Wang X, Dai Z, Zhu X, Li Y, Ma L, Cui X, Zhan T. Effects of mindfulness-based stress reduction on quality of life of breast cancer patient: A systematic review and meta-analysis. PLoS One. 2024 Jul 19;19(7):e0306643. doi: 10.1371/journal.pone.0306643. PMID: 39028716; PMCID: PMC11259293.
Introduction
Breast cancer is the most commonly diagnosed cancer type, with approximately 2.1 million new cases every year, making it the leading cause of death in women worldwide. At present, the most common treatment for breast cancer is surgical treatment, including breast-conserving surgery and sentinel lymph node biopsy. In addition to surgery, the main treatment methods for breast cancer include neoadjuvant chemotherapy, targeted therapy, endocrine therapy, and radiotherapy. Side effects can occur to varying degrees during treatment. Other effects include changes in body and body image, arm diseases (lymphedema, axillary syndrome), and functional changes. These factors can lead to a range of psychological problems in breast cancer patients, including pain, fatigue, sleep disturbances, anxiety, depression, perceived stress (PSS), cognitive dysfunction, and fear of
recurrence (FOR), greatly affecting their quality of life. The evidence indicates that anxiety and depression are significantly correlated with a decreased quality of life in breast cancer patients.
Patients experience enormous mental pressure either upon learning of their malignant tumors or during the course of treatment. The emotional state of cancer patients profoundly impacts the family around them and their daily activities. Negativity and depression don’t just have a negative impact on the entire family but also make it difficult for patients to cooperate with doctors with a positive attitude, seriously reducing their quality of life and potentially contributing to treatment non-adherence. Improving the psychological status of breast cancer patients is essential.
As a psychologically focused therapy, Mindfulness Based Stress Reduction (MBSR) can positively affect stress management. Patients can better manage their emotions, improve their inner focus, regulate their mental state with MBSR, and alleviate negative emotions such as loneliness, anxiety, and depression. MBSR is an eight-week group-based therapy which teaches mindfulness skills through various practices, including mindfulness of breath, thoughts, bodily sensations, sounds, and everyday activities, with weekly 2.5-hour sessions and one full retreat day. Participants are given recorded instructions for home practice for 45 minutes per day, six days a week. A growing body of robust evidence from several studies has demonstrated that MBSR has a significant effect on improving mental health and is beneficial for psychological states, anxiety, stress, depression, and pain.
This systematic review and meta-analysis aimed to comprehensively evaluate the impact of Mindfulness Based Stress Reduction (MBSR) therapy on the quality of life and psychological well-being of breast cancer patients. Although the latest meta-analysis suggests a slight improvement in the quality of life through MBSR, it is based on data up to April 2018, omitting several relevant randomized controlled trials (RCTs). Utilizing recent RCTs, this study sought to provide recent evidence for the clinical application of MBSR.
Results of the search
Initially, a systematic search yielded 1599 articles, which was winnowed down to 11 papers which were included in this study.
A total of 11 randomized controlled trials met the inclusion criteria, and detailed features of the included literature are presented in tabular form. The papers were published between 2009 and 2022. Seven studies were conducted in North America countries, two in China and two European studies. A total of 1644 patients were included in this study. Four articles used MBSR therapy for 6 weeks, while the remaining seven articles used MBSR for 8 weeks. Five articles reported on patients with stage 0-III breast cancer, three reported on patients with breast cancer during chemotherapy, one reported on neuropathic pain in breast cancer patients, and the remaining two articles focused on stage I-II and stage I-III breast cancer patients, respectively.
While reviewing the detailed characteristics of the studies I was astounded to see that two studies were reported to have provided MBSR classes of “two hour sessions six times a week for six weeks” (Lengacher 2009 and 2015). I retrieved the two studies referenced and found that there had been ”two-hour sessions weekly for six weeks”. Another study (Henderson 2012) was cited as providing “For eight weeks, seven sessions per week of 2.5 to 3.5 hours of therapy …” I retrieved this study and found that it had provided “seven weekly 2.5 to 3.5-hour sessions and one 7.5 hour intensive silent retreat session in the 6th week…” The error in the tables did not alter the findings of the study but might have confused readers who were not familiar with the “standard” MBSR curriculum and its most common variants.
Findings and Recommendations
An increasing number of doctors and nurses are turning to MBSR therapy to alleviate the negative emotions of breast cancer patients. The findings suggest that MBSR therapy effectively improves anxiety, depression, and emotional state in breast cancer patients. During chemotherapy, breast cancer patients may experience aggravated tumor-related symptoms, new symptoms, and an increased likelihood of psychiatric symptoms. The study demonstrates that MBSR significantly enhances coping skills in breast cancer patients. This analysis attributes this improvement to MBSR techniques, such as meditation and yoga, which enhance concentration and coping skills, redirecting patients toward a healthier self-awareness and self-relationship. However, there were no significant differences compared to usual care in terms of improving quality of life, sleep quality, post-traumatic growth, pain, and fatigue.
Clinical implications
Previous studies point to MBSR significantly reducing negative emotions such as anxiety, depression, stress, and fear of recurrence in breast cancer patients. Also, MBSR enhances patients’ coping abilities and positively influences their emotional states. Moreover, MBSR is characterized by its simplicity in implementation, and low economic cost, making it suitable for intervention. Applying MBSR can contribute to a more comprehensive and improved treatment system for breast cancer patients.
Limitations
The main limitation was the heterogeneity of patient populations in terms of inclusion criteria and
clinical features. Breast cancer patients may be at different stages of their illness, which could be an important confounder. Different conditions and prior therapies could also influence the results. For some patients in the early stage of the disease, surgical treatment can resolve the disease, while patients in the advanced stage of the disease may be followed by targeted therapy or
immunotherapy. No study was precise enough to assess whether treatment measures affect the effectiveness of MBSR at different stages of treatment. In addition the outcome indicators were inconsistent between different studies, and some studies lack sufficient indicators. This variability could lead to incomplete data interpretation. As there was measurable significant heterogeneity
across the studies, our conclusions should still be interpreted with caution.
Conclusion
MBSR is an effective intervention for reducing negative emotions and improving coping in breast cancer patients. However, to strengthen the evidence base, further trials with extended follow-up
periods and more tightly controlled conditions are warranted.
