Skip to main content
Log in

Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

To investigate prevalence and severity of symptoms and symptom clustering in breast cancer survivors who attended MBSR(BC). Women were randomly assigned into MBSR(BC) or Usual Care (UC). Eligible women were ≥ 21 years, had been diagnosed with breast cancer and completed treatment within 18 months of enrollment. Symptoms and interference with daily living were measured pre- and post-MBSR(BC) using the M.D. Anderson Symptom Inventory. Symptoms were reported as highly prevalent but severity was low. Fatigue was the most frequently reported and severe symptom among groups. Symptoms clustered into 3 groups and improved in both groups. At baseline, both MBSR(BC) and the control groups showed similar mean symptom severity and interference; however, after the 6-week post-intervention, the MBSR(BC) group showed statistically-significant reduction for fatigue and disturbed sleep (P < 0.01) and improved symptom interference items, compared to the control group. For the between-group comparisons, 11 of 13 symptoms and 5 of 6 interference items had lower means in the MBSR(BC) condition than the control condition. These results suggest that MBSR(BC) modestly decreases fatigue and sleep disturbances, but has a greater effect on the degree to which symptoms interfere with many facets of life. Although these results are preliminary, MBSR intervention post-treatment may effectively reduce fatigue and related interference in QOL of breast cancer survivors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Ashbury, F. D., Findlay, H., Reynolds, B., & McKerracher, K. (1998). A Canadian survey of cancer patients’ experiences: are their needs being met? Journal of Pain and Symptom Management, 16, 298–306. doi:S088539249800102X

    Article  PubMed  CAS  Google Scholar 

  • Baker, F., Denniston, M., Smith, T., & West, M. M. (2005). Adult cancer survivors: how are they faring? Cancer, 104, 2565–2576. doi:10.1002/cncr.21488

    Article  PubMed  Google Scholar 

  • Barsevick, A. M. (2007). The elusive concept of the symptom cluster. Oncology Nursing Forum, 34, 971–980. doi:MP3H25H0117T0547

    Article  PubMed  Google Scholar 

  • Bender, C. M., Ergyn, F. S., Rosenzweig, M. Q., Cohen, S. M., & Sereika, S. M. (2005). Symptom clusters in breast cancer across 3 phases of the disease. Cancer Nursing, 28, 219–225. doi:00002820-200505000-00011

    Article  PubMed  Google Scholar 

  • Bower, J. E., Ganz, P. A., Desmond, K. A., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2000). Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18, 743–753.

    PubMed  CAS  Google Scholar 

  • Byar, K. L., Berger, A. M., Bakken, S. L., & Cetak, M. A. (2006). Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life. Oncology Nursing Forum, 33, E18–E26. doi:10.1188/06.ONF.E18-E26

    Article  PubMed  Google Scholar 

  • Carlson, L. E., & Garland, S. N. (2005). Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med, 12, 278–285. doi:10.1207/s15327558ijbm1204_9

    Article  PubMed  Google Scholar 

  • Carlson, L. E., Ursuliak, Z., Goodey, E., Angen, M., & Speca, M. (2001). The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Supportive Care in Cancer, 9, 112–123.

    Article  PubMed  CAS  Google Scholar 

  • Carpenter, J. S., Elam, J. L., Ridner, S. H., Carney, P. H., Cherry, G. J., & Cucullu, H. L. (2004). Sleep, fatigue, and depressive symptoms in breast cancer survivors and matched healthy women experiencing hot flashes. Oncology Nursing Forum, 31, 591–5598. doi:10.1188/04.ONF.591-598

    Article  PubMed  Google Scholar 

  • Chen, M. L., & Lin, C. C. (2007). Cancer symptom clusters: a validation study. Journal of Pain and Symptom Management, 34, 590–599. doi:10.1016/j.jpainsymman.2007.01.008

    Article  PubMed  Google Scholar 

  • Chen, M. L., & Tseng, H. H. (2005). Identification and verification of symptom clusters in cancer patients. J Support Oncol, 3, 28–29.

    PubMed  Google Scholar 

  • Chen, M. L., & Tseng, H. C. (2006). Symptom clusters in cancer patients. Supportive Care in Cancer, 14, 825–830. doi:10.1007/s00520-006-0019-8

    Article  PubMed  Google Scholar 

  • Cimprich, B., Janz, N. K., Northouse, L., Wren, P. A., Given, B., & Given, C. W. (2005). Taking CHARGE: A self-management program for women following breast cancer treatment. Psychooncology, 14, 704–717. doi:10.1002/pon.891

    Article  PubMed  Google Scholar 

  • Cleeland, C. S., Bennett, G. J., Dantzer, R., Dougherty, P. M., Dunn, A. J., & Meyers, C. A. (2003). Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer, 97, 2919–2925. doi:10.1002/cncr.11382

    Article  PubMed  Google Scholar 

  • Cleeland, C. S., Mendoza, T. R., Wang, X. S., Chou, C., Harle, M. T., & Morrissey, M. (2000). Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer, 89, 1634–1646. doi:10.1002/1097-0142(20001001)89:7<1634:AID-CNCR29>3.0.CO;2-V

    Article  PubMed  CAS  Google Scholar 

  • Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28, 465–470.

    PubMed  CAS  Google Scholar 

  • Esper, P., & Heidrich, D. (2005). Symptom clusters in advanced illness. Seminars in Oncology Nursing, 21, 20–28.

    Article  PubMed  Google Scholar 

  • Francoeur, R. B. (2005). The relationship of cancer symptom clusters to depressive affect in the initial phase of palliative radiation. Journal of Pain and Symptom Management, 29, 130–155. doi:10.1016/j.jpainsymman.2004.04.014

    Article  PubMed  Google Scholar 

  • Fu, O. S., Crew, K. D., Jacobson, J. S., Greenlee, H., Yu, G., & Campbell, J. (2009). Ethnicity and persistent symptom burden in breast cancer survivors. J Cancer Surviv, 3, 241–250. doi:10.1007/s11764-009-0100-7

    Article  PubMed  Google Scholar 

  • Ganz, P. A., Desmond, K. A., Leedham, B., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2002). Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. Journal of the National Cancer Institute, 94, 39–49.

    Article  PubMed  Google Scholar 

  • Ganz, P. A., Guadagnoli, E., Landrum, M. B., Lash, T. L., Rakowski, W., & Silliman, R. A. (2003). Breast cancer in older women: quality of life and psychosocial adjustment in the 15 months after diagnosis. Journal of Clinical Oncology, 21, 4027–4033. doi:10.1200/JCO.2003.08.097

    Article  PubMed  Google Scholar 

  • Gaston-Johansson, F., Fall-Dickson, J. M., Bakos, A. B., & Kennedy, M. J. (1999). Fatigue, pain, and depression in pre-autotransplant breast cancer patients. Cancer Pract, 7, 240–247.

    Article  PubMed  CAS  Google Scholar 

  • Gelinas, C., & Fillion, L. (2004). Factors related to persistent fatigue following completion of breast cancer treatment. Oncology Nursing Forum, 31, 269–278. doi:10.1188/04.ONF.269-278

    Article  PubMed  Google Scholar 

  • Hann, D. M., Denniston, M. M., & Baker, F. (2000). Measurement of fatigue in cancer patients: further validation of the Fatigue Symptom Inventory. Quality of Life Research, 9, 847–854.

    Article  PubMed  CAS  Google Scholar 

  • Ivanova, M. O., Ionova, T. I., Kalyadina, S. A., Uspenskaya, O. S., Kishtovich, A. V., & Guo, H. (2005). Cancer-related symptom assessment in Russia: validation and utility of the Russian M.D. Anderson Symptom Inventory. Journal of Pain and Symptom Management, 30, 443–453. doi:10.1016/j.jpainsymman.2005.04.015

    Article  PubMed  Google Scholar 

  • Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163–190.

    Article  PubMed  CAS  Google Scholar 

  • Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., & Pbert, L. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry, 149, 936–943.

    PubMed  CAS  Google Scholar 

  • Kenefick, A. L. (2006). Patterns of symptom distress in older women after surgical treatment for breast cancer. Oncology Nursing Forum, 33, 327–335. doi:10.1188/06.ONF.327-335

    Article  PubMed  Google Scholar 

  • Kim, H. J., Barsevick, A. M., & Tulman, L. (2009). Predictors of the intensity of symptoms in a cluster in patients with breast cancer. J Nurs Scholarsh, 41, 158–165. doi:10.1111/j.1547-5069.2009.01267.x

    Article  PubMed  Google Scholar 

  • Kim, H. J., Barsevick, A. M., Tulman, L., & McDermott, P. A. (2008). Treatment-related symptom clusters in breast cancer: a secondary analysis. Journal of Pain and Symptom Management, 36, 468–479. doi:10.1016/j.jpainsymman.2007.11.011

    Article  PubMed  Google Scholar 

  • Kornblith, A. B., Herndon, J. E., 2nd, Weiss, R. B., Zhang, C., Zuckerman, E. L., & Rosenberg, S. (2003). Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer, 98, 679–689. doi:10.1002/cncr.11531

    Article  PubMed  Google Scholar 

  • Kwon, Y. C., Yun, Y. H., Lee, K. H., Son, K. Y., Park, S. M., & Chang, Y. J. (2006). Symptoms in the lives of terminal cancer patients: which is the most important? Oncology, 71, 69–76. doi:10.1159/000100450

    Article  PubMed  Google Scholar 

  • Lee, K., Cho, M., Miaskowski, C., & Dodd, M. (2004a). Impaired sleep and rhythms in persons with cancer. Sleep Med Rev, 8, 199–212. doi:10.1016/j.smrv.2003.10.001

    Article  PubMed  Google Scholar 

  • Lee, B. N., Dantzer, R., Langley, K. E., Bennett, G. J., Dougherty, P. M., & Dunn, A. J. (2004b). A cytokine-based neuroimmunologic mechanism of cancer-related symptoms. Neuroimmunomodulation, 11, 279–292. doi:10.1159/000079408

    Article  PubMed  CAS  Google Scholar 

  • Lengacher, C. A., Johnson-Mallard, V., Barta, M., Fitzgerald, S., Moscoso, M. S., Post-White, J. (2010). Feasibility of a Mindfulness-Based Stress Reduction Program for Early-Stage Breast Cancer Survivors. J Holist Nurs. doi: 10.1177/0898010110385938

  • Lengacher, C. A., Johnson-Mallard, V., Post-White, J., Moscoso, M. S., Jacobsen, P. B., & Klein, T. W. (2009). Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology, 18, 1261–1272. doi:10.1002/pon.1529

    Article  PubMed  Google Scholar 

  • Liu, L., Fiorentino, L., Natarajan, L., Parker, B. A., Mills, P. J., & Sadler, G. R. (2009). Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue and depression during chemotherapy. Psychooncology, 18, 187–194. doi:10.1002/pon.1412

    Article  PubMed  Google Scholar 

  • Miaskowski, C., Dodd, M., & Lee, K. (2004). Symptom clusters: the new frontier in symptom management research. J Natl Cancer Inst Monogr, 17-21. doi: 10.1093/jncimonographs/lgh023

  • Minor, H. G., Carlson, L. E., Mackenzie, M. J., Zernicke, K., & Jones, L. (2006). Evaluation of a Mindfulness-Based Stress Reduction (MBSR) program for caregivers of children with chronic conditions. Social Work in Health Care, 43, 91–109.

    Article  PubMed  Google Scholar 

  • Mishel, M. H., Germino, B. B., Gil, K. M., Belyea, M., Laney, I. C., & Stewart, J. (2005). Benefits from an uncertainty management intervention for African-American and Caucasian older long-term breast cancer survivors. Psychooncology, 14, 962–978. doi:10.1002/pon.909

    Article  PubMed  Google Scholar 

  • Okuyama, T., Wang, X. S., Akechi, T., Mendoza, T. R., Hosaka, T., & Cleeland, C. S. (2003). Japanese version of the MD Anderson Symptom Inventory: a validation study. Journal of Pain and Symptom Management, 26, 1093–1104. doi:S0885392403004196

    Article  PubMed  Google Scholar 

  • Rosenzweig, S., Reibel, D. K., Greeson, J. M., Brainard, G. C., & Hojat, M. (2003). Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med, 15, 88–92.

    Article  PubMed  Google Scholar 

  • Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2005). Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. Journal of Clinical Oncology, 23, 6083–6096. doi:10.1200/JCO.2005.09.548

    Article  PubMed  Google Scholar 

  • Scheier, M. F., Helgeson, V. S., Schulz, R., Colvin, S., Berga, S., & Bridges, M. W. (2005). Interventions to enhance physical and psychological functioning among younger women who are ending nonhormonal adjuvant treatment for early-stage breast cancer. Journal of Clinical Oncology, 23, 4298–4311. doi:10.1200/JCO.2005.05.362

    Article  PubMed  Google Scholar 

  • Servaes, P., Verhagen, C., & Bleijenberg, G. (2002). Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. European Journal of Cancer, 38, 27–43. doi:S095980490100332X

    Article  PubMed  CAS  Google Scholar 

  • Shapiro, S. L., Bootzin, R. R., Figueredo, A. J., Lopez, A. M., & Schwartz, G. E. (2003). The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study. Journal of Psychosomatic Research, 54, 85–91. doi:S0022399902005469

    Article  PubMed  Google Scholar 

  • Shimozuma, K., Ganz, P. A., Petersen, L., & Hirji, K. (1999). Quality of life in the first year after breast cancer surgery: rehabilitation needs and patterns of recovery. Breast Cancer Research and Treatment, 56, 45–57.

    Article  PubMed  CAS  Google Scholar 

  • Speca, M., Carlson, L. E., Goodey, E., & Angen, M. (2000). 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. Psychosomatic Medicine, 62, 613–622.

    PubMed  CAS  Google Scholar 

  • Stanton, A. L., Ganz, P. A., Kwan, L., Meyerowitz, B. E., Bower, J. E., & Krupnick, J. L. (2005). Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. Journal of Clinical Oncology, 23, 6009–6018. doi:10.1200/JCO.2005.09.101

    Article  PubMed  Google Scholar 

  • Thornton, L. M., Andersen, B. L., & Blakely, W. P. (2010). The pain, depression, and fatigue symptom cluster in advanced breast cancer: covariation with the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Health Psychology, 29, 333–337. doi:10.1037/a0018836

    Article  PubMed  Google Scholar 

  • Tsai, J. S., Wu, C. H., Chiu, T. Y., & Chen, C. Y. (2010). Significance of symptom clustering in palliative care of advanced cancer patients. Journal of Pain and Symptom Management, 39, 655-662. doi: 10.1016/j.jpainsymman.2009.09.005

    Article  PubMed  Google Scholar 

  • Tseng, T. H., Cleeland, C. S., Wang, X. S., & Lin, C. C. (2008). Assessing cancer symptoms in adolescents with cancer using the Taiwanese version of the M. D. Anderson Symptom Inventory. Cancer Nurs, 31, E9–E16. doi:10.1097/01.NCC.0000305728.50098.51

    Google Scholar 

  • Wang, X. S., Fairclough, D. L., Liao, Z., Komaki, R., Chang, J. Y., & Mobley, G. M. (2006a). Longitudinal study of the relationship between chemoradiation therapy for non-small-cell lung cancer and patient symptoms. Journal of Clinical Oncology, 24, 4485–4491. doi:10.1200/JCO.2006.07.1126

    Article  PubMed  Google Scholar 

  • Wang, X. S., Laudico, A. V., Guo, H., Mendoza, T. R., Matsuda, M. L., & Yosuico, V. D. (2006b). Filipino version of the M. D. Anderson Symptom Inventory: validation and multisymptom measurement in cancer patients. J Pain Symptom Manage, 31, 542–552. doi:10.1016/j.jpainsymman.2005.11.011

    Google Scholar 

  • Wang, X. S., Wang, Y., Guo, H., Mendoza, T. R., Hao, X. S., & Cleeland, C. S. (2004). Chinese version of the M. D. Anderson Symptom Inventory: validation and application of symptom measurement in cancer patients. Cancer, 101, 1890–1901. doi:10.1002/cncr.20448

    Google Scholar 

  • Yamagishi, A., Morita, T., Miyashita, M., & Kimura, F. (2009). Symptom prevalence and longitudinal follow-up in cancer outpatients receiving chemotherapy. Journal of Pain and Symptom Management, 37, 823–830. doi:10.1016/j.jpainsymman.2008.04.015

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The National Cancer Institute R-21 grant, R21-Ca109168-01A2.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cecile A. Lengacher.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lengacher, C.A., Reich, R.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 35, 86–94 (2012). https://doi.org/10.1007/s10865-011-9346-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-011-9346-4

Keywords

Navigation