Improve Mental and Physical Health in Women with Breast Cancer with Mindfulness
By John M. de Castro, Ph.D.
“What I’ve come to understand as a newly inaugurated breast cancer survivor is this: allowing a greater good to open up through me is more beneficial than expecting life to meet my personal demands. It is healthier for me to let go of my need for control in order to walk mindfully in the way of gratitude. And while my destiny will unfold with every step I take, the truth will manifest itself in time.” – Kimberly Holman
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 a heightened fear of reoccurrence, and an alteration of their body image.
Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including stress, sleep disturbance, and anxiety and depression.. Indeed, yoga practice has been found to improve sleep quality and memory, reduce the side effects from chemotherapy, relieve neuromuscular symptoms, and improve the quality of life in cancer survivors. Also, Tai Chi or Qigong practice has been shown to improve quality of life, reduce fatigue, and lower blood pressure and cortisol levels. Mindfulness-Based Stress Reduction (MBSR) combines meditation, yoga, and body scan meditation practices. As such, it should be an excellent treatment for the physical and psychological problems of women with breast cancer.
In today’s Research News article “Mindfulness and its efficacy for psychological and biological responses in women with breast cancer.” (See summary below), Sarenmalm and colleagues performed a randomized controlled clinical trial of the effectiveness of Mindfulness-Based Stress Reduction (MBSR) for the treatment of the physical and psychological problems of women with breast cancer. They recruited breast cancer patients who had completed “adjuvant chemotherapy and/or radiation therapy, with or without endocrine therapy.” Participants were randomly assigned to receive MBSR treatment for 8-weeks either instructor led or self-taught or no treatment. Measurements were taken before and after treatment and 1 month and 3 months later of depression, physical and psychological symptoms, health status, coping capacity, mindfulness, personal growth, and plasma measures of immune system and inflammatory system function.
They found that MBSR taught by an instructor produced significant benefits relative to the self-taught MBSR and no treatment groups. In particular, instructor led MBSR significantly reduced depression, psychological symptoms, physical symptoms, total symptom burden, and improved vitality, physical functioning, mental health, and general health. In addition, MBSR was found to significantly improve coping capacity, post-traumatic growth, and mindfulness, particularly non-reactivity, and the immune response.
These are remarkable, striking, and very significant findings. Women with breast cancer had clinically significant improvements in their mental and physical health as a result of participation in an instructor MBSR training. It is interesting that self-taught MBSR did not have the same significant benefits, underscoring the need for professional leadership of the MBSR group. The self-taught MBSR group was an excellent active control group. The strength of this control condition makes the results all the more important as it suggests that placebo effects were not responsible for the benefits.
The results make it clear that instructor led Mindfulness-Based Stress Reduction (MBSR) should be prescribed for the treatment of the physical and psychological problems of women with breast cancer.
“Women who had the most stress . . . benefited the most from the Mindfulness-Based Stress-Reduction for Breast Cancer program. The results of this study echo results from other small studies showing that mindfulness-based meditation can help ease the stress, anxiety, fear, and depression that often come along with a breast cancer diagnosis and treatment.” – BreastCancer.org
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Kenne Sarenmalm, E., Mårtensson, L. B., Andersson, B. A., Karlsson, P. and Bergh, I. (2017), Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. doi:10.1002/cam4.1052
Abstract
Many breast cancer survivors have to deal with a variety of psychological and physiological sequelae including impaired immune responses. The primary purpose of this randomized controlled trial was to determine the efficacy of a mindfulness-based stress reduction (MBSR) intervention for mood disorders in women with breast cancer. Secondary outcomes were symptom experience, health status, coping capacity, mindfulness, posttraumatic growth, and immune status. This RTC assigned 166 women with breast cancer to one of three groups: MBSR (8 weekly group sessions of MBSR), active controls (self-instructing MBSR) and non-MBSR. The primary outcome measure was the Hospital Anxiety and Depression Scale. Secondary outcome measures were: Memorial Symptom Assessment Scale, SF-36, Sense of Coherence, Five Facets of Mindfulness Questionnaire, and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometry for NK-cell activity (FANKIA) and lymphocyte phenotyping; concentrations of cytokines were determined in sera using commercial high sensitivity IL-6 and IL-8 ELISA (enzyme-linked immunosorbent assay) kits. Results provide evidence for beneficial effects of MBSR on psychological and biological responses. Women in the MBSR group experienced significant improvements in depression scores, with a mean pre-MBSR HAD-score of 4.3 and post-MBSR score of 3.3 (P = 0.001), and compared to non-MBSR (P = 0.015). Significant improvements on scores for distress, symptom burden, and mental health were also observed. Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumatic growth. Significant benefits in immune response within the MBSR group and between groups were observed. MBSR have potential for alleviating depression, symptom experience, and for enhancing coping capacity, mindfulness and posttraumatic growth, which may improve breast cancer survivorship. MBSR also led to beneficial effect on immune function; the clinical implications of this finding merit further research.
http://onlinelibrary.wiley.com.ezproxy.shsu.edu/doi/10.1002/cam4.1052/full