While many resources and coverings for managing malignancy are for sale to cancer patients, both disease itself and concomitant therapies can compromise standard of living . Because of the complexity of oncological care, effective non-pharmacological therapies which improve an individual's QOL, and without disturbing ongoing treatment, are sought after.
Mindfulness & QOL
Mindfulness, as defined by the Mental Health Foundation, is a technique of coughing up attention, where one brings conscious awareness to experiences in the present moment without judgement.1 In accessory for its use within psychiatric populations, mindfulness-based interventions have become common among cancer patients and care providers, as evidenced with a growing body of numerous studies and systematic reviews. Common forms of MBI include mindfulness-based stress reduction and mindfulness-based cancer recovery , that is specifically tailored for cancer patients.2 Both involve weekly group sessions with a facilitator and daily home practices, eg, meditation, to improve non-judgmental awareness.
QOL, as defined by the nation's Cancer Institute, is the overall enjoyment of life, including a person's sense of well-being and ability to carry out various activities.3 Within this review, studies is going to be considered which investigate results of MBI on QOL in cancer patients, including sleep, anxiety, depression, overall mental health, and self-reported well-being.
MBI & QOL in Cancer
Two 2012 meta-analyses make up the foundation of evidence that MBIs possess a clinically significant effect on cancer patients' QOL. The meta-analysis by Zainal et al, which pooled 9 studies , demonstrated that MBSR significantly reduced stress, anxiety, and depression in cancer of the breast patients.1 They figured MBIs have the potential to significantly improve the mental health of cancer of the breast patients and could be recommended as part of their rehabilitation.1 The second meta-analysis, by Cramer et al, including 3 RCTs , showed that when compared to usual care, MBSR was superior in the ability to reduce both depression and anxiety; the authors later concluded that MBIs show promise and warrant further research.4
A quantity of high-quality research has since become readily available for interpretation. These new studies, which implemented more rigorous designs, will be examined to help understand the effects of MBI on QOL in cancer patients-
Depression: A large RCT of 229 women with cancer of the breast, which implemented an 8-week MBSR program and compared it to standard care, revealed significant improvements in depression.5 Symptoms of depression significantly improved at the 8-week mark, while anger only improved after 12 weeks, indicating a comparatively quick effect for depressive symptoms when compared with others.
Pooled results of a meta-analysis by Huang et al, including 6 studies and 536 cancer patients, showed a substantial positive effect of MSBR on depressive symptoms when compared with controls.6 Post-examination of the studies included in the review found that regular supervision having a mindfulness teacher and yearly attendance at retreats/conferences maximize the advantages of MBSR for QOL aspects for example depression. Using MBSR CDs or DVDs, offering visual and auditory instruction, can improve adherence to some mindfulness protocol when illness prevents patients from being able to actively take part in seminars.6
Anxiety & Stress: A study published in Psycho-Oncology found that a 7-week MBSR intervention significantly improved anxiety symptoms not less than 6 months after completing the program.7 There is a noted delay in statistically significant improvement: although patients showed no benefit when assessed immediately after the MBSR course, significant improvement was achieved in the 1-month post-intervention assessment. Findings suggest that the absence of immediate results shouldn't infer ineffectiveness, but rather that the benefit might be slow to determine.7
A comparative RCT of MBSR found that a mindfulness intervention led to greater reduction of stress and overall social support post-training when compared to supportive-expressive group therapy .8 Authors Carlson et al also measured cortisol throughout the study as a biomarker for stress reduction, and located that MBSR could buffer unfavorable changes that will otherwise occur without psychosocial intervention. This study of 271 distressed cancer survivors found MBSR to profit QOL in areas such as stress level, your overal wellness, and social support, while also resulting in more normative diurnal cortisol profiles. These QOL benefits were seen across a variety of breast cancer survivors, from early-stage through stage III cancers.8
Sleep Quality & Cognition: Together with studies investigating the results of MBSR interventions for depression and anxiety, there's been a focus on sleep quality of cancer patients, which, when disturbed, can hinder QOL. Cancer survivors, randomized for an MBSR group that received a proper 6-week in-class program, experienced higher objective sleep-parameter scores, a greater number of total sleep time, and much less waking instances.9 Unlike other studies assessing sleep, this trial presented results not only with subjective sleep scores, but additionally objective ones.
In another study, 2 months of MBSR training was shown through cognitive testing to help breast and colorectal cancer survivors with fatigue enhance their attention and accuracy.10 Fatigue symptoms experienced by cancer people are often accompanied by cognitive impairment, resulting in a lesser QOL. This research establishes MBSR like a promising treatment for cognitive impairment, not just because of its effectiveness, but in addition for its lasting effects, because the improvements were found to last to the 6-month assessment point.10
This review presents evidence that MBI can positively influence QOL by managing psychological and cognitive cancer-related symptoms such as depression, anxiety, stress, and cognitive impairment. Studies assessed in this review consistently demonstrate that MBI can promote a better QOL status for cancer patients and survivors, plausibly making mindfulness-based therapies a useful part of cancer care in the future.
Based around the findings, MBI should be conducted for at least 7 weeks to have a therapeutic effect, include regular patient-practitioner meetings or seminars, and supply patients with resources, for example CDs or handouts, to improve compliance. It should be noted that symptom improvement could be delayed in certain patients, and so the absence of immediate QOL improvement shouldn't be interpreted being an unsuccessful intervention. MBI appear to be beneficial for both active cancer patients and survivors.
While this review substantiates the role of MBI in cancer patient QOL management, there have been some limitations to the studies reviewed. Many of these studies examined the outcome of MBI on breast cancer patients, thus conclusions cannot be definitively drawn for other forms of cancer with unique pathological features. Limitations of study design in some of the studies included the lack of control groups and blinding to allocation. However, some studies used very rigorous methodology. One study compared an MBI to a group support program with the same period of class time, in addition to a 1-day stress-management control group.8 The advantages observed in the MBI group were greater than those who work in the support group, and both of these interventions were more beneficial than the control group. This difference in effect shows that the advantages obtained by patients receiving MBIs aren't related to non-specific factors for example group/social interaction, attention from the clinician, or an expectation effect, but instead are related to the fabric covered in the mindfulness intervention. Additional large and rigorously-designed studies using active control groups can help establish a stronger causal link between MBI and QOL benefit for cancer patients and survivors to have an variety of cancer subtypes.
No studies reported adverse events or interactions along with other interventions associated with participation within the MBIs; however, dropouts were often poorly reported.4
Because MBIs are delivered inside a group setting, there is evidence of cost-effectiveness.7 Additionally, many of the studies documented further improvement following the completing this program, in addition to maintenance of clinical improvement at long-term follow-up assessments, without further participation in the intervention.
While not precisely known, it's been suggested that MBIs exert their effect on depression, anxiety, stress, and sleep by reduction of both rumination about past events and worry about the future. In cancer patients, this may include concerns about treatments, prognosis, or any other uncontrollable aspects of the disease. Mindfulness emphasizes the development of another reaction to challenges: instead of trying to change a hard situation , participants learn to connect with the problem in a different way.8
MBI appear to be a highly effective, safe, cost-effective, and feasible therapeutic option for better managing cancer patient and survivor symptoms related to poor QOL. According to ongoing research, practitioners should feel certain that MBI can help enhance the QOL of the cancer patients and help manage associated symptoms.