Branstrom, R., Kvillemo, P., & Moskowitz, J.T. (2012). A randomized study of the effects of mindfulness training on psychological well-being and symptoms of stress in patients treated for cancer at 6-month follow-up. International Journal of Behavioral Medicine, 19, 535–542. 

To report the six-month follow-up effects of a mindfulness stress reduction training program on perceived stress, depression, anxiety, post-traumatic stress symptoms, positive states of mind coping, self-efficacy, and mindfulness among patients treated for cancer

Patients with a previous cancer diagnosis were recruited and randomized into an intervention group or a waiting list control group. Questionnaires were sent to participants directly by mail after randomization at three and six months. The waiting list participants were scheduled to participate in the intervention program after six months. The intervention involved eight-week, two-hour, weekly sessions of mindfulness training. The sessions consisted of experiential and group exercises. The training was an adaptation of the Jon Kabat-Zinn program of mindfulness-based stress reduction (MBSR) from the Stress Reduction and Relaxation Clinic at the Massachusetts Medical center in Shrewsbury. For details of the program, the authors refer to a previous publication.

• N = 71  
• MEAN AGE = 51.8 years (SD = 30–65 years)
• MALES: 1, FEMALES: 70
• KEY DISEASE CHARACTERISTICS: Study was open to patients with varying cancer diagnoses who were not undergoing current radiation or chemotherapy treatment. Fifty-four patients had been treated for breast cancer, 10 for gynecological cancer, five for lymphatic cancer, one for pancreatic cancer, and one for neck cancer.
• OTHER KEY SAMPLE CHARACTERISTICS: Ten patients were diagnosed within the last year, 39 within one to two years, and 22 more than two years ago. Thirty-nine patients had a bachelor’s degree and 30 had full- or part-time employment. Twenty-three participants used antidepressants.

• SITE: Not stated/unknown    
• SETTING TYPE: Outpatient    
• LOCATION: Stockhom, Sweden

• PHASE OF CARE: Transition phase after active treatment
• APPLICATIONS: Elder care

Randomized, controlled intervention and wait-list groups; random selection of participants was done consecutively using a random sequence of numbers indicating group assignment

• The SPSS software’s random selection was used for the sequence of numbers.
• Power calculations were conducted to decide the adequate number of participants.
• Perceived Stress Scale (PSS)
• Hospital Anxiety and Depression Scale (HADS)
• Impact of Event Scale Revised (IES-R)
• Positive States of Minds (PSOM)
• Coping Self-Efficacy Scale (CSES)
• Five-Facet Mindfulness Questionnaire (FFMQ)
• Meditation practice: The frequency of meditation practice before and during the study period was assessed with one question.  
• The intervention effect was analyzed using multivariate repeated measure analysis of covariance (MANCOVA).

Compared to participants in the control group, the intervention group showed a larger increase in mindfulness at the six-month follow-up. There were no differences in any other outcomes between the intervention and control groups. 60% of the participants reported regular meditation practice during the intervention period. Continued meditation practice was associated with a significant reduction in post-traumatic stress symptoms of avoidance. Change in psychological distress, positive states of mind, and coping self-efficacy did not show any significant differences between the control and intervention group. There were trends in a greater reduction of perceived stress. There was a significant change in the intervention group reporting increases in mindfulness. Postintervention, 38% of the participants in the intervention group continued to meditate regularly. Those in the intervention group who continued to mediate regularly after the intervention had a significant reduction in post-traumatic avoidance symptoms at the six-month follow-up (t = 2.5, p < .5). No other significant intervention effects on psychological outcomes were found.

The study indicates the need to better understand the mechanism behind the effects of MBSR and the potential modification of mindfulness interventions to promote a sustained benefit over time. Future studies should examine the potential of additional intervention tools to encourage postintervention meditation practice. The short-term positive effects of mindfulness training and the particular time when mindfulness intervention might have the most positive effects should be further studied.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (sample characteristics)
• Key sample group differences that could influence results
• Findings not generalizable
• Subject withdrawals ≥ 10%
• Other limitations/explanation: Many measurement tools

The lack of sustained, positive effects from mindfulness training suggests that booster sessions or tools for increasing postintervention adherence to mindfulness practice would be beneficial. Assisting patients in integrating mindfulness training into everyday life would benefit patients as the increased dispositional level of mindfulness moderates the influence of stress on both depression and perceived health.