Using Mindfulness-Based Therapies for Symptom Management in Cancer

Rebecca Lehto, PhD, RN, OCN

Rebecca Lehto is an assistant professor at the Michigan State University College of Nursing in East Lansing.

Many cancer patients use complementary therapies for symptom management in conjunction with their standard medical treatment.¹ Mindfulness-based practices, classified in the mind—body category by the National Center for Complementary and Alternative Medicine (NCCAM),² are a group of complementary therapies that have gained increased popularity among cancer patients over the past two decades.

The uses of mindfulness-based therapies are rooted in ancient eastern contemplative practices and involve a combination of formal and informal meditation and gentle yoga, to cultivate an accepting, non-judgmental attitude of internal and external experiences.³ Mindfulness practices can lead to improved attention, increased awareness of mental and physical events, improvement in perceptions of wellbeing, and enhanced capacity to manage stressors.^4-6

Mindfulness-based stress reduction (MBSR), a program developed by Kabat-Zinn to treat pain and to reduce emotional distress in chronic conditions, is the most common format and incorporates eight weekly group sessions with a meditation retreat and daily home practice.⁷ Other popular programs include mindfulness-based cognitive therapy, which combines cognitive therapy with the MBSR components to treat conditions such as depression and chronic worry,^6,8 and acceptance and commitment therapy (ACT), used in the treatment of behavioral disorders.⁹

The number of studies that integrate mindfulness- based therapies in cancer care are increasing and showing promise in modifying psychological distress and improving health-related quality of life.^10,11 Much of this research has focused on women with breast cancer,^12-15 patients with early-stage disease,¹¹ and patients who are either posttreatment or well into the survivorship trajectory. ¹⁶

Many of the cancer-related studies have incorporated variations of the Kabat-Zinn MBSR intervention.^13,17-20 Studies involving cancer patients report that training in meditative practices resulted in significant improvements in mood, anxiety, depression, fatigue, health-related quality of life, stress, coping, and sleep quality.^16,21-26

Although research demonstrates strong potential for the efficacy of mindfulness-based therapies for patients with cancer, further studies are needed due to methodological variation, limited use of comparison groups, small sample sizes, incomplete intervention fidelity information, limited research in wider cancer populations, and inadequate information on sustained effects over time.^10,11 Further, there is minimal testing of mindfulness interventions during active treatment, a time when symptom management and quality of life are particularly challenged. While the mechanism of action behind mindfulness meditation practices for improving problematic symptoms is not yet substantiated,³ evidence from MRI brain scans indicates that mindfulness practice over a 8-week period resulted in changes in brain areas that are engaged in emotion regulation, attention, learning, and memory function.²⁷

Other research has demonstrated that meditative practices result in increased parasympathetic and decreased sympathetic nervous system activity contributing to relaxation and reduced stress.²⁸ Although more research is needed, studies suggest that meditative practices also positively influence neurogenic modulation of immune system responsiveness.^29,30

Mindfulness-based therapies represent a range of options within the NCCAM mind—body category that are widely utilized and have been shown to promote illness adjustment, reduce psychological distress, and improve health-related quality of life.10,11 Mindfulness-based therapies, emphasizing meditative practices, are economically delivered and once learned, are feasible for patients to use on their own. Further, such nontoxic strategies could be a reasonable option for symptom management that patients may elect to use during active treatment.

References

• Boon HS, Olatunde F, Zick SM. Trends in complementary/alternative medicine use by breast cancer survivors: Comparing survey data from 1998 and 2005. http://www.biomedcentral.com/content/pdf/1472-6874-7-4.pdf. Accessed June 16, 2014.
• National Institutes of Health, National Center for Complementary and Alternative Medicine. What is CAM? http://nccam.nih.gov/health/whatiscam/. Accessed June 16, 2014.
• Shapiro SFL, Carlson LE, Astin JA, Freedman B. Mechanisms of mindfulness. J Clin Psychol. 2006;62(3):373-386.
• Arch JJ, Craske MG. Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behav Res Ther. 2006;44(12):1849-1858.
• Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31(1):23-33.
• Delgado LC, Guerra P, Perakakis P, et al. Treating chronic worry: psychological and physiological effects of a training programme based on mindfulness. Behav Res Ther. 2010;48(9):873-882.
• Kabat-Zinn J. Full Catastrophe Living: Using The Wisdom Of Your Body And Mind To Face Stress, Pain, and Illness. 15th ed. New York, NY: Delta Trade Paperbacks; 2009.
• Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression. New York: Guilford Press; 2002.
• Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy. New York: Guilford Press; 1999.
• Ledesma D, Kumano H. Mindfulness-based stress reduction and cancer: a meta-analysis. Psychooncology. 2009;18(6):571-579.
• Shennon C, Payne S, Fenlon D. What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psychooncology. 2010;20(7):681-697.
• Tacón AM, Caldera YM, Ronaghan C. Mindfulness-based stress reduction in women with breast cancer. Families, Systems & Health. 2004;22(2):193-203.
• Witek-Janusek L, Albuquerque K, Chroniak KR, et al. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behavior & Immunity. 2008;22(6):969-981.
• Shapiro SL, Bootzin RR, Figueredo AJ, Lopez AM, Schwartz GE. 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.
• 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):1261-1272.
• Matchim Y, Armer JM, Stewart BR. Mindfulness-based stress reduction among breast cancer survivors: A literature review and discussion. Oncol Nurs Forum. 2011;38(2):E61-E71.
• 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):278-285.
• Bränström R, Kvillemo P, Brandberg Y, Moskowitz JT. Self-report mindfulness as a mediator of psychological well-being in a stress reduction for cancer patients—a randomized study. Ann Behav Med. 2010;39(2):151-161.
• Carlson LE, Speca M, Patel KD, Goodey E. 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):448-474.
• Carlson LE, Speca M, Faris P, Patel KD. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun. 2007;21(8):1038-1049.
• Garland SN, Carlson LE, Cook S, et al. A non-randomized comparison of mindfulness-based stress reduction and healing arts programs for facilitating post-traumatic growth and spirituality in cancer outpatients. Support Care Cancer. 2007;15(8):949-961.
• Wurtzen H, Dalton SO, Elsass P, et al. Mindfulness significantly reduces self-reported levels of anxiety and depression: results of a randomised controlled trial among 336 Danish women treated for stage I-III breast cancer. Eur J Cancer. 2013;49(6):1365-1373.
• Henderson VP, Clemow L, Massion AO, et al. The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial. Breast Cancer Res Treat. 2012;131(1):99-109.
• Andersen SR, Wurtzen H, Steding-Jessen M, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-344.
• Lengacher CA, Kip KE, Barta M, et al. A pilot study evaluating the effect of mindfulness-based stress reduction on psychological status, physical status, salivary cortisol, and interleukin-6 among advanced-stage cancer patients and their caregivers. J Holist Nurs. 2012;30(3):170-185.
• Lengacher CA, Reich RR, 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.
• Hölzel BK, Carmody J, Vangel M, et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011;191(1):36-43.
• Nesvold A, Fagerland, MW, Davanger S, et al. Increased heart rate variability during nondirective meditation. Eur J Prev Cardiol. 2012;19(4):773—780.
• Rosenkranz MA, Davidson RJ, MacCoon DG, et al. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain Behav Immun. 2013;27(1):174-184.
• Davidson JJ, Kabat-Zinn J, Schumacher J, et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003;65(1):564-570.