Mind-Body Medicine

Mind-Body Medicine

PEP Topic 
Fatigue
Description 

Mind-body medicine involves interventions that incorporate approaches to improve health and well-being with combined physiologic and psychological approaches. That combination can take multiple forms and combine a variety of psychological and mental disciplines with nutrition, activity, medications, and more. General mind-body medicine that combined such aspects as stress-reduction techniques, meditation, cognitive-behavioral approaches, yoga, and guided imagery, as well as physical activity and nutrition, has been studied for its effect on fatigue.

Effectiveness Not Established

Research Evidence Summaries

Appling, S. E., Scarvalone, S., MacDonald, R., McBeth, M., & Helzlsouer, K. J. (2012). Fatigue in breast cancer survivors: the impact of a mind-body medicine intervention. Oncology Nursing Forum, 39, 278–286.

doi: 10.1188/12.ONF.278-286
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Study Purpose:

To evaluate a group-based mind-body medicine (MBM) program for its impact on fatigue persisting at least six months beyond completion of adjuvant radiation or chemotherapy treatment among breast cancer survivors.

Intervention Characteristics/Basic Study Process:

A 10-week multimodal intervention was developed and pilot tested to address the needs of patients with breast cancer. Ten 1.5- to 2-hour weekly group sessions were held, with five to 10 breast cancer survivors per group. Techniques for cognitive restructuring, exercise, positive psychology and spirituality, yoga, nutrition, and alternative or complementary therapies were introduced sequentially at weekly intervals. Fatigue and mood were measured at baseline, the end of the intervention period, and two and six months postintervention.

Sample Characteristics:

  • The study included 68 women with stage I to III breast cancer; seven patients dropped out, which left 61 patients available for evaluation.
  • Age distribution and mean were not reported in the body of the article. A mean age of 56.8 years was reported in the abstract only.
  • Of the patients, 49% were Caucasian, 39% were married, and 30% had a body mass index  (BMI) greater than 30 kg/m2.
  • Mean time posttreatment was 2.6 years.
  • Patients were included if they
    • Were women aged 18 years and older
    • Had stage I to III breast cancer diagnosed within the past five years
    • Were currently disease-free
    • Were at least six months post-adjuvant therapy, with the exception of hormone therapy with trastuzumab
    • Had moderate-to-severe fatigue (measured by Short Form 36 [SF-36] vitality and fatigue subscale).
  • The Physical Activity Readiness Questionnaire (PAR-Q) screening tool was used to determine the ability of patients to participate in the exercise component; no activity restrictions were identified.

Setting:

The intervention was held at two sites in Maryland:  an urban community hospital and a semi-rural county health department.

Phase of Care and Clinical Applications:

  • Patients were undergoing the long-term follow-up phase of care.
  • The study has clinical applicability for late effects and survivorship.

Study Design:

The study followed a quasiexperimental, pre-/posttest design.

Measurement Instruments/Methods:

  • PAR-Q
  • Piper Fatigue Scale (PFS)
  • 10-cm visual analog scale (VAS)
  • Vitality subscale of the SF-36
     

Results:

  • Outcomes were assessed through self-administered questionnaires at the final session, and subsequently at two and six months following the final session. 
  • Improvement was noted by all three measures; fatigue decreased and vitality and energy increased significantly from baseline to the end of the program, and additional improvement was observed at two and six months following the intervention. 
  • The authors stated that “steady week-to-week improvements" in fatigue supported that the change in fatigue was a result of the intervention; however, they did not measure fatigue on a week-to-week basis.
  • Fatigue scores decreased by 40% at six months after completion of the 10-week program (p < 0.001 for both PFS and VAS). 
  • SF-36 vitality subscores increased by 6% (p < 0.001). 
  • Mood (VAS) improved parallel to the decrease in fatigue symptoms, with a 24% sustained improvement at six months compared to baseline scores (p < 0.004).
  • Adjustments for covariates did not alter the results.

Limitations:

  • The study had a small sample size, with less than 100 patients.
  • Multimodal interventions have potential for numerous confounding variables and lack of control for variations within the intervention. 
  • The question remains as to whether time is all that is required post-adjuvant treatment in the resolution of fatigue among breast cancer survivors. However, patients in this study completed adjuvant therapy an average of 2.6 years prior to the study, had persistent fatigue, and showed a marked improvement in fatigue scores (self-reported outcomes) measured over a 10-week period without additional intervention (if patients actually implemented any of the recommendations for exercise, nutrition, yoga, etc., then it was an additional intervention other than the group sessions. The authors did not measure adherence to these recommendations, which could have impacted the outcome of fatigue).
  • Comparison to other studies using a similar approach is difficult given the lack of extensive evaluation of multipronged interventions.
     

Nursing Implications:

Randomized, controlled studies should be conducted to confirm the efficacy of this program intervention. Nurses and interdisciplinary team members may help breast cancer survivors to reduce persistent fatigue through a multipronged programmatic approach focusing on stress reduction, cognitive-behavioral techniques to achieve positive change, nutrition, and physical activity.


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