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

Mindfulness

Abstract and key points

  • Mindfulness-based clinical interventions encompass multi-component mind-body modalities (mindfulness meditation, Yoga, psycho-education) aimed at reducing emotional distress, mood disturbances and fatigue and improving quality of life.
  • Existing evidence suggests that mindfulness-based clinical interventions may improve psychosocial adjustment, especially concerning the reduction of anxiety and depression. Effects on physical health need to be evaluated in future research.
  • While generally considered safe, the safety of mindfulness-based clinical interventions has not been rigorously assessed.

Mindfulness-based clinical interventions are mind-body modalities that may encompass multiple components: psycho-educational elements, mindfulness meditation exercises, cognitive-behavioral interventions and movement exercises. Core practices are: sitting meditation (breath awareness, focused attention), body scan (awareness of sensations in the body, 45 minute exercise), Hatha Yoga (mindful movement), walking meditation and insight meditation. The two most used mindfulness-based clinical interventions in oncology are: mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).

Evidence can be drawn from the analysis of seven systematic reviews including 39 individual randomized controlled trials, six non-randomized controlled trials and 24 uncontrolled trials, as well as a further 10 RCTs published after these systematic reviews. One overview of systematic reviews and meta-analyses of RCTs is included as well.

An overall summary of results shows that the two most widely used mindfulness-based clinical interventions – mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) – have positive short-term and probably also medium-term effects on psychological function, in particular on anxiety and depression of breast cancer patients. Similar results are reported in the general cancer population but only a small number of trials are available. All reported effects are however small and prone to potential methodological bias. Evidence for MBSR and MBCT on physical health is lacking which prevents any conclusions to be drawn. Only for fatigue, some trials suggest effects of MBSR over and above those of usual care. For sleep problems, specialized cognitive-behavioral therapy for insomnia seems to be superior to MBSR.

While MBSR and MBCT are generally considered to be safe in supportive cancer care, no rigorous assessment of the safety of mindfulness-based approaches in cancer patients is available. 

Citation

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

Document history

Summary fully revised and updated in August 2016 by Holger Cramer.
Updated in February 2016 by Ann-Christine Moenaert.
Summary first published in August 2012, authored by Ann-Christine Moenaert and Michaela Sieh.

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.