Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients

Abstract

Sleep disturbance is a very common problem for cancer patients that has largely not been addressed in the clinical intervention literature. Mindfulness meditation has demonstrated clinical benefits for a variety of patient populations in other areas of functioning. This study examined the effects of an 8-week Mindfulness-Based Stress Reduction (MBSR) program on the sleep quality of a heterogeneous sample of 63 cancer patients. Overall sleep disturbance was significantly reduced (p < .001) and participants reported that their sleep quality had improved (p < .001). There was also a significant reduction in stress (p < .001), mood disturbance (p = .001), and fatigue (p < .001). The associations among these changes and implications for improving quality of life of cancer patients are discussed.

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References

  1. Ancoli-Israel, S., Moore, P. J., & Jones, V. (2001). The relationship between fatigue and sleep in cancer patients: A review. European Journal of Cancer Care, 10, 245–255.

    PubMed  Article  Google Scholar 

  2. Barnes, E. A., & Bruera, A. (2002). Fatigue in patients with advanced cancer: A review. International Journal of Gynecological Cancer, 12, 424–428.

    PubMed  Article  Google Scholar 

  3. Beck, S. L., Schwartz, A. L., Towsley, G., Dudley, W., & Barsevick, A. (2004). Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. Journal of Pain and Symptom Management, 27, 140–148.

    PubMed  Article  Google Scholar 

  4. Berger, A. (2003). Treating fatigue in cancer patients. Oncologist, 8 Suppl 1, 10–14.

    Article  Google Scholar 

  5. Berger, A. M., & Higginbotham, P. (2000). Correlates of fatigue during and following adjuvant breast cancer chemotherapy: A pilot study. Oncology Nursing Forum, 27, 1443–1448.

    PubMed  Google Scholar 

  6. Bishop, S. R., Lau, M. A., Shapiro, S. L., Carlson, L. E., Anderson, N. D., Carmody, J. F., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.

    Article  Google Scholar 

  7. Buysse, D. J., Reynolds, C. F., III, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.

    PubMed  Article  Google Scholar 

  8. Carlson, L. E., Angen, M., Cullum, J., Goodey, E., Koopmans, J., Lamont, L., et al. (2004). High levels of untreated distress and fatigue in cancer patients. British Journal of Cancer, 90, 2297–2304.

    PubMed  Google Scholar 

  9. Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2003). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65, 571–581.

    PubMed  Article  Google Scholar 

  10. 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: Six month follow-up. Supportive Care in Cancer, 9, 112–123.

    PubMed  Article  Google Scholar 

  11. Carpenter, J. S., & Andrykowski, M. A. (1998). Psychometric evaluation of the Pittsburgh Sleep Quality Index. Journal of Psychosomatic Research, 45, 5–13.

    PubMed  Article  Google Scholar 

  12. Cella, D., Davis, K., Breitbart, W., & Curt, G. (2001). Cancer-related fatigue: Prevalence of proposed diagnositic criteria in a United States sample of cancer survivors. Journal of Clinical Oncology, 19, 3385–3391.

    PubMed  Google Scholar 

  13. Courneya, K. S., Friedenreich, C. M., Sela, R. A., Quinney, H. A., Rhodes, R. E., & Handman, M. (2003). The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes. Psycho-Oncology, 12, 357–374.

    PubMed  Article  Google Scholar 

  14. Engstrom, C. A., Strohl, R. A., Rose, L., Lewandowski, L., & Stefanek, M. E. (1999). Sleep alterations in cancer patients. Cancer Nursing, 22, 143–148.

    PubMed  Article  Google Scholar 

  15. Hall, M., Baum, A., Buysse, D. J., Prigerson, H. G., Kupfer, D. J., & Reynolds, C. F., III (1998). Sleep as a mediator of the stress-immune relationship. Psychosomatic Medicine, 60, 48–51.

    PubMed  Google Scholar 

  16. Hall, M., Buysse, D. J., Nowell, P. D., Nofzinger, E. A., Houck, P., Reynolds, C. F., III, et al. (2000). Symptoms of stress and depression as correlates of sleep in primary insomnia. Psychosomatic Medicine, 62, 227–230.

    PubMed  Google Scholar 

  17. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delacourt.

    Google Scholar 

  18. 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.

    PubMed  Article  Google Scholar 

  19. Kaplan, K. H., Goldenberg, D. L., & Galvin-Nadeau, M. (1993). The impact of a meditation-based stress reduction program on fibromyalgia. General Hospital Psychiatry, 15, 284–289.

    PubMed  Article  Google Scholar 

  20. Koopman, C., Nouriani, B., Erickson, V., Anupindi, R., Butler, L. D., Bachmann, M. H., et al. (2002). Sleep disturbances in women with metastatic breast cancer. The Breast Journal, 8, 362–370.

    PubMed  Article  Google Scholar 

  21. Lavidor, M., Weller, A., & Babkoff, H. (2003). How sleep is related to fatigue. British Journal of Health Psychology, 8, 95–105.

    PubMed  Article  Google Scholar 

  22. Leckie, M. S. & Thompson, E. (1979). Symptoms of stress inventory. Seattle: University of Washington.

    Google Scholar 

  23. Malone, M., Harris, A. L., & Luscombe, D. K. (1994). Assessment of the impact of cancer on work, recreation, home meanagement and sleep using a general health status measure. Journal of the Royal Society of Medicine, 87, 386–389.

    PubMed  Google Scholar 

  24. McNair, D. A., Lorr, M., & Droppelman, L. F. (1971). Profile of mood states. San Diego, CA: Educational and Industrial Testing Service.

    Google Scholar 

  25. Mendoza, T. R., Wang, X. S., Cleeland, C. S., Morrissey, M., Johnson, B. A., Wendt, J. K., et al. (1999). The rapid assessment of fatigue severity in cancer patients: Use of the Brief Fatigue Inventory. Cancer, 85, 1186–1196.

    PubMed  Article  Google Scholar 

  26. Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192–200.

    PubMed  Article  Google Scholar 

  27. Reibel, D. K., Greeson, J. M., Brainard, G. C., & Rosenzweig, S. (2001). Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. General Hospital Psychiatry, 23, 183–192.

    PubMed  Article  Google Scholar 

  28. Savard, J., Miller, S. M., Mills, M., O’Leary, A., Harding, H., Douglas, S., et al. (1999). Association between subjective sleep quality and depression on immunocompetence in low-income women at risk for cervical cancer. Psychosomatic Medicine, 61, 496–507.

    PubMed  Google Scholar 

  29. Savard, J., & Morin, C. M. (2001). Insomnia in the context of cancer: A review of a neglected problem. Journal of Clinical Oncology, 19, 895–908.

    PubMed  Google Scholar 

  30. Savard, J., Simard, S., Blanchet, J., Ivers, H., & Morin, C. M. (2001). Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep, 24, 583–590.

    PubMed  Google Scholar 

  31. Schwartz, A. L. (2000). Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Practice, 8, 16–24.

    PubMed  Article  Google Scholar 

  32. Schwartz, A. L., Mori, M., Gao, R., Nail, L. M., & King, M. E. (2001). Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Medicine & Science in Sports & Exercise, 33, 718–723.

    Article  Google Scholar 

  33. Shapiro, S. L., Astin, J. A., & Carlson, L. E. (2004) Mechanisms of mindfulness: A new way of seeing. Psychological Review.

  34. 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.

    PubMed  Article  Google Scholar 

  35. 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  Google Scholar 

  36. Tacon, A. M. (2003). Meditation as a complementary therapy in cancer. Family Community Health, 26, 64–73.

    PubMed  Google Scholar 

  37. Weissbecker, I., Salmon, P., Studts, J. L., Floyd, A. R., Dedert, E. A., & Sephton, S. E. (2002). Mindfulness-based stress reduction and sense of coherence among women with fibromyalgia. Journal of Clinical Psychology in Medical Settings, 9, 297–307.

    Article  Google Scholar 

  38. Yellen, S. B., Cella, D. F., Webster, K., Blendowski, C., & Kaplan, E. (1997). Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. Journal of Pain and Symptom Management, 13, 63–74.

    PubMed  Article  Google Scholar 

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Correspondence to Linda E. Carlson or Sheila N. Garland.

Additional information

Dr. Linda Carlson is funded by a Canadian Institutes of Health Research New Investigator Award. We would like to thank all of the participants in the MBSR program who have diligently completed questionnaires, and encourage their quest for healing and personal growth.

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

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Key words

  • mindfulness
  • meditation
  • cancer
  • sleep
  • stress
  • fatigue