Fish, J.A., Ettridge, K., Sharplin, G.R., Hancock, B., & Knott, V.E. (2014). Mindfulness-based cancer stress management: Impact of a mindfulness-based programme on psychological distress and quality of life. European Journal of Cancer Care, 23, 413–421. 

To explore the impact of mindfulness-based cancer stress management (MBCSM) programs on depression, anxiety, and stress in individuals affected by cancer with a secondary aim to evaluate the impact of MBCSM on quality of life and spiritual well-being

Four MBCSM programs were run for clients experiencing psychological distress related to cancer diagnoses. Each group consisted of 9–13 participants. The program consisted of eight, two-hour, weekly sessions in which mindfulness exercises were provided by an experienced counselor trained in mindfulness-based cognitive therapy. Participants also were asked to complete 40 minutes of meditation per day with the aid of notes, practice CDs, and home worksheets. A three-hour follow-up session was offered six weeks after the completion of the program. The program was modified to incorporate elements of the mindfulness-based stress reduction program developed by Jon Kabat-Zinn in 1990. Session 4 specifically included education about the psychoneuroimmunology of stress and an exploration of the cancer survivorship experience within the context of anxiety, depression, and stress.

• N = 26  
• AGE RANGE = 38–79 years
• MALES: 13%, FEMALES: 77%
• KEY DISEASE CHARACTERISTICS: Twenty-one patients were directly affected by cancer, five were caregivers, and the most common type of cancer was breast (42%).
• OTHER KEY SAMPLE CHARACTERISTICS: Time since diagnosis ranged from 2–84 months.

• SITE: Multi-site    
• SETTING TYPE: Outpatient    
• LOCATION: South Australia

• PHASE OF CARE: Diagnostic
• APPLICATIONS: Elder care  

Single-group, quasiexperimental study of participants directly and indirectly affected by cancer

• Global psychological distress was measured using a Visual Analog Distress Thermometer (VADT) scale.
• Levels of anxiety and depression were measured with a self-administered Hospital Anxiety and Depression Scale (HADS).  
• Quality of life and spiritual well-being were measured with the Functional Assessment of Cancer Therapy—General Version 4 (FACT-G).
• Mindfulness was measured with the short-form Freiburg Mindfulness Inventory (FMI).

Exploratory analysis indicated that there were no significant differences between baseline scores across sociodemographic groups. A series of Friedman tests indicated that there were significant differences in the levels of global psychological distress over time. Scores were significantly higher at baseline than postintervention for levels of global distress, anxiety, and depression. Global quality of life and spiritual well-being improved significantly over time. Emotional well-being and functional well-being were significantly higher postintervention than at the baseline assessment, which was maintained from baseline to follow-up (p = .001 and p = .001, respectively). Physical well-being improved from baseline to postintervention, which was determined to be significant at follow-up (p = .012). Mindfulness scores changed significantly over time. The level of mindfulness was significantly lower at baseline than postintervention, which was maintained through follow-up (p = .001).

Overall, the results of this study were positive with significant improvements in participants' levels of global distress, anxiety, and depression from baseline to postintervention. Improvements in psychological distress were sustained up to three months postintervention. This supports preliminary research on the effectiveness of mindfulness-based therapy in the treatment of cancer-related psychological distress.

• Small sample (< 30)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment) 
• Unintended interventions or applicable interventions not described that would influence results 
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%

Mindfulness training should be considered for patients with cancer to improve their levels of distress, anxiety, and depression. Mindfulness programs require trained personnel, and the program should involve an intervention over time with opportunity for follow-up over time.