PEP Topic 
Cognitive Impairment

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.

Effectiveness Not Established

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.

doi: 10.1002/pon.3296

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%


  • 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)


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.


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.


  • 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.