Zhang, M.F., Wen, Y.S., Liu, W.Y., Peng, L.F., Wu, X.D., & Liu, Q.W. (2015). Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: A meta-analysis. Medicine, 94, e0897-0. 

DOI Link

Purpose

STUDY PURPOSE: To perform a meta-analysis of the effectiveness of mindfulness-based interventions to assess the effectiveness of the interventions for relieving anxiety and depression in people with any form of cancer.
 
TYPE OF STUDY: Meta analysis and systematic review

Search Strategy

DATABASES USED: Medline, Cochrane Library, EMBASE, and Google Scholar
 
KEYWORDS: cancer, neoplasm, and carcinoma; depression; anxiety; mindfulness, meditation, psychotherapy, and behavior therapy
 
INCLUSION CRITERIA: Any study that involved adult participants diagnosed with cancer and receiving mindfulness-based therapeutic intervention with the comparison of usual care and reported changes in anxiety and depression levels in participants. 
 
EXCLUSION CRITERIA: Any study that did not evaluate changes in anxiety or depression.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 293
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The quality of the studies was evaluated by two reviewers with a third to resolve differences and utilized the Cochrane Risk of Bias tool. Anxiety and depression score from before to after intervention were determined by calculation of standardized mean difference (SMD) for each study and the pooled studies. Additional sub-group analysis was completed by type of cancer, type of mindfulness therapy, and the length of follow-up. Quality evaluation showed inadequate blinding of participants, but no other substantial risk of bias.

Sample Characteristics

  • SAMPLE RANGE ACROSS STUDIES: 71-229
  • FINAL NUMBER STUDIES INCLUDED = 7
  • TOTAL PATIENTS INCLUDED IN REVIEW = 888 participants (469 intervention group and 419 control group) 
  • KEY SAMPLE CHARACTERISTICS: Most of the studies involved women with breast cancer.  The majority of the cancers were stage I-III.

 

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Meta-analysis of the change in anxiety: Pooled SMD indicated statistically significant improvements in anxiety levels post mindfulness-based therapy intervention compared to control (pooled SMD = -0.75, 95% CI [-1.28, -0.22], p = 0.005). Sub-group analysis of anxiety indicated a differences by type of intervention with mindfulness-based art therapy (pooled SMD = -0.4, 95% CI [-0.66, -0.14], p = 0.003) and mindfulness-base cognitive therapy (pooled SMD = -0.53, 95% CI [-0.92, -0.15], p = 0.007) associated with statistically significant improvements in anxiety. The interventions had no significant effects stratified by cancer type.
 
Meta-analysis of depression: Pooled SMD indicated that depression was improved to a statistically significant degree in the intervention group when compared to the control group (pooled SMD = -0.9, 95% CI [-1.53, -0.26], p=0.006). Sub-group analysis indicated that MBSR was not significantly associated with decreased depression in patients with breast cancer, but did demonstrate statistically significant improvements in depression for other cancer types (pooled SMD = -0.6, 95% CI [-0.81, -0.38], p < 0.001).  Mindfulness-based art therapy and mindfulness-based cognitive therapy were associated with significant decreases in depression (pooled SMD = -0.69, 95% CI [-0.954, -0.426], p < 0.001; and pooled SMD = -0.08, 95% CI [-1.19, -0.4], p < 0.001, respectively).

Conclusions

The meta-analysis supported the efficacy of mindfulness-based therapies in the improvement of anxiety and depression levels for people with cancer. The authors note that previous meta-analysis of MBSR studies included only 2 of 9 studies that were RCTs. All seven studies included in this analysis were RCTs. MBSR and mindfulness-based art therapy were the most frequently used mindfulness therapies (5 of 7), and all studies reported anxiety and depression scores. Subgroup analysis of the data further supported the effectiveness of mindfulness-based intervention in relieving anxiety and depression across cancer type and stage.

Limitations

  • Lack of consistency in type of mindfulness-based intervention between studies.
  • The subgroup analysis indicated that some interventions may be more effective in specific cancer types.
  • None of the studies in the this meta-analysis indicated where participants were receiving concurrent medical or somatic treatment for anxiety or depression at the same time as the mindfulness-based interventions.  
  • Small number of studies and different forms of cancer in the studies

Nursing Implications

This meta-analysis supports the effectiveness of mindfulness-based interventions for management of cancer-related anxiety and depression.

Legacy ID

5676