The mindfulness-based stress reduction program for improving sleep quality in cancer survivors: A systematic review and meta-analysis

Self-compassion and mental health: Examining the mediational role of health behaviour engagement in emerging adults

OBJECTIVES

This observational longitudinal study examines whether engagement in health behaviours (general health behaviours, sleep hygiene, comfort food snacking) mediate the link between self-compassion and mental health among emerging adults.

DESIGN/METHOD

Participants were 332 emerging adults recruited from a large U.S. University (Mage = 19.0; SD = 1.8) who completed two electronic surveys 7-10 weeks apart (T1 and T2). The Hayes PROCESS macro model #4 was used to test whether engagement in health behaviours at T2 health mediated the association between T1 self-compassion and T2 mental health (5000 bootstrap samples).

RESULTS

T1 self-compassion was significantly associated with all T2 health behaviours except for comfort food snacking. T2 sleep hygiene behaviours mediated the relationship between T1 self-compassion and both T2 depression and T2 anxiety (bootstrapped 95% CIs [-.085, -.029] and [-.064, -.016], respectively), although the total effect of self-compassion on anxiety was no longer significant when accounting for T1 sleep hygiene and T1 anxiety. Overall T2 health behaviour engagement mediated the relationship between T1 self-compassion and T2 depression only (bootstrapped 95% CI [-.044, -.006]), although the mediation was non-significant after accounting for T1 overall health behaviour engagement and T1 depression.

CONCLUSIONS

Findings suggest that individuals with higher self-compassion engage more in overall health behaviours and sleep hygiene practices, and that sleep hygiene and general engagement in health behaviours help to explain the link between self-compassion and mental health symptoms over time. These findings highlight the multiple positive downstream effects of fostering self-compassion and have important implications for mental health care providers utilizing self-compassion to support health behaviour engagement in order to promote mental health.

Effects of mindfulness-based interventions (MBIs) on quality of sleep among patients with cancer: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The purpose of this systematic review and meta-analysis was to examine the effects of MBIs on quality of sleep in patients with cancer and explore methods, intervention and participants' characteristics as moderators to the effects.

METHOD

Ten electronic databases were searched from inception to October 2024 including Ovid Medline, CINAHL, PubMed, Scopus, APA PsycINFO, Age line, ProQuest Dissertation and Theses, Web of Science, Academic Search Complete, and ScienceDirect. We reviewed studies on quality of sleep outcomes for patients with cancer receiving mindfulness-based interventions based on Buddhist teaching. We only reviewed randomized controlled trials written in English. A random-effects model was used to compute the effect size. We used Funnel plot, Q statistics, and I2 to test the heterogeneity across studies. Also, we examined moderators to explore sources of heterogeneity.

RESULTS

Across 25 included studies providing 26 comparisons (N = 2263), 1157 cancer patients participated in mindfulness interventions; 1106 served as controls. Most cancer patients were males (s = 14). Mean age ranged from 39.02 to 70.86 yrs. (Mean = 53.70, SD = 6.52). Overall, MBIs had a moderate effect on improving quality of sleep among cancer patients (g = 0.598, 95 %CI 0.332, 0.864, p < .001, I2 = 88 %). Funding and time of outcome measure were moderators affecting ES. No primary studies reported the adverse effects.

CONCLUSION

MBIs significantly improved quality of sleep among patients with cancer. Clinicians should consider using MBIs as alternative complementary treatment for improving quality of sleep among patients with cancer.

Effect of daily mindfulness fluctuations on sleep and recovery-stress states in elite level judoka: an observational study

Introduction

Sleep is a fundamental factor in an athlete's ability to sustain peak performance and endurance. Mindfulness, defined as a state of intentional, non-judgmental awareness of the present moment, has been linked to positive effects on sleep. The present study aims to investigate which recovery and sleep parameters are influenced by interindividual differences in mindfulness tendencies and intraindividual daily fluctuations in mindfulness.

Methods

A two-week continuous monitoring study was conducted with 33 elite-level judoka (17 female, 16 male; age: M = 23.79, SD = 3.05) competing at the national and international level. Data collection included objective sleep monitoring via actigraphy and subjective monitoring through morning and evening self-report questionnaires. Sleep was analyzed as a function of both trait and daily mindfulness, as well as behavioral factors such as the number of training sessions, session intensity, and the implementation of recovery activities and naps.

Results

Multilevel analyses revealed significant positive associations between mindfulness and qualitative subjective sleep parameters, as well as morning and evening recovery-stress states. Among the mindfulness facets, acting with awareness emerged as the strongest predictor. In terms of quantitative sleep parameters, mindfulness influenced both subjective and objective sleep latencies.

Discussion

The findings suggest that mindfulness may play a key role in sleep regulation among athletes, particularly in enhancing perceived restfulness, improving recovery-stress states in the evening and morning, and facilitating the process of falling asleep. These results highlight mindfulness as a promising target for interventions aimed at improving subjective recovery and reducing sleep onset latencies through daily mindful behaviors. Furthermore, the study underscores the relative independence of qualitative and quantitative sleep parameters, suggesting they are influenced by distinct factors.

A Randomized Clinical Trial of Mindfulness-Based Stress Reduction Program Among Breast Cancer Survivors Post-Treatment: Evaluating Mediators of Cognitive Improvement

Introduction: The Mindfulness-Based Stress Reduction program for breast cancer survivors (MBSR [BCs]) is a stress-reducing program designed to increase cognitive functioning through four meditational practices. This randomized clinical trial aimed to determine if improvements in cognitive functioning and perceived cognitive abilities achieved from the MBSR(BC) were mediated through increased mindfulness, decreased rumination, and decreased perceived stress. Methods: Breast cancer survivors (BCSs) who met inclusion criteria of stage I, II, or III BC and received either chemotherapy (CT) or both CT and radiation were randomized to either the 6-week MBSR(BC), or Breast Cancer Education Support (BCES) program, or to a usual care (UC) regimen. Analysis of covariance was first implemented to identify potential mediators, followed by a formal mediational analysis to evaluate the effects of MBSR(BC) on 6-, 12-, and 26-week outcomes. Results: After consent, 212 BCS were randomized to MBSR(BC) (n = 91), BCES (n = 90), or UC (n = 31). The mean age was 56.5 and the majority of the BCS, 73.1%, were White and non-Hispanic. Results showed increases in "observing" as part of mindfulness as a potential mediator of MBSR(BC) effects on impairments on quality of life and logical memory at 6 months relative to UC. No mediation effects were identified for outcomes measured at 6 or 12 weeks and also when MBSR(BC) was compared with the BCES program. Discussion: These results partially supported our hypothesis that improvement in cognitive functioning would occur through increased mindfulness. Although few mediating relationships were identified, results showed a relationship between mindfulness and cognitive functioning. Both mediating relationships occurred through increases in "observing," a subconcept of "mindfulness," when compared to the MBSR(BC) with UC at 6 months. This study shows that mediators may help "optimize" clinical therapeutic treatment effects, thus contributing to the advancement of science.

TRIAL REGISTRATION

ClinicalTrials.gov, www.

CLINICALTRIALS

gov.

REGISTRATION NUMBER

NCT02786797.

An examination of the effectiveness of mindfulness-integrated cognitive behavior therapy on depression, anxiety, stress and sleep quality in Iranian women with breast cancer: a randomized controlled trial

Breast cancer causes numerous physical complications and mental stress that negatively impact patients' performance and quality of life. This study examined the effects of mindfulness-integrated cognitive behavior therapy (MICBT) on depression, anxiety, stress, and sleep quality in women with breast cancer. A clinical trial design with pre-tests and post-tests and a two-month follow-up were used in the current study. The target population was women with breast cancer, 30 of whom were selected through purposeful sampling. Then, 15 participants were placed in the intervention group and 15 in the control group with four random blocks. Those in the intervention group received mindfulness-integrated cognitive behavior therapy, while those in the control group received self-help (an educational book). Demographic questionnaires, the Depression, Anxiety, Stress Scale (DASS-21), and Pittsburgh Sleep Quality Index (PSQI) were used to collect data. Descriptive statistics such as frequency, mean and standard deviation, repeated measures ANOVA, and the Bonferroni test were used to analyze the data. The maximum alpha error level was considered 0.05 to test the hypotheses (p ≥ 0.05). The results showed the effectiveness of MICBT therapy on depression, anxiety, stress, and sleep quality (p < 0.05). The mean scores decreased in all variables, including from 15.47 ± 1.77 in the pre-test to 11.33 ± 4.25 in the post-test for depression, from 13.20 ± 2.60 in the pre-test to 8.67 ± 4.19 in the post-test for anxiety, from 19.73 ± 1.98 in the pre-test to 14.67 ± 2.69 in the post-test for stress and from 9.20 ± 1.74 in the pre-test to 5.07 ± 2.05 in the post-test for sleep quality. Based on the results of this study, it can be concluded that MICBT therapy is effective in reducing depression, anxiety, and stress and improving sleep quality in women with breast cancer. Therefore, it is recommended that affected women use psychological treatments such as MICBT in addition to medical treatments to deal with this stressful and challenging disease. MICBT can improve mood, offer a new cognitive and behavioral system, change patients' habits and thought patterns, and improve their lifestyle.

The association of life's essential 8 scores trajectory patterns with the risk of all cancer types

The "Life's Essential 8" (LE8) is a comprehensive lifestyle assessment tool by the American Heart Association, designed to mitigate cardiovascular disease risk by optimizing lifestyle factors including diet, physical activity, and other health metrics. While individual components of LE8 have been linked to reduced cancer risks, comprehensive studies on LE8 score trajectories over time and their relation to cancer risk are lacking. This study employed the Kailuan cohort, involving 48,330 participants who underwent three health examinations from 2006 to 2010 to determine their LE8 scores. LE8 score trajectories were analyzed using latent mixture modeling, and their association with incident cancer risks was assessed through Cox proportional hazard models, adjusting for confounders such as age, biological sex, and lifestyle behaviors. Three distinct LE8 trajectory patterns were identified: low-stable (21.2%), moderate-stable (49.4%), and elevated-stable (29.4%). Participants with elevated-stable trajectories showed a 21% (HR = 0.79; 95% CI: 0.70-0.90), 27% (HR = 0.73, 95% CI: 0.57-0.92), 51% (HR = 0.49, 95% CI: 0.32-0.77), 31% (HR = 0.69, 95% CI: 0.50-0.97) and 39% (HR = 0.61, 95% CI: 0.39-0.95) reduction in overall, lung, breast, colorectal and liver cancer risk compared to those with low-stable scores. Notably, the protective effect of elevated-stable LE8 scores against breast cancer was pronounced in participants with elevated CRP levels, indicating an interaction between inflammation and LE8 trajectories. Maintaining high and stable LE8 scores significantly associated with reduced cancer risk, underscoring the importance of integrating LE8 into public health and clinical strategies for cancer prevention. Kailuan study, ChiCTR-TNRC-11,001,489. Registered August 24, 2011-Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=8050 .

Combined mindfulness-based stress reduction and physical activity improved psychological factors and sleep quality in patients with MDD: A randomized controlled trial study

Non-pharmacological interventions are available to improve sleep quality including mindfulness-based stress reduction (MBSR) and physical activity (PA). The present study aimed to evaluate the effectiveness of the combination of MBSR and PA interventions as an augmentation to treatment as usual with sertraline to improve sleep and psychological factors among patients with MDD. Sixty-seven patients in outpatient care diagnosed with MDD for a minimum of 2 months (mean age: 35.32 ± 7.8; 65 % female) and currently on sertraline treatments were randomized into four groups including: 1) Physical activity, 2) MBSR, 3) Combination MBSR and physical activity (MBSRPA), and 4) Control. All participants completed self-reported questionnaires on sleep quality, depression, anxiety, and perceived stress from baseline to 8 weeks later at post-test and four weeks later at follow-up. Over time, sleep disturbance and psychological problems were reduced in all conditions when compared to the control. Moreover, MBSRPA had a more positive impacts on perceived stress, anxiety, depressive symptoms and sleep quality. The results of the present study confirmed the effectiveness of MBSRPA as an augmentation to standard therapy to help reduce symptoms of depression, anxiety, perceived stress, and sleep problems in patients with MDD.

The impact of extremely brief meditation and brief mindfulness interventions on assisted reproductive technologies success rates: A randomised controlled trial

OBJECTIVE

To investigate the effect of extremely brief meditation (EBMI) or brief mindfulness interventions (Brief MI) on pregnancy rate in women undergoing Assisted Reproductive Technology (ART).

METHODS

This is a prospective, three-armed, randomized controlled trial with women undergoing ART cycle, age ranging from 18 to 50 years. In the day of embryo transfer, the patients randomized to Brief MI group received a 15-minute audio of mindfulness. They were instructed to practice it daily, starting from the day of embryo transfer to the day of the pregnancy test, leading to a total of 180-210 minutes. Women randomized to EBMI met once a week during the waiting time between the embryo transfer and pregnancy test day in the same virtual room with a meditator instructor for 40 minutes, totalizing two sessions (80 minutes). The pregnancy rate was assessed via a blood test to measure hCG performed 2 weeks after embryo transfer.

RESULTS

A total of 68 women aged 37.5 ± 4.3y were included (EBMI, n = 24; Brief MI, n = 22 and CG, n = 22). Pearson's Chi-square test and Student's t-test for independent samples showed no significant differences between intervention and control groups. Both EBMI and Brief MI had no significant effect on pregnancy rate in women undergoing ART.

CONCLUSION

This randomized control trial revealed that the extremely brief meditation (EBMI) or self-managed brief mindfulness intervention (Brief MI) had no significant effect on pregnancy rates in infertile women undergoing ART cycles.

TRIAL REGISTRATION NUMBER

NCT04058262.

Proposal for Managing Cancer-Related Insomnia: A Systematic Literature Review of Associated Factors and a Narrative Review of Treatment

OBJECTIVE

Insomnia is common in patients with cancer. It has a multifactorial etiology that may include the disease process, adverse effects of anticancer therapies, and/or an association with other comorbidities. The purpose of this review was to identify risk factors for insomnia and suggest optimal management strategies.

METHODS

We conducted a systematic literature review to elucidate the risk factors for insomnia and sleep disturbances in patients with solid tumors. The effects of sleep medications in this population were also described.

RESULTS

A total of 75 publications were evaluated, including those on breast, lung, gynecologic, brain, head and neck, gastrointestinal, prostate, thyroid, and mixed cancers. We classified the factors related to insomnia or sleep disturbance in cancer into four categories: (1) patient demographic characteristics (e.g., age, marital or socioeconomic status); (2) mental state (e.g., depression or anxiety); (3) physical state (e.g., fatigue, pain, or restless legs syndrome); and (4) anticancer treatment-related (e.g., use of chemotherapy, opioids, or hormone therapy). Overall, literature on the pharmacologic treatment of insomnia is extremely limited, although some efficacy data for zolpidem and melatonin have been reported.

CONCLUSIONS

Demographic characteristics, physical and mental distress, and anticancer treatments are all risks for insomnia in patients with cancer. The limited evidence base for pharmacologic therapy in this patient population means that healthcare professionals need to implement a comprehensive and multidisciplinary pathway from screening to management.

Mindful Night-to-Day: A Pilot Feasibility Trial of a Mindfulness-Based Insomnia and Symptom Management Intervention for Patients with Hematologic Cancer

OBJECTIVES

Patients with hematologic cancer experience severe symptoms (i.e. insomnia, fatigue, pain, distress). Few interventions addressing insomnia and other symptoms exist for this population. Mindfulness-Based Therapy for Insomnia (MBTI) may be appropriate but has only been tested in healthy outpatients. This study aimed to develop and test an adapted MBTI protocol for hematologic cancer patients.

METHODS

Patient (n = 3) and clinician (n = 1) focus groups, and user-testing (N = 5) informed adaptation of Mindful Night-to-Day (MBTI+). A single-arm pilot trial (N = 32) evaluated feasibility (accrual, attrition, adherence), acceptability (intervention satisfaction), and changes to insomnia symptom severity (Insomnia Severity Index; primary outcome) and secondary outcomes (fatigue, pain, distress, pre-sleep arousal, mindfulness, symptom management self-efficacy) at baseline, post-intervention, and 1-month post-intervention. Descriptive statistics and paired sample t-tests were conducted.

RESULTS

Qualitative feedback informed MBTI+ content, format, and delivery. Mindfulness was used to increase symptom awareness (sleepiness vs. fatigue). Meditations and behavioral skills were applied to inpatient treatment. MBTI+ met feasibility (N = 32/12 months; 8.1% attrition; 83.8% adherence) and acceptability (M = 3.52/4.00) benchmarks. Insomnia symptom severity decreased (d = 1.20) from baseline to post-intervention, as did most secondary outcomes.

CONCLUSIONS

MBTI+ was feasible, acceptable, and showed promise for benefits throughout inpatient and outpatient treatment. Findings warrant further evaluation in a randomized trial.

Photovoice for leveraging traditional, complementary, and integrative medicine amongst black adults to improve sleep health and overall health

Introduction

Average adults are recommended to have 7-8 h of sleep. However insufficient sleep (IS defined as <7 h/nightly) is associated with increased risk of chronic diseases such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Traditional, complementary, and integrative medicine (TCIM), a burgeoning area of research and practice, leverages both modern and traditional approaches to improve health. Despite TCIM's recognition as a tool to improve sleep and related outcomes, there is a gap in literature in addressing its impact among black individuals, who experience a disproportionate burden of IS and chronic disease. This qualitative study aimed to increase understanding of TCIM practices to overcome IS and overall health in black communities.

Methods

Using photovoice methodology, a qualitative tool which applies community-engaged principles to produce culturally informed results through interviews and digital media, consented participants were recruited from Miami, Florida and (1) instructed to capture images over one week that communicated their TCIM to improve sleep and overall health on their mobile device; (2) interviewed using individual, semi-structured procedures to add "voice" to the "photos" they captured for ~20 min; and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for ~1.5 h. Both individual and focus group interviews were conducted over Zoom with recordings transcribed for formal content analysis using Nvivo software.

Results

The sample included N = 25 diverse US black individuals (M = 37, SD = 13, range 21-57). Approximately a quarter of the sample were unemployed (N = 7) and majority were women (N = 21). Results highlighted five themes including: (1) natural wellness (sleep supplements, comfort beverages, aromatherapy, herbalism, outdoors); (2) self-care (self-maintenance, physical activity, spatial comfort); (3) leisure (pet support, play); (4) mental stimulation (mindfulness, reading); and (5) spiritual wellness (faith-based practices). Study results elucidate the heterogeneity of diverse US black individuals regarding sociocultural knowledge, beliefs, and behaviors.

Conclusion

Addressing IS in black communities requires a comprehensive strategy that integrates cultural sensitivity, family and community dynamics, education, mental health support, and informed policymaking. Future studies should consider how sleep health literacy, stress appraisal, and coping strategies may vary by race/ethnicity for tailored intervention.

Combined Mindfulness-Based Stress Reduction and Exercise Intervention for Improving Psychological Well-Being in Patients With Non-Small Cell Lung Cancer

OBJECTIVE

This study aims to assess the clinical effectiveness of combining mindfulness-based stress reduction (MBSR) with exercise intervention in improving anxiety, depression, sleep quality and mood regulation in patients with non-small cell lung cancer (NSCLC).

METHODS

A total of 60 patients with NSCLC who had not received surgical treatment were selected using convenience sampling and divided into an intervention group and control group, with 30 patients in each group. The control group received conventional psychological nursing care, whereas the intervention group received a combination of MBwSR and exercise therapy. Before the intervention, a questionnaire was completed to collect the basic data of the two groups. Further questionnaires were administered at 6 and 8 weeks after treatment to assess anxiety, depression, sleep quality and other items included in the five-item Brief Symptom Rating Scale (BSRS-5).

RESULTS

No significant differences between the intervention and control groups were identified in terms of personal and clinical characteristics (p > 0.05). No significant differences were determined in the BSRS-5, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) or Pittsburgh Sleep Quality Index (PSQI) scores between the intervention and control groups before the intervention. However, 6 and 8 weeks after the intervention, scores were significantly lower in both groups (p < 0.001). Significant differences in the BSRS-5, SAS, SDS and PSQI scores were identified between the two groups at different time points (p < 0.001).

CONCLUSION

The combination of MBSR and exercise intervention demonstrated improvements in anxiety, depression, sleep quality and BSRS-5 scores in patients with NSCLC.

Eyes Wide Open: Sleep as a Potential Contributor to Racial and Ethnic Disparities in Cancer

U.S. racial and ethnic minoritized groups face disproportionate cancer burdens compared to White Americans. Investigating modifiable factors, such as sleep, that are socially patterned and inequitably distributed by race and ethnicity may advance understanding of cancer disparities and provide intervention opportunities. Emerging data suggest poor sleep health is associated with cancer. Yet, its contribution to racial and ethnic cancer disparities is understudied. In this narrative review, we explored the sleep-cancer relation through a disparities lens. We (i) summarized literature reporting on associations between sleep and cancer among racial and ethnic minority populations; (ii) examined potential sleep-cancer mechanisms; and (iii) discussed future directions. We identified five studies reporting on sleep-cancer associations among minoritized groups. Poor sleep health was associated with aggressive breast cancer among Black women, increased breast cancer risk among Asian women, and increased risk of breast and total cancer among Hispanic/Latinx Americans. Sleep and cancer disparities have similar socioeconomic and behavioral determinants, suggesting racial and ethnic minoritized groups may be vulnerable to poor sleep health and its adverse health impacts. Evidence indicates that the sleep-cancer disparities relation is an emerging, but important area of research that warrants further investigation, as sleep may be an avenue for reducing cancer disparities.

The interplay between stigma and sleep quality in breast cancer: A cross-sectional network analysis

PURPOSE

Stigma, a subjective internal shame, arises from the association of cancer with death. Sleep quality can be considered a product of stigma. However, the extent of overlap or difference between the two remains unclear.

METHODS

In total, 512 survivors with breast cancer were recruited from the "Be Resilient to Breast Cancer" project between May and August 2023. This study estimated the stigma, sleep quality, and their relationship by conducting a cross-sectional network analysis. The social impact scale and Pittsburgh Sleep Quality Index scale were employed in this study.

RESULTS

The core symptom for stigma from the network analysis was alienation by people (Strength = 1.213, Betweenness = 13, Closeness = 0.00211). The core symptom for sleep quality were the sleep quality (Str = 1.114, Bet = 17, Clo = 0.01586). Regarding the combination network, results showed that self-isolation and daytime dysfunction were the bridge nodes and that daytime dysfunction was positively associated with feeling less capable than before (according to self) (r = 0.15).

CONCLUSION

Our study demonstrates the core symptoms in different symptomatic networks, which can be targeted for treatment personalization and aid in the improvement of sleep quality and stigma in breast cancer patients.

The efficacy of mindfulness-based interventions on mental health among university students: a systematic review and meta-analysis

Introduction

We aimed to estimate the effect of mindfulness therapy on mental health.

Methods

Two researchers searched 12 databases to identify relevant trials that were published from 1 January 2018 to 1 May 2023. We performed a meta-analysis to determine the effect of mindfulness therapy on depression, which was measured by the Beck Depression Inventory (BDI), Patient Health Questionnaire-9 (PHQ-9), Quick Inventory of Depressive Symptomatology (QIDS), Hamilton Depression Rating Scale (HDRS), Patient-Reported Outcomes Measurement Information System (PROMIS), Hospital Anxiety and Depression Scale (HADS), and Depression Anxiety Stress Scales (DASS); anxiety, which was measured by the Beck Anxiety Inventory (BAI), PROMIS, and DASS, Generalized Anxiety Disorder-7 (GAD-7); stress, which was measured by the Perceived Stress Scale (PSS), DASS, and GAD-7; mindfulness, which was measured by the GAD-7, Five Facet Mindfulness Questionnaire (FFMQ), Mindful Attention Awareness Scale (MAAS), Short Form-12 Mental Component Score (SF-12 MCS) and Short Form-12 Physical Component Score (SF-12 PCS); and sleep quality, which was measured by the Pittsburgh Sleep Quality Index (PSQI). After screening studies based on the inclusion and exclusion criteria, 11 randomized controlled trials (RCTs) involving 1,824 participants were ultimately included.

Results

All these studies demonstrated positive effects of mindfulness therapy on depression (SMD = -0.33, 95% CI: [-0.44, -0.22], p < 0.00001, I2 = 29%), anxiety (SMD = -0.35, 95% CI: [-0.46, -0.25], p < 0.00001, I2 = 40%), stress (SMD = -0.39, 95% CI: [-0.48, -0.29], p < 0.00001, I2 = 69%) and sleep quality scores (SMD = -0.81, 95% CI: [-1.54, -0.09], p = 0.03, I2 = 0%). However, there was no significant difference in mindfulness (SMD = -0.12, 95% CI: [-0.36, -0.12], p = 0.34, I2 = 34%) between the mindfulness therapy group and the control group.

Discussion

In future studies, it is necessary to consider the investigation on whether the strategies of improving the mindfulness therapy in adherence and fidelity can work on the improvement of the outcomes in mental health.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, https://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42023469301].

The Effects of Complementary Therapies on Patient-Reported Outcomes: An Overview of Recent Systematic Reviews in Oncology

Many patients with cancer make use of complementary medicine alongside conventional medicine, but clinicians in oncology often lack the knowledge to adequately advise patients on the evidence base for complementary therapies. This study aims to provide an overview of recently published systematic reviews that assess the effects of complementary therapies on patient-reported health outcomes in patients with cancer. Systematic reviews, including a meta-analysis of at least two randomized controlled trials, were identified from the PubMed, Embase, Cochrane Library, CINAHL and PsycINFO databases. The methodological quality was assessed with AMSTAR 2. One hundred systematic reviews were included. The results suggest that several complementary therapies can improve health outcomes reported by patients with cancer, such as acupuncture to relieve pain, music interventions to reduce anxiety and yoga to improve cancer-related fatigue. The side effects related to complementary therapy use are generally mild. The results remain inconclusive for some intervention-outcome combinations. Many of the included systematic reviews insufficiently assessed the causes and impact of bias in their interpretation of the results. This overview of systematic reviews can support clinicians in counselling their patients on this topic and provide directions for future research and clinical practice guidelines in the field of complementary medicine.

Mind-Body Therapies for Sleep Disturbance among Patients with Cancer: A Systematic Review and Meta-analysis

OBJECTIVE

s: To assess whether mind-body therapies (MBTs) are effective for relieving sleep disturbance among patients with cancer.

DESIGN

Systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

Seven English electronic databases were searched from the date of inception to September 2022. All RCTs that included adults (≥18 years) who were treated with mindfulness, yoga, qigong, relaxation, and hypnosis were screened. The outcome was subjective and/or objective sleep disturbance.The revised Cochrane tool (RoB 2.0) was applied to evaluate the risk of bias. The RevMan software was applied to assessed each outcome according different control groups and assessment time points. Subgroup analyses were performed according to different categories of MBTs.

RESULTS

Sixty-eight RCTs (6339 participants) were identified. After requesting for missing data from corresponding authors of included RCTs, 56 studies (5051 participants) were included in the meta-analysis. The meta-analysis showed a significant immediate effect of mindfulness, yoga, relaxation, and hypnosis on subjective sleep disturbance, compared with usual care or wait list control, and the effect of mindfulness lasted at least 6 months. For objective sleep outcomes, we observed significant immediate effects of yoga on wake after sleep onset and of mindfulness on sleep onset latency and total sleep time. Compared with active control interventions, MBTs had no significant effect on sleep disturbance.

CONCLUSIONS

Mindfulness, yoga, relaxation, and hypnosis were effective in sleep disturbance severity reduction among patients with cancer at post-intervention, and the effect of mindfulness lasted at least 6 months. Future MBTs studies should apply both objective and subjective sleep measurement tools.

Interventions to Improve Sleep for People Living With or Beyond Cancer (2018-2022)

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to physical activity interventions and cognitive behavioral therapy-insomnia to improve sleep for people living with and beyond cancer.

A systematic review and meta-analysis of mindfulness-based stress reduction for arterial hypertension

Arterial hypertension is a major public health issue. Non-pharmacological approaches like Mindfulness-Based Stress Reduction (MBSR) might be a promising addition to conventional therapy. This systematic review and meta-analysis aim to evaluate the effects of MBSR on systolic (SBP) and diastolic blood pressure (DBP) among individuals with prehypertension or hypertension. We searched Medline/PubMed, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) from their inception until August 1st 2021. RCTs were included that compared MBSR to any control intervention in participants with diagnosed prehypertension (120-139/80-89 mmHg) or hypertension (≥140/≥90 mmHg). Mean differences (MD) and 95% confidence intervals (CI) were calculated. Risk of Bias was assessed using the Cochrane tool. Seven RCTs with 429 participants were included. Very low quality of evidence was found for positive effects of MBSR on SBP (MD = -11.26 mmHg, 95%CI = -20.24 to -2.29, p = 0.01) but no evidence for effects on DBP levels (MD = -3.62 mmHg, 95%CI = -8.52 to 1.29, p = 0.15) compared to waitlist control. Compared to active control, very low quality of evidence was found for positive effects on DBP (MD = -5.51 mmHg, 95%CI = -10.93 to -0.09, p = 0.05) but no effects on SBP levels (MD = -4.33 mmHg, 95%CI = -12.04 to 3.38, p = 0.27). Overall, the studies showed a high degree of heterogeneity. The effects found were robust against selection, detection, and attrition bias. Only one RCT reported safety data. MBSR may be an option for lowering blood pressure in people with prehypertension to hypertension. More and larger high-quality studies are needed to substantiate our findings.

The association between sleep problems and general quality of life in cancer patients and in the general population

Objective

It is well-known that patients with cancer frequently experience sleep problems, and that sleep quality is associated with general quality of life (QoL). The aims of this study were to analyze the relationship between sleep problems and other components of QoL in more detail and to investigate sex and age differences in sleep quality in cancer patients in comparison with the general population.

Method

This study comprised one general population sample (n = 4,476) and eight samples with cancer patients (n between 323 and 4,020). Sleep Quality was measured using the QoL questionnaire EORTC QLQ-C30.

Results

All of the cancer patient groups reported more sleep problems than the general population. Sleep problems were associated with all facets of QoL both in cancer patients and in the general population. The highest associations were found in cancer patients for fatigue (r = 0.52) and emotional functioning (r = -0.47). The association between sleep quality and general QoL was lower in the cancer samples (r = -0.37) than in the general population (r = -0.46). Female cancer patients reported markedly more sleep problems than male patients did (d = 0.45), while this sex difference was lower in the general population (d = 0.15). In contrast to the general population, younger cancer patients had greater trouble sleeping than older patients did (d = -0.17).

Conclusion

The results underline the significance of the role mental factors play in sleep problems. Health care providers should pay special attention to female patients and younger patients concerning this issue.

Comparing the effect of emotional freedom technique on sleep quality and happiness of women undergoing breast cancer surgery in military and nonmilitary families: A quasi-experimental multicenter study

PURPOSE

The aim of this study was to compare the effect of emotional freedom technique (EFT) on sleep quality and happiness of women who underwent breast cancer surgery and lived in military and nonmilitary families.

DESIGN AND METHODS

The patients were randomly divided into four groups of military intervention (n = 34), nonmilitary intervention (n = 33), military control (n = 31), and nonmilitary control (n = 35). Data were collected using demographic information form, Pittsburgh Sleep Quality Index, and Oxford Happiness Questionnaire.

FINDINGS

The mean scores of sleep quality and happiness in military and nonmilitary intervention groups improved significantly immediately and 1 month after the intervention compared to control groups (p < 0.001). However, there was no statistically significant difference between the military and nonmilitary intervention groups regarding the mean scores of sleep quality and happiness before, immediately, and 1 month after the intervention (p > 0.05).

PRACTICE IMPLICATIONS

Given the efficacy of EFT in improving sleep quality and happiness, it is recommended that this technique be taught to nurses to implement in the entire process of providing nursing care to cancer patients.

Psycho-oncology interventions focusing on fatigue and sleep disturbances

PURPOSE OF REVIEW

Cancer-related fatigue (CRF) and sleep disturbances are common symptoms among patients with cancer. They are often conceptualized as a part of a larger symptom cluster, also comprising pain and emotional distress. Despite their prevalence and long-lasting effects, CRF and sleep disturbances are still poorly addressed in clinical settings. Specific interventions are needed to manage these symptoms.

RECENT FINDINGS

In addition to conventional pharmacological therapies, other kinds of interventions are increasingly being developed in oncology. This review will discuss three categories of interventions for patients with cancer and their interest in alleviating CRF and sleep disturbances: physical exercises (e.g., aerobic, resistance training, running, free weights), psychological interventions (e.g., cognitive-behavioural therapy, psychoeducational interventions), and mind-body interventions (e.g., yoga, mindfulness, hypnosis). The multicomponent aspect of these interventions seems particularly important to address these symptoms.

SUMMARY

The findings detailed in this review will allow the scientific community, as well as health professionals working in oncology settings, to be informed about new nonpharmacological therapeutic options to help patients to manage their symptoms. It could eventually help to improve existing interventions for these patients.

Prevalence of Sleep Disturbance in Patients With Cancer: A Systematic Review and Meta-Analysis

Sleep disturbance is one of the most common and troubling symptoms that harm the quality of life throughout all phases of treatment and stages of the illness among patients with cancer. The aim of this meta-analysis is to examine the present status of sleep disturbance prevalence in patients with cancer. The following databases were searched: PubMed, CINAHL, MEDLINE, EMBASE, PsycINFO, from inception to April 2021. Prevalence rates were pooled with meta-analysis using a random-effects model. A total of 160 studies (N = 46,279) published between 1998 and 2021 met the inclusion criteria. The overall prevalence of sleep disturbance was 60.7% (26,448/46,279 participants, 95% CI 58.1-63.3%) with significant heterogeneity between studies (p < .000, τ2 = .0000, I2 = 96.4%). This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce sleep disturbance and improve the quality of life of cancer patients.

Hypnosis, Meditation, and Self-Induced Cognitive Trance to Improve Post-treatment Oncological Patients' Quality of Life: Study Protocol

Introduction

A symptom cluster is very common among oncological patients: cancer-related fatigue (CRF), emotional distress, sleep difficulties, pain, and cognitive difficulties. Clinical applications of interventions based on non-ordinary states of consciousness, mostly hypnosis and meditation, are starting to be investigated in oncology settings. They revealed encouraging results in terms of improvements of these symptoms. However, these studies often focused on breast cancer patients, with methodological limitations (e.g., small sample size, no control group, and no follow-up). Another non-ordinary state of consciousness may also have therapeutic applications in oncology: self-induced cognitive trance (SICT). It seems to differ from hypnosis and meditation, as it involves the body more directly. Thus, investigating its clinical applications, along with hypnosis and meditation interventions, could improve available therapeutic options in oncology. This article details the study protocol of a preference-based longitudinal controlled superiority trial aiming to assess the effectiveness of 3 group interventions (hypnosis, meditation, and SICT) to improve oncological patients’ quality of life, and more specifically CRF, emotional distress, sleep, pain, and cognitive difficulties (primary outcomes).

Methods and analysis

A power analysis required a total sample of 160 patients. Main inclusion criteria are: cancer diagnosis, active treatments completed for less than a year, no practice of hypnosis, meditation, or SICT, and presence of at least one of these four symptoms: fatigue, sleep difficulties, depression, or anxiety. Each participant will choose the intervention in which they want to participate (hypnosis, mindful self-compassion meditation, SICT, or no intervention—control group). To test the effectiveness of the interventions, data will be collected by questionnaires and neurobiological measures and directly from the medical record at four time points: before inclusion in the study (baseline); immediately after the intervention; and at 3- and 12-month follow-up. The longitudinal data in each group will then be measured.

Discussion

In addition to standard cancer therapies, there is a growing interest from patients in complementary approaches, such as hypnosis, meditation, and SICT. The results of this study will be useful to increase knowledge about short- and long-term effectiveness of 3 group interventions for CRF, emotional distress, sleep, pain, and cognitive difficulties in patients with different cancers.

Clinical Trial Registration

ClinicalTrials.gov/ (NCT04873661). Retrospectively registered on the 29th of April 2021. url: https://clinicaltrials.gov/ct2/show/NCT04873661

Effect of qigong for sleep disturbance-related symptom clusters in cancer: a systematic review and meta-analysis

OBJECTIVES

To examine the effects of qigong interventions on sleep disturbance-related symptom clusters for cancer patients and to explore the possible mediating role of fatigue and depression in affecting sleep.

METHODS

In this systematic review and meta-analysis, a systematic search was conducted through October 2020 by searching multiple English and Chinese databases. Inclusion was limited to randomized controlled trials that measured the effect of qigong on sleep and fatigue/depressive symptoms in cancer patients. Eleven studies involving 907 cancer patients were included in the systematic review, whereas the meta-analysis included ten studies with 851 cancer patients.

RESULTS

The most commonly investigated form of qigong was Taichi, and the intervention length ranged from 10 days to 6 months. All studies employed self-reported measurements. Overall, qigong significantly improved sleep (SMD = -1.28, 95% CI: -2.01, -0.55) and fatigue (SMD = -0.89, 95% CI: -1.59, -0.19) in cancer patients post-intervention, but not depressive symptoms (SMD = -0.69, 95% CI: -1.81, 0.42). Notably, the benefits on sleep and fatigue became non-significant after 3 months. Qigong's effect on sleep was significantly mediated by its effect on fatigue (β = 1.27, SE = 0.24, p = 0.002), but not depressive symptoms (β = 0.53, SE = 0.26, p = 0.106).

CONCLUSIONS

Qigong can be recommended for improving sleep disturbance-fatigue symptom clusters in the cancer population, while qigong's benefit on sleep is likely based on its effect on reducing fatigue. Future qigong studies should adopt more rigorous design and employ strategies to maintain longevity of intervention benefits.