Mindfulness-Based Interventions in Cancer Care
Written by:
Karen Kane McDonnell, PhD, RN, Associate Professor David G. Gallerani, MPH, Research Associate Amanda R. Myhren-Bennett, MSN, RN, PhD student
Lung Cancer Survivorship Research Program, College of Nursing, University of South Carolina, Columbia, SC, USA
Mindfulness is derived from Buddhist traditions and described by one author as an intentional and nonjudgmental awareness of the present moment (Kabat-Zinn, 1990). Mindfulness-based interventions (MBIs) are used to treat and prevent a wide range of chronic conditions.
Mindfulness-Based Stress Reduction (MBSR)—a group-based, eight-week program and one of the most well-known MBIs—was developed by Jon Kabat-Zinn, PhD, currently founding executive director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School in the United States and its renowned Stress Reduction Clinic.
Gentle yoga (sitting) and other mindfulness practices are woven into interventions designed to improve 
the quality of life of cancer survivors and their families.
Mindfulness specifically helps survivors of cancer, their family members, and/or friends cope with symptoms of cancer, cancer therapies, and related stress (Rouleau, Garland, & Carlson, 2015). Dubbed a “healing practice” by Carlson and Speca (2010), mindfulness may even enhance immune system performance and reduce harmful levels of circulating stress hormones.
The Foundation: MBCR
Mindfulness-Based Cancer Recovery (MBCR) is one of many interventions built on MBSR (Carlson & Speca, 2010). At each session, participants engage in mindfulness practices, including gentle yoga and meditations. By repeatedly returning their attention to current experiences, participants gradually learn to disengage from dysfunctional thoughts and experience the emotions and bodily sensations of the present moment. Like MBSR, MBCR teaches participants to stop worrying or ruminating about the past and the future and to simply allow life experiences to unfold.
Mindfulness-Based Cancer Recovery (MBCR) is one of many interventions built on MBSR (Carlson & Speca, 2010). At each session, participants engage in mindfulness practices, including gentle yoga and meditations. By repeatedly returning their attention to current experiences, participants gradually learn to disengage from dysfunctional thoughts and experience the emotions and bodily sensations of the present moment. Like MBSR, MBCR teaches participants to stop worrying or ruminating about the past and the future and to simply allow life experiences to unfold.
Randomized clinical trials involving MBSR, MBCR, and other MBIs have shown efficacy in patients with cancer—that is, they have yielded improved psychosocial and physical outcomes (Carlson, 2017; Johannsen et al., 2016; Lengacher et al., 2016; Zhang et al., 2015). Yet, very few studies have involved survivors of early-stage non-small-cell lung cancer (NSCLC). With consultation from Linda Carlson, Enbridge Research Chair in Psychosocial Oncology at the University of Calgary and co-founder of the Tom Baker Cancer Centre’s MBCR program, a team of researchers, clinicians, and mindfulness practitioners adapted MBCR for this specific population of survivors of lung cancer and family members (dyads).
Breathe Easier
In 2017–18, the adapted program, Breathe Easier, was pilot tested using a prospective, one-group, repeated measure, mixed-method design, for feasibility (recruitment, retention, adherence, acceptability) and preliminary effects (symptom improvement—of dyspnea, fatigue, stress, and insomnia).
The following instruments measured outcome variables (see footnote 1):
• FACIT Dyspnea Short Forms
• FACIT Fatigue Scale v. 4
• Perceived Stress Scale v. 4
• Pittsburgh Sleep Quality Index
Using Stata v. 14, descriptive statistics were obtained for feasibility measures. Student t-tests were performed for subset comparisons. Face-to-face interviews (all audio-recorded and transcribed) extracted dyads’ perceptions. NVivo Pro 12 was used for data management, and thematic analysis was used for data analysis.
Results
The greatest challenge was recruitment. This and other facts about the sample follow:
- 20% recruitment (31 dyads or 62 participants of 164 survivors reached)
- 94% retention
- 62% African American
- 44% male
Adherence was demonstrated by good attendance and exceeding expectations on home assignments (breathing exercises and meditations). All participants practiced gentle movements (sitting, standing, and floor yoga) and met about 80% of expectations.
All agreed the intervention materials were easy to use, that learning yoga and breathing exercises helped them, and that involving a family member was important. Survivors had less dyspnea and less perceived stress over time. Fatigue and sleep scores improved for both survivors and family members. Six themes emerged from interview data and enriched our understanding of feasibility and preliminary outcomes:
The intervention Breathe Easier included cultivating an awareness of breath and breathing exercises 
- Learning to Breathe Easier
- Interacting with Others Benefits Me
- Stretching, Releasing Tension, and Feeling Energized
- Enhanced Closeness with Committed Partners
- Refocusing on Living
- Sustaining New Skills Is a Decision
Conclusions
The pilot test’s strong retention, adherence, and acceptability demonstrate strong feasibility overall. Slow recruitment may be attributable to the isolating nature of lung cancer, uniqueness of the intervention, relatively low volume of early-stage survivors, and/or requirement of a family member to take part.
Preliminary outcome data indicate benefits of Breathe Easier over time for both survivors of NSCLC and their family members. Intervention development team members were inspired by participants’ engagement and are seeking funding to implement the next steps.
References:
Carlson, L. E. (2017). Mindfulness and cancer care: Easing emotional and physical suffering. Alternative and Complementary Therapies, 23(5), 167–170.
Carlson, L., & Speca, M. (2010). Mindfulness-based cancer recovery: A step-by-step MBSR approach to help you cope with treatment and reclaim your life. Oakland, CA: New Harbinger Publications.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York, NY: Delacourt.
Lengacher, C. A., Reich, R. R., Paterson, C. L., Ramesar, S., Park, J. Y., Alinat, C., … Jacobsen, P. B. (2016). Examination of broad symptom improvement resulting from mindfulness-based stress reduction in breast cancer survivors: A randomized controlled trial. Journal of Clinical Oncology, 34(24), 2827.
Johannsen, M., O’Connor, M., O’Toole, M. S., Jensen, A. B., Højris, I., & Zachariae, R. (2016). Efficacy of mindfulness-based cognitive therapy on late post-treatment pain in women treated for primary breast cancer: A randomized controlled trial. Journal of Clinical Oncology, 34(28), 3390-3399.
Rouleau, C. R., Garland, S. N., & Carlson, L. E. (2015). The impact of mindfulness-based interventions on symptom burden, positive psychological outcomes, and biomarkers in cancer patients. Cancer Management and Research, 7, 121.
Zhang, M., Wen, Y., Liu, W., Peng, L., Wu, X., & Liu, Q. (2015). Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: A meta-analysis. Medicine, 94(45), 1–9.
Footnotes (1) References for instruments: Carpenter, J. S., & Andrykowski, M. A. (1998). Psychometric evaluation of the Pittsburgh sleep quality index. Journal of Psychosomatic Research, 45(1), 5–13; Choi, S. W., Victorson, D. E., Yount, S., Anton, S., & Cella, D. (2011). Development of a conceptual framework and calibrated item banks to measure patient-reported dyspnea severity and related functional limitations. Value in Health, 14(2), 291-306.Roberti, J. W., Harrington, L. N., & Storch, E. A. (2006). Further psychometric support for the 10‐item version of the perceived stress scale. Journal of College Counseling, 9(2), 135-147. Webster, K., Cella, D., & Yost, K. (2003). The functional assessment of chronic illness therapy (FACIT) measurement system: properties, applications and interpretation. Health and Quality of Life Outcomes, 1(79), 1-7.
