This is an in-depth assessment of the current evidence for mindfulness for cancer-related fatigue. Follow the links for other information regarding mindfulness for cancer:
The findings of reliable systematic reviews (SRs) on mindfulness-based interventions for cancer-related fatigue (CrF) published in the past five years (2021-2026) have been summarized below. CAM Cancer appraised the quality of the SRs with the AMSTAR2 tool and only included SRs of moderate or high quality, while SRs of low or critically low quality were excluded. The full description of the included SRs can be found in the evidence tables.
General characteristics of included studies
Number of studies: Four systematic reviews (McCloy 2022; Lan 2024; Johns 2021; Haussmann 2022).
Number of RCTs per SR: 13-21 RCTs
Number of participants per SR: between 1,992 and 2,326 participants
Participants: Adults with cancer; mixed cancer types, stages, during or post-treatment. Predominantly breast cancer patients.
Interventions: Mindfulness-based stress reduction (most common); Mindfulness-based cognitive therapy (MBCT), Mindfulness-based cancer recovery (MBCR). Mindfulness-based art therapy (MBAT) and compassion-based or adapted mindfulness programs. Typically 6–8 week programs with meditation, body scan, and mindfulness exercises.
Comparators: Waitlist control (WLC), usual care (UC), active controls (e.g., psychoeducation, supportive therapy, relaxation, metacognition therapy).
Outcome measures: Cancer-related fatigue (CrF); measured using multiple validated tools (no standardization), including FACT-F, FSI, MFSI-SF, FSS; QLQ-C30 fatigue subscale, POMS, MDASI, CIS-FS.
Effects of the mindfulness on cancer-related fatigue
Overall, the four SRs reported improvements in cancer-related fatigue across all SRs with moderate to large effects. However, the certainty of evidence was low in all SRs.
Large effects were reported in two SRs: SMD −0.81 (−1.17, −0.44), p < 0.001 (McCloy, 2022) and SMD −0.73 (−0.98, −0.49), p < 0.001 (Haussmann, 2022).
Moderate effects were reported in one SR: SMD 0.60 (0.36, 0.83), p < 0.001 (Johns, 2021).
Small–moderate effects in one SR: SMD −0.32 (−0.42, −0.22), p < 0.01 (Lan 2024).
Follow-up effects were sustained but reduced benefit over time was observed (e.g., Johns SMD 0.42, McCloy SMD −0.55; ; Lan 2024 SMD −0.19).
Certainty of evidence (GRADE): Low certainty in two SRs. Not assessed in the two other SRs but likely similar due to bias and heterogeneity.
Adverse events: Very limited reporting of adverse events.
Limitations of the evidence
Quality of the SRs: SRs were generally of moderate to high methodological quality, but their interpretation was limited by weaknesses in the primary studies.
Common limitations across included studies: Risk of bias assessed is overall high, mainly due to performance and detection bias. Lack of blinding is a common shortcoming as behavioural treatments are challenging to blind. Further common limitations were high heterogeneity regarding interventions (different MBI types), population and outcome measures (multiple fatigue scales); small sample sizes in many trials; limited subgroup analyses (e.g., cancer stage, treatment type); and potential publication bias.
