Effectiveness Not Established

Meditation

for Sleep-Wake Disturbances

Meditation refers to a variety of practices to focus the mind and increase awareness. A person who is meditating may use certain techniques, such as specific postures and attention to breathing. Meditation has been examined as a way to address anxiety, cognitive impairment, depression, sleep-wake disturbances, and fatigue in patients with cancer. It has also been examined as a way to address caregiver strain and burden.

Research Evidence Summaries

Milbury, K., Chaoul, A., Biegler, K., Wangyal, T., Spelman, A., Meyers, C.A., . . . Cohen, L. (2013). Tibetan sound meditation for cognitive dysfunction: Results of a randomized controlled pilot trial. Psycho-Oncology.

Study Purpose

Test the effect of Tibetan sound meditation on cognitive function

Intervention Characteristics/Basic Study Process

Patients randomly were assigned to the treatment group or a wait list control group. The intervention consisted of 12 meditation sessions that were 60 minutes long and incorporated instructions on developing breathing, awareness, and concentration skills, as well as visualization maneuvers. The intervention was offered twice a week over six weeks. A CD recording and printed materials were provided to the participants with the expectation that they practice the intervention independently at home. Objective and subjective outcome measures were evaluated at baseline and one month after completion of the intervention. Subjective measures also were completed during the last week of the intervention. Class attendance and participant satisfaction were tracked to measure the feasibility of the intervention program.

Sample Characteristics

  • N = 42 (18/24)  
  • MEAN AGE = 53.6 years
  • MALES: 0%, FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: All subjects had breast cancer, had received chemotherapy 6–60 months prior to study participation, and were on hormonal therapy at the time of enrollment.
  • EDUCATION: Some college or higher: 95.6%, TSM: 74.9%

Setting

  • SITE: Single-site  
  • SETTING TYPE: Outpatient  
  • LOCATION: MD Anderson Cancer Center

Phase of Care and Clinical Applications

  • PHASE OF CARE: Late effects and survivorship
  • APPLICATIONS: Late effects and survivorship  

Study Design

Randomized clinical trial

Measurement Instruments/Methods

  • Digit span test
  • Digit symbol test
  • Controlled Oral Word Association Test
  • Rey Auditory Verbal Learning Test
  • Functional Assessment of Cancer Therapy (FACT)-Cog
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Pittsburgh Sleep Quality Index (PSQI)
  • Brief Fatigue Inventory (BFI)
  • Medical Outcomes Study 36-item (SF-36)
  • Functional Assessment of Chronic Illness Therapy—Spiritual Well-being Scale (FACIT-Sp)

Results

No significant differences were seen between the intervention or control groups in either objective or subjective measures of cognitive function over time. Although significantly less depressive symptoms were found in the treatment group (p = 0.05) during the last week of the intervention, this effect was no longer significant one month later, indicating that the result was not sustainable. No significant differences between groups over time were found for fatigue or sleep-wake disturbances. Although all treatment group participants attended at least 50% of the class sessions, compliance was a variable for both class and individual participation.

Conclusions

Findings from this study do not provide clear support for a significant effect of Tibetan sound meditation on cognitive function, fatigue, or sleep-wake disturbances. However, this intervention may have a limited, short-term effect on decreasing depression.

Limitations

  • Small sample (< 100)
  • Risk of bias (no appropriate attentional control condition)
  • Unintended interventions or applicable interventions not described that would influence results
  • Findings not generalizable
  • Subject withdrawals ≥ 10%
  • Feasibility may be an issue, as evidenced by subject withdrawal prior to the initiation of the intervention (may indicate that the “treatment” is too burdensome) and the variability in overall treatment participation. Generalization of the result to all patients with cancer is not possible due to the population used for the study.

 

Nursing Implications

Although this treatment was not associated with improvements in objective or subjective measures of cognitive function, it was underpowered and lacking consistent patient compliance with the intervention. Further research with larger sample sizes may be warranted to determine effectiveness.

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Yun, M.R., Song, M., Jung, K.H., Yu, B.J., & Lee, K.J. (2017). The effects of mind subtraction meditation on breast cancer survivors' psychological and spiritual well-being and sleep quality: A randomized controlled trial in South Korea. Cancer Nursing, 40, 377–385.

Study Purpose

The purpose was to examine effects of mind subtraction meditation on depression and other aspects of well-being.

Intervention Characteristics/Basic Study Process

Patients were randomized to groups receiving meditation or an active control of self-management education. The meditation group participated in sessions twice weekly for two hours over eight weeks. The first four sessions included self-management education, and full meditation began during the fifth session. Group members were sent texts and emails to encourage home meditation twice per week. The education group had two-hour sessions weekly for four weeks, including information on relationships, communication, managing stress, and comfort. Study assessments were done at baseline and weeks 4 and 8.

Sample Characteristics

  • N = 52; 48 assessed at week 8   
  • AGE: Mean 48.44 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Breast cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Mean time since surgery was 9 months; most had chemotherapy and endocrine therapy.

Setting

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: South Korea

Study Design

RCT with active control

Measurement Instruments/Methods

  • CES-D for depression
  • Beck Anxiety Inventory
  • FACT-Breast – quality of life
  • Satisfaction With Life Scale
  • Pittsburgh Sleep Quality Index – Korean version
  • Posttraumatic Growth Index

Results

There were no differences between groups at week 4. At week 8, there were significant group differences in depression (p = 0.034), perceived stress (p = 0.009), anxiety (p = 0.036), as well as other measures. Before meditation, 90% of those in the meditation group reported sleep problems, and after the intervention, 9.1% reported problems. Evaluation of change in sleep quality showed more in the meditation group reported improvement and none reported worsening sleep quality over the eight-week study period (p = 0.010). Attendance in both groups ranged from 75% to 100% of the sessions.

Conclusions

Participation in meditation resulted in improved symptoms of depression and anxiety and improvement in sleep quality.

Limitations

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Risk of bias (no appropriate attentional control condition)
  • Other limitations/explanation: It is not stated whether sessions were done in a group setting, in which case, group interaction and support could have affected results. The education group received much less attention.

Nursing Implications

Meditation may be beneficial for patients to improve sleep and reduce symptoms of anxiety and depression. Additional evidence beyond this study is needed to evaluate these effects.

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