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Mollaog Lu MC, Mollaog Lu S, Akin EB, Mollaog Lu M, Yanmiş S. The Effect of Art Therapy on Pain, Emesis, Anxiety, and Quality of Life in Operated Breast Cancer Patients: Randomized Control Trials. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:371-382. [PMID: 37824754 DOI: 10.1089/jicm.2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Background: Breast cancer symptoms related to the disease nature and treatments develop and the quality of life of patients is impacted. Art therapy improves the quality of life by increasing symptom control and treatment compliance. This study aimed to determine the effect of art therapy on pain, emesis, anxiety, and quality of life in operated breast cancer patients. Methods: This experimental research was carried out with a total of 60 patients, 30 in the intervention group (IG) and 30 in the control group (CG), who received treatment in the Oncology Center of Sivas Cumhuriyet University Practice and Research Hospital. A Personal Information Form, the Pain Intensity-Visual Analog Scale, the Rhodes Index of Nausea, Vomiting, and Retching, the Beck Anxiety Inventory, and the Functional Assessment of Cancer Therapy Scale-General (FACT-G) were used to collect research data. Within the scope of the research, IG received chemotherapy sessions for 10 weeks (five sessions) with 2-week intervals by an art specialist in marbling, accompanied by ney music. CG received no intervention. The obtained data were uploaded to the SPSS (22.0) program and statistical analysis was performed. Results: The decrease in the pain, nausea-vomiting, and anxiety levels of the patients in IG and the increase in their quality of life after the art therapy accompanied by ney music were statistically significant compared with the first follow-up (p < 0.05). There was no statistically significant change in the quality of life of the patients in the CG, whereas their pain, nausea-vomiting, and anxiety scores increased. According to the comparison between IG and CG, there was a significant difference in favor of IG in terms of pain severity, quality of life, emesis, and anxiety levels (p < 0.05). Conclusions: The art of marbling with ney was effective in operated breast cancer patients experiencing pain, emesis, and anxiety and improved their quality of life. Clinical Trial Registration: NCT05666583.
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Affiliation(s)
| | - Songül Mollaog Lu
- Department of Fine Arts, Faculty of Education, Sivas Cumhuriyet University, Sivas, Turkey
| | - Esra Başer Akin
- Department of Nursing, Faculty of Health Science, Sivas Cumhuriyet University, Sivas, Turkey
| | - Mukadder Mollaog Lu
- Department of Nursing, Faculty of Health Science, Sivas Cumhuriyet University, Sivas, Turkey
| | - Safiye Yanmiş
- Department of Internal Diseases Nursing, Faculty of Health Sciences, Erzincan Binali Yıldırım University, Erzincan, Turkey
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Moreira MDF, Gamboa OL, Oliveira MAP. Mindfulness intervention effect on endometriosis-related pain dimensions and its mediator role on stress and vitality: a path analysis approach. Arch Womens Ment Health 2024; 27:45-55. [PMID: 37848766 DOI: 10.1007/s00737-023-01381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
Endometriosis-related pain is supposedly mainly responsible for generating psychological stress and deteriorating the quality of life. However, the interaction between these factors has not been investigated, considering its multidimensional nature and through the path of effects of psychosocial approaches. The present study aims to investigate the effect of a brief mindfulness-based intervention (bMBI) on pain dimensions and its mediator role on psychological stress and QoL-Vitality improvement. A secondary analysis of a pilot randomized controlled trial using a series of parallel and serial mediators was carried out. The results showed that bMBI improves the sensory (B = -6.09 [-9.81, -2.52], β = -0.42) and affective (B = -3.40 [-5.02, -1.80], β = -0.47) pain. The bMBI effect on psychological stress reduction was mediated by these changes in sensory (B = -2.81 [-6.06, -0.41], β = -0.21) and affective (B = -1.97 [-5.07, -0.17], β = -0.15) pain. Serial sensory pain and psychological stress reduction (B = 2.27 [0.11, 5.81], β = -0.09) mediated the bMBI effect on quality of life vitality. Meditation training promotes additional improvement in affective and sensory pain characteristics through which psychological stress is reduced. The sensory pain dimension must be positively impacted in combination with psychological stress for the bMBI improves women's vitality. Adding a psychosocial intervention like meditation training to the standard treatment plan may be required for some women to achieve the needed changes to restore well-being.
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Affiliation(s)
- Marcelo de França Moreira
- Faculty of Medical Sciences, State University of Rio de Janeiro, Avenida Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil.
| | - Olga Lucia Gamboa
- EQness, Sydney, Australia
- School of Psychology, A19 - Griffith Taylor Building, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Marco Aurelio Pinho Oliveira
- Department of Gynecology, State University of Rio de Janeiro, Avenida Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
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Torricelli L, Rabitti E, Cafaro V, Cavuto S, De Vincenzo F, Cavuoto M, Turola E, Di Leo S. Mindfulness-based therapies for cancer patients and families: a systematic review. BMJ Support Palliat Care 2024; 13:e494-e502. [PMID: 35304361 DOI: 10.1136/bmjspcare-2021-003392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mindfulness-based therapies (MBTs) addressed to patients with cancer have been widely studied in the last two decades, and their efficacy has been systematically reviewed and meta-analysed. Although findings from literature highlight benefits of MBTs on several patients' health outcomes, these should be appraised taking into consideration the characteristics of the selected studies. In this systematic review, we summarised the current evidence of the efficacy of MBTs in improving the quality of life of both patients with cancer and their relatives, with a focus on the methodological quality, type of MBT evaluated and population involved in existing randomised controlled trials (RCTs). METHODS We searched English language articles published until February 2021. Couples of authors independently applied inclusion criteria and extracted findings. Thirty RCTs were included. RESULTS Nearly half of the studies were performed in English-speaking countries outside of Europe, with females diagnosed with breast cancer. Most considered heterogeneous phases of illness; one study only was performed on relatives. In most cases, different measures were employed to evaluate the same outcome. The efficacy of MBTs has been demonstrated in 25 of the 30 included articles. The methodological quality of RCTs was acceptable. CONCLUSION The heterogeneity of studies' characteristics makes findings on the efficacy of MBTs poorly informative with reference to different clinical and cancer-related psychological conditions. Studies on more homogeneous samples by cancer site and phase, as well as performed in different cultural contexts, could provide a basis for better evaluating and targeting MBTs' protocols for the specific needs of patients with cancer and their relatives.
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Affiliation(s)
- Laura Torricelli
- Psycho-oncology Unit, Azienda USL-IRCCS of Reggio Emilia, via Amendola, Reggio Emilia, Italy
| | - Elisa Rabitti
- Psycho-oncology Unit, Azienda USL-IRCCS of Reggio Emilia, via Amendola, Reggio Emilia, Italy
| | - Valentina Cafaro
- Psycho-oncology Unit, Azienda USL-IRCCS of Reggio Emilia, via Amendola, Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Azienda USL-IRCCS of Reggio Emilia, via Amendola, Reggio Emilia, Italy
| | - Francesco De Vincenzo
- Department of Human Sciences, European University of Rome, via degli Aldobrandeschi, Rome, Lazio, Italy
| | - Maristella Cavuoto
- Psycho-oncology Unit, Azienda USL-IRCCS of Reggio Emilia, via Amendola, Reggio Emilia, Italy
| | - Elena Turola
- Clinical Trials and Statistics Unit, Azienda USL-IRCCS of Reggio Emilia, via Amendola, Reggio Emilia, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL-IRCCS of Reggio Emilia, via Amendola, Reggio Emilia, Italy
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Abstract
Breast cancer is the most commonly diagnosed cancer in women. Associated psychological symptoms include stress, adjustment difficulties, anxiety, depression, impaired cognitive function, sleep disturbances, altered body image, sexual dysfunction, and diminished overall well-being. Distress screening and assessment identifies women who will benefit from therapeutic interventions. Addressing these symptoms improves compliance with treatment and outcomes including disease-related outcomes, psychological symptoms, and quality of life. The most effective treatments include teaching coping skills such as expressing emotion, along with other structured cognitive behavioral, interpersonal, and mindfulness approaches. Patients should be provided these psychosocial supports throughout their cancer journey.
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Affiliation(s)
- Jennifer Kim Penberthy
- Department of Psychiatry & Neurobehavioral Sciences, UVA Cancer Center, University of Virginia School of Medicine & Health System, PO Box 800623, Charlottesville, VA 22908, USA.
| | - Anne Louise Stewart
- Department of Psychiatry & Neurobehavioral Sciences, UVA Cancer Center, University of Virginia School of Medicine & Health System, PO Box 800623, Charlottesville, VA 22908, USA
| | - Caroline F Centeno
- Department of Psychiatry & Neurobehavioral Sciences, UVA Cancer Center, University of Virginia School of Medicine & Health System, PO Box 800623, Charlottesville, VA 22908, USA
| | - David R Penberthy
- Department of Radiation Oncology, Penn State Cancer Institute, Penn State Health Milton S. Hershey College of Medicine, Hershey, PA, USA
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Chang YC, Tseng TA, Lin GM, Hu WY, Wang CK, Chang YM. Immediate impact of Mindfulness-Based Cognitive Therapy (MBCT) among women with breast cancer: a systematic review and meta-analysis. BMC Womens Health 2023; 23:331. [PMID: 37349700 PMCID: PMC10288664 DOI: 10.1186/s12905-023-02486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) may have positive physiological and psychological benefits for breast cancer survivors. However, few studies involved a combination of the relevant literatures to confirm the effects. METHODS Our study included randomized controlled trials (RCTs) and non-RCTs comparing interventions of MBCT and control protocols for alleviation of symptoms among breast cancer survivors. We calculated pooled mean differences (MDs), standardized mean differences (SMDs), and 95% confidence intervals (CIs) by using random effects models to estimate summary effect sizes. RESULTS Thirteen trials with 20-245 participants were considered in our studies; for the meta-analysis, 11 of these studies were eligible for assessment. The pooled meta-analysis results revealed that at the end of the MBCT intervention, participants' anxiety (SMD, - 0.70; 95% CI, - 1.26 to - 0.13; I2 = 69%), pain (SMD, - 0.64; 95% CI, - 0.92 to - 0.37; I2 = 0%), and depression (SMD, - 0.65; 95% CI, - 1.14 to - 0.17; I2 = 75%) levels significantly decreased, and their mindfulness (MD, 8.83; 95% CI, 3.88 to 13.78; I2 = 68%) levels significantly increased. CONCLUSION The MBCT may be associated with improved pain, anxiety, depression, and mindfulness. However, the quantitative analysis pointed to an inconclusive result due to moderate to high levels of heterogeneity among indicator of anxiety, depression, and mindfulness. Future work requires more studies to better elucidate the clinical significance of this possible association. The results suggest that MBCT is highly beneficial as an intervention for patients who have received treatment for breast cancer.
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Affiliation(s)
- Yun-Chen Chang
- School of Nursing and Graduate Institute of Nursing, China Medical University, 406, Taichung, Taiwan
- Nursing Department, China Medical University Hospital, Taichung, Taiwan
| | - Tzuhui Angie Tseng
- Department of Environmental and Cultural Resources, National Tsing Hua University, Hsinchu, Taiwan
| | - Gen-Min Lin
- Departments of Medicine, Hualien-Armed Forces General Hospital, Hualien City, Taiwan
- Tri-Service General Hospital, National Defense Medical Center, Taipei City, 100, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine, National Taiwan University, 100, Taipei City, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei City, 100, Taiwan
| | - Chih-Kai Wang
- Cancer Center, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yuh-Ming Chang
- Department of Neurology, Hsinchu Mackay Memorial Hospital, No. 690, Sec. 2, Guangfu Rd., East Dist., Hsinchu City, 30071, Taiwan.
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Buskbjerg C, O'Toole MS, Zachariae R, Jensen AB, Frederiksen Y, Johansen C, von Heymann A, Speckens A, Johannsen M. Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark. BMJ Open 2023; 13:e066505. [PMID: 36948567 PMCID: PMC10040060 DOI: 10.1136/bmjopen-2022-066505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION One in five breast cancer (BC) survivors are affected by persistent pain years after completing primary treatment. While the efficacy of psychological interventions for BC-related pain has been documented in several meta-analyses, reported effect sizes are generally modest, pointing to a need for optimisation. Guided by the Multiphase Optimization Strategy, the present study aims to optimise psychological treatment for BC-related pain by identifying active treatment components in a full factorial design. METHODS AND ANALYSIS The study uses a 2×3 factorial design, randomising 192 women with BC-related pain (18-75 years) to eight experimental conditions. The eight conditions consist of three contemporary cognitive-behavioural therapy components, namely: (1) mindful attention, (2) decentring, and (3) values and committed action. Each component is delivered in two sessions, and each participant will receive either zero, two, four or six sessions. Participants receiving two or three treatment components will be randomised to receive them in varying order. Assessments will be conducted at baseline (T1), session by session, every day for 6 days following the first session in each treatment component, at post-intervention (T2) and at 12-week follow-up (T3). Primary outcomes are pain intensity (Numerical Rating Scale) and pain interference (Brief Pain Inventory interference subscale) from T1 to T2. Secondary outcomes are pain burden, pain quality, pain frequency, pain catastrophising, psychological distress, well-being and fear of cancer recurrence. Possible mediators include mindful attention, decentring, and pain acceptance and activity engagement. Possible moderators are treatment expectancy, treatment adherence, satisfaction with treatment and therapeutic alliance. ETHICS AND DISSEMINATION Ethical approval for the present study was received from the Central Denmark Region Committee on Health Research Ethics (no: 1-10-72-309-40). Findings will be made available to the study funders, care providers, patient organisations and other researchers at international conferences, and published in international, peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05444101).
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Affiliation(s)
- Cecilie Buskbjerg
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Yoon Frederiksen
- Deparment of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- The Sexology Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika von Heymann
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Speckens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maja Johannsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Cox-Martin E, Phimphasone-Brady P, Hoffecker L, Glasgow RE. Psychosocial Interventions for Pain Management in Breast Cancer Survivors: A RE-AIM Evaluation. J Clin Psychol Med Settings 2023; 30:182-196. [PMID: 35562602 DOI: 10.1007/s10880-022-09874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 12/24/2022]
Abstract
Psychosocial interventions for breast-cancer-related pain are effective, yet over 45% of survivors continue to struggle with this often-chronic side effect. This study evaluated multilevel indicators that can influence successful translation of interventions into clinical practice. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was applied to evaluate reporting of individual and setting/staff-level intervention indicators. A systematic search and multi-step screening process identified 31 randomized controlled trials for psychosocial interventions for breast cancer-related pain. Average reporting of indicators for individual-level dimensions (Reach and Effectiveness) were 65.2% and 62.3%, respectively. Comparatively, indicators for setting/staff-level dimensions were reported at a lower average frequency (Implementation, 46.8%; Adoption, 15.2%; Maintenance, 7.7%). Low reporting of setting/staff-level dimensions suggests gaps in the sustained implementation of psychosocial interventions. Implementation science methods and frameworks could improve trial design and accelerate the translation of psychosocial interventions for breast cancer-related pain into clinical practice.
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Affiliation(s)
- Emily Cox-Martin
- VA Puget Sound Health Care System, 9600 Veterans Dr SW, Tacoma, WA, 98493, USA.
| | | | - Lilian Hoffecker
- Strauss Health Sciences Library, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Russell E Glasgow
- Department of Family Medicine, and ACCORDS Center, University of Colorado School of Medicine, Aurora, CO, USA
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Rosendahl J, Gawlytta R, Ressel E, Rodeck J, Strauss B, Mehnert-Theuerkauf A, Koranyi S. Efficacy of group therapy to reduce mental distress in women with non-metastatic breast cancer: A systematic review and meta-analysis of randomized controlled trials. Psychooncology 2023; 32:331-341. [PMID: 36588187 DOI: 10.1002/pon.6082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Group treatments have proven to be effective for many mental disorders and showed beneficial effects in patients with medical illness. Aim of this systematic review and meta-analysis is to summarize the efficacy of group therapy for women with non-metastatic breast cancer. METHODS We included studies comparing group therapy for women with non-metastatic breast cancer to non-active control groups, active control conditions, and individual psychotherapy. The primary outcome was mental distress, secondary outcomes were quality of life, coping, existential outcomes, fatigue, pain, and side effects. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, PsycINFO, and DARE complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups. RESULTS Thirty-seven studies (5902 patients) were included. Small effects on mental distress in favor of group treatment were found (non-active control groups: n = 19, g = 0.42, 95% CI [0.29; 0.56], I2 = 61.6%; active control conditions: n = 6, g = 0.20, 95% CI [0.06; 0.35], I2 = 0%). Cognitive-behavioral therapy (CBT) and third wave CBT group approaches proved to be most effective. Group treatments also showed beneficial effects on secondary outcomes, with most profound evidence on quality of life and coping. CONCLUSIONS Results suggest that group interventions have the potential to reduce mental distress in women facing breast cancer. In the light of the considerable heterogeneity of most study effects, there is a need for more rigorous studies to strengthen the promising evidence and for trials examining the impact of patient and intervention characteristics on outcomes. REGISTRATION PROSPERO international prospective register of systematic reviews, CRD42020184357.
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Affiliation(s)
- Jenny Rosendahl
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Romina Gawlytta
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Eva Ressel
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Johanna Rodeck
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Susan Koranyi
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2023; 1:CD008729. [PMID: 36628983 PMCID: PMC9832339 DOI: 10.1002/14651858.cd008729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | - Sally Doherty
- Psychiatry, Royal College of Surgeons in Ireland- Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
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Li C, Hou W, Ding D, Yang Y, Gu S, Zhu Y. Evidence Mapping Based on Systematic Reviews of Cognitive Behavioral Therapy for Neuropathic Pain. Neural Plast 2023; 2023:2680620. [PMID: 36994240 PMCID: PMC10041341 DOI: 10.1155/2023/2680620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/03/2023] [Accepted: 02/18/2023] [Indexed: 03/31/2023] Open
Abstract
Objective This evidence mapping is aimed at identifying, summarizing, and analyzing the available evidence on cognitive behavioral therapy (CBT) for neuropathic pain (NP). Methods This study was conducted following the methodology of Global Evidence Mapping (GEM). Searches were conducted in PubMed, Embase, the Cochrane Library, and PsycINFO to identify systematic reviews (SRs) with or without meta-analysis published before February 15, 2022. The authors independently assessed eligibility, extracted data, and evaluated the methodological quality of the included SRs using AMSTAR-2. The results were presented in the tables and a bubble plot based on the identified population-intervention-comparison-outcome (PICO) questions. Results A total of 34 SRs met the eligibility criteria. According to the AMSTAR-2, 2 SRs were rated "high," 2 SRs were rated "moderate," 6 SRs were rated "low," and 24 SRs were rated "critically low." The most common study design utilized to evaluate the efficacy of CBT for NP was the randomized controlled trial. In total, 24 PICOs were identified. Migraine was the most studied population. CBT for NP usually reaches the "potentially better" result at follow-up. Conclusions Evidence mapping is a useful way to present existing evidence. Currently, the existing evidence on CBT for NP is limited. Overall, the methodological quality of the included SRs was low. Further improvements in the methodological quality of SRs and more research on the most efficient CBT formats for NP are recommended in the future.
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Affiliation(s)
- Conghui Li
- 1The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- 2Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Weiqian Hou
- 1The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- 2Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Dongfang Ding
- 1The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- 2Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Yujie Yang
- 3University of Health and Rehabilitation Sciences, Qingdao, Shandong 266000, China
| | - Shanshan Gu
- 4Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Yi Zhu
- 1The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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Ladenbauer S, Singer J. Can Mindfulness-Based Stress Reduction Influence the Quality of Life, Anxiety, and Depression of Women Diagnosed with Breast Cancer? -A Review. Curr Oncol 2022; 29:7779-7793. [PMID: 36290892 PMCID: PMC9600006 DOI: 10.3390/curroncol29100615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Breast cancer is the most common form of cancerous disease worldwide. Its treatment leads to a variety of physiological and psychological side effects. This review investigates the question of how mindfulness-based stress reduction (MBSR), a stress management program, can influence the quality of life, anxiety, and depression of women diagnosed with breast cancer. METHODS A systematic literature search was conducted in PubMed/MEDLINE and Cochrane Library. Screening by title, abstract and full text was performed, whereby only those articles were included that fit the inclusion criteria. A risk of bias assessment was performed for each included study. RESULTS Overall, six studies were included, but not every study investigated all three outcomes. Two studies found positive impacts on quality of life, whereas three did not find a positive correlation between the intervention and quality of life. Four out of six studies found a positive relation between MBSR and anxiety scores, but only half of the included studies found positive results for the interaction between MBSR and depression scores. CONCLUSION Published data suggest that anxiety can be positively influenced by MBSR, which can be used to improve the psychological care of breast cancer patients, both during and after treatment. However, further studies with larger patient numbers and longer observation periods should be conducted in order to elucidate the full potential of MSBR on important areas such as depression and quality of life.
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Affiliation(s)
| | - Josef Singer
- Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Department of Internal Medicine 2, University Hospital Krems, 3500 Krems, Austria
- Correspondence:
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13
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Nicklas L, Albiston M, Dunbar M, Gillies A, Hislop J, Moffat H, Thomson J. A systematic review of economic analyses of psychological interventions and therapies in health-related settings. BMC Health Serv Res 2022; 22:1131. [PMID: 36071425 PMCID: PMC9450839 DOI: 10.1186/s12913-022-08158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background This review aims to synthesise evidence on the economic impact of psychological interventions and therapies when applied to a broad range of physical health conditions. Methods The following bibliographic databases were searched for relevant articles: MEDLINE (Ovid), EMBASE (Ovid) and PsycINFO (Ebsco). As this review was intended to update an earlier review, the date range for the search was restricted to between January 2012 and September 2018. Reference lists from the review articles were also searched for relevant articles. Study quality was evaluated using the Scottish Intercollegiate Network Guidelines (SIGN) appraisal checklists for both economic studies and Randomised Controlled Trials (RCTs). When the economic analyses did not provide sufficient detail for quality evaluation, the original RCT papers were sought and these were also evaluated. Half of the papers were quality rated by a second author. Initial agreement was high and all disagreements were resolved by discussion. Results This yielded 1408 unique articles, reduced to 134 following screening of the title and abstract. The full texts of the remaining articles were reviewed by at least one team member and all exclusions were discussed and agreed by the team. This left 46 original research articles, alongside five systematic reviews. Fifty-seven per cent of the articles were deemed to be of high quality, with the remainder of acceptable quality. Fifteen different medical conditions were covered, with chronic pain (10 articles) and cancer (9 articles) being the two most investigated health conditions. Three quarters of the papers reviewed showed evidence for the cost-effectiveness of psychological interventions in physical health, with the clearest evidence being in the field of chronic pain and cancer. Conclusions This paper provides a comprehensive integration of the research on the cost-effectiveness of psychological therapies in physical health. Whilst the evidence for cost-effectiveness in chronic pain and cancer is encouraging, some health conditions require further study. Clearly, as the primary research is international, and was therefore conducted across varying health care systems, caution must be exercised when applying the results to counties outside of those covered. Despite this, the results are of potential relevance to service providers and funders. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08158-0.
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Affiliation(s)
- Leeanne Nicklas
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK.
| | - Mairi Albiston
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | - Martin Dunbar
- Stobhill Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Alan Gillies
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | | | - Helen Moffat
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Judy Thomson
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
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Zhang A, Wang K, Blumenstein K, Brose A, Kemp C, Meister D, Solomon P. For whom and what outcomes does cognitive-behavioral-therapy work among cancer survivors: a systematic review and meta-analysis. Support Care Cancer 2022; 30:8625-8636. [PMID: 36040671 DOI: 10.1007/s00520-022-07337-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of CBT for individuals diagnosed with cancer across a broad range of outcome domains, i.e., functional health, psychological health, health behaviors, social relational, and general wellness. METHODS A comprehensive search of 7 databases, 91 published reviews, and 4 professional websites was performed on August 30th, 2021. English-language clinical trials of CBT for cancer patients/survivors were included. Studies were independently screened, and data were extracted by 2 reviewers, and discrepancies were resolved by consensus among the investigative team. A total of 151 clinical trials (154 articles) published between 1986 and 2021 were included in the analysis. RESULTS CBT was overall effective for cancer patients/survivors in the domains of functional health, g = 0.931, p < 0.001, psychological health, g = 0.379, p < 0.001, and general wellness, g = 0.257, p < 0.001, but ineffective in domains of health behaviors, g = 0.792, p > 0.05, and social relational outcomes, g = 0.319, p > 0.05. Additional subgroup and moderator analyses further revealed CBT's differential treatment effect for different within domain outcomes, across different cancer disease stages, and CBT delivery format. CONCLUSIONS Findings of the study showed that CBT is an effective treatment for individuals diagnosed with cancer. However, treatment effects differ by important disease- and intervention-related factors, which should be considered when recommending CBT for cancer patients/survivors.
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Affiliation(s)
- Anao Zhang
- University of Michigan School of Social Work, 1080 South University Avenue, MI, 48109, Ann Arbor, USA.
- Michigan Medicine Adolescent and Young Adult Oncology Program, Ann Arbor, MI, USA.
| | - Kaipeng Wang
- University of Denver Graduate School of Social Work, CO, Denver, USA
| | - Kate Blumenstein
- Rosalind Franklin University Chicago Medical School, Chicago, IL, USA
| | - Anna Brose
- Wheaton College in Illinois, Chicago, IL, USA
| | - Chris Kemp
- University of Michigan School of Social Work, 1080 South University Avenue, MI, 48109, Ann Arbor, USA
| | - Dalton Meister
- University of Michigan School of Social Work, 1080 South University Avenue, MI, 48109, Ann Arbor, USA
| | - Phyllis Solomon
- University of Pennsylvania School of Social Policy & Practice, PA, Philadelphia, USA
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Pre- and post-operative psychological interventions to prevent pain and fatigue after breast cancer surgery (PREVENT): Protocol for a randomized controlled trial. PLoS One 2022; 17:e0268606. [PMID: 35802618 PMCID: PMC9269362 DOI: 10.1371/journal.pone.0268606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Breast cancer is the most common cancer type among women worldwide with over a million new cases each year. More than 40% of these women will struggle with chronic pain and fatigue after surgery, regardless of surgical procedure. These consequences are detrimental and result in distress and disability, including work disability. Few attempts have been made to prevent chronic pain and fatigue after surgery by applying a psychological approach, despite psychological risk factors being crucial in the development of both chronic pain and fatigue. In this study, we aim to develop and test an easily implementable strategy of preventing chronic pain and fatigue after breast cancer surgery. The intervention strategy involves a pre-operative hypnosis session and a web-based post-operative Acceptance and Commitment Therapy (ACT). The hypnosis has previously been found effective in alleviating acute post-operative pain and fatigue in breast cancer patients, while ACT is well suited to cancer populations as it offers a model of healthy adaptation to difficult circumstances. Together they form an intervention strategy with both a preventive and a rehabilitative focus.
Methods/Design
This randomized controlled trial aims to estimate the effects of the pre- and post- operative interventions compared to attentional control and treatment as usual (TAU) and will also include a qualitative process evaluation. Participants will be randomized to receive either a pre-operative brief hypnosis session and a post-operative web-based psychological intervention (iACT) or a pre-operative one-session mindfulness through an audio file and post-operative TAU. Self-reported questionnaire data and biomarker data will be assessed pre-surgery, post-surgery and 3 and 12 months after surgery. In addition, we will assess registry data on sick leave and prescriptions until 2-year follow-up. In the qualitative process evaluation, data will be collected from participants from both study arms (through interviews and a diary) and two different analyses performed (socio-narrative and Grounded Theory) with the objective to describe the development of chronic post-surgical pain and fatigue and the potential influence of the interventions on these processes. The study is set-up to demonstrate a minimum difference in pain of 1 point on NRS (0–10) and 3 points on FACIT-F (0–52) between the groups at 3-months follow-up by including 200 breast cancer patients in total.
Discussion
This trial will be the first study to estimate the effect of a combined pre-operative hypnosis with a post-operative iACT to prevent pain and fatigue after breast cancer surgery. The results from our study might i) help the large group of women affected by chronic pain and fatigue after breast cancer surgery, ii) shed light on the mechanisms involved in chronic pain and fatigue development, and iii) serve as a model for other surgical procedures.
Trial registration
Clinicaltrials.gov, registration number NCT04518085. Registered on January 29th, 2020. https://clinicaltrials.gov/ct2/show/NCT04518085.
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Ruano A, García-Torres F, Gálvez-Lara M, Moriana JA. Psychological and Non-Pharmacologic Treatments for Pain in Cancer Patients: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2022; 63:e505-e520. [PMID: 34952171 DOI: 10.1016/j.jpainsymman.2021.12.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Pain is the most fearful symptom in cancer. Although there is a relationship between psychosocial variables and oncologic pain, psychological and non-pharmacological treatments for pain management in cancer patients are not very widespread. OBJECTIVES To analyze the efficacy of psychological and non-pharmacological treatments for reducing pain in cancer patients. METHODS We performed a systematic review following the PRISMA protocol. In January 2021, data were extracted from PubMed, Web of Science and Scopus, including randomised controlled trials (RCT) published in the last five years (from 28 January, 2015 to December 15, 2020), in the English language and whose sample was patients with cancer pain. The database search used the following keywords: cancer, cancer-related pain, psychological intervention, non-pharmacologic intervention. The Cochrane risk of bias assess ment for randomised trials (RoB 2) was used for quality appraisal. RESULTS After the inclusion and exclusion criteria were applied, ten papers were fully screened. The evidence suggested that the most effective interventions to reduce cancer pain were mindfulness-based cognitive therapy, guided imagery and progressive muscle relaxation and emotional and symptom focused engagement (EASE). Music therapy and brief cognitive behavioral strategies (CBS) require more research, while coping skills training and yoga did not show positive effects. Overall, we obtained a moderate size effect (d = 0.642, 95% CI: 0.125-1.158) favourable to psychological and non-pharmacologic treatments at post-treatment, which increased at follow-up (k = 5, d = 0.826, 95% CI: 0.141-1.511). CONCLUSION This study provides insight into psychological interventions which might be applied and contribute to cancer-related pain reduction in adults. Although the results are not completely consistent, they may shed light on psychology applications in the oncology environment.
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Affiliation(s)
- Alejandra Ruano
- Department of Psychology, University of Cordoba (A.R., F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, University of Cordoba (A.R., F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC) (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Reina Sofia University Hospital (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain.
| | - Mario Gálvez-Lara
- Department of Psychology, University of Cordoba (A.R., F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC) (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Reina Sofia University Hospital (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain
| | - Juan A Moriana
- Department of Psychology, University of Cordoba (A.R., F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC) (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Reina Sofia University Hospital (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain
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Tang Y, Chen H, Zhou Y, Tan ML, Xiong SL, Li Y, Ji XH, Li YS. Analgesic Effects of Repetitive Transcranial Magnetic Stimulation in Patients With Advanced Non-Small-Cell Lung Cancer: A Randomized, Sham-Controlled, Pilot Study. Front Oncol 2022; 12:840855. [PMID: 35372024 PMCID: PMC8969560 DOI: 10.3389/fonc.2022.840855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/25/2022] [Indexed: 12/30/2022] Open
Abstract
Objective Current pharmacological intervention for the cancer-related pain is still limited. The aim of this study was to explore whether repetitive transcranial magnetic stimulation (rTMS) could be an effective adjuvant therapy to reduce pain in patients with advanced non-small cell lung cancer (NSCLC). Methods This was a randomized, sham–controlled study. A total of 41 advanced NSCLC patients with uncontrolled pain (score≥4 on pain intensity assessed with an 11-point numeric rating scale) were randomized to receive active (10 Hz, 2000 stimuli) (n = 20) or sham rTMS (n = 20) for 3 weeks. Pain was the primary outcome and was assessed with the Numeric Rating Scale (NRS). Secondary outcomes were oral morphine equivalent (OME) daily dose, quality of life (WHO Quality of Life-BREF), and psychological distress (the Hospital Depression and Anxiety Scale). All outcomes were measured at baseline, 3 days, 1 week, 2 weeks, and 3 weeks. Results The pain intensity in both groups decreased gradually from day 3 and decreased to the lowest at the week 3, with a decrease rate of 41.09% in the rTMS group and 23.23% in the sham group. The NRS score of the rTMS group was significantly lower than that of the sham group on the week 2 (p < 0.001, Cohen’s d =1.135) and week 3 (p=0.017, Cohen’s d = -0.822). The OME daily dose, physiology and psychology domains of WHOQOL-BREF scores, as well as the HAM-A and HAM-D scores all were significantly improved at week 3 in rTMS group. Conclusion Advanced NSCL patients with cancer pain treated with rTMS showed better greater pain relief, lower dosage of opioid, and better mood states and quality of life. rTMS is expected to be a new effective adjuvant therapy for cancer pain in advanced NSCLC patients.
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Affiliation(s)
- Ying Tang
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Han Chen
- Department of Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yi Zhou
- Department of Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ming-Liang Tan
- Department of Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Shuang-Long Xiong
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Yan Li
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiao-Hui Ji
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Yong-Sheng Li
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
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Effects of Mindfulness-Based Therapy for Cancer Patients: A Systematic Review and Meta-analysis. J Clin Psychol Med Settings 2022; 29:432-445. [DOI: 10.1007/s10880-022-09862-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
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19
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Jiang N, Zhang YX, Zhao J, Shi HY, Wang T, Jin W, Wang JW, Yu JM. The mediator role of stigma in the association of mindfulness and social engagement among breast cancer survivors in China. Support Care Cancer 2022; 30:5007-5015. [PMID: 35192056 PMCID: PMC8861258 DOI: 10.1007/s00520-022-06882-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aims to explore the association between mindfulness and social engagement among Chinese breast cancer survivors (BCSs) and the mediator role of stigma in the relation of mindfulness and social engagement. METHODS This cross-sectional study was conducted among 937 BCSs from March to April 2021 in Shanghai, China. Data were collected using the Mindful Attention Awareness Scale, the Stigma Scale for Chronic Illness 8-item version, and the index of social engagement. Descriptive statistics, independent-sample t-test, one-way ANOVA, and regression analyses were used to explore the role of stigma in the association of mindfulness and social engagement among Chinese BCSs. RESULTS Social engagement levels differed significantly by participant's BMI, education level, employment status, personal monthly income, monthly per capita household income. Mindfulness was positively correlated with social engagement, and stigma was negatively correlated with mindfulness and social engagement among Chinese BCSs. Stigma plays a complete mediating role in the relationship between mindfulness and social engagement in BCSs. CONCLUSION In the practice of individual mindfulness intervention on social engagement of BCSs, health care providers should identify and eliminate the constraints, which restrain the reduction of stigma level while individual mindfulness is being enhanced.
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Affiliation(s)
- Nan Jiang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Yu-Xin Zhang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Jie Zhao
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Hong-Yan Shi
- Dental Disease Prevention and Treatment Center of Minhang District, 1038 Fanxing Road, Shanghai, 201107 China
| | - Ting Wang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Wei Jin
- Department of Health Instruction, Shanghai Municipal Center for Health Promotion, Shanghai, 200040 China
| | - Ji-Wei Wang
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Jin-Ming Yu
- Key Lab of Health Technology Assessment of Ministry of Health, Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
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Chappell AG, Yuksel S, Sasson DC, Wescott AB, Connor LM, Ellis MF. Post-Mastectomy Pain Syndrome: An Up-to-Date Review of Treatment Outcomes. JPRAS Open 2021; 30:97-109. [PMID: 34522756 PMCID: PMC8426165 DOI: 10.1016/j.jpra.2021.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Post-mastectomy pain syndrome (PMPS) is a known debilitating surgical complication. While research on prevention, risk factors, and treatments have been conducted, there remains no cohesive treatment paradigm. The aim of our study is to synthesize the existing evidence on PMPS treatment, which may facilitate the implementation of standardized, effective management strategies. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search was developed and translated for MEDLINE, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and ClinicalTrials.gov. The databases were searched using a combination of free terms, phrase searching, and database-specific controlled vocabulary related to PMPS. All unique records were by two independent reviewers. Publications on chronic (>3 months duration) pain after breast cancer-related surgery were included. Limited case series, case reports, and editorials were not included. RESULTS A total of 3402 articles from the years 1946-2019 resulted from the literature search after deduplication. Twenty-seven articles met final inclusion criteria for analysis, which revealed 10 major treatment modalities: fat grafting, neuroma surgery, lymphedema surgery, nerve blocks and neurolysis, laser, antidepressants, neuromodulators, physical therapy, mindfulness-based cognitive therapy, and capsaicin. CONCLUSIONS In this review, we present a comprehensive assessment of the treatments available for PMPS that may help guide breast surgeons and reconstructive surgeons to employ the most effective treatment strategies for these patients. This review supports the importance of multimodal, multidisciplinary care in improving the management of PMPS.
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Affiliation(s)
- Ava G. Chappell
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Selcen Yuksel
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel C. Sasson
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Annie B. Wescott
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine. Chicago, Illinois
| | - Lauren M. Connor
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marco F. Ellis
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Chang PJ, Asher A, Smith SR. A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment. Cancers (Basel) 2021; 13:5191. [PMID: 34680339 PMCID: PMC8534110 DOI: 10.3390/cancers13205191] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 01/10/2023] Open
Abstract
Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct. The purpose of this review is to clearly outline different pain sources based on anatomic location that commonly occur following treatment for breast cancer, and to provide tailored and evidence-based recommendations for the evaluation and treatment of each disorder.
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Affiliation(s)
- Philip J. Chang
- Department of Physical Medicine and Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Arash Asher
- Department of Physical Medicine and Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Sean R. Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA;
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Danon N, Al-Gobari M, Burnand B, Rodondi PY. Are mind-body therapies effective for relieving cancer-related pain in adults? A systematic review and meta-analysis. Psychooncology 2021; 31:345-371. [PMID: 34545984 PMCID: PMC9291932 DOI: 10.1002/pon.5821] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess whether mind-body therapies are effective for relieving cancer-related pain in adults, since at least one-third of adults with cancer are affected by moderate or severe pain. METHODS We searched for all randomized or quasi-randomized controlled trials that included adults (≥18 years) with cancer-related pain who were treated with mind-body therapies (mindfulness, hypnosis, yoga, guided imagery, and progressive muscle relaxation) in MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index, Web of Science, trials registers, and reference lists. The primary outcome was pain intensity. We calculated the standardized mean differences and 95% confidence intervals (CIs) and assessed the risk of bias. RESULTS We identified 40 primary studies involving a total of 3569 participants. The meta-analysis included 24 studies (2404 participants) and showed a significant effect of -0.39 (95% CI -0.62 to -0.16) with considerable heterogeneity (I2 = 86.3%, p < 0.001). After we excluded four "outlier" studies in sensitivity analyses, the effect size remained significant but weaker. There was a high risk of bias in all studies, for example, performance bias due to lack of participant blinding. Patients in multiple settings were included but many studies were of low quality. CONCLUSIONS Mind-body therapies may be effective in improving cancer pain, but the quality of the evidence is low. There is a need for further high-quality clinical trials.
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Affiliation(s)
- Nadia Danon
- Pain Center and Center for Integrative and Complementary Medicine, Department of Anesthesiology, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Center for Primary Care and Public Health (Unisanté) and Cochrane Switzerland, University of Lausanne, Lausanne, Switzerland
| | - Muaamar Al-Gobari
- Center for Primary Care and Public Health (Unisanté) and Cochrane Switzerland, University of Lausanne, Lausanne, Switzerland.,Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Bernard Burnand
- Center for Primary Care and Public Health (Unisanté) and Cochrane Switzerland, University of Lausanne, Lausanne, Switzerland
| | - Pierre-Yves Rodondi
- Center for Primary Care and Public Health (Unisanté) and Cochrane Switzerland, University of Lausanne, Lausanne, Switzerland.,Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
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Abstract
PURPOSE OF REVIEW Depression is a prevalent comorbidity in cancer that significantly increases the risk for numerous negative health outcomes. This review updates the current evidence base for management of depression in cancer, highlighting new research directions based on the inflammatory hypothesis of depression. RECENT FINDINGS Research on pharmacotherapy and psychotherapy for depression in cancer has shown mixed efficacy partly because of methodological issues arising from the phenomenology of depression in cancer. After decades of stagnancy, more recent high-quality clinical trials are beginning to provide an evidence base to guide treatment. Inflammatory cytokine-associated depression is a subtype of depression that may have particular relevance in cancer, opening new avenues to explore therapeutic targets and biobehavioral impacts of interventions, which may improve cancer outcomes. SUMMARY The continuum of severity in cancer-related depression is important to consider in management approaches. Choice of treatment should be personalized to the patient and their symptom profile as there is currently insufficient evidence to recommend any particular medication or psychotherapy over another. Psychological interventions should be considered first line for mild-to-moderate depression, and pharmacological treatment added for more severe depression, which can be optimally delivered within a collaborative care model. VIDEO ABSTRACT http://links.lww.com/YCO/A62.
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Affiliation(s)
- Aliza A Panjwani
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
| | - Madeline Li
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
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24
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Feng B, Hu X, Lu WW, Wang Y, Ip WY. Are mindfulness treatments effective for pain in cancer patients? A systematic review and meta-analysis. Eur J Pain 2021; 26:61-76. [PMID: 34369040 DOI: 10.1002/ejp.1849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/22/2021] [Accepted: 07/31/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Mindfulness-based interventions (MBIs) have been recently applied in pain management and cancer care. However, inconsistencies exist concerning the effectiveness of MBIs on pain control among cancer patients. Therefore, this study aimed to examine the efficacy of MBIs on pain in cancer patients via a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS Databases (MEDLINE, PubMed, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov) were searched using key terms related to pain, cancer and mindfulness. The primary outcome was pain intensity. Standardized mean difference (SMD) of each outcome with 95% confidence interval (95% CI) was calculated. The quality of evidence was assessed by GRADE assessment. RESULTS Ten RCTs with 843 participants were included. Significant pooled effects of MBIs on pain intensity were found at both short-term (SMD = -0.19, 95% CI [-0.33 to -0.04]) and long-term (SMD = -0.20, 95% CI [-0.35 to -0.05]) follow-up, whereas no significance was observed for pain interference. In subgroup analyses, significant intervention effects were only seen in clinic-based MBIs compared to remote MBIs, and pooled effects of MBIs in attenuating pain were discovered relative to passive rather than active comparators. GRADE ratings showed moderate certainty of evidence in MBIs for pain intensity but low for pain interference. CONCLUSIONS The efficacy of MBIs in reducing pain intensity among cancer patients was revealed in this meta-analysis, albeit with a small effect size. Future research is warranted to optimize mindfulness treatment for pain control in cancer patients with high methodological quality and a large sample size. SIGNIFICANCE The effect of MBIs on pain in cancer patients was demonstrated in our analysis, albeit with small effect sizes. High-quality RCTs are needed to verify the efficacy of MBIs on cancer patients or survivors with pain complaints. Future trials should take into account the specific pain outcome measures (pain intensity or pain interference), the approach of intervention provision (clinic-based or remote MBI, group or individual practice), the duration and frequency of interventions and the comparators (passive or active control arms).
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Affiliation(s)
- Beibei Feng
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Orthopaedics & Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xiaoqian Hu
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - William W Lu
- Department of Orthopaedics & Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yuling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wing-Yuk Ip
- Department of Orthopaedics & Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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25
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Pardos-Gascón EM, Narambuena L, Leal-Costa C, Ramos-Morcillo AJ, Ruzafa-Martínez M, van-der Hofstadt Román CJ. Effects of Mindfulness-Based Cognitive Therapy for Chronic Pain: A Multicenter Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6951. [PMID: 34209604 PMCID: PMC8297331 DOI: 10.3390/ijerph18136951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 01/20/2023]
Abstract
The prevalence of chronic pain in Spain is 15%. The objective of this study was to evaluate the efficacy of mindfulness-based cognitive therapy on patients with chronic pain. A quasi-experimental design of repeated measures pre- and post-test (N = 57) was carried out at three hospitals from the province of Alicante. Self-reported assessment measurements of pain intensity, anxiety-depression symptoms, perception of health status, interference of pain on sleep, self-efficacy in pain, acceptance, and mindfulness attitude were included. The T-test indicates significant differences in intensity of present pain, mental quality of life, and depression (medium effect sizes), as well as in self-efficacy: total score, symptom management and pain control (medium effect sizes), sleep disturbances and quantity of sleep (large effect sizes). MBCT is effective in reducing many symptoms in patients with chronic pain, although its maintenance needs to be further investigated.
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Affiliation(s)
| | - Lucas Narambuena
- Child-Youth Mental Health Unit, Can Misses Hospital, 07800 Ibiza, Spain;
| | | | | | | | - Carlos J. van-der Hofstadt Román
- Hospital Psychology Unit, Department of Health Psychology, Institute of Health and Biomedical Research of Alicante (ISABIAL), General University Hospital of Alicante, Miguel Hernández University, 03010 Alicante, Spain;
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26
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Foust Winton RE, Draucker CB, Von Ah D. Pain Management Experiences Among Hospitalized Postcraniotomy Brain Tumor Patients. Cancer Nurs 2021; 44:E170-E180. [PMID: 32657900 PMCID: PMC7794082 DOI: 10.1097/ncc.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Brain tumors account for the majority of central nervous system tumors, and most are removed by craniotomies. Many postcraniotomy patients experience moderate or severe pain after surgery, but patient perspectives on their experiences with pain management in the hospital have not been well described. OBJECTIVE The aim of this study was to describe how patients who have undergone a craniotomy for brain tumor removal experience pain management while hospitalized. METHODS Qualitative descriptive methods using semistructured interviews were conducted with patients on a neurological step-down unit in an urban teaching hospital in the Midwest United States. Interviews focused on how patients experienced postcraniotomy pain and how it was managed. Narratives were analyzed with standard content analytic procedures. RESULTS Twenty-seven participants (median age, 58.5 years; interquartile range, 26-41 years; range, 21-83 years) were interviewed. The majority were white (n = 25) and female (n = 15) and had an anterior craniotomy (n = 25) with sedation (n = 17). Their pain experiences varied on 2 dimensions: salience of pain during recovery and complexity of pain management. Based on these dimensions, 3 distinct types of pain management experiences were identified: (1) pain-as-nonsalient, routine pain management experience; (2) pain-as-salient, routine pain management experience; and (3) pain-as-salient, complex pain management experience. CONCLUSIONS Many postcraniotomy patients experience their pain as tolerable and/or pain management as satisfying and effective; others experience pain and pain management as challenging. IMPLICATIONS FOR PRACTICE Clinicians should be attuned to needs of patients with complex pain management experiences and should incorporate good patient/clinician communication.
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Affiliation(s)
- Rebecca E Foust Winton
- Author Affiliation: Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis
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Marked sexual dimorphism in neuroendocrine mechanisms for the exacerbation of paclitaxel-induced painful peripheral neuropathy by stress. Pain 2021; 161:865-874. [PMID: 31917777 DOI: 10.1097/j.pain.0000000000001798] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chemotherapy-induced neuropathic pain is a serious adverse effect of chemotherapeutic agents. Clinical evidence suggests that stress is a risk factor for development and/or worsening of chemotherapy-induced peripheral neuropathy (CIPN). We evaluated the impact of stress and stress axis mediators on paclitaxel CIPN in male and female rats. Paclitaxel produced mechanical hyperalgesia, over the 4-day course of administration, peaking by day 7, and still present by day 28, with no significant difference between male and female rats. Paclitaxel hyperalgesia was enhanced in male and female rats previously exposed to unpredictable sound stress, but not in rats that were exposed to sound stress after developing paclitaxel CIPN. We evaluated the role of the neuroendocrine stress axes: in adrenalectomized rats, paclitaxel did not produce hyperalgesia. Intrathecal administration of antisense oligodeoxynucleotides (ODN) reduced expression of β2-adrenergic receptors on nociceptors, and paclitaxel-induced hyperalgesia was slightly attenuated in males, but markedly attenuated in females. By contrast, after intrathecal administration of antisense ODN to decrease expression of glucocorticoid receptors, hyperalgesia was markedly attenuated in males, but unaffected in females. Both ODNs together markedly attenuated paclitaxel-induced hyperalgesia in both males and females. We evaluated paclitaxel-induced CIPN in stress-resilient (produced by neonatal handling) and stress-sensitive (produced by neonatal limited bedding). Neonatal handling significantly attenuated paclitaxel-induced CIPN in adult male, but not in adult female rats. Neonatal limited bedding did not affect the magnitude of paclitaxel-induced CIPN in either male or female. This study provides evidence that neuroendocrine stress axis activity has a marked, sexually dimorphic, effect on paclitaxel-induced painful CIPN.
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28
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A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 2021; 5:631-652. [PMID: 33875837 DOI: 10.1038/s41562-021-01093-w] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022]
Abstract
Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.
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29
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Nissen ER, Zachariae R, O'Connor M, Kaldo V, Jørgensen CR, Højris I, Borre M, Mehlsen M. Internet-delivered Mindfulness-Based Cognitive Therapy for anxiety and depression in cancer survivors: Predictors of treatment response. Internet Interv 2021; 23:100365. [PMID: 33552930 PMCID: PMC7843453 DOI: 10.1016/j.invent.2021.100365] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The present study investigates possible predictors of treatment response in an Internet-delivered Mindfulness-Based Cognitive Therapy (iMBCT) intervention with therapist support. This iMBCT program, a fully online delivered intervention with asynchronous therapist support, has previously been shown to be efficacious in reducing symptoms of anxiety and depression in women treated for breast cancer and men treated for prostate cancer. METHODS Eighty-two breast- and prostate cancer survivors experiencing psychological distress received 8 weeks of therapist-guided iMBCT. Primary outcomes were improvement in anxiety and depression scores from baseline to post-treatment and from baseline to six-months follow-up. Clinical predictors included levels of depression and anxiety at the time of screening and at baseline, as well as time since diagnosis. Demographic predictors included age and educational level. Therapy-related predictors included working alliance, self-compassion, and five facets of mindfulness. Mixed Linear Models were employed to test the prediction effects over time. RESULTS Higher levels of baseline depression were associated with increased treatment response in anxiety at post-treatment, and lower levels of self-compassion were associated with increased treatment response in depression at post-treatment. None of the proposed predictors significantly predicted treatment response at six-months follow-up. CONCLUSION The findings suggest that iMBCT can be provided for cancer survivors regardless of their age, educational level, and time since diagnosis (up to five years) and that therapeutic alliance is not crucial for treatment response. We did not identify characteristics predicting treatment response, although many factors were tested. Still, other characteristics may be predictors, and given the relatively small sample size and a large number of statistical tests, the results should be interpreted with caution.
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Key Words
- Anxiety
- BDI-II, Beck Depression Inventory II
- Breast cancer
- Depression
- FFMQ-SF, Five Facet Mindfulness Questionnaire – Short Form
- FFMQ-SF-AA, FFMQ-SF subscale Acting with Awareness
- FFMQ-SF-DS, FFMQ-SF subscale Describing
- FFMQ-SF-NJ, FFMQ-SF subscale Non-Judging of inner experience
- FFMQ-SF-NR, FFMQ-SF subscale Non-Reactivity to inner experience
- FFMQ-SF-OB, FFMQ-SF subscale Observing
- Internet-delivered therapy
- MBCT, Mindfulness-Based Cognitive Therapy
- MBI, Mindfulness-Based Intervention
- MBSR, Mindfulness-Based Stress Reduction
- Mindfulness-Based Cognitive Therapy
- Prostate cancer
- RCT, randomized controlled trial
- SCS-SF, Self-Compassion Scale – Short Form
- STAI-Y, State-Trait Anxiety Inventory, Y-Form
- WAI-C, Working Alliance Inventory – Client Form
- iMBCT, Internet-delivered Mindfulness-Based Cognitive Therapy
- iMBI, Internet-delivered Mindfulness-Based Intervention
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Affiliation(s)
- Eva Rames Nissen
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark,Corresponding author at: Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 11, DK-8000 Aarhus C, Denmark.
| | - Robert Zachariae
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Maja O'Connor
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden,Department of Psychology, Linnaeus University, Växjö, Sweden
| | | | - Inger Højris
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Mimi Mehlsen
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
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30
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Baydoun M, Moran C, McLennan A, Piedalue KAL, Oberoi D, Carlson LE. Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants' Adherence to Home Practice. Patient Prefer Adherence 2021; 15:1225-1242. [PMID: 34135575 PMCID: PMC8200136 DOI: 10.2147/ppa.s267064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although mindfulness-based interventions (MBIs) have demonstrated efficacy for alleviating psychological distress in cancer survivors, little is known about the extent to which participants adhere to assigned home practice. The purpose of this systematic review was to summarize and appraise the literature on rates and correlates of adherence to mindfulness home practice among cancer survivors. METHODS Four databases (PubMed, Psychology and Behavioral Sciences, PsycInfo, and CINAHL) were searched for studies published before October 15, 2020. Articles were included if they evaluated the benefits of an MBI program for adults with cancer. RESULTS Twenty-one studies (N=1811 participants) meeting the inclusion criteria were identified (randomized controlled trials (n=13), non-randomized controlled designs (n=2), single-group studies (n=6)). The pooled adherence rate for participants' home practice was 60% of the assigned amount, which equated to 27 min per day during the intervention period. There was some evidence for a relationship between home practice of mindfulness techniques and improvements in mood, stress, anxiety, depression, and fear of cancer recurrence (correlation coefficients ranged from 0.33 to 0.67). Factors including marital status, mood disturbance at baseline, intervention modality, and personality traits were evaluated in relation to adherence to home practice, but the current literature was inadequate to evaluate whether a relationship exists. CONCLUSION Adherence to mindfulness home practice among cancer survivors is suboptimal, and most of the correlates of adherence studied to date are non-modifiable. More research is warranted to scrutinize the role of home practice in mindfulness-based interventions, including assessment of modifiable factors influencing adherence to improve benefits for this population.
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Affiliation(s)
- Mohamad Baydoun
- Cumming School of Medicine, Department of Psychosocial Oncology, University of Calgary, Calgary, Canada
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Andrew McLennan
- Cumming School of Medicine, Department of Psychosocial Oncology, University of Calgary, Calgary, Canada
| | - Katherine-Ann L Piedalue
- Cumming School of Medicine, Department of Psychosocial Oncology, University of Calgary, Calgary, Canada
| | - Devesh Oberoi
- Cumming School of Medicine, Department of Psychosocial Oncology, University of Calgary, Calgary, Canada
| | - Linda E Carlson
- Cumming School of Medicine, Department of Psychosocial Oncology, University of Calgary, Calgary, Canada
- Correspondence: Linda E Carlson Department of Psychosocial Oncology, Cancer Control Alberta – Holy Cross Site, 2202 2nd St. SW, Calgary, Alberta, CanadaT2S 3C1Tel +1 403-355-3207 Email
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Ngamkham S, Yang JJ, Smith EL. Thai Buddhism-Based Mindfulness for Pain Management in Thai Outpatients with Cancer: A Pilot Study. Asia Pac J Oncol Nurs 2021; 8:58-67. [PMID: 33426191 PMCID: PMC7785079 DOI: 10.4103/apjon.apjon_43_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate Thai Buddhism-based Mindfulness (TBbM) feasibility based on recruitment and retention rates and to obtain preliminary data regarding changes (effect sizes) in pain severity and other outcomes when comparing control to intervention participants following TBbM use. METHODS A randomized controlled trial was conducted in the Outpatient Department at Sawanpracharak Hospital, Thailand, from April 2018 to February 2019. Seventeen participants completed the pretest and posttest. Both groups (control group [n = 10] and intervention group [n = 7]) received usual care and watched a 25-min educational video about cancer pain. The intervention group participated in a 3-day mindfulness training program at a Buddhist temple and continued practicing at home for 8 weeks. Data were collected at baseline and at 1 and 2 months postintervention. RESULTS One-hundred and thirty-five participants met the eligibility criteria; 112 (82%) declined to participate and 6 of 23 (26%) were lost to follow-up/dropped out. Control and intervention participants had an average age of 44 (± 8.77) and 56 years (± 7.41), respectively. When compared to the control group, the TBbM participants reported no statistically significant improvements in pain or other outcomes. While not statistically significant, the effect size indicated that pain did improve in the TBbM group (Cohen's d = 0.41). CONCLUSIONS Given the suboptimal recruitment and retention rates, modification of the intervention is warranted. Further, our findings suggest that the intervention had a moderate effect on pain. To evaluate efficacy, future adequately powered studies are needed to test a more feasible TBbM intervention.
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Affiliation(s)
- Srisuda Ngamkham
- Department of Fundamental Nursing and Nursing Administration, Boromarajonani College of Nursing Sawanpracharak Nakhonsawan, Nakhonsawan, Thailand
| | - James J. Yang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ellen Lavoie Smith
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
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Systematic scoping review of interactions between analgesic drug therapy and mindfulness-based interventions for chronic pain in adults: current evidence and future directions. Pain Rep 2020; 5:e868. [PMID: 33251471 PMCID: PMC7690768 DOI: 10.1097/pr9.0000000000000868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/29/2020] [Accepted: 09/22/2020] [Indexed: 01/17/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. None of the mindfulness-based clinical trials for chronic pain included in this review analyzed the interaction effects between mindfulness interventions and concomitant analgesic drug therapies. Most patients with chronic pain do not find adequate pain relief with a single treatment, and accumulating evidence points to the added benefits of rational combinations of different treatments. Given that psychological therapies, such as mindfulness-based interventions (MBIs), are often delivered in conjunction with concomitant analgesic drug therapies (CADTs), this systematic scoping review examines the evidence for any interactions between MBIs and CADTs. The protocol for this review has been published and registered. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and PsycINFO databases were searched until July 2019. We included randomized controlled trials that evaluated the efficacy of MBIs for the treatment of chronic pain. A total of 40 randomized controlled trials (2978 participants) were included. Thirty-nine of 40 (97.5%) included mindfulness-based clinical trials allowed the use of CADTs. However, only 6 of these 39 (15.4%) trials provided adequate details of what these CADTs were, and only 4 (10.3%) trials controlled for CADTs. Of great relevance to this review, none of the included trials analyzed the interactions between MBIs and the CADTs to determine whether they have an additive, synergistic, or antagonistic effect on chronic pain. Adverse events were inconsistently reported, and no judgment could be made about safety. Future trials assessing the interactions between MBIs and CADTs, with better harms reporting, are needed to better define the role of MBIs in the management of chronic pain.
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Oberoi S, Yang J, Woodgate RL, Niraula S, Banerji S, Israels SJ, Altman G, Beattie S, Rabbani R, Askin N, Gupta A, Sung L, Abou-Setta AM, Zarychanski R. Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2012598. [PMID: 32766801 PMCID: PMC7414391 DOI: 10.1001/jamanetworkopen.2020.12598] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Mindfulness-based interventions (MBIs), grounded in mindfulness, focus on purposely paying attention to experiences occurring at the present moment without judgment. MBIs are increasingly used by patients with cancer for the reduction of anxiety, but it remains unclear if MBIs reduce anxiety in patients with cancer. OBJECTIVE To evaluate the association of MBIs with reductions in the severity of anxiety in patients with cancer. DATA SOURCES Systematic searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and SCOPUS were conducted from database inception to May 2019 to identify relevant citations. STUDY SELECTION Randomized clinical trials (RCTs) that compared MBI with usual care, waitlist controls, or no intervention for the management of anxiety in cancer patients were included. Two reviewers conducted a blinded screening. Of 101 initially identified studies, 28 met the inclusion criteria. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted the data. The Cochrane Collaboration risk-of-bias tool was used to assess the quality of RCTs, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Summary effect measures were reported as standardized mean differences (SMDs) and calculated using a random-effects model. MAIN OUTCOMES AND MEASURES Our primary outcome was the measure of severity of short-term anxiety (up to 1-month postintervention); secondary outcomes were the severity of medium-term (1 to ≤6 months postintervention) and long-term (>6 to 12 months postintervention) anxiety, depression, and health-related quality of life of patients and caregivers. RESULTS This meta-analysis included 28 RCTs enrolling 3053 adults with cancer. None of the trials were conducted in children. Mindfulness was associated with significant reductions in the severity of short-term anxiety (23 trials; 2339 participants; SMD, -0.51; 95% CI, -0.70 to -0.33; I2 = 76%). The association of mindfulness with short-term anxiety did not vary by evaluated patient, intervention, or study characteristics. Mindfulness was also associated with the reduction of medium-term anxiety (9 trials; 965 participants; SMD, -0.43; 95% CI, -0.68 to -0.18; I2 = 66%). No reduction in long-term anxiety was observed (2 trials; 403 participants; SMD, -0.02; 95% CI, -0.38 to 0.34; I2 = 68%). MBIs were associated with a reduction in the severity of depression in the short term (19 trials; 1874 participants; SMD, -0.73; 95% CI; -1.00 to -0.46; I2 = 86%) and the medium term (8 trials; 891 participants; SMD, -0.85; 95% CI, -1.35 to -0.35; I2 = 91%) and improved health-related quality of life in patients in the short term (9 trials; 1108 participants; SMD, 0.51; 95% CI, 0.20 to 0.82; I2 = 82%) and the medium term (5 trials; 771 participants; SMD, 0.29; 95% CI, 0.06 to 0.52; I2 = 57%). CONCLUSIONS AND RELEVANCE In this study, MBIs were associated with reductions in anxiety and depression up to 6 months postintervention in adults with cancer. Future trials should explore the long-term association of mindfulness with anxiety and depression in adults with cancer and determine its efficacy in more diverse cancer populations using active controls.
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Affiliation(s)
- Sapna Oberoi
- Departments of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jiayu Yang
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Saroj Niraula
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Shantanu Banerji
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Sara J. Israels
- Departments of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gary Altman
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sara Beattie
- Alberta Blood and Marrow Transplant Program, Alberta Health Services, University of Calgary, Calgary, Alberta, Canada
| | - Rasheda Rabbani
- George and Fay Yee Center for Healthcare Innovation, Winnipeg Regional Health Authority, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Abha Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ahmed M. Abou-Setta
- George and Fay Yee Center for Healthcare Innovation, Winnipeg Regional Health Authority, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Park S, Sato Y, Takita Y, Tamura N, Ninomiya A, Kosugi T, Sado M, Nakagawa A, Takahashi M, Hayashida T, Fujisawa D. Mindfulness-Based Cognitive Therapy for Psychological Distress, Fear of Cancer Recurrence, Fatigue, Spiritual Well-Being, and Quality of Life in Patients With Breast Cancer-A Randomized Controlled Trial. J Pain Symptom Manage 2020; 60:381-389. [PMID: 32105790 DOI: 10.1016/j.jpainsymman.2020.02.017] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 01/04/2023]
Abstract
CONTEXT Mindfulness-based interventions have been receiving growing attention in cancer care. OBJECTIVES The purpose of this randomized controlled trial is to examine the effectiveness of mindfulness-based cognitive therapy (MBCT) for psychological distress (anxiety and depression), fear of cancer recurrence (FCR), fatigue, spiritual well-being, and quality of life (QOL) in Japanese ambulatory patients with Stage I-III breast cancer. METHODS A total of 74 patients were randomly assigned to either an eight-week MBCT intervention group (n = 38) or a wait-list control group (n = 36). The primary outcome was psychological distress, measured on Hospital Anxiety and Depression Scale. The secondary outcomes were FCR (Concerns About Recurrence Scale-overall anxiety subscale), fatigue (Brief Fatigue Inventory), spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual), QOL (Functional Assessment of Cancer Therapy-General), and mindfulness skills (Five Facet Mindfulness Questionnaire). The participants were assessed at baseline (T0), Week 8 (T1), and Week 12 (T2). The results were analyzed using a intention-to-treat linear mixed model. RESULTS The participants in the MBCT group experienced significantly better outcomes in their psychological distress (Cohen's d = 1.17; P < 0.001), FCR (d = 0.43; P < 0.05), fatigue (d = 0.66; P < 0.01), spiritual well-being (d = 0.98; P < 0.001), and QOL (d = 0.79; P < 0.001) compared with the control group. The difference remained significant at T2 (four weeks after completion of the intervention). CONCLUSION MBCT was demonstrated to improve well-being that encompasses psychological, physical, and spiritual domains in Japanese patients with nonmetastatic breast cancer. The favorable effect was maintained up to four weeks after the completion of the intervention.
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Affiliation(s)
- Sunre Park
- Faculty of Nursing and Medical Care, Keio University, Shinjuku-ku, Tokyo, Japan.
| | - Yasuko Sato
- Department of Nursing, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Yuka Takita
- Faculty of Nursing and Medical Care, Keio University, Shinjuku-ku, Tokyo, Japan; Department of Nursing, Faculty of Health Sciences, Tokyo Kasei University, Itabashi-ku, Tokyo, Japan
| | - Noriko Tamura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Akira Ninomiya
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Teppei Kosugi
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan; Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Maiko Takahashi
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tetsu Hayashida
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan; Division of Patient Safety, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Price-Blackshear MA, Pratscher SD, Oyler DL, Armer JM, Cheng AL, Cheng MX, Records K, Udmuangpia T, Carson JW, Ann Bettencourt B. Online couples mindfulness-based intervention for young breast cancer survivors and their partners: A randomized-control trial. J Psychosoc Oncol 2020; 38:592-611. [PMID: 32552446 DOI: 10.1080/07347332.2020.1778150] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Young breast cancer survivors (YBCS) face unique challenges in coping with disease, distress, and relationship concerns. The purposes of this study were to understand the acceptability and feasibility of an online Mindfulness-Based Intervention (MBI) for YBCS and their partners (i.e., Couples Mindfulness-Based Intervention: C-MBI) and to compare the effectiveness of the C-MBI to a closely-matched control, an online MBI for individuals (I-MBI). METHODS YBCS and their partners were recruited. Couples were randomly assigned to an 8-week C-MBI (couples = 41) or to I-MBI (couples = 36), which included one-hour video modules, a manual, and guided-meditation audios. Both couple members participated in the C-MBI; only the YBCS participated in the control I-MBI. Participants answered surveys about individual- and couple-level functioning at baseline and post-intervention. RESULTS Online delivery was shown to be feasible and acceptable. For YBCS and their partners, levels of perceived stress, anxiety, depression, and fatigue were lower after the intervention, in both conditions. Unexpectedly, however, participating in the C-MBI appeared to have detrimental effects on dyadic adjustment and relationship quality. CONCLUSION Although YBCS and their partners reported online delivery was acceptable and benefited well-being, for couple-based MBIs to have benefits for relationship functioning, it may be necessary for couples to have the support of other couples and an instructor. Online delivery may be particularly acceptable and effective for clinical populations, including YBCS. Medical professionals may be more likely to recommend online-MBI programs to cancer survivors, because the programs are of little or no cost.
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Affiliation(s)
| | - Steven D Pratscher
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Danielle L Oyler
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - An-Lin Cheng
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas, Kansas City, Missouri, USA
| | - Maggie X Cheng
- Department of Applied Mathematics, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Kathie Records
- University of Missouri-St. Louis, College of Nursing, St. Louis, Missouri, USA
| | | | - James W Carson
- Departments of Anesthesiology & Perioperative Medicine, and Psychiatry, Oregon Health and Science University, Portland, Oregon, USA
| | - B Ann Bettencourt
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
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Haslam A, Herrera-Perez D, Gill J, Prasad V. Patient Experience Captured by Quality-of-Life Measurement in Oncology Clinical Trials. JAMA Netw Open 2020; 3:e200363. [PMID: 32129865 PMCID: PMC7057133 DOI: 10.1001/jamanetworkopen.2020.0363] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Quality of life (QoL) is an important consideration in cancer medicine, especially because drugs are becoming more costly and may only result in modest gains in overall survival. However, there has been no descriptive analysis for the points at which QoL is measured in cancer trials. OBJECTIVE To estimate the prevalence of studies that measure QoL at different points and see how many studies measure QoL for the entirety of a patient's life. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis includes all articles on oncology clinical trials in the 3 highest-impact oncology journals, published between July 2015 and June 2018, that reported QoL outcomes. MAIN OUTCOMES AND MEASURES Data were abstracted on when QoL was assessed and the characteristics of these studies. RESULTS For all 149 studies that met inclusion criteria, QoL assessment was high during treatment (104 articles [69.8%]), during follow-up (81 articles [54.4%]), and after the end of the intervention (68 articles [45.6%]). In 5 of the 149 studies (3.4%), QoL was assessed until death, including in only 1 of the 74 studies on metastatic or incurable cancers. Among these 5 studies, only 1 (20%) used a drug intervention, 1 (20%) used a behavioral intervention, and 2 (40%) used a radiation intervention; only 1 of 5 was in the metastatic setting. The number of studies that reported a positive QoL outcome (ie, QoL outcome was more favorable in the intervention group than in the control group) was between 42 of 81 articles (51.9%) and 16 of 28 articles (57.1%) for most QoL assessment points but only 1 of 5 articles (20%) for studies measuring QoL until death. CONCLUSIONS AND RELEVANCE This study found that most clinical trials assessed QoL during the treatment or intervention and often during a given amount of follow-up but infrequently assessed QoL on disease progression and rarely followed QoL until the end of the patient's life. Most studies reporting QoL until the end of life reported worse QoL outcomes for the intervention group than the control group. Future research and policy recommendations should consider not just short-term QoL outcomes but QoL outcomes throughout the patient's cancer care.
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Affiliation(s)
- Alyson Haslam
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | | | - Jennifer Gill
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
- Center for Health Care Ethics, Oregon Health & Science University, Portland
- Division of General Medicine, Department of Medicine, Oregon Health & Science University, Portland
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Nori P, Kline-Quiroz C, Stubblefield MD. Cancer Rehabilitation:: Acute and Chronic Issues, Nerve Injury, Radiation Sequelae, Surgical and Chemo-Related, Part 2. Med Clin North Am 2020; 104:251-262. [PMID: 32035567 DOI: 10.1016/j.mcna.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cancer affects millions of individuals, and approximately half will develop functional impairments. Cancers that commonly, either from direct effects or from its treatments, result in functional impairments include breast, head and neck, brain, and spinal cord tumors. There is a plethora of potential impairments including pain, spasticity, dystonia, weakness, and neurogenic bowel or bladder. This article reviews the functional impairments frequently encountered in breast, head and neck, brain, and spinal cord tumors. The authors also discuss management and treatment options incorporated in comprehensive cancer rehabilitation to address these impairments to maximize and maintain function and quality of life.
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Affiliation(s)
- Phalgun Nori
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Cristina Kline-Quiroz
- MedStar Health/Georgetown, National Rehabilitation Hospital, 102 Irving Street Northwest, Washington, DC 20010, USA
| | - Michael D Stubblefield
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Select Medical, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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Psychosocial Interventions for Pain Management in Advanced Cancer Patients: a Systematic Review and Meta-analysis. Curr Oncol Rep 2020; 22:3. [PMID: 31965361 PMCID: PMC8035102 DOI: 10.1007/s11912-020-0870-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose of Review This systematic review and meta-analysis aimed to synthesize the evidence on the effects of psychosocial interventions on pain in advanced cancer patients. Recent Findings The included studies investigated the effects of relaxation techniques, cognitive-behavioral therapy, music therapy, mindfulness- and acceptance-based interventions, and supportive-expressive group therapy. Overall, we found a small, but significant effect on pain intensity (d = − 0.29, CI = − 0.54 to − 0.05). Effect sizes were highly heterogeneous between studies. We did not find evidence for the superiority of any of the intervention types. However, psychosocial interventions may be more effective if they specifically targeted pain distress as the primary outcome. Summary Although findings were mixed, psychosocial interventions can be recommended to complement comprehensive care to alleviate pain in patients facing an advanced or terminal stage of the disease. Future research should develop innovative interventions tailored specifically for pain relief.
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Behzadmehr R, Dastyar N, Moghadam MP, Abavisani M, Moradi M. Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review. Complement Ther Med 2020; 49:102318. [PMID: 32147038 DOI: 10.1016/j.ctim.2020.102318] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This systematic review aimed to evaluate the efficacy of CAM interventions for cancer-related pain in breast cancer patients. METHODS Databases (PubMed, Scopus, Web of Science, and EMBASE) were searched from January 1, 2000, up to April 31, 2019, using the keywords: Complementary and alternative medicine therapies and cancer related pain. Standard tools were used to evaluate the quality of the studies included. RESULTS Of the 3742 articles found, 46 articles comprising 3685 participants entered the final phase. Our results indicate that interventions including acupuncture/acupressure, tai chi/qi gong, hypnosis, meditation, music therapy, yoga, massage, reflexology, and Reiki improve cancer-related pain in breast cancer patients. However, aromatherapy had no effect on the same. CONCLUSIONS Despite the positive effect of various CAM interventions in reducing cancer-related pain, necessary precautions should be adopted to use them alongside other treatments to control cancer pain in the clinical setting.
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Affiliation(s)
- Razieh Behzadmehr
- Department of Radiology, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Neda Dastyar
- Department of Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Mahdieh Poodineh Moghadam
- Department of Nursing, Faculty of Nursing and Midwifery, Zabol University of Medical Sciences, Zabol, Iran
| | - Mahnaz Abavisani
- MSc of Medical Surgical Nursing, Department of Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mandana Moradi
- Clinical Pharmacy Department, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran.
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Guarino A, Polini C, Forte G, Favieri F, Boncompagni I, Casagrande M. The Effectiveness of Psychological Treatments in Women with Breast Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9010209. [PMID: 31940942 PMCID: PMC7019270 DOI: 10.3390/jcm9010209] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/14/2022] Open
Abstract
Breast cancer is the most prevalent oncological disease among women, and it represents the second oncological cause of death. Many studies have considered the quality of life in people with breast cancer because this condition has high comorbidity with mental distress, anxiety, affective disorders and depression. Psychological interventions can reduce the stressful consequences of both the diagnosis and the medical treatments of breast cancer. However, different methods (e.g., group or individual therapy) and focus (e.g., improving personal skills or increasing emotional well-being) do not help to identify which type of psychological therapy can be more effective in improving quality of life in patients with breast cancer. This study was aimed to systematically review and compare, by means of a meta-analysis, the efficacy of cognitive behavioural, supportive-expressive or psycho-educational treatments in women with breast cancer, focusing on anxiety, depression, mood and quality of life as outcomes. The PRISMA statement was adopted. MEDLINE, PsycINFO, PUBMED and PsycArticles databases were used, and reference lists were examined for additional publications. In the selection of the articles were included studies considering women between 18 and 65 years who were diagnosed with breast cancer at any stage and under any treatment, and who underwent psychological group interventions. At the end of the systematic review, 45 studies met all inclusion criteria and were analysed in the meta-analysis. The overall effect size was medium, especially considering cognitive behavioural therapy and psycho-educational treatments. However, the studies are characterised by high methodological heterogeneity. Despite some limitations, this review and meta-analysis partially confirm the efficiency of cognitive-behavioural and psycho-educational therapies in the improvement of well-being in women with breast cancer.
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Affiliation(s)
- Angela Guarino
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (G.F.); (F.F.)
- Correspondence:
| | - Cristina Polini
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (C.P.); (I.B.); (M.C.)
| | - Giuseppe Forte
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (G.F.); (F.F.)
| | - Francesca Favieri
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (G.F.); (F.F.)
| | - Ilaria Boncompagni
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (C.P.); (I.B.); (M.C.)
| | - Maria Casagrande
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, 00185 Rome, Italy; (C.P.); (I.B.); (M.C.)
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Zhao Q, Zheng S, Delaney GP, Moylan E, Agar MR, Koh ES, Lai H, Birling Y, Zhang GS, Wang K, Ma Y, Zhu X. Acupuncture for Cancer Related Pain: Protocol for a Pragmatic Randomised Wait-List Controlled Trial. Integr Cancer Ther 2020; 19:1534735420976579. [PMID: 33300382 PMCID: PMC7734530 DOI: 10.1177/1534735420976579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Acupuncture has been proved effective for cancer related pain (CRP) in China, America and some other countries. However, there is relative lack of evidence to support the use of acupuncture for CRP in Australia. OBJECTIVES To assess the effectiveness and safety of acupuncture for management of CRP in a real-world setting and to understand cancer patients' experience of undergoing acupuncture for CRP. METHODS A pragmatic randomised controlled trial will be conducted in South Western Sydney Local Health District (SWSLHD) in NSW, Australia. Adults with cancer related pain (n = 106) will be randomised in a 1:1 ratio to receive the acupuncture intervention up front versus after a wait list period of 4 weeks. Pain level (by Numerical Rating Scale), analgesic use, auricular acupressure frequency and adverse events will be assessed at baseline, mid-treatment and post-treatment. Expectancy on trial outcome (by Credibility and Expectancy questionnaire) will be assessed at baseline. The perspective of the participants (by an interview) will be recorded after the last intervention. EXPECTED OUTCOMES We hypothesise that acupuncture will relieve cancer related pain at mid-treatment and post-treatment. We also hypothesise that few adverse events will be provoked by acupuncture. TRIAL REGISTRATION Australia New-Zealand Clinical Trial Registry (ACTRN12620000325909).
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Affiliation(s)
- Qi Zhao
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
| | - Suyang Zheng
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
- Nanjing University of Chinese Medicine, Nanjing, China
| | | | - Eugene Moylan
- South Western Sydney Local Health District, NSW, Australia
| | - Meera R. Agar
- South Western Sydney Local Health District, NSW, Australia
- University of Technology Sydney, NSW, Australia
- University of NSW, NSW, Australia
| | - Eng-Siew Koh
- South Western Sydney Local Health District, NSW, Australia
| | - Hezheng Lai
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
| | - Yoann Birling
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
| | | | - Kang Wang
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
- Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yong Ma
- Nanjing University of Chinese Medicine, Nanjing, China
- Affiliated Hospital of Nanjing University of Chinese Medicine
| | - Xiaoshu Zhu
- Chinese Medicine Centre, Western Sydney University, NSW, Australia
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Ehde DM, Alschuler KN, Day MA, Ciol MA, Kaylor ML, Altman JK, Jensen MP. Mindfulness-based cognitive therapy and cognitive behavioral therapy for chronic pain in multiple sclerosis: a randomized controlled trial protocol. Trials 2019; 20:774. [PMID: 31882017 PMCID: PMC6935157 DOI: 10.1186/s13063-019-3761-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/26/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic pain is one of the most prevalent and disabling symptoms associated with multiple sclerosis (MS). Individuals with MS are interested in nonpharmacologic pain management approaches. Cognitive-behavioral therapy (CBT) is efficacious in improving MS-related pain outcomes. Mindfulness-based cognitive therapy (MBCT) is a promising, alternative approach. Little is known about moderators of these treatments' outcomes, however. This article describes the study protocol for the first randomized controlled trial comparing MBCT, CBT, and usual care and examining treatment effect moderators in individuals with chronic pain and MS. METHODS We will conduct a single-center, randomized, single blind, parallel-group trial comparing MBCT, CBT, and usual care in adults with MS and chronic pain. Both interventions will be delivered via eight group sessions using videoconferencing technology. Primary (average pain intensity) and secondary outcomes (including pain interference, depressive symptoms, fatigue, and sleep) will be assessed pre-treatment, mid-treatment, post-treatment, and at 6-month follow up. Potential treatment moderators will be assessed pre-treatment. We hypothesize that participants randomly assigned to MBCT or CBT will report significantly greater reductions in average pain intensity than participants assigned to usual care at post-treatment (primary study endpoint) and 6-month follow up. We also hypothesize that mindfulness, pain catastrophizing, and behavioral activation pre-treatment will moderate response to both active treatments, but not response to usual care. DISCUSSION Findings will provide important new information about the efficacy and moderators of two nonpharmacologic pain management approaches delivered using technology to overcome common barriers to treatment access. The knowledge gained may lead to better patient-treatment matching and, ultimately, better pain treatment outcomes in MS. TRIAL REGISTRATION ClinicalTrials.gov, NCT03782246. Registered on 20 December 2018.
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Affiliation(s)
- Dawn M. Ehde
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
| | - Kevin N. Alschuler
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
- Department of Neurology, School of Medicine, University of Washington, UW Multiple Sclerosis Center, 1536 N 115th St, McMurray Building Suite 130, Seattle, WA 98133 USA
| | - Melissa A. Day
- School of Psychology, University of Queensland, 330 McElwain Building, Brisbane, Queensland 4072 Australia
| | - Marcia A. Ciol
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
| | - Makena L. Kaylor
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
| | - Jennifer K. Altman
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, 325 9th Ave, Box 359612, Seattle, WA 98104 USA
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The effectiveness of mindfulness-based interventions among cancer patients and survivors: a systematic review and meta-analysis. Support Care Cancer 2019; 28:1563-1578. [DOI: 10.1007/s00520-019-05219-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 11/28/2019] [Indexed: 01/01/2023]
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Sun H, Huang H, Ji S, Chen X, Xu Y, Zhu F, Wu J. The Efficacy of Cognitive Behavioral Therapy to Treat Depression and Anxiety and Improve Quality of Life Among Early-Stage Breast Cancer Patients. Integr Cancer Ther 2019; 18:1534735419829573. [PMID: 30791739 PMCID: PMC6432673 DOI: 10.1177/1534735419829573] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Positive results have appeared among nonmetastatic breast cancer patients with the use of cognitive behavioral therapy (CBT). However, earlier stage patient results have been mixed. This novelty of this study was the focus on stage I and II breast cancer patients. The objective of the current study was to conduct a meta-analysis of psychosocial functions in early-stage breast cancer survivors to determine its efficacy. METHODS A search of Cochrane Library, EMBASE, MEDLINE, PsycInfo, and PubMed yielded 3237 abstracts, which were independently evaluated by research pairs. Meta-analysis was conducted on 8 studies that included a total of 1053 patients. Psychosocial functions were categorized according to 3 domains: (1) anxiety, (2) depression, and (3) quality of life. RESULTS Improvement in anxiety was observed in patients treated with CBT relative to controls without CBT ( P = .04). Depression and quality of life improvement was not observed in the CBT group within or after 4 months of treatment ( P > .05). CONCLUSIONS The results indicated that observed improvements in anxiety in patients with early-stage breast cancer were moderate. The effectiveness of CBT for the improvement of patient outcomes could not be determined, given the methodological and clinical shortcomings of the included trials.
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Affiliation(s)
- Haoyao Sun
- 1 The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Hualei Huang
- 2 Community Health Service Center, Economic-Technical Development Zone, Taicang, Jiangsu, People's Republic of China
| | - Shengjun Ji
- 1 The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Xiaochen Chen
- 1 The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Yongqing Xu
- 2 Community Health Service Center, Economic-Technical Development Zone, Taicang, Jiangsu, People's Republic of China
| | - Fenglan Zhu
- 3 Taicang First People's Hospital Affiliated to Soochow University, Taicang, Jiangsu, People's Republic of China
| | - Jinchang Wu
- 1 The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
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“First do no harm”: why don't we measure adverse events routinely in psychological treatment trials for people with chronic pain? Pain 2019; 161:666-667. [DOI: 10.1097/j.pain.0000000000001771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Wells C, Malins S, Clarke S, Skorodzien I, Biswas S, Sweeney T, Moghaddam N, Levene J. Using smart-messaging to enhance mindfulness-based cognitive therapy for cancer patients: A mixed methods proof of concept evaluation. Psychooncology 2019; 29:212-219. [PMID: 31654533 PMCID: PMC7004102 DOI: 10.1002/pon.5256] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 11/07/2022]
Abstract
Objective Depression and anxiety lead to reduced treatment adherence, poorer quality of life, and increased care costs amongst cancer patients. Mindfulness‐based cognitive therapy (MBCT) is an effective treatment, but dropout reduces potential benefits. Smart‐message reminders can prevent dropout and improve effectiveness. However, smart‐messaging is untested for MBCT in cancer. This study evaluates smart‐messaging to reduce dropout and improve effectiveness in MBCT for cancer patients with depression or anxiety. Methods Fifty‐one cancer patients attending MBCT in a psycho‐oncology service were offered a smart‐messaging intervention, which reminded them of prescribed between‐session activities. Thirty patients accepted smart‐messaging and 21 did not. Assessments of depression and anxiety were taken at baseline, session‐by‐session, and one‐month follow‐up. Logistic regression and multilevel modelling compared the groups on treatment completion and clinical effectiveness. Fifteen post‐treatment patient interviews explored smart‐messaging use. Results The odds of programme completion were eight times greater for patients using smart‐messaging compared with non‐users, controlling for age, gender, baseline depression, and baseline anxiety (OR = 7.79, 95% CI 1.75 to 34.58, p = .007). Smart‐messaging users also reported greater improvement in depression over the programme (B = ‐2.33, SEB = .78, p = .004) when controlling for baseline severity, change over time, age, and number of sessions attended. There was no difference between groups in anxiety improvement (B = ‐1.46, SEB = .86, p = .097). In interviews, smart‐messaging was described as a motivating reminder and source of personal connection. Conclusions Smart‐messaging may be an easily integrated telehealth intervention to improve MBCT for cancer patients.
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Affiliation(s)
- Chloe Wells
- Department of PsychologyNottingham Trent UniversityNottinghamUK
| | - Sam Malins
- Institute of Mental HealthUniversity of NottinghamNottinghamUK
- Specialist ServicesNottinghamshire Healthcare NHS Foundation TrustNottinghamshireUK
| | - Simon Clarke
- Department of PsychologyNottingham Trent UniversityNottinghamUK
| | | | - Sanchia Biswas
- Specialist ServicesNottinghamshire Healthcare NHS Foundation TrustNottinghamshireUK
| | - Tim Sweeney
- Specialist ServicesNottinghamshire Healthcare NHS Foundation TrustNottinghamshireUK
| | | | - Jo Levene
- Specialist ServicesNottinghamshire Healthcare NHS Foundation TrustNottinghamshireUK
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Nissen ER, O'Connor M, Kaldo V, Højris I, Borre M, Zachariae R, Mehlsen M. Internet-delivered mindfulness-based cognitive therapy for anxiety and depression in cancer survivors: A randomized controlled trial. Psychooncology 2019; 29:68-75. [PMID: 31600414 PMCID: PMC7004073 DOI: 10.1002/pon.5237] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 01/03/2023]
Abstract
Objective Internet‐delivered interventions may alleviate distress in cancer survivors with limited access to psychological face‐to‐face treatment. In collaboration with a group of cancer survivors, we developed and tested the efficacy of a therapist‐assisted internet‐delivered mindfulness‐based cognitive therapy (iMBCT) program for anxiety and depression in cancer survivors. Methods A total of 1282 cancer survivors were screened for anxiety and depression during their routine oncology follow‐up; eligible breast (n = 137) and prostate cancer (n = 13) survivors were randomized to iMBCT or care‐as‐usual (CAU) wait‐list. Primary outcomes of anxiety and depression were assessed at baseline, 5 weeks, 10 weeks (post intervention), and 6 months. Results Significant effects were found for both anxiety (Cohen's d = 0.45; P = .017) and depressive symptoms (d = 0.42; P = .024) post intervention. The effects were maintained at follow‐up for anxiety (d = 0.40; P = .029), but not for depressive symptoms (d = 0.28; P = .131). Conclusions Our preliminary findings suggest iMBCT to be a helpful intervention for cancer survivors suffering from symptoms of anxiety. Further studies on the efficacy for symptoms of depression are needed.
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Affiliation(s)
- Eva Rames Nissen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Maja O'Connor
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden.,Department of Psychology, Linnaeus University, Växjö, Sweden
| | - Inger Højris
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mimi Mehlsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Bisseling E, Cillessen L, Spinhoven P, Schellekens M, Compen F, van der Lee M, Speckens A. Development of the Therapeutic Alliance and its Association With Internet-Based Mindfulness-Based Cognitive Therapy for Distressed Cancer Patients: Secondary Analysis of a Multicenter Randomized Controlled Trial. J Med Internet Res 2019; 21:e14065. [PMID: 31628791 PMCID: PMC6827984 DOI: 10.2196/14065] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/18/2019] [Accepted: 07/03/2019] [Indexed: 01/20/2023] Open
Abstract
Background Mindfulness-based cognitive therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based MBCT (eMBCT) has been found to be an effective alternative for MBCT. The therapeutic alliance (the bond between therapist and patient,) is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs. Objective This study aimed to (1) explore whether early therapeutic alliance predicts treatment dropout in MBCT or eMBCT, (2) compare the development of the therapeutic alliance during eMBCT and MBCT, and (3) examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at posttreatment in both conditions. Methods This study was part of a multicenter randomized controlled trial (n=245) on the effectiveness of MBCT or eMBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (ie, early therapeutic alliance), week 5, and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale, and mental well-being, measured with the Mental Health Continuum-Short Form. Results The strength of early therapeutic alliance did not predict treatment dropout in MBCT or eMBCT (B=−.39; P=.21). Therapeutic alliance increased over time in both conditions (F2,90=16.46; Wilks λ=0.732; P<.001). This increase did not differ between eMBCT and MBCT (F1,91=0.114; P=.74). Therapeutic alliance at week 2 predicted a decrease in psychological distress (B=−.12; t114=−2.656; P=.01) and an increase in mental well-being (B=.23; t113=2.651; P=.01) at posttreatment. The relationship with reduction of psychological distress differed between treatments: a weaker early therapeutic alliance predicted higher psychological distress at posttreatment in MBCT but not in eMBCT (B=.22; t113=2.261; P=.03). Conclusions A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at posttreatment in both conditions. Interestingly, the strength of therapeutic alliance appeared to be more related to treatment outcome in group-based MBCT than in eMBCT. Trial Registration ClinicalTrials.gov NCT02138513; https://clinicaltrials.gov/ct2/show/NCT02138513
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Affiliation(s)
- Else Bisseling
- Radboudumc for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Linda Cillessen
- Radboudumc for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Melanie Schellekens
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, Netherlands
| | - Félix Compen
- Radboudumc for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marije van der Lee
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, Netherlands
| | - Anne Speckens
- Radboudumc for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
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Cillessen L, Johannsen M, Speckens AEM, Zachariae R. Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials. Psychooncology 2019; 28:2257-2269. [PMID: 31464026 PMCID: PMC6916350 DOI: 10.1002/pon.5214] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Mindfulness-based interventions (MBIs) are increasingly used within psycho-oncology. Since the publication of the most recent comprehensive meta-analysis on MBIs in cancer in 2012, the number of published trials has more than doubled. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), testing the efficacy of MBIs on measures of psychological distress (primary outcome) and other health outcomes in cancer patients and survivors. METHODS Two authors conducted independent literature searches in electronic databases from first available date to 10 October 2018, selected eligible studies, extracted data for meta-analysis, and evaluated risk of bias. RESULTS Twenty-nine independent RCTs (reported in 38 papers) with 3274 participants were included. Small and statistically significant pooled effects of MBIs on combined measures of psychological distress were found at post-intervention (Hedges's g = 0.32; 95%CI: 0.22-0.41; P < .001) and follow-up (g = 0.19; 95%CI: 0.07-0.30; P < .002). Statistically significant effects were also found at either post-intervention or follow-up for a range of self-reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain (g: 0.20 to 0.51; p: <.001 to.047). Larger effects of MBIs on psychological distress were found in studies (a) adhering to the original MBI manuals, (b) with younger patients, (c) with passive control conditions, and (d) shorter time to follow-up. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post-intervention. CONCLUSIONS MBIs appear efficacious in reducing psychological distress and other symptoms in cancer patients and survivors. However, many of the effects were of small magnitude, suggesting a need for intervention optimization research.
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Affiliation(s)
- Linda Cillessen
- Center for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Maja Johannsen
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Anne E M Speckens
- Center for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Molefi-Youri W. Is there a role for mindfulness-based interventions (here defined as MBCT and MBSR) in facilitating optimal psychological adjustment in the menopause? Post Reprod Health 2019; 25:143-149. [PMID: 30880559 DOI: 10.1177/2053369119835964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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