Written by Holger Cramer, Ann-Christine Moenaert and the CAM-Cancer Consortium.
Updated October 24, 2016

Mindfulness

Does it work?

This summary is based on systematic reviews published in the last five years (since 2012) and subsequently published randomized controlled trials (RCTs). These publications indicate fast growing research efforts considering that the first RCT on the use of MBSR/MBCT in oncology dates from 2000. Details of the included studies are presented in table 1 for the systematic reviews and table 2 for the controlled clinical trials

Systematic reviews and meta-analyses

One overview of systematic reviews on mindfulness-based interventions in healthcare in general including six systematic reviews on cancer, 31 and seven systematic reviews 32-37 are available.

Four systematic reviews evaluate MBSR/MBCT in breast cancer patients and three in patients with various cancer diagnoses. There is some overlap in the systematic reviews in terms of the 39 individual RCTs, 6 non-randomized controlled trials, and 24 uncontrolled trials included (see table 1). The systematic review of systematic reviews by Gotink includes the systematic reviews by Piet et al 35 and Cramer et al 33.

The effect of mindfulness-based stress reduction (MBSR) has most commonly been investigated in female breast cancer patients. While most reviews would also have included mindfulness-based cognitive therapy (MBCT), no studies specifically on this intervention were located. 

A common critique of these meta-analyses and systematic reviews is the lack of comparisons with other group-based psychosocial interventions not allowing for the identification of effects specifically attributed to specific mindfulness components rather than the attention and peer support associated with participation in psychosocial group based interventions 35. In addition the focus of most reviews on breast cancer patients and thus limits the generalization of the results of these studies towards the global cancer patient population. 

All systematic reviews on breast cancer mentioned methodological shortcomings of the included studies. Methodological shortcomings of the reviews themselves further limit the conclusions of the reviews. These include small numbers of included trials 32-34, inadequate methodology for meta-analysis (ie, the use of mean differences for analyses of different outcome measures) 32, and lack of safety assessment in all but one review 33

Randomized controlled trials

An additional 10 RCTs were located, which were published after the above-mentioned reviews 38-47. For a description of included RCTs please see table 2. Four RCTs included breast cancer patients, another four mixed cancer populations and one lung cancer and prostate cancer, respectively.

Summary of effects by outcome

Effects of MBSR on depression

For breast cancer patients, the meta-analysis Cramer et al. (2012) 33 reported small short-term effects of MBSR compared to usual care on depression. Comparable effects were found in the meta-analysis by Huang et al. (2015) 32, however this analysis used inadequate methods which limit its conclusions. While the meta-analysis by Zainal et al. (2012) 34 found moderate sized effects on depression, the magnitude of effects was reduced when only randomized trials were considered. The most recent meta-analysis by Zhang et al. (2016) 48 finally reported large effect sizes favoring MBSR over usual care.

With regards to the systematic reviews in mixed cancer populations, The meta-analysis by Piet et al. (2012) 35 found small short- and longer-term effects of MBSR on depression for both, innergroup and within-group comparisons. Zhang et al. (2015) 37 found large short-term effects and no medium-term effects favoring MBSR over usual care.

Two of the subsequently published RCTs assessed depression  reporting no difference between MBSR and a sleep hygiene intervention 45 or usual care 44.

Effects of MBSR on anxiety

All four SRs in breast cancer patients assessed anxiety. Cramer et al. (2012) 33 found moderate short-term effects of MBSR compared to usual care on anxiety. Again, the effects reported by Huang et al. (2015) 32 are limited by the inadequate methodology used. Zainal et al. (2012) 34 reported moderate sized effects on anxiety for uncontrolled pre-post comparisons, and small effects when only randomized trials were considered. Zhang et al. (2016) 48 found small short-term effects of MBSR compared to usual care on anxiety, but moderate short-term effects on cancer-specific fear of recurrence.

For a mixed cancer population Piet et al. (2012) 35 reported moderate short- and longer-term effects of MBSR on anxiety when only innergroup comparisons were considered. The effect sizes were small when only randomized trials were considered. In contrast, the more recent review by Zhang et al. (2015) 37 found moderate short-term effects of MBSR on anxiety when compared to usual care, but no medium-term effects.

For anxiety, one of the subsequently published RCTs found effects favoring MBSR over usual care 44, while another did not 46.

Effects of MBSR on stress

Three SRs including breast cancer patients assessed stress. Huang et al. (2015) 32 reported short-term effects of MBSR on stress. Zainal et al. (2012) 34 reported moderate effects on anxiety for uncontrolled pre-post comparisons, and small effects for randomized trials. The most recent meta-analysis by Zhang et al. (2016) 48 found no effects of MBSR on stress in relation to usual care.

Stress was assessed in five of the subsequently published RCTs. Two RCTs reported positive effects of MBSR compared to supportive-expressive therapy 40 or usual care 47, while three found no group differences between MBSR and cognitive therapy 39, a sleep hygiene intervention 45, or usual care (44).

Effects of MBSR on spirituality

The meta-analyses by Cramer et al. (2012) 33 and by Zhang et al. (2016) 48 including breast cancer patients found no effects of MBSR beyond usual care on spirituality.

Effects of MBSR on mindfulness

Based on the review by Piet et al. (2012) 35 including patients with various cancers, MBSR has small short-term effects on mindfulness in both, uncontrolled trails and randomized group comparisons.

The three RCTs published after the systematic reviews report mixed results 45-47.

Effects of MBSR or MBCT on other outcomes

For general distress, only one 47 out of two RCTs found effects of MBSR 47 or MBCT 41 beyond usual care; two studies found no effects of MBSR beyond other psychological interventions 39, 40 reported positive effects of MBSR compared to usual care.

Regarding fatigue, no differences between MBSR and psychoeducation occurred, while MBSR and MBCT were superior to usual care 38, 44.

Health-related quality of lifewas measured in six RCTs; no group differences between MBSR and a sleep hygiene intervention occurred 45; MBSR was superior to usual care in one out of four trials 43, 44, 47; and MBCT was superior to usual care in two trials 38, 41.

Mixed results were found for sleep 39, 45 and pain 41, 44

Citation Holger Cramer, Ann-Christine Moenaert, CAM-Cancer Consortium. Mindfulness [online document]. http://ws.cam-cancer.org/The-Summaries/Mind-body-interventions/Mindfulness. October 24, 2016.

References

  1. Kabat-Zinn J. Mindfulness-Based Interventions in Context: Past, Present, and Future. Clin Psychol Sci Prac. 2003;10(2):144-56.
  2. Campbell TS, Labelle LE, Bacon SL, Faris P, Carlson LE. Impact of Mindfulness-Based Stress Reduction (MBSR) on attention, rumination and resting blood pressure in women with cancer: a waitlist-controlled study. Journal of behavioral medicine. 2012;35(3):262-71. 
  3. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic medicine. 2003;65(4):571-81. 
  4. Carmody J, Baer RA. How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of clinical psychology. 2009;65(6):627-38. 
  5. Carlson LE, Speca M. Mindfulness-based Cancer Recovery. 1 ed. Oakland, CA: New Harbinger Publications, Inc.; 2010.
  6. Altschuler A, Rosenbaum E, Gordon P, Canales S, Avins AL. Audio recordings of mindfulness-based stress reduction training to improve cancer patients' mood and quality of life--a pilot feasibility study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2012;20(6):1291-7. 
  7. Foley E, Baillie A, Huxter M, Price M, Sinclair E. Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: a randomized controlled trial. Journal of consulting and clinical psychology. 2010;78(1):72-9. 
  8. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-oncology. 2009;18(12):1261-72.
  9. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. Journal of holistic nursing : official journal of the American Holistic Nurses' Association. 2011;29(2):107-17. 
  10. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. Journal of behavioral medicine. 2012;35(1):86-94. 
  11. Rosenbaum E. Here For Now: Living Well with Cancer Through Mindfulness. . 2 ed. Hardwick, Massachusetts: Satya House Publications; 2005.
  12. Birnie K, Garland SN, Carlson LE. Psychological benefits for cancer patients and their partners participating in mindfulness-based stress reduction (MBSR). Psycho-oncology. 2010;19(9):1004-9.
  13. Branstrom R, Kvillemo P, Brandberg Y, Moskowitz JT. Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients--a randomized study. Annals of behavioral medicine. 2010;39(2):151-61. 
  14. Carlson LE, Garland SN. Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. International journal of behavioral medicine. 2005;12(4):278-85. 
  15. Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M. The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Supportive care in cancer. 2001;9(2):112-23. 
  16. Kieviet-Stijnen A, Visser A, Garssen B, Hudig W. Mindfulness-based stress reduction training for oncology patients: patients' appraisal and changes in well-being. Patient education and counseling. 2008;72(3):436-42.
  17. Kvillemo P, Branstrom R. Experiences of a mindfulness-based stress-reduction intervention among patients with cancer. Cancer nursing. 2011;34(1):24-31. 
  18. Matousek RH, Dobkin PL. Weathering storms: a cohort study of how participation in a mindfulness-based stress reduction program benefits women after breast cancer treatment. Current oncology (Toronto, Ont). 2010;17(4):62-70. 
  19. Tacon AM, McComb J. Mindful exercise, quality of life, and survival: a mindfulness-based exercise program for women with breast cancer. Journal of alternative and complementary medicine (New York, NY). 2009;15(1):41-6.
  20. Carlson LE, Speca M, Faris P, Patel KD. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, behavior, and immunity. 2007;21(8):1038-49. 
  21. Jacobs TL, Epel ES, Lin J, Blackburn EH, Wolkowitz OM, Bridwell DA, et al. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology. 2011;36(5):664-81. 
  22. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, behavior, and immunity. 2008;22(6):969-81. 
  23. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. Journal of psychosomatic research. 2004;57(1):35-43. 
  24. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29(4):448-74. 
  25. Garland E, Gaylord S. Envisioning a Future Contemplative Science of Mindfulness: Fruitful Methods and New Content for the Next Wave of Research. Complementary health practice review. 2009;14(1):3-9. 
  26. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in mindfulness-based stress reduction in women who completed treatment for breast cancer. Complementary therapies in clinical practice. 2011;17(2):65-70..
  27. Shapiro SL, Carlson LE, Astin JA, Freedman B. Mechanisms of mindfulness. Journal of clinical psychology. 2006;62(3):373-86.
  28. Campo RA, Leniek KL, Gaylord-Scott N, Faurot KR, Smith S, Asher G, et al. Weathering the seasons of cancer survivorship: mind-body therapy use and reported reasons and outcomes by stages of cancer survivorship. Supportive care in cancer. 2016;24(9):3783-91. 
  29. Santorelli SF. Mindfulness-based Stress Reduction (MBSR): standards of practice. Shrewsbury, MA: Center for Mindfulness in Medicine, Health Care & Society Department of Medicine Division of Preventive and Behavioral Medicine 2014. Available from: https://www.umassmed.edu/contentassets/24cd221488584125835e2eddce7dbb89/mbsr_standards_of_practice_2014.pdf, accessed 17 October 2016.
  30. Center for Mindfulness. Minfulness-based professional education 2014. Available from: http://www.umassmed.edu/cfm/training/, accessed 17 October 2016. .
  31. Gotink RA, Chu P, Busschbach JJ, Benson H, Fricchione GL, Hunink MG. Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PloS one. 2015;10(4):e0124344. 
  32. Huang HP, He M, Wang HY, Zhou M. A meta-analysis of the benefits of mindfulness-based stress reduction (MBSR) on psychological function among breast cancer (BC) survivors. Breast cancer (Tokyo, Japan). 2016;23(4):568-76.
  33. Cramer H, Lauche R, Paul A, Dobos G. Mindfulness-based stress reduction for breast cancer-a systematic review and meta-analysis. Current oncology (Toronto, Ont). 2012;19(5):e343-52.
  34. Zainal NZ, Booth S, Huppert FA. The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis. Psycho-oncology. 2013;22(7):1457-65. 
  35. Piet J, Wurtzen H, Zachariae R. The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis. Journal of consulting and clinical psychology. 2012;80(6):1007-20. 
  36. Rush SE, Sharma M. Mindfulness-Based Stress Reduction as a Stress Management Intervention for Cancer Care: A Systematic Review. Journal of evidence-based complementary & alternative medicine. Epub 5 August 2016.
  37. Zhang MF, Wen YS, Liu WY, Peng LF, Wu XD, Liu QW. Effectiveness of Mindfulness-based Therapy for Reducing Anxiety and Depression in Patients With Cancer: A Meta-analysis. Medicine. 2015;94(45):e0897-0. 
  38. van der Lee ML, Garssen B. Mindfulness-based cognitive therapy reduces chronic cancer-related fatigue: a treatment study. Psycho-oncology. 2012;21(3):264-72. 
  39. Garland SN, Carlson LE, Stephens AJ, Antle MC, Samuels C, Campbell TS. Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: a randomized, partially blinded, noninferiority trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2014;32(5):449-57. 
  40. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer. Journal of clinical oncology. 2013;31(25):3119-26.
  41. Johannsen M, O'Connor M, O'Toole MS, Jensen AB, Hojris I, Zachariae R. 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. 2016;34(28):3390-9.
  42. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, et al. Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors. Supportive care in cancer. 2016;24(10):4085-96. 
  43. Lehto RH, Wyatt G, Sikorskii A, Tesnjak I, Kaufman VH. Home-based mindfulness therapy for lung cancer symptom management: a randomized feasibility trial. Psycho-oncology. 2015;24(9):1208-12. 
  44. Lengacher CA, Reich RR, Paterson CL, Ramesar S, Park JY, Alinat C, et al. Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. Journal of clinical oncology. 2016;34(24):2827-34. 
  45. Lipschitz DL, Kuhn R, Kinney AY, Grewen K, Donaldson GW, Nakamura Y. An Exploratory Study of the Effects of Mind-Body Interventions Targeting Sleep on Salivary Oxytocin Levels in Cancer Survivors. Integrative cancer therapies. 2015;14(4):366-80. 
  46. Victorson D, Hankin V, Burns J, Weiland R, Maletich C, Sufrin N, et al. Feasibility, acceptability and preliminary psychological benefits of mindfulness meditation training in a sample of men diagnosed with prostate cancer on active surveillance: results from a randomized controlled pilot trial. Psycho-oncology. Epub 5 May 2016.
  47. Zernicke KA, Campbell TS, Speca M, McCabe-Ruff K, Flowers S, Carlson LE. A randomized wait-list controlled trial of feasibility and efficacy of an online mindfulness-based cancer recovery program: the eTherapy for cancer applying mindfulness trial. Psychosomatic medicine. 2014;76(4):257-67.
  48. Zhang J, Xu R, Wang B, Wang J. Effects of mindfulness-based therapy for patients with breast cancer: A systematic review and meta-analysis. Complementary therapies in medicine. 2016;26:1-10.
  49. Castillo RJ. Depersonalization and meditation. Psychiatry. 1990;53(2):158-68.
  50. National Center for Complementary and Integrative Health. Meditation: in depth. Available from: https://nccih.nih.gov/health/meditation/overview.htm, accessed 17 October 2016.