Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants’ Adherence to Home Practice

Baydoun, M. et al | 2021 | Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants’ Adherence to Home Practice | https://doi.org/10.2147/PPA.S267064

This systematic review aims to evaluate adherence to home practice in studies evaluating the effects of MBI programs on psychological distress outcomes in cancer patients. The purpose of the review was to :

1. To evaluate the extent to which cancer patients report completing formal (meditation, body scan, yoga) and/or informal (doing everyday activities mindfully) home practice exercises assigned within the context of MBIs.
2. To identify factors influencing adherence to mindfulness home practice among cancer patients.
3. To evaluate the relationship between the amount of home practice and intervention effects on psychological distress.

Abstract

Background

 Although mindfulness-based interventions (MBIs) have demonstrated efficacy for alleviating psychological distress in cancer survivors, little is known about the extent to which participants adhere to assigned home practice. The purpose of this systematic review was to summarize and appraise the literature on rates and correlates of adherence to mindfulness home practice among cancer survivors.

Methods
Four databases (PubMed, Psychology and Behavioral Sciences, PsycInfo, and CINAHL) were searched for studies published before October 15, 2020. Articles were included if they evaluated the benefits of an MBI program for adults with cancer.

Results

 Twenty-one studies (N equal to 1811 participants) meeting the inclusion criteria were identified (randomized controlled trials (n equal to 13), non-randomized controlled designs (n equal to 2), single-group studies (n eqaul to 6)). The pooled adherence rate for participants’ home practice was 60 per cent of the assigned amount, which equated to 27 min per day during the intervention period. There was some evidence for a relationship between home practice of mindfulness techniques and improvements in mood, stress, anxiety, depression, and fear of cancer recurrence (correlation coefficients ranged from 0.33 to 0.67). Factors including marital status, mood disturbance at baseline, intervention modality, and personality traits were evaluated in relation to adherence to home practice, but the current literature was inadequate to evaluate whether a relationship exists.

Conclusion

Adherence to mindfulness home practice among cancer survivors is suboptimal, and most of the correlates of adherence studied to date are non-modifiable. More research is warranted to scrutinize the role of home practice in mindfulness-based interventions, including assessment of modifiable factors influencing adherence to improve benefits for this population.

Systematic review Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants’ Adherence to Home Practice

Depression and anxiety among people living with and beyond cancer

Niedzwiedz, C. L. et al. | Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority | BMC Cancer | Volume 19, Article number: 943 (2019)

Abstract

Background

A cancer diagnosis can have a substantial impact on mental health and wellbeing. Depression and anxiety may hinder cancer treatment and recovery, as well as quality of life and survival. We argue that more research is needed to prevent and treat co-morbid depression and anxiety among people with cancer and that it requires greater clinical priority. For background and to support our argument, we synthesise existing systematic reviews relating to cancer and common mental disorders, focusing on depression and anxiety.

We searched several electronic databases for relevant reviews on cancer, depression and anxiety from 2012 to 2019. Several areas are covered: factors that may contribute to the development of common mental disorders among people with cancer; the prevalence of depression and anxiety; and potential care and treatment options. We also make several recommendations for future research. Numerous individual, psychological, social and contextual factors potentially contribute to the development of depression and anxiety among people with cancer, as well as characteristics related to the cancer and treatment received. Compared to the general population, the prevalence of depression and anxiety is often found to be higher among people with cancer, but estimates vary due to several factors, such as the treatment setting, type of cancer and time since diagnosis. Overall, there are a lack of high-quality studies into the mental health of people with cancer following treatment and among long-term survivors, particularly for the less prevalent cancer types and younger people. Studies that focus on prevention are minimal and research covering low- and middle-income populations is limited.

Conclusion

Research is urgently needed into the possible impacts of long-term and late effects of cancer treatment on mental health and how these may be prevented, as increasing numbers of people live with and beyond cancer.

Full article at BMC Cancer

Health care use during cancer survivorship

Kelly M. Kenzik | Health care use during cancer survivorship: Review of 5 years of evidence | Cancer | First published: 18 December 2018

Abstract

Improvements in treatment strategies have resulted in increasing survival rates among patients diagnosed with cancer but also result in a growing population of individuals who have greater health care needs. These needs will persist from diagnosis throughout the continuing phase of care, or the survivorship phase.

To better define models of survivorship care, there must be a strong evidence base in survivor health care use patterns. The objective of this review, which covers studies from 2012 to January 2018, was to evaluate the available evidence on patterns of health care visits among survivors of adult cancers and to understand what is known about the rate of health care visits, the physician specialties associated with these visits, and/or the types health care settings (eg, outpatient, emergency room).

The findings underscore the importance of primary care, with the majority of studies reporting that more than 90% of survivors visited a primary care provider in the prior year. Visits to oncologists and/or other physician specialties were positively associated with receiving cancer screenings and obtaining quality care for noncancer‐related conditions. High care density/low care fragmentation between physician specialties had lower costs and a lower likelihood of redundant health care utilization.

The follow‐up in almost all studies was 3 years, providing short‐term evidence; however, as the survivorship period lengthens with improved treatments, longer follow‐up will be required. The long‐term patterns with which survivors of cancer engage the health care system are critical to designing long‐term follow‐up care plans that are effective in addressing the complex morbidity that survivors experience.

Mindfulness-Based Interventions and Sleep Among Cancer Survivors

The purpose of this critical examination is to present results from a critical analysis of randomised controlled trials and provide a synthesis of this body of work | Current Oncology Reports

Sleep problems among cancer survivors are gaining research attention. To our knowledge, there have been six randomized control trials published from 2013 to 2015 that test the effects of mindfulness-based interventions (MBIs) on sleep as a primary or secondary outcome.

Our examination of the literature highlights important methodological issues and variability among trials. We conclude our review by offering solutions to facilitate more scientific rigor in future studies.

Full reference: Christodoulou, G. & Black , D.S. (2017) Mindfulness-Based Interventions and Sleep Among Cancer Survivors: a Critical Analysis of Randomized Controlled Trials. Current Oncology Reports. Vol. 19 (Issue 09)
Article 60.

Many young cancer patients do not receive adequate fertility information and support

All cancer patients of reproductive age should be provided with fertility information and referrals for fertility preservation, researchers urge | ScienceDaily

In the analysis of 23 relevant studies, investigators found that many clinicians are broadly informed about the risk to their patients’ fertility brought about by cancer treatment, but many factors hinder the appropriate discussions and referrals needed to provide adequate fertility support to patients of reproductive age. For example, some oncology clinicians may lack appropriate fertility knowledge and be unsure whose role it is to provide fertility support.

• Overview via ScienceDaily
• Original research article

Young adult cancer survivors struggle to get back to normal

Cancer survivors often talk about wanting to get back to normal, but a new study indicates many young adults who survived the disease struggle with attaining this goal two years after their initial diagnosis |ScienceDaily

Researchers collected data from 215 cancer patients aged 14 to 39 years who visited five medical facilities nationwide between March 2008 and April 2010. Patients completed a self-report measure of social functioning within the first four months of diagnosis, and again at 12 months and 24 months later. They also answered questions about their social interactions with family and friends, psychological needs and mental health.

Thirty-two percent of the survivors reported consistently low social functioning over time — and some had been off treatment. Zebrack and colleagues say this could stem from the transition from treatment to off-treatment survivorship, a time fraught with new challenges to a cancer survivor, including the negative impact on finances, body image, work plans, relationship with spouse/significant other and plans for having children.

In addition, those reporting low scores on social functioning also had high levels of distress, possibly reflecting an impaired ability to reintegrate into social activities due to the effects of cancer, the study showed.

• Overview via ScienceDaily
• Original research article

Computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors

Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems | BMC Cancer

Background: Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands

Discussion: Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored.

Full reference: Golsteijn, R.H.J. et al. (2017) Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive. BMC Cancer. 17:446

Return to work of cancer patients

To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy | BMJ Open

Objectives: The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes.

Conclusions: RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme. A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW, reduced fatigue and increased importance of work, work ability, and quality of life.

Full reference: Leensen, M.C.J. et al. (2017) Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands. BMJ Open 7:e014746.

Cancer as a stressful life event: Perceptions of children with cancer and their peers

Howard Sharp, K.M. Cancer. Published online: 4 May 2017

Background: The medical traumatic stress model is commonly applied to childhood cancer, assuming that the diagnosis of cancer is a traumatic event. However, to the authors’ knowledge, little is known regarding what specifically children perceive as stressful about cancer or how it compares with other stressful events more often experienced by children.

 

Conclusions: Children do not necessarily view their cancer experience as their most stressful life event. The findings of the current study suggest that the diagnosis of cancer might be better viewed as a manageable stressor rather than a major trauma, and are consistent with the change in the fifth edition of the DSM to eliminate the diagnosis of a life-threatening illness as a qualifying trauma for PTSD.

Read the full abstract here

Issues of Survivorship and Rehabilitation in Soft Tissue Sarcoma

Gerrand, C. & Furtado, S. Clinical Oncology | Published online: 22 April 2017

As the number of survivors of extremity soft tissue sarcoma increases, so does the need to understand the experience of survivors and develop measures, systems and services that support rehabilitation into normal life roles.

Survivorship includes considerations of the physical, psychological and social domains, of which the physical sequelae of treatment are the best characterised in the literature. The survivorship experience may include disability, pain, lymphoedema, psychological problems, as well as difficulty with employment, relationships and lower quality of life.

Rehabilitation strategies for extremity sarcoma patients must be personalised, holistic and begin early in the pathway, ideally before the first treatment intervention.The International Classification of Functioning, Disability and Health model is a useful framework for combining assessments, including objective outcome measures, which can be combined into a rehabilitation prescription. Research is needed to develop an evidence base for rehabilitation interventions to support patients with extremity soft tissue sarcoma.

Read the full abstract here