Effectiveness of online mindfulness-based interventions for cancer patients: a systematic review and meta-analysis

Effects of internet-based mindfulness interventions on anxiety and depression symptoms in cancer patients: A meta-analysis

OBJECTIVE

This meta-analysis aimed to evaluate the effectiveness of internet-based mindfulness interventions on anxiety and depression symptoms in patients with cancer.

METHODS

Eight databases (Cochrane Library, PubMed, Embase, and PsycINFO CNKI, Wanfang, VIP, and CBM) were systematically searched from the inception of databases to August 2023 for randomized controlled trials (RCTs). Two independent reviewers rigorously assessed the risk of bias and extracted data using a pre-established form. The meta-analysis, conducted using Stata version 16, calculated pooled effect sizes and 95% confidence intervals (CIs). Sensitivity analysis was employed to find the source of heterogeneity, and potential publication bias was evaluated through funnel plot analysis and the Egger test.

RESULTS

This study included 10 studies, involving a total of 1314 patients. The results of the meta-analysis showed that Internet-based mindfulness interventions were effective in reducing anxiety [SMD = -0.38, 95% CI (-0.51, -0.25), P < 0.01] and depression [SMD = -0.36, 95% CI (-0.49, -0.23), P < 0.01], particularly when the duration of the program was within 8 weeks and each session lasted <45 min. Interventions guided by therapists proved to be more effective than those without therapist guidance in improving anxiety and depression in cancer patients, and synchronous online interaction with therapists were found to yield the most noticeable improvements in anxiety and depression.

CONCLUSION

Internet-based mindfulness interventions, especially synchronous online interaction with therapists, contribute to alleviating anxiety and depression symptoms in cancer patients. The effectiveness is more pronounced when the intervention duration per session is limited to 45 min and the overall intervention duration is within 8 weeks. The medium to long-term efficacy of the intervention needs further validation through more high-quality research.

The Effect of Electroencephalographic Biofeedback Therapy on Anxiety and Overall Well-being in Patients with Rectal Cancer

This study aimed to investigate the effectiveness of electroencephalographic (EEG) biofeedback therapy in reducing anxiety levels and improving overall well-being among patients diagnosed with rectal cancer. A randomised controlled trial was conducted with 150 patients with rectal cancer who were randomly assigned to either the intervention group (n = 75) or the control group (n = 75). The intervention group received 16 sessions of EEG biofeedback therapy over 8 weeks, whereas the control group received standard care. Anxiety levels were assessed using the State-Trait Anxiety Inventory at baseline, post-intervention, 3-month follow-up, 6-month follow-up and 12-month follow-up. Secondary outcomes, including quality of life, sleep quality, treatment adherence, cortisol levels and heart rate variability (HRV), were also evaluated. The intervention group showed significant reductions in state anxiety (p < 0.001) and trait anxiety (p < 0.001) compared with the control group at all post-intervention time points. Significant improvements were also observed in the intervention group for quality of life (p < 0.001), sleep quality (p < 0.001), treatment adherence (p < 0.001), cortisol levels (p < 0.01) and HRV (p < 0.01). The effects were maintained at the 12-month follow-up. Electroencephalographic biofeedback therapy is an effective non-pharmacological intervention for reducing anxiety levels and improving overall well-being in patients with rectal cancer. The findings suggest that incorporating EEG biofeedback therapy into the standard care of patients with rectal cancer may enhance their psychological well-being, quality of life, sleep quality, treatment adherence, physiological stress responses and autonomic function. Long-term benefits were observed, indicating the sustainability of the intervention's effects. Further research is warranted to investigate the underlying mechanisms and potential applications of EEG biofeedback therapy in other cancer populations.

Digital Health Interventions to Improve Mental Health in Patients With Cancer: Umbrella Review

BACKGROUND

Mental health plays a key role across the cancer care continuum, from prognosis and active treatment to survivorship and palliative care. Digital health technologies offer an appealing, cost-effective tool to address psychological needs.

OBJECTIVE

This umbrella review aims to summarize and evaluate the available evidence on the efficacy of digital health interventions for improving mental health and psychosocial outcomes for populations with cancer.

METHODS

Literature searches were conducted in Embase, PsycINFO, PubMed, CINAHL, the Cochrane Library, and Web of Science from their inception to February 4, 2024. Systematic reviews (with or without meta-analysis) investigating the efficacy of digital health interventions for psychosocial variables in patients with cancer were included. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews-2 tool.

RESULTS

In total, 78 systematic reviews were included in this review. Among diverse delivery modalities and types of digital interventions, websites and smartphone apps were the most commonly used. Depression was the most frequently addressed, followed by quality of life, anxiety, fatigue, and distress. The qualities of the reviews ranged from critically low to high. Generally, despite great heterogeneity in the strength and credibility of the evidence, digital health interventions were shown to be effective for mental health in patients with cancer.

CONCLUSIONS

Taken together, digital health interventions show benefits for patients with cancer in improving mental health. Various gaps were identified, such as little research specifically focusing on older adult patients with cancer, a scarcity of reporting high-precision emotion management, and insufficient attention to other certain mood indicators. Further exploration of studies with standardized and rigorous approaches is required to inform practice.

TRIAL REGISTRATION

PROSPERO CRD42024565084; https://tinyurl.com/4cbxjeh9.

Benefits of Remote-Based Mindfulness on Physical Symptom Outcomes in Cancer Survivors: Systematic Review and Meta-Analysis

Background

Many cancer survivors experience a wide range of symptoms closely linked to psychological problems, highlighting the need for psychological treatment, one of the most popular being mindfulness. The use of the internet has greatly increased in the last decade, and has encouraged the use of remote-based interventions to help people living with cancer access treatment remotely via devices.

Objective

The primary aim of this study was to explore the efficacy of internet-based mindfulness interventions on the physical symptoms of people living with cancer, where physical symptoms are defined as distressing somatic experiences (eg fatigue, insomnia, and pain) regardless of the underlying cause. The secondary aim was to investigate interventions for the quality of life (QoL).

Methods

This study followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Relevant articles were systematically searched using electronic databases, namely Scopus, Medline through PubMed, Cumulated Index in Nursing and Allied Health Literature (CINAHL) through EBSCOhost, and Cochrane Central Database. Randomized controlled and pilot trials involving adults and/or older adults with cancer and using remote-based mindfulness interventions compared to usual care were included. The quality of the trials included in this study was assessed using the revised Cochrane risk of bias, version 2.0. This study estimated the standardized mean difference (SMD) and mean difference (MD) with 95% CI. The I2 test was used to identify potential causes of heterogeneity. Publication bias was assessed using contour-enhanced funnel plots and the Egger linear regression test to reveal a small study effect.

Results

The initial search yielded 1985 records, of which 13 studies were ultimately included. After treatment, remote-based mindfulness significantly reduced fatigue (SMD -0.94; 95% CI: -1.56 to -0.33; P=.002), sleep disturbance (SMD -0.36; 95% CI: -0.60 to -0.12; P=.004), and improved physical function (SMD .25; 95% CI: 0.09 to 0.41; P=.002) compared to that observed before treatment. However, compared with usual care, remote-based mindfulness showed a statistically significant reduction only in sleep disturbance (SMD: -0.37; 95% CI: -0.58 to -0.16; P=.0006) after treatment. Moreover, remote-based mindfulness was not statistically significant in reducing pain both within and between groups.

Conclusions

Remote-based mindfulness shows promise in reducing sleep disturbances; however, its impact on fatigue, pain, and physical function may be limited.

Web-based interventions for fear of cancer recurrence: A scoping review with a focus on suggestions for the development and evaluation of future interventions

PURPOSE

The objective of this scoping review is to provide an overview of the available evidence on the effectiveness of web-based interventions for fear of cancer recurrence (FCR) and a discussion of drawbacks and possible improvements for web-based interventions identified in the reviewed studies. These steps fulfil the aim of this review, which is to offer suggestions for developing future web-based interventions based on the reviewed studies.

METHODS

Five databases (PubMed, MEDLINE, EMBASE, SCOPUS and Web of Science) were searched. Original peer-reviewed articles, written in English, on web-based interventions for FCR were included for review. The data from the included studies was synthesised thematically.

RESULTS

We included 34 papers reporting on 28 interventions. Most of the studies in the papers were quantitative and mixed quantitative studies with a qualitative element, e.g. an interview post-intervention. Interventions were most commonly trialled with women breast cancer patients. Top three countries where studies were conducted were USA, Australia and the Netherlands. The most common theoretical framework for interventions is cognitive behavioural therapy (CBT), followed by mindfulness-based and mixed CBT, mindfulness, acceptance and commitment therapy (ACT), relaxation approaches. FCR was the primary focus/measure in 19 Studies, in 9 studies FCR was a secondary/related outcome/measure. Overall, the evidence of efficacy of web-based interventions on FCR is mixed.

CONCLUSIONS

The existing research suggests several key points for producing more robust evidence about the effectiveness of web-based interventions for FCR. First, the studies suggest that it is a priority to better define eligibility criteria to proactively include people with higher levels of FCR. Second, there is a need for longer-term follow-up and outcome measuring period. Third, research examining the reasons for dropout from web-based interventions for FCR is critical to improve the effectiveness of web-based interventions. Fourth, while web-based interventions do not involve the costs of transportation, traveling time, space, equipment, cleaning, and other expenses, further cost utility analyses should be performed. Finally, future studies should assess how intervention accessibility, adherence, and effectiveness can be improved across different intervention designs, varying from intensive synchronous individual therapist-assisted web-based programme to blended designs combining the advantages of face-to-face and internet-based elements, to entirely self-managed programmes.

IMPLICATIONS FOR CANCER SURVIVORS

Developing and evaluating more accessible FCR treatments have been identified among top international FCR research priorities (Shaw et al. 2021). While there is some evidence that web-based interventions can be as effective as face-to-face interventions, currently there is a dearth of systematic data about the ways in which the web-based modality specifically can enhance supportive care for FCR. Developing knowledge about effective web-based interventions has implications for cancer survivors as they can be presented with more accessible, low-cost and low-burden options for managing fear of cancer recurrence.

Online eurythmy therapy for cancer-related fatigue: a prospective repeated-measures observational study exploring fatigue, stress, and mindfulness

Introduction

Cancer is a debilitating disease with an often chronic course. One of the most taxing and prevalent sequelae in this context is cancer-related fatigue (CRF) resulting from the disease and/or associated treatments. Over the last years mindfulness-based interventions such as eurythmy therapy (ERYT), a mindful-movement therapy from anthroposophic medicine, have emerged as promising adjunct therapies in oncology. This prospective study investigated an online implementation of ERYT for CRF using a single arm repeated-measures design based on two consecutive studies.

Method

Study 1 consisted of an initial assessment before, during, after, and at follow up of a 6-week online ERYT-based program in a mixed sample of N = 165 adults with or without cancer diagnosis. Study 2 involved a similar design with an adapted 8-week online ERYT-based program in a sample of N = 125 adults who had been diagnosed with cancer. Outcomes were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue, Perceived Stress Scale, Mindful Attention Awareness Scale, and Insomnia Severity Index (for Study 1 all, for Study 2 only the former three). We additionally performed an exploratory analysis regarding practice frequency and duration. Data were analyzed using Linear Mixed-Effect Models per outcome; ANOVA was used for practice times.

Results

For Study 1, mixed-effects model estimates showed no significant effect on fatigue, but pointed to significantly improved emotional and physical well-being, reduced stress, as well as increased mindfulness (mixed subjects). Functional and social well-being or sleep quality did not change significantly. Study 2 model estimates on the other hand showed significantly improved CRF in conjunction with the ERYT-based online intervention, as well as improved stress and mindfulness scores (cancer-diagnosed subjects).

Conclusion

Taken together, while our results should be interpreted with caution given the single-arm design and relatively high dropout, they suggest online ERYT may be associated with a reduction in fatigue for individuals diagnosed with cancer, an increase in mindfulness, and benefits for stress and certain well-being indicators. The online group format is advantageous in view of affordability and accessibility, the latter being particularly relevant for individuals who due to high symptom severity cannot leave their homes. Randomized-controlled studies will be needed to confirm these findings.

A multisite feasibility randomized clinical trial of mindfulness-based resilience training for aggression, stress, and health in law enforcement officers

BACKGROUND

Law enforcement officers (LEOs) are exposed to significant stressors that can impact their mental health, increasing risk of posttraumatic stress disorder, burnout, at-risk alcohol use, depression, and suicidality. Compromised LEO health can subsequently lead to aggression and excessive use of force. Mindfulness training is a promising approach for high-stress populations and has been shown to be effective in increasing resilience and improving mental health issues common among LEOs.

METHODS

This multi-site, randomized, single-blind clinical feasibility trial was intended to establish optimal protocols and procedures for a future full-scale, multi-site trial assessing effects of mindfulness-based resilience training (MBRT) versus an attention control (stress management education [SME]) and a no-intervention control, on physiological, attentional, and psychological indices of stress and mental health. The current study was designed to enhance efficiency of recruitment, engagement and retention; optimize assessment, intervention training and outcome measures; and ensure fidelity to intervention protocols. Responsiveness to change over time was examined to identify the most responsive potential proximate and longer-term assessments of targeted outcomes.

RESULTS

We observed high feasibility of recruitment and retention, acceptability of MBRT, fidelity to assessment and intervention protocols, and responsiveness to change for a variety of putative physiological and self-report mechanism and outcome measures.

CONCLUSIONS

Results of this multi-site feasibility trial set the stage for a full-scale, multi-site trial testing the efficacy of MBRT on increasing LEO health and resilience, and on decreasing more distal outcomes of aggression and excessive use of force that would have significant downstream benefits for communities they serve.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03784846 . Registered on December 24th, 2018.

Group, Blended and Individual, Unguided Online Delivery of Mindfulness-Based Cognitive Therapy for People With Cancer: Feasibility Uncontrolled Trial

BACKGROUND

Online mindfulness based cognitive therapy (eMBCT) has been shown to reduce psychological distress in people with cancer. However, this population has reported lack of support and asynchronous communication as barriers to eMBCT, resulting in higher nonadherence rates than with face-to-face MBCT. Using a co-creation process, we developed 2 formats of eMBCT: group, blended (combination of therapist-guided group and individual online sessions) and individual, unguided (individual, unguided online sessions only). Group, blended eMBCT offers peer support and guidance, whereas individual, unguided eMBCT offers flexibility and the possibility of large-scale implementation.

OBJECTIVE

The objective of this nonrandomized feasibility study was to assess aspects of feasibility of the group, blended and individual, unguided eMBCT interventions.

METHODS

Participants were people with cancer who chose between group, blended and individual, unguided eMBCT. Both intervention conditions followed the same 8-week eMBCT program, including an introductory session and a silent day (10 sessions total). All sessions for individual, unguided eMBCT occurred via the platform Minddistrict, whereas group, blended eMBCT consisted of 3 online videoconference sessions guided by a mindfulness teacher and 5 sessions via Minddistrict. We assessed the feasibility of the intervention quantitatively and qualitatively by evaluating its acceptability among participants. Additionally, we assessed limited efficacy by looking at the number of questionnaires participants completed pre- and postintervention.

RESULTS

We included 12 participants for each eMBCT condition. Participants in group, blended eMBCT completed, on average, 9.7 of 10 sessions, compared with an average 8.3 sessions for individual, unguided eMBCT (excluding dropouts). Of the 24 participants, 13 (54%) agreed to be interviewed (5 unguided and 8 blended). Participants in both conditions reported positive experiences, including the convenience of not having to travel and the flexibility to choose when and where to participate. However, among the barriers for participation, participants in the group, blended condition reported a preference for more group sessions, and participants in the individual, unguided condition reported a lack of guidance. Additionally, for the group, blended condition, the effect sizes were small for all outcome measures (Hedges g range=0.01-0.36), except for fatigue, which had a moderate effect size (Hedges g=0.57). For the individual, unguided condition, the effect sizes were small for all outcome measures (Hedges g range=0.24-0.46), except for mindfulness skills (Hedges g=0.52) and engagement with the intervention (Hedges g=1.53).

CONCLUSIONS

Participants in this study had a positive experience with group, blended and individual, unguided eMBCT. Based on the results from this study, we will adjust the intervention prior to conducting a full-scale randomized controlled trial to evaluate effectiveness; we will add 1 group session to the group, blended eMBCT using Zoom as the platform for the group sessions; and we will send reminders to participants to complete questionnaires.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05336916; https://clinicaltrials.gov/ct2/show/NCT05336916.