kverno KS, Weiss SM (1993) Immunological responses of breast cancer patients to behavioral interventions. Biofeedback Self Regul 18(1):1–22PubMedCrossRef
53.
go back to reference Greer S, Morris T, Pettingale KW, Haybittle JL (1990) Psychological response to breast cancer and 15-year outcome. Lancet 1:49–50CrossRef Greer S, Morris T, Pettingale KW, Haybittle JL (1990) Psychological response to breast cancer and 15-year outcome. Lancet 1:49–50CrossRef
54.
Metadata
Title
The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial
Authors
Virginia P. Henderson
Lynn Clemow
Ann O. Massion
Thomas G. Hurley
Susan Druker
James R. Hébert
Publication date
01-01-2012
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2012
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-011-1738-1

Other articles of this Issue 1/2012

Breast Cancer Research and Treatment 1/2012 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

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