What is it?
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), 8-week standardised group programs. MBCT further includes elements from cognitive behavioural therapy.
Does it work?
In the context of cancer care, mindfulness is used as a supportive treatment to alleviate cancer-related symptoms and adverse effects of cancer treatments. CAM Cancer has summarised the data from systematic reviews published in the last five years (2021 to Jan 2026) about the efficacy of mindfulness-based interventions for the following symptoms:
Anxiety and depression
- MBSR has positive short-, medium-, and potentially long-term effects on anxiety in women with breast cancer. Positive short-, medium-, and long-term effects were also found in mixed cancer types but cannot be applied to specific types of cancer other than breast cancer. Positive effects in children and adolescents with mixed types of cancer are limited by methodological flaws of the included studies.
- MBCT might also improve anxiety in women with breast cancer.MBSR has positive short- and medium-term effects on depression in women with breast cancer. Positive short- and medium-term effects were also found in mixed cancer types but cannot be applied to specific types of cancer other than breast cancer. Positive effects in children and adolescents with mixed types of cancer are limited by methodological flaws of the included studies. MBCT might also improve depression in women with breast cancer.
- MBSR seems to reduce stress in women with breast cancer in the short-term. It seems not to be superior to other psychological interventions. Positive effects in children and adolescents with mixed types of cancer are limited by methodological flaws of the included studies. MBCT might also improve stress in women with breast cancer. Effects in other types of cancer are unclear
Fatigue
Four systematic reviews of mindfulness-based interventions for cancer-related fatigue published between 2021 and Jan 2026 were included.
- SRs reported that MBI consistently reduced cancer-related fatigue with moderate to large effect sizes.
- However, confidence in the evidence is low, due to methodological limitations and heterogeneity.
Pain
- Two SRs report small benefits overal: small but statistically significant reductions in pain intensity in cancer patients.
- Benefits are modest and sometimes not superior to active controls or remote (online) formats..
- Low–moderate confidence in results: Evidence is limited by study quality and heterogeneity.
Sleep
- Moderate improvements in subjective sleep: Mindfulness-based interventions show consistent small-to-moderate (sometimes large) improvements in self-reported sleep quality and disturbance.
- Benefits are less clear versus active controls, and objective sleep outcomes are inconsistent and limited.
- Low confidence in evidence: Overall certainty is low due to bias, heterogeneity, and reliance on subjective measures.
Is it safe?
MBSR and MBCT are generally considered safe in supportive cancer care. However, the overall safety of mindfulness- and meditation-based interventions has not been systematically assessed and is often underreported.
Description and definition
Mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) are structured, multi-component mind–body interventions that integrate psychoeducation, mindfulness meditation, cognitive–behavioural elements, and gentle movement practices. Core techniques include sitting meditation (focused attention on the breath), body scan, Hatha yoga, walking meditation, and insight meditation.
Mindfulness is commonly defined as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally” (Kabat‑Zinn 2003). These approaches are grounded in an ethical framework emphasising non-harming.
MBCT was specifically developed to prevent relapse in recurrent depression and includes more explicit psychoeducational components and shorter formal practices compared with MBSR.
Background and prevalence
Mindfulness-based interventions are derived from Buddhist contemplative traditions but were introduced into Western clinical practice by Kabat‑Zinn in 1979 for patients with chronic pain. They have since been adapted for use in secular healthcare settings. MBCT was later developed by Segal, Williams and Teasdale, combining mindfulness with cognitive behavioural therapy (Campbell 2012).
Alleged indications/claims of efficacy
MBSR and MBCT are widely used in supportive cancer care to address symptoms including emotional distress, anxiety, depression, sleep disturbances, fatigue, and reduced quality of life, (Chen 2025; Pedro 2021).
Adapted mindfulness programmes tailored for cancer populations are widely available and include mindfulness-based cancer recovery programmes (Pedro 2021; Chen 2025; Carlson 2010). These interventions are increasingly offered in integrative oncology settings, alongside growing use as self-help approaches through books and digital platforms.
Mechanisms of action
Overall, the effects of mindfulness are best understood within a biopsychosocial framework, (Grossman 2004); where psychological processes (e.g. attention, emotion regulation), neural changes (e.g. reduced amygdala reactivity, enhanced prefrontal control), endocrine responses (e.g. reduced cortisol and immune processes (e.g. reduced inflammation, enhanced immune function) interact to influence health outcomes. (Alsubaie 2017; Carlson 2004; Garland 2009; Matousek 2011).
Application and providers
The standard MBSR programme consists of eight weekly group sessions lasting 2.5–3.5 hours, plus a full-day retreat, totalling approximately 20–35 hours of contact time. Shortened versions adapted for cancer patients have also been evaluated (Carlson 2010). Evidence suggests that reduced contact hours do not necessarily diminish psychological benefits (Carmody 2009), which may improve accessibility for patients experiencing treatment-related burdens such as fatigue.
Participants are typically encouraged to engage in daily home practice (approximately 45 minutes, six days per week). Greater adherence to home practice has been associated with increased mindfulness and improved psychological outcomes (Carmody 2009). Follow-up support, such as retreats or drop-in sessions, may be offered in some settings (Carlson 2010). Online and app-based formats are increasingly available.
Legal aspects
Training of MBSR and MBCT teachers is not formally regulated. However, established institutions such as the Center for Mindfulness at the University of Massachusetts and the Oxford Mindfulness Centre have developed structured training pathways and competency frameworks (Santorelli 2014; OMC 2026).
Requirements typically include formal coursework, supervised teaching, and a sustained personal meditation practice. However, specific standards, including required training hours and prior meditation experience, vary across organisations.
Supportive and palliative care
Details of the included studies are presented in table 1 for the systematic reviews and table 2 for the RCTs.
The effect of mindfulness-based stress reduction (MBSR) has most commonly been investigated in female breast cancer patients or mixed cancer populations, which also predominantly included female breast cancer patients. Five systematic reviews evaluate MBSR/MBCT in breast cancer patients and seven in patients with various cancer diagnoses. There is substantial overlap in the systematic reviews in terms of the 142 individual RCTs, 9 non-randomized controlled trials, and 79 uncontrolled trials included (see table 1). Four systematic reviews also included RCTs on mindfulness-based cognitive therapy (MBCT).
A common critique of these meta-analyses and systematic reviews is the lack of comparisons with other group-based psychosocial interventions. This does not allow 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. In addition, the focus of most studies in the reviews is on breast cancer patients and thus limits the generalization of the results of these studies towards the global cancer patient population.
All systematic reviews mentioned methodological shortcomings of the included studies. Methodological shortcomings of the reviews themselves further limit their conclusions. These include small numbers of included trials (Castahel 2018, Huang 2016, Tomlinson 2020) inadequate search strategies (Castahel 2018), inadequate methodology for meta-analysis (ie, the use of mean differences for analyses of different outcome measures or the pooling of studies with various control groups) (Huang 2016, He 2020, Oberoi 2020) and lack of safety assessment in all but two reviews (Haller 2017, Schell 2019). One systematic review did not formally assess methodological quality or risk of bias of the included studies (Rush 2017). For a description of the included systematic reviews please see table 1.
An additional 24 RCTs were not included in the reviews: 12 RCTs including breast cancer patients, published after the Cochrane review’s search period (Mohammadi 2018, Pintado 2017, Pouy 2018, Rosen 2018, Witek-Janusek 2019, Bagherzadeh 2020, Gok Metin 2019, Mirmamoodi 2018, Park 2020, Price-Blackshear 2020, van der Gucht 2020, Zhao 2019), nine RCTs including mixed cancer populations (Kubo 2019, Lipschitz 2015, van der Lee 2012, Ahmadiqaragezlou 2020, Hunter 2020, Kubo 2020, Nissen 2019, Victorson 2020, Wirth 2019), one RCT each of lung cancer (Lehto 2015), colorectal cancer (Black 2017), and cervical cancer (Zhang 2019b), respectively. For a description of included RCTs please see table 2.
Description of included studies
Effects of MBSR on depression
For breast cancer patients, the Cochrane Review (Schell 2019) found high-quality evidence for short-term effects of MBSR compared to usual care on depression (effect size [ES]=-0.54, 95% confidence interval [CI]=-0.86 to -0.22), moderate-quality evidence for medium-term effects (ES=-0.32, 95% CI=-0.58 to -0.06) and no evidence for longer-term effects. Comparable effects were found in the meta-analyses by Haller 2017 and by Huang 20156. However, Huang et al. used inadequate methods which limit its conclusions. The meta-analyses by Castanhel 2018, Zhang 2016 and Zhang 2019 also reported effects favouring MBSR over usual care. Haller 2017 also reported effects favouring MBSR over other active interventions in reducing depression. Results from two RCTs in breast cancer patients were mixed (Rosen 2018, Zhang 20197b).
With regards to mixed cancer populations, the meta-analysis by Zhang 2015 (SMD −0.90, 95% CI −1.53, −0.26, P = 0.006)found large short-term effects but no medium-term effects favouring MBSR over usual care, the meta-analysis by Cillessen 2019 found small short-term but no longer-term effects, and the meta-analysis by Oberoi 2020 found short- and medium-term but no long-term effects.
Subsequently published RCT assessed depression and reported no effects of MBSR in breast cancer (Mirmamoodi 2018) or mixed cancer populations (Kubo 2020, Victorson 2020, Wirth 2019).
Effects of MBSR on anxiety
The Cochrane Review by (Schell 2019) found moderate-quality evidence for short- (ES=-0.29, 95% CI=-0.50 to -0.08) and medium-term effects (ES=-0.28, 95%CI=-0.49 to -0.07) of MBSR compared to usual care on anxiety in patients with breast cancer. Longer-term effects were not significant. The meta-analyses by Castanhel 2018 and Zhang 2019a also reported effects favouring MBSR over usual care. Zhang 2016 found small short-term effects of MBSR compared to usual care on anxiety, but moderate short-term effects on cancer-specific fear of recurrence. Again, the effects reported by Huang 2016 are limited by the inadequate methodology used. Haller 2017 found short-, moderate- and long-term effects of MBSR compared to usual care; and also reported effects favouring MBSR over other active interventions.
For a mixed cancer population, the systematic review by Zhang 2015 found moderate short-term effects of MBSR on anxiety when compared to usual care (SMD −0.75, 95% confidence interval −1.28, −0.22, P = 0.005), but no medium-term effects, the meta-analysis by Cillessen 2019 found small short-term and longer-term effects, and the meta-analysis by Oberoi 2020 found short- and medium-term but no long-term effects.
Subsequently published RCTs in breast cancer found reduced anxiety (Mirmahmoodi 2018), while effects in mixed cancer populations were inconclusive for both traditional live mindfulness-based programs (Pouy 2018, Ahmadiqaragezlou 2020, Victorson 2017) as well as for mindfulness apps (Kubo 2019, Kubo 2020).
Effects of MBSR on stress
Four systematic reviews including breast cancer patients assessed stress. Haller 2017, Huang 2016 and Zhang 2019a found short-term effects on stress. The meta-analysis by Zhang 2016 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 inconclusive effects of MBSR compared to usual care (Pouy 2018, Mirmahmoodi 2018). One RCT found positive effects of MBSR compared to an attention-control intervention (Witek-Janusek 2019); while two found no group differences between MBSR and a sleep hygiene intervention (Lipschitz 2015) or a breathing intervention (Wirth 2019).
Effects of MBSR on fatigue
In the Cochrane Review by Schell 2019, moderate-quality evidence for short-term effects of MBSR compared to usual care on fatigue in patients with breast cancer was found (ES=-0.50, 95%CI=-0.86 to -0.14). The meta-analyses by Haller 2017 and Zhang 2019a also reported effects favouring MBSR over usual care; while the meta-analysis by Castanhel 2018 found no effects based on only 2 RCTs. In mixed cancer population, meta-analyses found positive short- and medium-term effects of MBSR compared to various control interventions (Cillessen 2020, He 2020, Xie 2019).
Further RCTs found effects favouring MBSR over usual care in women with breast cancer (Gok Metin, 2019, van der Gucht 2020), while no effects of a mindfulness app on fatigue were found (Lehto 2015).
Effects of MBSR on quality of life
Based on RCTs on women with breast cancer, the Cochrane Review by Schell 2019 found low- -quality evidence for short-term improvements of quality of life due to MBSR compared to usual care but did not perform a meta-analysis due to concerns about missing data. Haller 2017 and Zhang 2016 also found short-term effects. Zhang 2019a found no effects on general quality of life but on emotional wellbeing, psychological and cognitive function. In mixed cancer populations, the meta-analysis by Oberoi 2020 found short- and medium but no longer-term effects on fatigue.
Subsequent RCTs found mixed effects of MBSR on quality of life of women with different types of cancer (Hunter 2020), breast cancer (Rosen 2018, Gok Metin 2019), or lung cancer (Lehto 2015). Two further RCTs found positive effects of a mindfulness app on quality of life of mixed cancer groups when compared to an untreated control group (Kubo 2019, Kubo 2020).
Effects of MBSR on mindfulness
Based on the meta-analysis by Zhang 2019a including patients with breast cancer, MBSR has short-term effects on mindfulness. The RCTs published after the systematic reviews report mixed results (Kubo 2019, Lipschitz 2015, Mohammadi 2018, Rosen2018, Witek-Janusek2019, Kubo 2020, Price-Blackshear 2020, Victorson 2020, Wirth 2019).
Effects of MBSR on sleep
For sleep, the meta-analysis by Haller 2017 found positive short-term effects of MBSR compared to usual care in breast cancer patients, while Zhang 2019a did not. In a subsequent RCT, MBSR was superior to an attention-control intervention (Zhang 2019b). In patients with cervical cancer, positive effects were found on subjective sleep measures, but not on actigraphy or polysomnography (Zhang 2019b).
Effects of MBSR on other outcomes
For general distress, the meta-analysis by Cillessen et al. (2019) found medium- and long-term effects of mindfulness-based interventions (g = 0.32; 95% CI 0.22‐0.41; P <0.001) and follow‐up (g = 0.19; 95%CI: 0.07‐0.30; P < .002). No effects of a mindfulness app beyond usual care was found in subsequent RCTs (Kubo 2020).
In one meta-analysis, no effects of MBSR on pain in women with breast cancer was found (Zhang 2019a). A subsequent RCT in mixed cancer found no effects on pain (Kubo 2019).
The meta-analysis by Zhang 2016 including breast cancer patients found no effects of MBSR beyond usual care on spirituality.
Single RCTs found positive effects on cancer-related symptoms (Lehto 2015), body image (Pintado 2017), life expectancy (Pouy 2018), cognitive function (van der Gucht 2020), and nausea (Hunter 2020) no effects were found on vomiting (Hunter 2020) sexual function (Bagherzadeh 2020), social isolation (Victorson 2020), self-compassion (Victorson 2020) or posttraumatic growth (Victorson 2020), and mixed effects on immune parameters and cortisol reactivity (Black 2017, Witek-Janusek 2019, Mirmahmoodi 2018, Wirth 2019).
Effects of MBSR in children and adolescents with cancer
In their systematic review, Tomlinson 2020 found positive effects on quality of life, distress, depression, anxiety, fear of cancer recurrence, stress, affect, analgesia use, mindfulness, and heart rate in children and adolescents with mixed types of cancer. These findings however are limited by the methodological flaws of the included studies, of which only 2 were RCTs.
Effects of MBCT
While RCTs of MBCT were included in some of the above SRs, no SRs specifically on MBCT are available. The effects of MBCT in cancer are thus reported for the available individual RCTs.
MBCT programs reduced fatigue severity in fatigued cancer survivors (van der Lee 2012), as well as depression, anxiety, quality of life, fatigue, and mindfulness in breast cancers patients (Park 2020). MBCT improved both subjective and objective sleep quality in cancer patients with insomnia, the latter assessed by actigraphy and polysomnography (Zhao 2019). Internet-based MBCT programs improved anxiety, depression, and stress but not quality of life and insomnia (Nissen 2019). MBCT effectively reduced pain and pain medication use (Johannsen 2016 included in Haller 2017) and functional impairment (van der Lee 2012) in one RCT each.
Quality of life was increased by face-to-face and web-based MBCT programs in groups of patients with mixed cancer types reporting increased pain (Johannsen 2016) or fatigue (van der Lee 2012).
Mindfulness-based interventions (MBIs) are generally considered low risk, with very few serious adverse events reported. However, the overall safety of mindfulness- and meditation-based interventions has not been systematically assessed and is often underreported (Wong 2018; Farias 2020; Britton 2021; Baer 2021; O'Brien-Venus 2024).
No systematic reviews specifically focusing on the safety of MBIs in oncology are currently available. Therefore, this summary is based on evidence from general populations rather than cancer patients.
Adverse events
One systematic review including 36 randomised controlled trials (RCTs) (25 mindfulness-based stress reduction [MBSR], 11 mindfulness-based cognitive therapy [MBCT]) found that the number of reported adverse events was very low and similar between mindfulness and control groups (<1%) (Wong 2018). No serious adverse events were reported.
Another systematic review of meditation-based interventions, including 83 studies, reported an overall prevalence of adverse events of 8.3%, comparable to rates observed in psychotherapy. Higher rates were reported in observational studies (33.2%) compared with experimental studies (3.7%) (Farias 2020).
Common adverse events
Reported adverse events are generally mild and include:
- Psychological/emotional: anxiety, depression, increased stress
- Cognitive: thought disorganisation, confusion, unusual thinking patterns
- Perceptual: mild visual or auditory disturbances (non-severe, hallucination-like experiences)
Serious or rare adverse events
Rare cases reported in the literature (primarily from individual case reports and not specific to mindfulness interventions) suggest that meditation practices may trigger or worsen symptoms in individuals with certain psychiatric conditions. These include psychotic episodes, severe mood disturbances, suicidal ideation, dissociation, mania.
However, these events are uncommon and the evidence base remains limited (Farias 2020).
Contraindications
No absolute contraindications are known. However, individuals with existing mental or physical health conditions should consult their healthcare provider before starting a mindfulness or meditation practice and inform their instructor of any relevant conditions (Cramer 2016).
A systematic review of 39 RCTs in individuals with psychosis found no evidence that mindfulness interventions are harmful in this population, despite earlier concerns (O'Brien-Venus 2024).
Interactions
No direct pharmacological interactions have been identified. However, clinical trials rarely assess interactions with medications (Park 2020).
There are also some concerns that mindfulness practices may exacerbate symptoms when combined with psychological treatments if not appropriately guided (Britton 2021).
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Citation
CAM Cancer Consortium. Mindfulness [online document], June 2026.
Document history
Summary updated in June 2026 by the CAM Cancer Collaboration. Summary updated in March 2021, October 2019 and 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.
Next update due: June 2029
Photos: Mostphotos.com
