Objective Cancer-related fatigue (CRF) is one of the most common, persistent, and disabling symptoms associated with cancer and its treatment. Evidence-based treatments that are acceptable to patients are critically needed. This study examined the efficacy of Mindfulness-Based Stress Reduction (MBSR) for CRF and related symptoms. Method A sample of 35 cancer survivors with clinically-significant CRF was randomly assigned to a 7-week MBSR-based intervention or wait-list control group. The intervention group received training in mindfulness meditation, yoga, and self-regulatory responses to stress. Fatigue interference (primary outcome) and a variety of secondary outcomes (e.g., fatigue severity, vitality, disability, depression, anxiety, sleep disturbance) were assessed at baseline, post-intervention, and 1-month follow-up. Bonferroni correction was employed to account for multiple comparisons. Controls received the intervention after the 1-month follow-up. Participants in both groups were followed for 6 months after completing their respective MBSR courses to assess maintenance of effects. Results Compared to controls, the MBSR group reported large post-intervention reductions as assessed by effect sizes (d) in the primary outcome, fatigue interference (d= −1.43, p<.001), along with fatigue severity (d= −1.55, p<.001), vitality (d= 1.29, p<.001), depression (d= −1.30, p<.001), and sleep disturbance (d= −0.74, p=.001). Results were maintained or strengthened at 1-month follow-up, the point at which significant improvements in disability (d= −1.22, p<.002) and anxiety (d= −0.98, p=.002) occurred. Improvements in all outcomes were maintained 6 months after completing the course. MBSR adherence was high, with 90% attendance across groups and high rates of participant-reported home practice of mindfulness. Conclusions MBSR is a promising treatment for CRF and associated symptoms.

Purpose Cancer-related fatigue (CRF) is a disruptive symptom for many survivors. Despite promising evidence for efficacy of Mindfulness-Based Stress Reduction (MBSR) in reducing CRF, no trials comparing it to an active comparator for fatigued survivors have been published. The purpose of this trial was to compare MBSR to psychoeducation for CRF and associated symptoms. Methods Breast (n=60) and colorectal (n=11) cancer survivors (stage 0–III) with clinically significant CRF after completing chemotherapy and/or radiation therapy an average of 28 months prior to enrollment were randomized to MBSR or psychoeducation/support groups (PES). MBSR focused on mindfulness training; PES focused on CRF self-management. Outcomes included CRF interference (primary), CRF severity and global improvement, vitality, depression, anxiety, sleep disturbance, and pain. Outcomes were assessed at baseline (T1), post-intervention (T2), and 6-month follow-up (T3) using intent-to-treat analysis. Results Between-group differences in CRF interference were not significant at any time point; however, there was a trend favoring MBSR (d=−0.46, p=0.073) at T2. MBSR participants reported significantly greater improvement in vitality (d=0.53, p=0.003) and were more likely to report CRF as moderately-to-completely improved compared to the PES group (χ2 (1)=4.1765, p=0.041) at T2. MBSR participants also reported significantly greater reductions in pain at T2 (d=0.53, p=0.014). In addition, both MBSR and PES produced moderate-to-large and significant within-group improvements in all fatigue outcomes, depression, anxiety, and sleep at T2 and T3 compared to T1. Conclusion MBSR and PES appear efficacious for CRF and related symptoms. Larger trials including a usual care arm are warranted.

No abstract

ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients and warrants further investigation.

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.

Background Fear of a breast cancer recurrence is the most prevalent and disruptive source of distress for long-term survivors and their partners. However, few studies have focused on predictors of fear of recurrence. The aim of this study is to test the efficacy of the Social Cognitive Processing Theory (SCPT) in predicting fear of recurrence in long-term breast cancer survivors diagnosed at age 45 or younger and their partners. Methods In a large cross-sectional study, breast cancer survivors (N=222) 3–8 years from diagnosis and their partners completed a survey assessing demographic characteristics, fear of recurrence, social constraints, and cognitive processing (intrusive thoughts and cognitive avoidance). Mediation analyses were conducted for survivors and partners separately to determine if cognitive processing would mediate the relationship between social constraints and fear of recurrence. Results Cognitive processing mediated the relationship between social constraints and fear of recurrence both for survivors [F(3,213)= 47.541, R2=.401, p<.001] and partners [F(3,215)= 27.917, R2=.280, p<.001). Demographic variables were not significant predictors of fear of recurrence. Conclusions As predicted, cognitive processing mediated the relationship between social constraints and fear of recurrence. Results expand the utility of the SCPT in long-term survivors and their partners by supporting its use in intervention design.

Background Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancer survivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence‐based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group‐based ACT for FCR in BCS. Methods Post‐treatment BCS (91 patients with stage I‐III disease) with clinical FCR randomly were assigned to ACT (6 weekly 2‐hour group sessions), survivorship education (SE; 6 weekly 2‐hour group sessions), or enhanced usual care (EUC; one 30‐minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post‐traumatic stress, depression, QOL, and other FCR‐related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1 month after the intervention (T3), and 6 months after the intervention (T4) using intent‐to‐treat analysis. Results Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within‐group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between‐group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P < .001) and EUC (Cohen d, 0.61; P < .01). For 10 of 12 secondary outcomes, only ACT produced significant within‐group reductions across all time points. By T4, significant moderate to large between‐group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR‐related psychological distress. Conclusions Group‐based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.

LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the efficacy of venlafaxine in alleviating hot flashes and improving secondary outcomes.2. Identify the week of treatment that venlafaxine was most effective.3. List three side effects associated with venlafaxine.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACT Background. Although venlafaxine reduces self-reported hot flashes, no data have established the drug's impact on physiologically documented hot flashes. Two randomized, double-blind, placebo-controlled crossover trials examined the efficacy of two doses of venlafaxine in relation to physiological and self-reported hot flashes and other outcomes, including negative affect, fatigue, sleep, and quality of life.Methods. Sample: 57 breast cancer survivors in the low-dose study; 20 in the high-dose study. Setting: university cancer clinics in the Southeast and Midwest. Intervention: 37.5 mg of venlafaxine (low-dose study) or 75 mg of venlafaxine (high-dose study). Measures: hot flash frequency (physiological monitor, diary, and event marker), hot flash severity (diary), hot flash bother (diary), and questionnaires for hot flash impact on daily life, negative affect, fatigue, sleep, and quality of life.