Eyles, C., Leydon, G.M., Hoffman, C.J., Copson, E.R., Prescott, P., Chorozoglou, M., & Lewith, G. (2015). Mindfulness for the self-management of fatigue, anxiety, and depression in women with metastatic breast cancer: A mixed methods feasibility study. Integrative Cancer Therapies, 14, 42–56. 

DOI Link

Study Purpose

To determine the feasibility and acceptability of mindfulness-based stress reduction to manage the symptoms of fatigue, anxiety, and depression in women with metastatic breast cancer

Intervention Characteristics/Basic Study Process

An eight-week mindfulness-based (Kabat Zinn) stress reduction course was taught by a trained, experienced instructor. The sessions in weeks 1 and 8 were two and a half hours, and week 2–7 sessions were two hours. Week 6 included a day of mindfulness of four and a half hours. Home practice with CDs 30 minutes a day was recommended. Sessions were done in a group setting.

Sample Characteristics

  • N = 19  
  • AGE RANGE = 37–65 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Metastatic breast cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Mean years since metastatic breast cancer diagnosis was 2.76; Eastern Cooperative Oncology Group (ECOG) Performance scores 0–2; stable disease; life expectancy at least six months

Setting

  • SITE: Single site  
  • SETTING TYPE: Outpatient    
  • LOCATION: Community oncology center, United Kingdom

Phase of Care and Clinical Applications

  • PHASE OF CARE: End-of-life care
  • APPLICATIONS: Palliative care 

Study Design

Mixed method design using qualitative and quantitative data with repeated measures

Measurement Instruments/Methods

Qualitative data consisted of interviews one to two weeks prior to the course and four months after the course. Quantitative data consisted of four questionnaires delivered at five time points: the Brief Fatigue Inventory (BFI), the Hospital Anxiety and Depression Scale (HADS), the EuroQol Quality of Life-5 Dimensions, and the Toronto Mindfulness Scale (TMS) at baseline and at weeks 4, 8, 15, and 24. Quantitative data consisted of one questionnaire at two time points: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) at baseline and at week 24.

Results

The qualitative data showed themes of barriers to participation and recruitment challenges, acceptability, and benefits as well as acceptability and challenges. For the quantitative data, improvement was noted in depression (p = 0.044), cognitive functioning (p = 0.015), quality of life, insomnia (p = 0.007), and anxiety (p = 0.000). However, this could not be correlated with an increase in mindfulness as measured. A large number of patients declined to participate because of their level of illness, and one patient dropped out because of increased illness. There was no significant change in fatigue. There was very high variability in change scores.

Conclusions

A group mindfulness-based stress reduction intervention appeared feasible for patients with stable advanced cancer. However, the intervention as used here was time intensive. This type of intervention may be helpful in dealing with some symptoms in patients with advanced disease.

Limitations

  • Small sample (< 30)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Intervention expensive, impractical, or training needs
  • Other limitations/explanation: Cost to train mindfulness instructors; time commitment for patients; repeated measures design raises the question of potential testing effect as the same instruments were used repeatedly; no control comparison or attention control study design, so it is impossible to tell how much of the changes seen in anxiety and depression were due to the group interaction rather than the intervention

Nursing Implications

There is an opportunity to study mindfulness-based stress reduction in patients with metastatic breast cancer and other patients with advanced disease. This study showed that this may be feasible; however, recruitment was difficult, and patients identified barriers related to severity of illness, time commitment, and travel to attend sessions.