Meditation

TOTAL REFERENCES RETRIEVED: 1,030 references were retrieved.

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Use the CLEAR = NPT quality checklist. Most studies did not provide the information needed for quality assessment. Sixteen studies had good quality, and 17 had moderate or acceptable quality.

• FINAL NUMBER STUDIES INCLUDED = 40; 36 in meta analysis
• SAMPLE RANGE ACROSS STUDIES: 18–207
• KEY SAMPLE CHARACTERISTICS: Only 3 studies included were done with patients with cancer. Several studies were done with healthy subjects and college students.

PHASE OF CARE: Not provided

Interventions incorporating meditative practices have overall positive effects on mood.

Very few studies included patients with cancer, and the review incorporated findings from normal health controls as well as individuals with various acute and chronic diseases. All types of practices including imagery and those involving movement were considered together. Although there are certainly some similarities in the mental components of many of these practices, it is unclear that they would be routinely viewed as the same. Many studies also included counseling, education, and psychoeducational types of components, which can be expected to confound results.

Findings suggest that in the general population and patients with various types of chronic disease, interventions that involve incorporation of mindfulness and meditative types of practice may be beneficial in reducing anxiety. The application specifically forcancer care is difficult to determine because there were so few studies involving patients with cancer. Nurses can expect that some patients may benefit from meditative practices, and these approaches may be more acceptable to some ethnic groups.

To determine the effects of a mindfulness intervention on anxiety, depression, and spirituality

The intervention involved 30–60-minute cyclic meditation and yoga training with practice at home. In pretherapy sessions, patients learned the cyclic meditation program and were recommended to perform the therapy at home once daily. After two weeks, patients met therapists in a second session to talk about their impressions.

• The study reported on a sample of 28 patients.
• Mean patient age was 60 years (SD = 9.2).
• The sample was 85.7% female and 14.3% male.
• Most patients were diagnosed with breast cancer, with other sites including colon, stomach, and bladder.
• All patients were actively receiving either chemotherapy, radiation, or medication at a general hospital.

• Single site
• Outpatient clinic
• Western Japan

Patients were undergoing the active treatment phase of care.

A pre/post-intervention study design was used.

• Functional Assessment of Chronic Illness Therapy–Spirituality (FACIT-Sp)
• Hospital Anxiety and Depression Scale (HADS)
• Caregiving Consequence Inventory: Selected two items to measure appreciation
• Benefit Finding Scale: Three items to measure growth
• Pain and physical symptoms measured on a 10-point numeric scale

Anxiety (p = 0.01) and depression (p = 0.009) decreased significantly. There was no significant change related to spirituality. Spirituality is correlated with anxiety and depression.

Mindfulness-based cyclic meditation affects anxiety and depression for Japanese patients with cancer and may be effective as an individual short-term therapy.

• The study had a small sample.
• The study did not have a control or comparison group.
• No information was given regarding patients’ adherence to home practice.

This type of intervention may be helpful to some patients to affect anxiety and depression during cancer treatment. The amount of training required for administration of the therapy, as well as therapist time with the patient, suggests that this approach may be feasible.

The intervention was autogenic training (AT), a type of meditation, with mental exercises:

• Heaviness of limbs
• Warmth of limbs
• Calm regular heartbeat
• Easy breathing
• Abdominal warmth
• Cooling of forehead

Measurements were taken at baseline and at the end of two monthly periods. Patients were observed for evidence of meditative state. Group 1 (control) received one home visit, and group II (intervention) received one home visit plus two months of AT intervention.

The study reported on a sample of 31 women with early-stage breast cancer.

A randomized controlled trial design was used.

• Hospital Anxiety and Depression Scale (HADS)
• T and B cell markers
• Unpaired t tests
• Calculations of blood results and HADS scores were made of mean and standard deviation.

Results showed a p value of 0.0027 between groups for anxiety. T and B cell markers remained similar in both groups. The AT group reported improved HADS anxiety levels (t = 2.00, p = 0.092). There was no statistical difference in HADS scores for patients within the group.

• The study had a small sample of women with early-stage breast cancer.
• Specialized education was needed to provide the AT.
• The authors state a limitation may be that only 7 of 16 patients in the experimental group achieved a meditative state.

Investigate the effects of meditation on the symptoms of anxiety, depression, and fatigue in women who were receiving radiation therapy for breast cancer

The intervention group received a total of 12 meditation therapy sessions during its six-week radiation therapy period. The control group received only conventional radiation therapy. The meditation intervention was Brain Wave Vibration meditation, which is based on a Korean traditional exercise, simple movements, music, and positive messages (changing weekly). This focuses on the senses of the body, relaxing the body and mind and relieving negative thoughts through natural rhythmic movements.

• N = 83    
• MEAN AGE = 47 years
• MALES: 0%, FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Female patients with breast cancer undergoing breast conservation and radiation therapy with curative intent
• OTHER KEY SAMPLE CHARACTERISTICS: Primarily married, primarily financially stable, primarily HER-2/neu negative

• SITE: Single site  
• SETTING TYPE: Outpatient  
• LOCATION: Asan Cancer Center, Seoul, Korea

• PHASE OF CARE: Active anti-tumor treatment
• APPLICATIONS: Elder care

Randomized, controlled trial

• Hospital Anxiety and Depression Scale (HADS)
• Revised Piper Fatigue Scale
• The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30

Patients who received meditation therapy saw mild improvements, with a reduction in anxiety and fatigue. Patients in the control group also showed significant reduction in fatigue and anxiety, and post-intervention scores actually were lower for both of these in the control group. No effect was seen for depression.

The study states that an “affirmation” can be made that meditation can be used as a non-invasive intervention for improving fatigue and anxiety. However, results showed significant reductions in these symptoms for patients in the control group as well. This provides minimal support for effectiveness of the approach used here.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Unintended interventions or applicable interventions not described that would influence results
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%
• Korean study, using a Korean meditation technique; likely not generalizable to the United States
• Big impact on time
• Not a billable service; great staff time and training involved
• Unclear whether the meditation was in a group setting or individual; what relation did group dynamics play in a group of patients who may have met together 12 times and formed an effective peer-to-peer support group?
• The study was underpowered by the author's calculations.
• An intent to treat analysis was used, but how this was applied was not stated.

Nurses likely would not have any options of referral to meditation resources. Something more generalizable, like relaxation or mindfulness, would have been a better option for a study. The study is Korean; typically educated Korean women may have had previous exposure to meditation, and the intervention would be more acceptable to them than to American women.

To determine if a mindfulness-based stress reduction (MBSR) intervention is effective in improving psychological and physical status in breast cancer survivors

The intervention was six group sessions of an MBSR program using meditation and body scan techniques. Participants received a training manual and audiotapes to support home practice of various forms of meditation and gentle yoga. The training manual included weekly objectives, exercises, program content, and a daily diary for recording practice activities.

• The study reported on a sample of 82 female patients with breast cancer.
• In terms of age, 40% were younger than 55 years, and 27.4% were older than 65 years; the MBSR group had a significantly larger percentage of younger patients.
• All patients had undergone surgery and received either adjuvant radiation or chemotherapy. Therapy was completed within the prior 18 months.
• Of the sample, 56% were employed; 72.6% were white, non-Hispanic; 78.5% had at least some college level education; and 25% were on medications for depression.

• Single site
• Outpatient setting
• Florida

• Patients were undergoing the transition phase of care after initial treatment.
• The study has clinical applicability for late effects and survivorship.

A randomized controlled trial design was used.

• Concerns About Recurrence Scale – 30 items
• State-Trait Anxiety Inventory – 20 items
• Center for Epidemiologic Studies Depression Scale (CESDS) – 20 items
• Perceived Stress Scale – 10 items assessing how often in the past month life situations were stressful
• Life Orientation Test – 6 items to assess expectancy for positive and negative life outcomes
• Medical Outcomes Study Short Form General Health Survey
• Medical Outcomes Social Support Survey – 19 items

Seventy percent of participants were determined to be compliant with the program. Intervention participants had better mean scores for state anxiety and depression compared to the control group at six weeks (p = 0.004; p = 0.03).

The MBSR program improved psychological distress, fear of recurrence, and quality of life among patients with breast cancer who recently transitioned from active treatment. The extent of practice of MBSR activities appears to influence the overall degree of benefit derived. A large percentage of patients were able to comply with a complex MBSR intervention.

• The study had a limited follow-up period.
• The study design lacked an attentional control.

Whether benefits seen were due to the actual intervention or the supportive aspects of the group was unable to be determined. More than half of eligible patients approached for enrollment declined due to scheduling issues, travel distance, lack of interest, and other issues. This suggests that such a program is limited in application related to these types of issues.

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.

To determine the effectiveness of Tong Len meditation on depression, stress, anxiety, and self-perception of quality of life in a population of patients with cancer.

Tong Len meditation (Tibetan meditation practice), a distant healing compassionate act, was used for three months, three times a week for 15-20 minutes on a group of patients with cancer. The evaluation of the results with the POMS and EQ 5 D questionnaires took place after two months, three months, and one month after treatment cessation.

• N = 77
• MEAN AGE = 57.09
• MALES: 6.8%,FEMALES: 93.2%
• KEY DISEASE CHARACTERISTICS: Mostly patients with breast cancer
• THER KEY SAMPLE CHARACTERISTICS: Patients with psychiatric disorders and patients in advance stage or terminal stage of cancer were excluded

• SITE: Single site
• SETTING TYPE: Not specified
• LOCATION: Bologna, Italy

• PHASE OF CARE: Multiple phases of care

• Double-blind randomized, controlled trial

• Profile of Mood States
• EORTC Quality of Life Core 30 questionnaire

Considering the results of Tong Len meditation on depression, there was a significant improvement (p = 0.003) in the treatment group. As far as the other components, there were no significant differences between treatment and control groups. There was a significant increase in levels of vigor and activity in the control group (p = 0.009). In both groups, there was an increase in self-perceived quality of life, possibly due to a “white lab coat\" effect.

Tong Len meditation does not show statistically significant evidence to support scientific efficacy on depression, anxiety, or stress. It does show an improvement in both groups in self-perceived quality of life and an overall psychological gain, which might reflect a positive \"white lab coat\" effect.

• Small sample (less than 100)
• Risk of bias (sample characteristics)
• Intervention expensive, impractical, or training needs

Although Tong Len meditation might be beneficial to patients with cancer, the results of this study should be interpreted with caution due to limitations, including small sample size, non-homogeneity of tumor pathology, and cancer treatment.

To test the feasibility of a brief self-administered psychological intervention to improve well-being in patients with cancer

The intervention consisted of patient diary and CD meditation for home use with brief telephone support. Patients were requested to record three positive experiences each day in the diary and to plan one enjoyable activity each week and record in the diary. A recorded mindfulness “body scan” (meditation approach) 10 minutes in length was provided to each patient, and he or she was instructed to use this twice a day. Brief telephone contact was made in weeks 1, 2, and 4 to answer questions and encourage continued home practice.

• The study reported on a sample of 46 patients.
• Mean patient age was 60.8 years for women and 72.4 years for men.
• The sample was 47.8% female and 52.2% male.
• Female patients were diagnosed with breast cancer, and male patients were diagnosed with prostate cancer.

• Outpatient setting
• United Kingdom

Patients were undergoing the transition phase of care after initial treatment.

A randomized controlled trial design was used.

• World Health Organization Quality of Life Scale (WHO-QOL-BREF)
• Hospital Anxiety and Depression Scale (HADS)
• Social and Occupational Functional Assessment Scale (SOFAS): Interviewer-rated measure of overall level of functioning
• Life Orientation Test–revised (LOTR): 10-item scale to measure optimism/pessimism
• Ten-Item Personality Inventory (TIPI)

The drop-out rate was almost 50% at the six-week point. Quality of life showed significant improvement at the six-week point (p = 0.046). No other significant differences were identified.

Compliance rates of patients remaining in the study suggest that the approaches used here were easy enough to use and acceptable to them; however, the extremely high drop-out rate suggests that the actual feasibility of this approach for any length of time is questionable.

• The study had a small sample size.
• The study has questionable feasibility due to the high drop-out rate.
• The final sample was too small to detect any significant differences.

This study involved multiple follow-up periods and several self-report questionnaires. The burden of this activity may have contributed to the high drop-out rate.

To evaluate the effects of guided meditation and music on patients’ anxiety, pain, and fatigue during breast biopsy

Patients were randomly assigned to meditation, music, or standard care with supportive dialogue. Patients in the meditation and music groups were given headphones. During the procedure, patients in the meditation group listened to an audio recorded medication designed to help patients relax and focus on feelings of kindness and compassion. The music group listened to their choice of music. The standard care control group received supportive dialogue during the procedure. Biopsies were done with local anesthesia. Study assessments were done pre and post biopsy.

• N = 121   
• MEAN AGE = 52.96 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Patients undergoing breast biopsy. Of these, 30% had previous breast biopsy.  
• OTHER KEY SAMPLE CHARACTERISTICS: The majority were Caucasian. The average education level was 15 years.

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: North Carolina

• PHASE OF CARE: Diagnostic

• Three-group, randomized, controlled trial

• State-Trait Anxiety Inventory (STAI)
• Numeric pain scale (0–10)
• Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)
• Questionnaire on the Quality of Physician-Patient Interaction (QQPPI)
• 11-point numeric scale to assess engagement in the study interventions

Anxiety declined in all groups, while those in the meditation group (p = 0.04) and the music group (p = 0.03) had greater decline in anxiety compared to controls. Fatigue declined in all, with no significant differences between groups. Decline in pain differed among the study groups. The music group had greater increases in pain than the meditation group (p = 0.03), and pain increased in the control group. No difference in pain scores existed between the music and control groups. Overall post-procedure pain scores averaged 1.8.

The study findings suggest that a meditation intervention during biopsy may help to reduce patient anxiety and pain.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Very low pain scores suggest floor effects in measurement.
• Single point in time measurement of anxiety post-procedure—does not determine longer term effects on anxiety

This study showed that listening to a meditation intervention during breast biopsy was associated with lower anxiety postprocedure. This is a low-risk intervention that may be helpful for patients; however, whether this effect would have lasted for any length of time after the procedure is unknown.

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

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.

• 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.

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

RCT with active control

• 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

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.

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

• 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.

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.