by Pam Harrison
May 24, 2011 (Washington, DC) — Group sessions during which cancer survivors are taught meditation, mindful yoga, and communication techniques significantly improve psychological symptoms and quality of life (QoL), especially among breast cancer survivors.
Ruth Lerman, MD, from William Beaumont Hospital in Royal Oak, Michigan, and her colleagues conducted a study in which female cancer survivors were randomized to attend weekly 2-hour classes for 8 weeks plus a single 4-hour weekend retreat or were wait-listed (control group). She presented the findings here at the American Society of Breast Surgeons 12th Annual Meeting.
The intervention group significantly improved on all psychological and QoL measures assessed, compared with the control group.
Mindfulness studies have been done before in cancer survivors, but few randomized controlled trials have been done in the same population, Dr. Lerman noted.
“All participants benefited, but breast cancer patients showed the strongest improvement, possibly because they felt the most significance from doing the segment on self-awareness and breast exam, or perhaps because so many others had the same illness and this decreased their sense of isolation,” Dr. Lerman said. “I think it is important for physicians to inquire about QoL and symptoms, even as patients get further away from diagnosis and treatment, and to make appropriate referrals.”
In the study, 77 patients were randomized — 53 to the intervention group and 24 to the control group. Approximately 71% of the women were breast cancer survivors, but the 2 groups did not differ by cancer type. The mean age was approximately 58 years and, on average, patients were about 4 years out from their diagnosis. Forty-eight patients completed the 8-week intervention, and 20 patients in the control group completed the study.
All subjects were evaluated using standardized instruments. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) was used to evaluate QoL; the Symptoms of Stress Inventory (SOSI) was used to evaluate multiple domains of stress, and the Symptoms Checklist (SCL-90-R) was used to evaluate multiple psychological symptoms.
“Patients were taught 3 forms of meditation, mindful yoga, and mindful communication techniques,” Dr. Lerman explained. “In the first 6 weeks, they were taken through a structured personal sharing experience; in the seventh week, they were taught mindful breast self-exam awareness techniques; and in the last week, there was a discussion about body image and sexuality.”
In addition to the classes, participants were encouraged to practice 45 minutes of daily meditation or yoga, or both, and to record daily logs of their practice.
Compared with the control group, patients in the intervention group showed a significant improvement on the SCL-90-R (P = .013), with an effect size of 0.373, which is considered a moderate effect size. “Quality of life for the [intervention] group was P = .005 in terms of significance, and the breast cancer subgroup had an even stronger significance (P = .001),” Dr. Lerman said. All domains in symptoms of stress improved in the intervention group, with 6 of 8 subscales (measured on the SOSI) achieving significance (P ≤ .049).
In contrast, changes observed in the control group did not achieve statistical significance on any of the parameters measured.
|SOSI||Muscle Tension||0.551 (moderate)|
Some Improvement in Control Group
As Dr. Lerman noted, there might have been a greater difference in changes in the 2 groups had they not used wait-list patients as the control group. “Wait-list control patients start to get benefit already. Just knowing that they will be doing this program soon and just knowing that some sort of help is coming might improve their scores,” she said. She also felt it was “notable” that patients continued to experience enough distress years after treatment to come and sign up for what was a “pretty demanding” program.
“We had an 87% attendance rate and the average practice monitored by the log patients kept was 30 minutes a day, which I thought was pretty good,” Dr. Lerman said.
Session cochair Sheldon Feldman, MD, from Columbia University in New York City, told Medscape Medical News that there is an “absolutely huge need” for cancer survivor interventions, and that survivorship research was extremely important. “We have about 3 million breast cancer survivors living in the United States today. We have a large population of survivors, some of whom continue to have very significant symptoms related to their breast cancer diagnosis and treatment.
The intervention assessed by Dr. Lerman and her team was “well constructed,” and the study was done in an appropriately controlled way, Dr. Feldman noted.
“What they showed was that patients taught mindfulness meditation and yoga had tremendous benefit from the program, with significant reductions in anxiety and improved QoL. Wellness survivorship programs are underfunded, but there are opportunities for some women to do this on their own, depending on where they live.”
Reprint from MedScape