Mindfulness Based Breast Cancer Management: Review Study
Farahbakhsh K1, Mokri Vala M2*
1 Associated Professor, Psychology Department, Allameh Tabataba'i University, Tehran, Iran.
2 PhD, Psychology Department, Allameh Tabataba'i University, Tehran, Iran.
Mehrnoush Mokri vala, PhD,
Psychology Department, Allameh Tabataba'i University, Tehran, Iran.
Received: October 26, 2016; Accepted: November 04, 2016; Published: November 07, 2016
Citation: Farahbakhsh K, Mokri Vala M (2016) Mindfulness Based Breast Cancer Management: Review Study. Int J Chronic Dis Ther. 2(6), 48-47.
Copyright: Mokri Vala M© 2016. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Background & Aim: Breast cancer are involved with physiological, psychological, pathological, cultural and even social factors therefore for breast cancer management a comprehensive assessment and an individualized plan should be provided. This review attempted to illustrate the present evidence supporting mindfulness based methodologies and therapeutic approaches, and demonstrate the process of interventions for breast cancer pain syndrome.
Methods: This study included all indexed studies during last 10 years. We searched MEDLINE, CINAHL, PsycINFO, Cochrane, SID and Magiran from 2006 through April 2016. We included prospective, controlled health care intervention studies of female with breast cancer populations, focusing on pain.
Results: Eight studies met the inclusion criteria mostly focused on mindfulness-based therapies. This systematic review found some evidence for the effectiveness of mindfulness based stress reduction in improving psychological health such as quality of life, stress, anxiety, depression, anxiety, social support, unhappiness etc.
Conclusion: We found moderate strength of supports in case of effectiveness of mindfulness interventions, particularly mindfulness based stress reduction that introduced as third view therapies.
5.Discussion and Conclusion
Breast Cancer; Pain; Psychology; Mindfulness.
Breast cancer is a heterogeneous disease with a number of factors that influence the prognosis and chance for cure . In Iran the economic burden of breast cancer is US$ 947,374,468. Most of the cost (77%) pertained to the productivity lost due to breast cancer deaths and the direct medical cost accounted for 18.56% of the estimated total cost . Similar to other developing countries, the incidence rate of breast cancer has increased in Iran in recent years and it is the most common cancer in women .
In breast cancer, assessment can identify concurrent psychological symptoms such as depression  or anxiety  as well as the psychosocial sequelae of pain including fear , insomnia , or agitation . Therefore, the treatment of cancer pain inherently requires psycho as well as physical therapies.
Despite the importance of pain management, the patients and physicians are going through common available method of using medications which results to many side effects and more complications in treatment process . Chemotherapy found to be associated with nausea, vomiting, hair loss, cognitive dysfunction, fatigue, changes in sexual functioning and reductions in quality-oflife ratings . On the other hand, experienced physicians faced frequently with breast cancer patients who presents pain without any physical sign or reason. While some other are adjusted quickly with cancer pain breast cancer consequences . Hence, more non aggressive ways for managing breast cancer are needed . Psychosocial interventions are aimed at enhancing a sense of control over the pain or underlying disease. Breathing exercises, relaxation, imagery, hypnosis, and other behavioral therapies can be very useful. Among different recent psychotherapy approaches, mindfulness-based stress reduction (MBSR) seems to be especially effective for a variety of psychosocial cancer symptoms such as stress, depression, anxiety, and reduced quality of life [13-15]. Mindfulness based therapies is designed to help people avoid habitual negative thoughts, emotions and behavioural patterns. Instead, increased awareness and acceptance is seen as allowing for new ways to respond and cope both in relation to oneself and the wider world. Mindfulness training has been linked to changes in areas of the brain responsible for affect regulation, and to stress impulses reactions; in turn, these changes influence body functions .
Some reviews already conducted in term of cancer management indeed previous reviews addressed general cancer populations. This study specifically addressed breast cancer populations, complications such as breast loosing, body image, self-confidence, depression and anxiety is more common. Such patients frequently have multiple coexisting symptoms and other sources of suffering; thus, the effects of interventions on pain outcomes may differ in this population. Consequently, we conducted a systematic review to evaluate the effectiveness of acceptance-based interventions targeting pain in patients with breast cancer.
We searched PubMed, Scopus, google scholar, MEDLINE, CINAHL, PsycINFO, Cochrane, SID and Magiran from 2009 through April 2016 additional studies from reference lists of eligible articles and relevant systematic reviews, as part of an review of interventions for pain management among patients with breast cancer.
We included randomized and non-randomized studies with control group that included a majority of breast cancer patients with acceptance-based therapies. The author screened the abstract and then at the full article level for eligibility (Figure 1). Abstracted data from included articles, abstracted information on population characteristics, study design, setting, description of interventions, types of interventions used, study outcomes, including pain related out comes and study statistics. We did not conduct meta-analysis because the reporting of outcomes was too heterogeneous to allow for quantitative synthesis.
Studies of mindfulness-based interventions that were clearly different from the original MBSR or MBCT programs, such as mindfulness-based exercise orart therapy were excluded, but variations of the MBSR or MBCT programs, such as those of program length,frequency, or duration did not hinder inclusion. Studies that included patients with a diagnosis of breast cancer regardless of current treatment status were selected, but studies that included heterogeneous cancer populations were excluded.
We screened 315 titles and abstracts and 177 articles; 46 met the criteria for full review. Of these 46 articles, 8 met all the inclusion criteria for health care interventions targeting pain in patients with breast cancer (Figure 1).
The 10 included studies spanned the years 2007 to 2015. The median sample size was 116.5 patients (range 16-271; Table 1). In all, eight studies examined breast cancer populations. 28 Mean age of study participants, by study, ranged from 50 years to approximately 66 years. Of 8 study 5 targeted to examine the effectiveness of mindfulness based intervention on stress, one included coping styles, 6 of them targeted depression, five considered anxiety, in 6 study quality of life was main variable, in two studies social support assessed in pre and post intervention. All studies were randomized-controlled trials (RCTs).
Discussion and Conclusion
The field of psychosocial oncology has advanced over the past 2 decades, with a strong body of evidence supporting the efficacy of cognitive-behavioral interventions. Social workers and psychologists are skilled in the assessment of psychological needs and selection of coping strategies . The management of symptoms in women with breast cancer is challenging and is frequently made even more so by the potentially psychological related complications . Although some women with breast cancer can live for long periods. Maintaining the highest quality of life while optimizing disease control should be the mainstay of care .
This systematic review found some evidence for the effectiveness of mindfulness based stress reduction in improving psychological health such as quality of life, stress, anxiety, depression, anxiety, social support, unhappiness etc. in breast cancer patients, although the evidence was limited by incomplete reporting and shortcomings in the methodology specially in explanation of techniques and underlying mechanisms of them. Rarely authors paid attention on reason of efficacy of the therapy. In addition, mostly in studies breast cancer patients of different stages considered as a same group while the patients quality of life and pain level extremely affected by illness stage. As previous reviews also mentioned no study reported adverse events, and reasons for dropouts were poorly reported. Those findings are unsatisfying, because safety is a major focus in the evaluation of therapies .
The existing data are promising, but further and more rigorous research is needed before the evidence for mindfulness in supportive breast cancer treatment can be conclusively judged.
- Irvin W, Muss HB, Mayer DK (2011) Symptom management in metastatic breast cancer. Oncologist. 16(9): 1203-1214.
- Daroudi R, Sari AA, Nahvijou A, Kalaghchi B, Najafi M, et al., (2015) The Economic Burden of Breast Cancer in Iran. Iran J public Health. 44(9): 1225-1233.
- Harirchi I, Kolahdoozan S, Karbakhsh M, Chegini N, Mohseni SM, et al., (2011) Twenty years of breast cancer in iran: Downstaging without a formal screening program. Ann Oncol. 22( 1): 93–97.
- De Medeiros MC, Veiga DF, Sabino Neto M, Abla LE, Juliano Y, et al., (2010) Depression and conservative surgery for breast cancer. Clinics. 65(12):1291-1294.
- Baqutayan SM (2012) The effect of anxiety on breast cancer patients. Indian J psychol Med. 34(2):119-123.
- Reyes-Gibby CC, Anderson KO, Morrow PK, Shete S, Hassan S (2012) Depressive symptoms and health-related quality of life in breast cancer survivors. J Women's Health. 21(3): 311-318.
- Fiorentino L, Ancoli-Israel S (2006) Insomnia and its treatment in women with breast cancer. Sleep Med Rev. 10(6): 419-429.
- Holland AJ, Davidson PW, Prasher VP, Janicki MP (2008) Assessment of Behavioral and Psychiatric Disorders. Mental Health, Intellectual Disabilities and the Aging Process. 15: 38.
- Savard J, Ivers H, Savard MH, Morin CM (2015) Cancer treatments and their side effects are associated with aggravation of insomnia: Results of a longitudinal study. Cancer. 121(10):1703-11.
- Kayl AE, Meyers CA (2006) Side-effects of chemotherapy and quality of life in ovarian and breast cancer patients. Current Opinion in Obstetrics and Gynecology. 18(1): 24-28.
- Asghari Moghadam MA, Karimzadeh N, Amarlou P (2005) The role of cancer pain coping with cancer adjustment. J Behav. 12(13 ): 1- 22.
- Satija A, Ahmed SM, Gupta R, Ahmed A, Rana SP, et al., (2014) Breast cancer pain management-A review of current & novel therapies. Indian J Med Res. 139(2): 216-225.
- Ledesma D, Kumano H (2009) Mindfulness-based stress reduction and cancer: a meta-analysis. Psychooncology. 18(6): 571–579.
- Musial F, Büssing A, Heusser P, Choi KE, Ostermann T (2011) Mindfulness- based stress reduction for integrative cancer care: a summary of evidence. Forsch Komplementmed.18(4):192–202.
- Shennan C, Payne S, Fenlon D (2011) What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psych oncology. 20(7): 681–697.
- De Vibe M, Solhaug I, Tyssen R, Friborg O, Rosenvinge JH, et., (2013) Mindfulness training for stress management: a randomized controlled study of medical and psychology students. BMC Med Educ. 13(1): 1.
- Situ D, Wang J, Shao W, Zhu ZH (2011) Assessment and treatment of cancer pain: from Western to Eastern. Ann palliative Med. 1(1): 32-44.
- Henderson VP, Clemow L, Massion AO, Hurley TG, Druker S, et al., (2012) The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial. Breast Cancer Res Treat. 131(1): 99-109.
- Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, et al., (2013) A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 12(5): 404-413.
- Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, et al., (2013) Randomized controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 31(25): 3119-3126.
- Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, et al., (2010) Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 29(2): 107-117.
- Sharplin GR, Jones SB, Hancock B, Knott VE, Bowden JA, et al., (2010) Mindfulness-based cognitive therapy: an efficacious community-based group intervention for depression and anxiety in a sample of cancer patients.Med J Aust. 193(5): S79-s82.
- Lengacher CA, Johnson‐Mallard V, Post‐White J, Moscoso MS, Jacobsen PB, et al., (2009) Randomized controlled trial of mindfulness‐based stress reduction (MBSR) for survivors of breast cancer. Psycho‐Oncology. 18(12):1261-1272.
- Lengacher CA, Kip KE, Post-White J, Fitzgerald S, Newton C, et al., (2011) Lymphocyte recovery after breast cancer treatment and mindfulness-based stress reduction (MBSR) therapy. Biol Res Nurs. 15(1): 37-47.
- Foley E, Baillie A, Huxter M, Price M, Sinclair E (2010) Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: a randomized controlled trial. J Consult Clin Psychol. 78(1): 72-79.
- Carlson LE, Beattie TL, Giese‐Davis J, Faris P, Tamagawa R, et al., (2015) Mindfulness‐based cancer recovery and supportive‐expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors.Cancer. 121(3): 476-84.
- Paice JA1, Ferrell B (2011) The management of cancer pain. CA Cancer J Clin. 61(3):157-182.
- Hickey M, Peate M, Saunders CM, Friedlander M (2009) Breast cancer in young women and its impact on reproductive function. Hum Reprod Update. 15(3): 323-339.
- Cramer H, Lauche R, Paul A, Dobos G (2012) Mindfulness-based stress reduction for breast cancer - a systematic review and meta-analysis. Curr Oncol. 9(5): e343-e352.