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 sleep disturbances/insomnia 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 (SRs), one with network meta-analysis (Han 2023a) and without (Han 2023b).
Number of RCTs and participants per SR: SR and network meta-analysis (NMA) of 47 RCTs, included 4,325 participants. SR and meta-analysis of 68 RCTs, including 24 mindfulness RCTs. Included 6,339 participants (5,051 included in meta-analysis).
Participants: Adults (≥18 years) with cancer, including early-stage cancer patients during or after treatment (Han 2023a); patients with any cancer type and any stage (Han 2023b).
Interventions: Mindfulness-based interventions: Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cancer Recovery (MBCR), Mindfulness-Based Cognitive Therapy (MBCT), and other mindfulness approaches.
Other mind-body therapies evaluated alongside mindfulness included yoga, qigong/tai chi, relaxation techniques, hypnosis, guided imagery, and mixed mind-body interventions (NMA).
Comparators: Usual care (UC), wait-list control (WLC), treatment as usual.
Active control interventions, including education, support programmes, exercise, CBT and other non-mindfulness interventions.
Outcomes: Subjective sleep disturbance: sleep quality, insomnia severity, sleep problems measured by PSQI, ISI, PROMIS, EORTC QLQ-C30 and other validated scales.
Objective sleep outcomes, including sleep efficiency, sleep onset latency, total sleep time, wake after sleep onset; measures obtained through actigraphy, polysomnography, sleep diaries and armband devices.
Effects of the intervention
Subjective sleep disturbance
Both reviews found that mindfulness interventions improved subjective sleep outcomes compared with usual care or wait-list controls. Benefits were observed both during active cancer treatment and after completion of treatment. Effects were generally maintained over time, with evidence of sustained benefit up to at least six months.
Moderate–large to large effects were reported for immediate, midterm, and long-term effects of sleep disturbance in one SR: SMD = -0.74 (95% CI -1.10 to -0.37); -0.75 (95% CI -1.13 to -0.38); -0.94 (95% CI -1.54 to -0.34), p = 0.001(Han 2023b). Certainty of evidence was not formally assessed but likely affected by methodological limitations.
When compared with active control interventions, no significant effects of mindfulness interventions on subjective sleep disturbance were reported.
Mindfulness was among the most effective mind-body interventions included in the network meta-analysis, although cognitive behavioural therapy (CBT) generally demonstrated larger effects when compared indirectly with other interventions. Large effects reported in the SR with network comparison up to ~0.85 (Han 2023a) (95% CI 0.20 to 1.50); SUCRA 88.9%; GRADE: Moderate certainty.
Objective sleep outcomes
Findings for objective sleep parameters were less consistent than for subjective sleep outcomes. Some improvements were reported in one SR for sleep onset latency and total sleep time.
Mindfulness interventions did not demonstrate clear superiority for sleep efficiency or wake after sleep onset. Han 2023b reported no significant effects and Han 2023a reported relatively low rankings for mindfulness on objective sleep efficiency outcomes: SUCRA: 42.2%, considerably lower than qigong (93.8%) and CBT (83.3%).
Limitations of the evidence
Quality of systematic reviews: Moderate to high methodological quality with appropriate NMA methods, risk-of-bias assessment, inconsistency evaluation, and GRADE assessment (Han 2023a). Low-to-moderate quality according to AMSTAR-2 (Han 2023b). The review did not adequately integrate risk-of-bias findings into interpretation and did not conduct GRADE assessments.
Common limitations across included studies: Many studies had high risk of bias or some concerns, especially regarding blinding, missing outcome data, selective reporting, deviations from intended interventions. High heterogeneity across studies in cancer diagnoses and treatment stages, intervention content, duration and delivery, outcome measures used.
Heavy reliance on self-reported sleep measures in largely unblinded trials increases the potential for measurement bias. Few studies reported objective sleep outcomes, limiting confidence in conclusions regarding physiological sleep improvements.
Many trials were small pilot studies with limited statistical power.
Neither review systematically assessed adverse events.
