Meditation

To evaluate the effects of mediation group classes on patient and caregiver self-reported symptoms

This was an observational pilot that studied participants (patients and their caregivers) attending any of the three mediation group classes offered at a comprehensive cancer center. Classes were based on Tibetan mind-body mediation tradition, and spanned either 60 or 90 minutes in length, depending on type of class—power breath, sacred sounds, or movement and breath. Instructors of each mediation class consisted of mind-body therapists with at least five years of oncology experience. Participants completed a pre- and post-class Edmonton Symptom Assessment Scale (ESAS). Because participants could attend more than one meditation class, only data from the first visit of the 142 participants was examined. Data obtained from the ESAS was used to analyze symptoms individually and as subscales.

• N =142 (76 patients and 66 caregivers)   
• MEAN AGE: For patients: 57.5 years; for caregivers: 57.6 years
• MALES: Patients: 19.7%; caregivers: 22.7%  
• FEMALES: Patients: 80.3%; caregivers: 77.3%
• CURRENT TREATMENT: Participants spanned cancer continuum from prevention, active treatment, survivorship, or living with advanced cancer
• KEY DISEASE CHARACTERISTICS: Patient diagnoses included: breast (38.2%), hematologic (10.5%), skin (10.5%), thoracic/head and neck (9.2%), gastrointestinal (6.6%), gynecological (6.6%), and other (18.4%). Cancer staging included: local (56.6%), advanced (15.8%), and unstaged (27.6%)

• SITE: Single site   
• SETTING TYPE: Not specified    
• LOCATION: MD Anderson Cancer Center (Houston, Texas)

PHASE OF CARE: Multiple phases of care

Observational pilot that analyzed self-reported symptom information from patients and caregivers attending medication classes offered at a comprehensive cancer center between May and December 2015

ESAS was completed by participants before and after classes. Symptoms of the ESAS were analyzed both globally (subscales) and individually. ESAS subscales were scored as follows:

1. Global Distress Score (GDS) as sum of pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, sense of well-being and shortness of breath (0-90)
2. Physical Distress Score (PHS) as sum of pain, fatigue, nausea, drowsiness, appetite, and shortness of breath (0-60)
3. Psychological Distress Score (PSS) as sum of depression and anxiety (0-20)

Clinically significant reduction of an individual symptom was defined as > 1; for ESAS global distress score (GDS) > 3; for physical distress score (PHS) > 2; for psychological distress score (PSS) > 2. Higher scores represented worse outcomes for the stated symptom or subscale.

For all participants there was a clinically and statistically significant decrease (improvement) in symptom of shortness of breath (mean = -1.2; p = 0.001), global distress (-5.17, p < 0.0001), fatigue (-1.34, p < 0.0001), anxiety (-1.26, p < 0.001). For patients, there was clinically significant improvement in dyspnea (mean = -1.12; p = 0.013). No clinically significant symptom change was observed when comparing class duration (60- versus 90-minute class). There was no clinically significant difference in participant symptom burden at baseline or in score reduction by group, or by attendance of one versus two or more classes.

Group mediation class, when used in conjunction to standard of therapy, shows a possible subjective improvement in shortness of breath, global distress, well-being, fatigue, and anxiety in the oncology population, but more research is warranted.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition)
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: A limitation to the use of mediation classes for symptom reduction in the oncology population is the need/cost for training such techniques as described in the study. The instructors of the meditation classes described in this study were mind-body practitioners with at least five years of oncology experience, and the institution already had a long-established integrative medicine program that was offered to patients on a rolling basis as part of standard of care by clinicians. Generalizability of the population is limited because of the fact that participants were self-selected and not randomized to meditation class. Also limiting generalizability was the fact that participants were of variable staging, cancer diagnoses, care spectrum, and caregivers. There was also no account for participants who may have attended a meditation class prior to the study period or engage in self-practice. For self-reported symptoms, the longitudinal effects of attending regular meditation class has not been examined. Assessments were immediately pre- and post-intervention, so it is unknown if there are any long-term benefits of meditation in this population.

Further research on the long-term effects and continued use of group meditation on shortness of breath is warranted.