Effect of mindfulness-based stress reduction on somatic symptoms, distress, mindfulness and spiritual wellbeing in women with breast cancer: Results of a randomized controlled trial

Abstract

Submit your article to this journal ABSTRACTBackground. Women with breast cancer experience different symptoms related to surgical or adjuvant therapy. Previous fi ndings and theoretical models of mind -body interactions suggest that psychological wellbeing, i.e. levels of distress, infl uence the subjective evaluation of symptoms, which infl uences or determines functioning. The eight-week mindfulness-based stress reduction (MBSR) program signifi cantly reduced anxiety and depression in breast cancer patients in a randomized controlled trial (NCT00990977). In this study we tested the effect of MBSR on the burden of breast cancer related somatic symptoms, distress, mindfulness and spiritual wellbeing and evaluated possible effect modifi cation by adjuvant therapy and baseline levels of, distress, mindfulness and spiritual wellbeing. Material and methods. A population-based sample of 336 women Danish women operated for breast cancer stages I -III were randomized to MBSR or usual care and were followed up for somatic symptoms, distress, mindfulness skills and spiritual wellbeing post-intervention and after six and 12 months. Effect was tested by general linear regression models post-intervention, and after six and 12 months follow-up and by mixed effects models for repeated measures of continuous outcomes. Effect size (Cohen ' s d) was calculated to explore clinical signifi cance of effects among intervention group. Finally, modifi cation of effect of MBSR on burden of somatic symptoms after 12 months ' follow-up by adjuvant therapy and baseline levels of, distress, mindfulness and spiritual wellbeing were estimated. Results. General linear regression showed a signifi cant effect of MBSR on the burden of somatic symptoms post-intervention and after 6 months ' follow-up. After 12 months ' follow-up, no signifi cant effect of MBSR on the burden of somatic symptoms was found in mixed effect models. A statistically signifi cant effect of MBSR on distress was found at all time-points and in the mixed effect models. Signifi cant effects on mindfulness were seen after six and 12 months and no signifi cant effect was observed for spiritual wellbeing. No signifi cant modifi cation of MBSR effect on somatic symptom burden was identifi ed. Conclusion. This fi rst report from a randomized clinical trial on the long-term effect of MBSR fi nds an effect on somatic symptom burden related to breast cancer after six but not 12 months follow-up providing support for MBSR in this patient group.

Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer – explorative analyses from a randomized controlled trial

“…The reported results vary, with two of the studies showing that higher baseline distress predicted greater reductions in psychological symptoms [12], fear of recurrence, and fatigue [10]. In contrast, no statistically significant moderation effects were found for somatic symptoms [7] or general health [11]. None of the available studies had specifically included pain as their primary outcome measure.…”

“…As mindfulness, defined as bringing attention to the experience that unfolds moment-by-moment in a non-judgmental way [8] and psychological distress have been negatively associated [9], it could be hypothesized that initial distress levels may influence the susceptibility for symptom improvement during MBI. A number of studies have investigated the possible moderating role of baseline psychological distress on the effect of MBI on various outcomes in breast cancer patients [7,[10][11][12]. The reported results vary, with two of the studies showing that higher baseline distress predicted greater reductions in psychological symptoms [12], fear of recurrence, and fatigue [10].…”

“…We did not find statistically significant interaction effects for the remaining proposed psychological moderators, namely baseline psychological distress and alexithymia, suggesting that initial psychological distress levels and alexithymia do not influence the effect of MBCT on pain intensity. With respect to baseline psychological distress, the existing studies report mixed results [7,[10][11][12], with the comparison of study results being further complicated by the many different (non-pain) outcomes used in the available studies, as the moderating role of psychological distress may vary across outcomes. Regarding alexithymia, ours is the first study to explore alexithymia as a possible moderator of MBI and the results should therefore be considered preliminary.…”

“…It is possible that these risk factors are differentially associated with various treatment responses to pain interventions as patients characterized by younger age, having undergone ALND surgery, radiotherapy, and/or endocrine treatment may experience higher levels of pain after breast cancer treatment, which may in turn predict susceptibility for change during pain interventions. Only one study has investigated radiotherapy, chemotherapy, and endocrine therapy as moderators of the effect of MBI on somatic symptoms in breast cancer patients, but found no statistically significant interactions [7]. So far, no studies have specifically investigated possible clinical moderators of MBI on persistent pain in breast cancer patients.…”

Illness Perceptions in Women with Breast Cancer—a Systematic Literature Review

“…Incorporating these reactions into the medical management of patients is nowadays almost routine. This statement is supported by the use of methods to assess quality of life (QOL) and “patient-reported outcomes” (PRO) [ 1 •, 2 ]. In modern medicine, QOL and PRO are not merely buzz words, but they lay the foundation for patient centered care, with shared decision making and self-management skills that help improve patients’ QOL [e.g., 3 •, 4 ].…”