Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    CAS  Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Google Scholar 

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

    Article  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

  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.

    CAS  Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  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.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  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.

    Chapter  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors thank the participants for their active engagement in this clinical trial and encourage their continued health and wellness.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shelley A. Johns.

Ethics declarations

Funding

Research reported in this publication was supported by the Walther Cancer Foundation (0106–01), Indiana Clinical and Translational Sciences Institute (Grant # TR000163 and # TR000006), and the National Cancer Institute of the National Institutes of Health under Award Number K05CA175048. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Conflict of interest

The authors have no conflict of interest to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Johns, S.A., Von Ah, D., Brown, L.F. et al. Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal cancer survivors: effects on cancer-related cognitive impairment. J Cancer Surviv 10, 437–448 (2016). https://doi.org/10.1007/s11764-015-0494-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-015-0494-3

Keywords

  • Cancer
  • Oncology
  • Mindfulness
  • MBSR
  • Cognition
  • Attention