Skip to main content

Mindfulness-Based Stress Reduction (MBSR) in Oncology

Rationale and Review

Abstract

The use of mindfulness-based stress reduction (MBSR) programmes has become increasingly common in many healthcare settings over the last decade. However, the use and indications for MBSR in an oncology setting has not been well explicated. This paper provides an overview of the psychosocial challenges of cancer diagnosis, treatment and recovery, followed by a description of how MBSR programmes have and may be used with cancer populations, using our programme in Calgary, Canada, as an exemplar.

Research investigating the use of MBSR shows significant improvements in mood, decreased stress symptoms, and normalisation of hormonal and immune function. MBSR has also been shown to be effective for decreasing the high levels of sleep disturbance often found in cancer patients. An instrument to measure levels of mindfulness, the Mindful Attention Awareness Scale (MAAS), has been developed and validated for use with cancer patients. Issues germane to working with this population such as considerations during patient screening for the MBSR programme and facilitatory training are discussed. Finally, the use of research designs such as dismantling studies and qualitative methods are considered.

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

References

  1. Carlson LE, Angen M, Cullum J, et al. High levels of untreated distress and fatigue in cancer patients. Br J Cancer 2004; 90: 2297–304

    PubMed  CAS  Google Scholar 

  2. Carlson LE, Bultz BD. Cancer distress screening: needs, methods and models. J Psychosom Res 2003; 55: 403–9

    PubMed  Article  Google Scholar 

  3. Balneaves LG, Kristjanson LJ, Tataryn D. Beyond convention: describing comple mentary therapy use by women living with breast cancer. Patient Educ Couns 1999; 38(2): 143–53

    PubMed  Article  CAS  Google Scholar 

  4. Hilsden RJ, Verhoef MJ. Complementary therapies: evaluating their effectiveness in cancer. Patient Educ Couns 1999; 38: 101–8

    PubMed  Article  CAS  Google Scholar 

  5. Carlson LE, Ursuliak Z, Goodey E, et al. The effects of a mindfulness meditation based stress reduction program on mood and symptoms of stress in cancer outpatients: six month follow-up. Support Care Cancer 2001; 9(2): 112–23

    PubMed  Article  CAS  Google Scholar 

  6. Speca M, Carlson LE, Goodey E, et al. 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

    PubMed  CAS  Google Scholar 

  7. Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considera tions and preliminary results. Gen Hosp Psychiatry 1982; 4(1): 33–47

    PubMed  Article  CAS  Google Scholar 

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

    Google Scholar 

  9. Verhoef MJ, Hilsden RJ, O’Beirne M. Complementary therapies and cancer care: an overview. Patient Educ Couns 1999; 38: 93–100

    PubMed  Article  CAS  Google Scholar 

  10. Baer RA. Mindfulness training as clinical intervention: a conceptual and empirical review. Clin Psychol Sci Prac 2003; 10(2): 125–43

    Article  Google Scholar 

  11. Bishop SR. What do we really know about mindfulness-based stress reduction?. Psychosom Med 2002; 64(1): 71–83

    PubMed  Google Scholar 

  12. Kabat-Zinn J, Santorelli S. Mindfulness-based stress reduction professional train ing resource manual. Worchester (MA): Center for Mindfulness in Medicine, Health Care and Society, 1999

    Google Scholar 

  13. Cunningham AJ, Edmonds CV. Group psychological therapy for cancer patients: a point of view, and discussion of the hierarchy of options. Int J Psychiatry Med 1996; 26(1): 51–82

    PubMed  Article  CAS  Google Scholar 

  14. Sourkes BM, Massie MJ, Holland JC. Psychotherapeutic issues. In: Holland J, editor. Textbook of psychooncology. Oxford: Oxford University Press, 1998: 694–700

    Google Scholar 

  15. Miller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry 1995; 17: 192–200

    PubMed  Article  CAS  Google Scholar 

  16. Moore NG. The center for mindfulness in medicine: meditation training for the body’s innate wisdom. Altern Ther Health Med 1998; 4(2): 32–3

    PubMed  CAS  Google Scholar 

  17. Leckie MS, Thompson E. Symptoms of Stress Inventory. Seattle (WA): University of Washington, 1979

    Google Scholar 

  18. McNair DA, Lorr M, Droppelman LF. Profile of Mood States. San Diego (CA): Educational and Industrial Testing Service, 1971

    Google Scholar 

  19. Massion AO, Hebert JR, Wertheimer MD, et al. Meditation, melatonin and breast/ prostate cancer: hypothesis and preliminary data. Med Hypotheses 1995; 44: 39–46

    PubMed  Article  CAS  Google Scholar 

  20. Tooley GA, Armstrong SM, Norman TR, et al. Acute increases in night-time plasma melatonin levels following a period of meditation. Biol Psychol 2000; 53(1): 69–78

    PubMed  Article  CAS  Google Scholar 

  21. Lissoni P, Barni S, Mandala M, et al. Decreased toxicity and increased efficacy of cancer chemotherapy using the pineal hormone melatonin in metastatic solid tumour patients with poor clinical status. Eur J Cancer 1999; 35(12): 1688–92

    PubMed  Article  CAS  Google Scholar 

  22. Lissoni P, Tancini G, Paolorossi F, et al. Chemoneuroendocrine therapy of meta static breast cancer with persistent thrombocytopenia with weekly low-dose epirubicin plus melatonin: a phase II study. J Pineal Res 1999; 26(3): 169–73

    PubMed  Article  CAS  Google Scholar 

  23. Vijayalaxmi Jr TCR, Reiter RJ, Herman TS. Melatonin: from basic research to cancer treatment clinics. J Clin Oncol 2002; 20(10): 2575–601

    PubMed  Article  CAS  Google Scholar 

  24. van der Pompe G, Duivenvoorden HJ, Antoni MH, et al. Effectiveness of a short-term group psychotherapy program on endocrine and immune function in breast cancer patients: an exploratory study. J Psychosom Res 1997; 42(5): 453–66

    PubMed  Article  Google Scholar 

  25. Ticher A, Haus E, Ron IG, et al. The pattern of hormonal circadian time structure (acrophase) as an assessor of breast-cancer risk. Int J Cancer 1996; 65(5): 591–3

    PubMed  Article  CAS  Google Scholar 

  26. Sephton SE, Sapolsky RM, Kraemer HC, et al. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst 2000; 92(12): 944–1000

    Article  Google Scholar 

  27. Touitou Y, Bogdan A, Levi F, et al. Disruption of the circadian patterns of serum cortisol in breast and ovarian cancer patients: relationships with tumour marker antigens. Br J Cancer 1996; 74(8): 1248–52

    PubMed  Article  CAS  Google Scholar 

  28. Kamei T, Toriumi Y, Kimura H, et al. Decrease in serum cortisol during yoga exercise is correlated with alpha wave activation. Percept Mot Skills 2000; 90 (3 Pt 1): 1027–32

    PubMed  Article  CAS  Google Scholar 

  29. Carlson LE, Speca M, Patel KD, et al. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone-sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 2004; 29(4): 448–74

    PubMed  Article  CAS  Google Scholar 

  30. Davidson RJ, Kabat-Zinn J, Schumacher J, et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 2003; 65(4): 564–70

    PubMed  Article  Google Scholar 

  31. Solberg EE, Halvorsen R, Sundgot-Borgen J, et al. Meditation: a modulator of the immune response to physical stress? A brief report. Br J Sports Med 1995; 29(4): 255–7

    PubMed  Article  CAS  Google Scholar 

  32. Greer S. Mind-body research in psychooncology. Adv Mind Body Med 1999; 15(4): 236–44

    PubMed  CAS  Google Scholar 

  33. Lewis CE, O’Brien RM, Barraclough J, editors. The psychoimmunology of cancer. 2nd ed. Oxford: Oxford University Press, 2002

    Google Scholar 

  34. Carlson LE, Speca M, Patel KD, et al. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med 2003; 65(4): 571–81

    PubMed  Article  Google Scholar 

  35. Aaronson NK, Ahmedzai S, Bergman B, et al. The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–76

    PubMed  Article  CAS  Google Scholar 

  36. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 2001; 19(3): 895–908

    PubMed  CAS  Google Scholar 

  37. Carlson LE, Garland SN. Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med 2005; 12(4): 278–85

    PubMed  Article  Google Scholar 

  38. Shapiro SL, Bootzin RR, Figueredo AJ, et al. The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study. J Psychosom Res 2003; 54(1): 85–91

    PubMed  Article  Google Scholar 

  39. Saxe GA, Hebert JR, Carmody JF, et al. Can diet in conjunction with stress reduction affect the rate of increase in prostate specific antigen after biochemi cal recurrence of prostate cancer?. J Urol 2001; 166(6): 2202–7

    PubMed  Article  CAS  Google Scholar 

  40. Baer Dimidjian S, Linehan M. Defining an agenda for future research on the clinical application of mindfulness practice. Clin Psychol Sci Prac 2003; 10(2): 166–71

    Article  Google Scholar 

  41. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 2003; 84(4): 822–48

    PubMed  Article  Google Scholar 

  42. Carlson LE, Brown KW. Validation of the mindful attention awareness scale in a cancer population. J Psychosom Res 2005; 58(1): 29–33

    PubMed  Article  Google Scholar 

  43. Kabat-Zinn J, Massion AO, Hebert JR, Rosenbaum E. Meditation. In: Holland JF, editor. Psycho-oncology. New York: Oxford University Press, 1998: 767–779

    Google Scholar 

  44. Sellick SM, Crooks DL. Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions. Psychooncology 1999; 8: 315–33

    PubMed  Article  CAS  Google Scholar 

  45. Fawzy FI, Fawzy NW, Hyun CS, et al. Malignant melanoma: effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry 1993; 50(9): 681–9

    PubMed  Article  CAS  Google Scholar 

  46. Zabora J, BrintzenhofeSzoc K, Curbow B, et al. The prevalence of psychological distress by cancer site. Psychooncology 2001; 10(1): 19–28

    PubMed  Article  CAS  Google Scholar 

  47. Hanson FM, Suman VJ, Rummans TA, et al. Physical, psychological and social well-being of women with breast cancer: the influence of disease phase. Psychooncology 2000; 9(3): 221–31

    Article  Google Scholar 

  48. Liang LP, Dunn SM, Gorman A, et al. Identifying priorities of psychosocial need in cancer patients. Br J Cancer 1990; 62(6): 1000–3

    PubMed  Article  CAS  Google Scholar 

  49. Kabat-Zinn J, Chapman A, Salmon P. Relationship of cognitive and somatic components of anxiety to patient preference for different relaxation techniques. Mind-Body Med 1997; 2(3): 101–9

    Google Scholar 

  50. Kabat-Zinn J. Mindfulness based interventions in context: past, present and future. Clin Psychol Sci Prac 2003; 10(2): 144–56

    Article  Google Scholar 

  51. Roemer L, Orsillo SM. Mindfulness: a promising intervention strategy in need of further study. Clin Psychol Sci Prac 2003; 10(2): 172–8

    Article  Google Scholar 

  52. Wampold BE. Methodological problems in identifying efficacious psychotherapies. Psychother Res 1997; 7: 21–43

    Article  Google Scholar 

  53. Stewart DE, Cheung AM, Duff S, et al. Attributions of cause and recurrence in long-term breast cancer survivors. Psychooncology 2001; 10: 179–83

    PubMed  Article  CAS  Google Scholar 

  54. Waxier-Morrison N, Doll R, Hislop TG. The use of qualitative methods to strengthen psychosocial research on cancer. J Psychosoc Oncol 1995; 13(1/2): 177–91

    Article  Google Scholar 

  55. Brennan C, Stevens J. A grounded theory approach towards understanding the self perceived effects of meditation on people being treated for cancer. Aust J Holist Nurs 1998; 5(2): 20–6

    PubMed  CAS  Google Scholar 

  56. Truant T, Bottorff JL. Decision making related to complementary therapies: a process of regaining control. Patient Educ Couns 1999; 38: 131–42

    PubMed  Article  CAS  Google Scholar 

  57. Coker KH. Meditation and prostate cancer: integrating a mind/body intervention with traditional therapies. Semin Urol Oncol 1999; 17(2): 111–8

    PubMed  CAS  Google Scholar 

  58. Spira JL. Group therapies. In: Holland J, editor. Textbook of psychooncology. Oxford: Oxford University Press, 1998: 701–716

    Google Scholar 

  59. Reibel DK, Greeson JM, Brainard GC, et al. Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. Gen Hosp Psychiatry 2001; 23(4): 183–92

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgements

Dr Linda Carlson is funded by a New Investigator Award from the Canadian Institutes of Health Research, and Mr Michael Mackenzie was supported through Dr Carlson’s Research Allowance, also from the Canadian Institutes of Health Research. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Linda E. Carlson.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mackenzie, M.J., Carlson, L.E. & Speca, M. Mindfulness-Based Stress Reduction (MBSR) in Oncology. Evid-Based-Integrative-Med 2, 139–145 (2005). https://doi.org/10.2165/01197065-200502030-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/01197065-200502030-00005

Keywords

  • Melatonin
  • Mindfulness Training
  • Mindfulness Meditation
  • Mood Disturbance
  • Meditation Practice