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: Two systematic reviews (Danon 2022; Feng 2021)
Number of RCTs per SR and participants: 10 and 40 RCTs with 843 and 3,569 participants, respectively.
Participants: Adult cancer patients (≥18 years) with various cancer types and stages, during or after treatment
Interventions: Various mindfulness-based interventions (MBIs): Mindfulness-based stress reduction (MBSR); Mindfulness-based cognitive therapy (MBCT), Acceptance and Commitment therapy (ACT), mindful yoga/yoga based mindfulness, and app-based/mHealth mindfulness.
Comparators: Waitlist control (WLC), usual care (UC), active controls.
Primary outcomes: pain intensity using multiple validated tools, including VAS, NRS, BPI PROMIS.
Effects of the mindfulness on cancer-related pain
Overall, mindfulness-based interventions in cancer populations showed small but statistically significant reductions in pain intensity in the two included SRs. The certainty of the evidence is judged as low to moderate.
In the first SR, mindfulness-based interventions showed a small statistically significant effect on pain: SMD = −0.31 (−0.61, −0.00), p < 0.05. The certainty of evidence was not formally assessed but the conclusions emphasize the low certainty in the underlying evidence base. (Danon 2022)
In the second SR, small but statistically significant reductions in pain intensity were reported at both short- and long-term follow-up. (Feng 2021) Short-term SMD=−0.19 (−0.33, −0.04), p < 0.05; long-term: SMD=−0.20 (−0.35, −0.05), p < 0.05). The GRADE assessment indicated moderate certainty of evidence for the effect of mindfulness-based interventions on pain intensity. Subgroup analyses reported no significant improvements when compared with active comparators or remote mindfulness-based interventions.
Adverse events: Were not assessed by either of the SRs.
Limitations of the evidence
Quality of the systematic reviews: Ranged from moderate to moderate-high quality, with no critical flaws identified. The shortcomings included limited integration of risk of bias into the synthesis and incomplete assessment of publication bias.
Common limitations across included studies: The RCTs included in the SRs were predominantly rated as having high or unclear risk of bias, with only few studies at low risk. Common key issues are the lack of blinding, which is challenging to achieve in behavioural interventions, and substantial heterogeneity in terms of interventions, cancer types, outcomes; inconsistent intervention formats (face-to-face vs remote); variability in outcome measurement tools and limited reporting transparency as well as small sample sizes.
