By John M. de Castro, Ph.D.
“The mindfulness elements of accepting things as they are, turning towards rather than away from difficult emotional experience, and embracing change as a constant are helpful antidotes to these difficult realities. The emotion-regulation strategies practiced in mindfulness-based interventions help to prevent worry about the future and rumination over past events, and allow people to live more fully in the present moment, regardless of what lies ahead. The inevitability of loss, change and eventual death are helpful to face in general, but are both more challenging and more powerful for people directly facing a life threat like cancer.” – Linda Carlson
About 12.5% of women in the U.S. develop invasive breast cancer over their lifetimes and every year about 40,000 women die. Indeed, more women in the U.S. die from breast cancer than from any other cancer, besides lung cancer. Breast cancer diagnosis, however, is not a death sentence. It is encouraging that the death rates have been decreasing for decades from improved detection and treatment of breast cancer. Five-year survival rates are now at around 95%.
The improved survival rates mean that more women are now living with cancer. Surviving cancer, however, carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day. In addition, breast cancer survivors can have to deal with the consequences of chemotherapy, and often experience increased fatigue, pain, and bone loss, reduced fertility, difficulty with weight maintenance, damage to the lymphatic system, heightened fear of reoccurrence, and an alteration of their body image. With the loss of a breast or breasts, scars, hair shedding, complexion changes and weight gain or loss many young women feel ashamed or afraid that others will reject or feel sorry for them. As a result, survivors often develop psychological symptoms of stress, anxiety, depression, and impaired cognitive functioning.
Psychologically, cancer survivors frequently suffer from anxiety, depression, mood disturbance, Post-Traumatic Stress Disorder (PTSD), sleep disturbance, fatigue, sexual dysfunction, loss of personal control, impaired quality of life, and psychiatric symptoms which have been found to persist even ten years after remission.
Unfortunately, most of these residual problems often go untreated. So, safe and effective treatments for the residual symptoms in breast cancer survivors are needed. Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual psychological symptoms and improve cognitive function. Most of the research, however, has been performed with postmenopausal women. But, 25% of breast cancer survivors are younger and premenopausal. In today’s Research News article “Mindfulness meditation for younger breast cancer survivors: A randomized controlled trial.” See:
or below or view the full text of the study at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393338/
Bower and colleagues examine the efficacy of mindfulness training for premenopausal breast cancer survivors. They recruited premenopausal breast cancer survivors who had completed primary treatment at least 3 months prior to participation and randomly assigned them to either receive a 6-week Mindful Awareness Practice program or to a wait-list control group. The participants were assessed with a battery of psychological tests. They also measured a set of genetic markers of inflammation. Assessments were performed before and 1-2 weeks after treatment and also 3 months later.
They found that mindfulness training produced significant improvements in the patients’ psychological state. In comparison to control participants, the mindfulness training group had significant decreases in perceived stress, depression, fatigue, subjective sleep disturbance, and hot flashes/night sweats, and significant increases in positive emotions, peace and meaning. For the most part the effects were not maintained at 3-month follow-up. In addition, the mindfulness training appeared to decrease inflammation as the mindfulness trained group showed a reduction in pro-inflammatory genetic markers and an increase in anti-inflammatory genetic markers.
These results are encouraging and suggest that the psychological well-being and inflammation can be improved with mindfulness training for premenopausal breast cancer survivors. Previous studies have demonstrated that mindfulness training with healthy individuals improves their psychological and emotional state and reduces inflammation. These results suggest that breast cancer survivors benefit as well. These improvements are particularly important for the breast cancer survivors as they are generally struggling with the psychological, emotions, and physical ramifications of their diagnosis and treatment. It is reassuring that mindfulness training can help.
Of concern is the fact that the psychological treatment effects were not maintained 3-months later. It is unclear if the women maintained their mindfulness practices following training as they were encouraged to do. It is possible that more encouragement and perhaps booster sessions may be needed to maintain the benefits.
Regardless, improve symptoms in breast cancer survivors with mindfulness.
“We already know that psychosocial interventions like mindfulness meditation will help you feel better mentally, but now for the first time we have evidence that they can also influence key aspects of your biology.” – Dr. Linda Carlson
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Bower, J. E., Crosswell, A. D., Stanton, A. L., Crespi, C. M., Winston, D., Arevalo, J., … Ganz, P. A. (2015). Mindfulness meditation for younger breast cancer survivors: A randomized controlled trial. Cancer, 121(8), 1231–1240. http://doi.org/10.1002/cncr.29194
Abstract
Purpose: Premenopausal women diagnosed with breast cancer are at risk for psychological and behavioral disturbances after cancer treatment. Targeted interventions are needed to address the needs of this vulnerable group.
Methods: This randomized trial provided the first evaluation of a brief mindfulness-based intervention for younger breast cancer survivors designed to reduce stress, depression, and inflammatory activity. Women diagnosed with early-stage breast cancer before age 50 who had completed cancer treatment were randomly assigned to a 6-week Mindful Awareness Practices (MAPS) intervention (n = 39) or wait-list control (n = 32). Participants completed questionnaires at pre- and post-intervention to assess stress and depressive symptoms (primary outcomes) as well as physical symptoms, cancer-related distress, and positive outcomes. Blood samples were collected to examine genomic and circulating markers of inflammation. Participants also completed questionnaires at a three-month follow-up.
Results: In linear mixed models, the MAPS intervention led to significant reductions in perceived stress (P = .004) and marginal reductions in depressive symptoms (P = .094), as well as significant reductions in pro-inflammatory gene expression (P = .009) and inflammatory signaling (P = .001) at post-intervention. Improvements in secondary outcomes included reduced fatigue, sleep disturbance, and vasomotor symptoms and increased peace and meaning and positive affect (Ps < .05). Intervention effects on psychological and behavioral measures were not maintained at three-month follow-up, though reductions in cancer-related distress were observed at this assessment.
Conclusions: A brief mindfulness-based intervention showed preliminary short-term efficacy in reducing stress, behavioral symptoms, and pro-inflammatory signaling in younger breast cancer survivors.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393338/
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