Breast Cancer Research and Treatment

, Volume 131, Issue 1, pp 99–109

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

  • Virginia P. Henderson
  • Lynn Clemow
  • Ann O. Massion
  • Thomas G. Hurley
  • Susan Druker
  • James R. Hébert
Clinical Trial

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.

Keywords

Mindfulness-based stress reduction program Quality of life Psychosocial factors Expectancy Breast cancer psychosocial intervention 

Supplementary material

10549_2011_1738_MOESM1_ESM.doc (222 kb)
Supplementary material 1 (DOC 222 kb)

References

  1. 1.
    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 27:32–63PubMedCrossRefGoogle Scholar
  2. 2.
    van’t Spijker A, Trijsburg RW, Duivenvoorden HJ (1997) Psychological sequelae of cancer diagnosis: a metaanalytical review of 58 studies after 1980. Psychosom Med 59:280–293PubMedGoogle Scholar
  3. 3.
    Heim E, Valach L, Sheffner L (1997) Coping and psychosocial adaptation: longitudinal effects overtime and stages in breast cancer. Psychosom Med 59:408–418PubMedGoogle Scholar
  4. 4.
    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 33:25–39CrossRefGoogle Scholar
  5. 5.
    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 149:936–943PubMedGoogle Scholar
  6. 6.
    Kabat-Zinn J, Lipworth L, Burney V (1985) The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med 8:163–189PubMedCrossRefGoogle Scholar
  7. 7.
    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):4818–4820PubMedCrossRefGoogle Scholar
  8. 8.
    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):345–351PubMedCrossRefGoogle Scholar
  9. 9.
    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):475–484PubMedCrossRefGoogle Scholar
  10. 10.
    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):558–584PubMedGoogle Scholar
  11. 11.
    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):17–27PubMedCrossRefGoogle Scholar
  12. 12.
    Ledesma D, Kumano H (2009) Mindfulness-based stress reduction and cancer: a meta-analysis. Psycho-oncology 18(6):571–579PubMedCrossRefGoogle Scholar
  13. 13.
    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):1261–1272PubMedCrossRefGoogle Scholar
  14. 14.
    Lengacher CA, Reich RR, Post-White J, Moscoso MS, Shelton MM, Barta M, Le N, Budhrani P (2011) Mindfulness-based stress reduction in post-treatment breast cancer. J Behav Med. doi:10.1007/s10865-011-9346-4.:00-000
  15. 15.
    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):85–91PubMedCrossRefGoogle Scholar
  16. 16.
    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):20–32PubMedCrossRefGoogle Scholar
  17. 17.
    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):1143–1152PubMedCrossRefGoogle Scholar
  18. 18.
    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):1791–1797PubMedCrossRefGoogle Scholar
  19. 19.
    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 4:33–47PubMedCrossRefGoogle Scholar
  20. 20.
    Kabat-Zinn J (1990) Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. Delacorte, New YorkGoogle Scholar
  21. 21.
    Kabat-Zinn J, Chapman-Waldrop A (1988) Compliance with an outpatient stress reduction program: rates and predictors of completion. J Behav Med 11:333–352PubMedCrossRefGoogle Scholar
  22. 22.
    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 2:159–173CrossRefGoogle Scholar
  23. 23.
    Bandura A (1986) Social foundation of thought and action: a social cognitive theory. Prentice-Hall, Englewood CliffsGoogle Scholar
  24. 24.
    Bandura A (1997) Self efficacy: the exercise of control. W. H. Freeman & Co, New YorkGoogle Scholar
  25. 25.
    Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84:191PubMedCrossRefGoogle Scholar
  26. 26.
    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 53:563–571PubMedCrossRefGoogle Scholar
  27. 27.
    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 24:563–570PubMedCrossRefGoogle Scholar
  28. 28.
    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 101:332–341CrossRefGoogle Scholar
  29. 29.
    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)Google Scholar
  30. 30.
    Cella DF, Tulsky DS (1990) Measuring quality of life today: methodological aspects. Oncology 4(5):29–38PubMedGoogle Scholar
  31. 31.
    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 11:570–579PubMedGoogle Scholar
  32. 32.
    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 60612Google Scholar
  33. 33.
    Namir S, Wolcott DL, Fawzy FI, Alumbaugh MJ (1987) Coping with AIDS: psychological and health implications. J Appl Soc Psychol 17:309–328CrossRefGoogle Scholar
  34. 34.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedCrossRefGoogle Scholar
  35. 35.
    Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Clin Consult Psychol 56:893–897CrossRefGoogle Scholar
  36. 36.
    Derogatis LR (1977) SCL-90-R (revised version manual-1). Baltimore Google Scholar
  37. 37.
    Rosenberg M (1979) Conceiving the self. Basic Books, New YorkGoogle Scholar
  38. 38.
    Russell D, Peplau L, Cutrona C (1980) The revised UCLA loneliness scale: concurrent and discriminative validity evidence. J Pers Soc Psychol 39:472–480PubMedCrossRefGoogle Scholar
  39. 39.
    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 18:203–209PubMedCrossRefGoogle Scholar
  40. 40.
    Antonovsky A (1987) Unraveling the mystery of health. Jossey-Bass, San FranciscoGoogle Scholar
  41. 41.
    Antonovsky A (1993) The structure and properties of the sense of coherence scale. Soc Sci Med 36:725–733PubMedCrossRefGoogle Scholar
  42. 42.
    Antonovsky A (1990) Pathways leading to successful coping and health. In: Rosenbaum M (ed) Learned resourcefulness. Springer, New York, p 31Google Scholar
  43. 43.
    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 HospitalGoogle Scholar
  44. 44.
    Watson M, Greer S (1983) Development of a questionnaire measure of emotional control. J Psychosom Res 27(4):299–305PubMedCrossRefGoogle Scholar
  45. 45.
    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 101:421–431PubMedCrossRefGoogle Scholar
  46. 46.
    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):13–34PubMedCrossRefGoogle Scholar
  47. 47.
    Knobf MT (2011) Clinical update: psychosocial responses in breast cancer survivors. Sem Oncol Nurs 27(3):e1–e14CrossRefGoogle Scholar
  48. 48.
    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):104–110PubMedCrossRefGoogle Scholar
  49. 49.
    Linden W, Satin JR (2007) Avoidable pitfalls in behavioral medicine outcome research. Ann Behav Med 33(2):143–147PubMedCrossRefGoogle Scholar
  50. 50.
    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):1770–1780PubMedCrossRefGoogle Scholar
  51. 51.
    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):121–128CrossRefGoogle Scholar
  52. 52.
    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):1–22PubMedCrossRefGoogle Scholar
  53. 53.
    Greer S, Morris T, Pettingale KW, Haybittle JL (1990) Psychological response to breast cancer and 15-year outcome. Lancet 1:49–50CrossRefGoogle Scholar
  54. 54.
    Watson M (1983) Psychosocial intervention with cancer patients: a review. Psychol Med 13:839–846PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Virginia P. Henderson
    • 1
    • 2
  • Lynn Clemow
    • 3
  • Ann O. Massion
    • 4
    • 5
  • Thomas G. Hurley
    • 2
    • 6
  • Susan Druker
    • 7
  • James R. Hébert
    • 1
    • 2
    • 6
  1. 1.Department of Family and Preventive Medicine, School of Medicine University of South CarolinaColumbiaUSA
  2. 2.Cancer Prevention & Control ProgramUniversity of South CarolinaColumbiaUSA
  3. 3.Department of MedicineColumbia UniversityNew YorkUSA
  4. 4.Department of PsychiatryUniversity of New Mexico School of MedicineAlbuquerqueUSA
  5. 5.Behavioral Health Care LineNew Mexico VA Health Care SystemAlbuquerqueUSA
  6. 6.Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  7. 7.Division of Preventive and Behavioral MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA

Personalised recommendations