A Mindfulness-Based Intervention as a Supportive Care Strategy for Patients with Metastatic Non-Small Cell Lung Cancer and Their Spouses: Results of a Three-Arm Pilot Randomized Controlled Trial

Abstract

Background Although mindfulness‐based interventions have been widely examined in patients with nonmetastatic cancer, the feasibility and efficacy of these types of programs are largely unknown for those with advanced disease. We pilot‐tested a couple‐based meditation (CBM) relative to a supportive‐expressive (SE) and a usual care (UC) arm targeting psychospiritual distress in patients with metastatic lung cancer and their spousal caregivers. Patients and Methods Seventy‐five patient‐caregiver dyads completed baseline self‐report measures and were then randomized to one of the three arms. Couples in the CBM and SE groups attended four 60‐minute sessions that were delivered via videoconference. All dyads were reassessed 1 and 3 months later. Results A priori feasibility benchmarks were met. Although attendance was high in both groups, dyads in the CBM group indicated greater benefit of the sessions than those in the SE group (patients, CBM mean = 2.63, SE mean = 2.20, p = .003; spouses, CBM mean = 2.71, SE mean = 2.00, p = .005). Compared with the UC group, patients in the CBM group reported significantly lower depressive symptoms (p = .05; d = 0.53) and marginally reduced cancer‐related stress (p = .07; d = 0.68). Medium effect sizes in favor of the CBM compared with the SE group for depressive symptoms (d = 0.59) and cancer‐related stress (d = 0.54) were found. Spouses in the CBM group reported significantly lower depressive symptoms (p < .01; d = 0.74) compared with those in the UC group. Conclusion It seems feasible and possibly efficacious to deliver dyadic interventions via videoconference to couples coping with metastatic lung cancer. Mindfulness‐based interventions may be of value to managing psychological symptoms in the palliative care setting. Clinical trial identification number. NCT02596490 Implications for Practice The current randomized controlled trial has established that a mindfulness approach to the management of patients’ and spouses’ psychospiritual concerns is acceptable and subjectively deemed more beneficial than a supportive‐expressive treatment for patients with metastatic non‐small cell lung cancer (NSCLC). We also revealed that videoconference delivery, here FaceTime, is an acceptable approach even for geriatric patients with metastatic NSCLC and that patients and their spousal caregivers prefer a dyadic delivery of this type of supportive care strategy. Lastly, this trial has laid the foundation for the role of mindfulness‐based interventions in the palliative care setting supporting patients with advanced NSCLC and their spousal caregivers.

Variables associated with distress amongst informal caregivers of people with lung cancer: A systematic review of the literature

“…In a further three‐arm study 53 (mindfulness based intervention vs. social support vs. usual care), depression was reduced in the mindfulness group compared to usual care only ( F = 7.39, p < 0.01, d = 0.74). A further study 54 reported that psychological distress was reduced for caregivers who followed a tailored palliative care plan, selfcare plan and educational sessions compared to those receiving usual care ( p ≤ 0.01).…”

“…Risk of bias in relation to the eight intervention studies is summarised in Table 2 (with further details in Table S2). While four of the intervention studies 48,50,51,53 were judged to be at low risk of bias overall, there was insufficient detail to make a clear judgment in some domains, particularly in relation to blinding. One further study 49 was rated as 'unclear' overall.…”

“…While distress was conceptualised broadly, 25 the majority of studies assessed psychological distress, that is, depression and anxiety. There was some heterogeneity in the questionnaires used to measure distress, as follows (in some studies two measures of distress were employed): Hospital Anxiety and Depression Scale (HADS; n = 6), 22,32,34,36,41,49 Hamilton Depression Rating Scale (n = 3), 29,30,32 Brief Symptom Inventory (BSI; n = 1 reported in four articles), 17,[37][38][39] Center for Epidemiological Studies Depression (CESD; n = 7), 30,35,40,44,45,46,53 Anxiety and Depression measures (n = 1), 51 Beck's Depression Inventory (BDI; n = 1), 42 Patient Health Questionnaire and Generalised Anxiety Disorders scale (PHQ GAD; n = 2), 50,52 Death Anxiety Scale (n = 1). 43 Twelve studies reported the proportion of participants who reached clinically relevant levels of depression and/or anxiety.…”

Mindfulness‐Based Couple Interventions: A Systematic Literature Review

“…Overall, a decrease over time was shown in at least one partner. Studies reported either benefits for both partners (Birnie et al, 2010; Carson et al, 2004; Milbury, Li, et al, 2020; Price‐Blackshear et al, 2020), or only for one partner (Berk et al, 2019; Duncan & Bardacke, 2010; Hsiao et al, 2016; Milbury, Weathers, et al, 2020). No change was found only in one study, which did not examine a clinical sample and reported low statistical power (Gambrel & Piercy, 2015a).…”

Psychoeducational Interventions for Caregivers of Persons With Multiple Sclerosis: Protocol for a Randomized Trial

“…The use of websites and other technologies (eg, videoconference) to deliver interventions has been well established, feasible, and acceptable to patients and caregivers [ 40 , 45 - 49 ]. In addition, previous research has noted the benefits of eHealth interventions for anxiety and depression, support for self-management activities, and improvement of family functioning in a variety of populations [ 41 , 43 , 46 , 48 ].…”