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Lengacher CA, Reich RR, Paterson CL, Shelton M, Shivers S, Ramesar S, Pleasant ML, Budhrani-Shani P, Groer M, Post-White J, Johnson-Mallard V, Kane B, Cousin L, Moscoso MS, Romershausen TA, Park JY. A Large Randomized Trial: Effects of Mindfulness-Based Stress Reduction (MBSR) for Breast Cancer (BC) Survivors on Salivary Cortisol and IL-6. Biol Res Nurs 2018; 21:39-49. [PMID: 30079756 DOI: 10.1177/1099800418789777] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Breast cancer survivors (BCS) often experience psychological and physiological symptoms after cancer treatment. Mindfulness-based stress reduction (MBSR), a complementary and alternative therapy, has reduced subjective measures of stress, anxiety, and fatigue among BCS. Little is known, however, about how MBSR affects objective markers of stress, specifically the stress hormone cortisol and the pro-inflammatory cytokine interleukin-6 (IL-6). In the present study, BCS ( N = 322) were randomly assigned to a 6-week MBSR program for BC or usual-care control. Measurements of cortisol, IL-6, symptoms, and quality of life were obtained at orientation and 6 weeks. Cortisol and IL-6 were also measured prior to and after the MBSR(BC) class Weeks 1 and 6. The mean age of participants was 56.6 years and 69.4% were White non-Hispanic. Most had Stage I (33.8%) or II (35.7%) BC, and 35.7% had received chemotherapy and radiation. Cortisol levels were reduced immediately following MBSR(BC) class compared to before the class Weeks 1 and 6 (Wilcoxon-signed rank test; p < .01, d = .52-.56). IL-6 was significantly reduced from pre- to postclass at Week 6 (Wilcoxon-signed rank test; p < .01, d = .21). No differences were observed between the MBSR(BC) and control groups from baseline to Week 6 using linear mixed models. Significant relationships with small effect sizes were observed between IL-6 and both symptoms and quality of life in both groups. Results support the use of MBSR(BC) to reduce salivary cortisol and IL-6 levels in the short term in BCS.
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Affiliation(s)
| | - Richard R Reich
- 2 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Carly L Paterson
- 3 Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Melissa Shelton
- 1 College of Nursing, University of South Florida, Tampa, FL, USA
| | - Steve Shivers
- 4 Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Sophia Ramesar
- 1 College of Nursing, University of South Florida, Tampa, FL, USA
| | | | | | - Maureen Groer
- 1 College of Nursing, University of South Florida, Tampa, FL, USA
| | | | | | - Bradley Kane
- 1 College of Nursing, University of South Florida, Tampa, FL, USA
| | - Lakeshia Cousin
- 1 College of Nursing, University of South Florida, Tampa, FL, USA
| | | | | | - Jong Y Park
- 2 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Reich RR, Lengacher CA, Alinat CB, Kip KE, Paterson C, Ramesar S, Han HS, Ismail-Khan R, Johnson-Mallard V, Moscoso M, Budhrani-Shani P, Shivers S, Cox CE, Goodman M, Park J. Mindfulness-Based Stress Reduction in Post-treatment Breast Cancer Patients: Immediate and Sustained Effects Across Multiple Symptom Clusters. J Pain Symptom Manage 2017; 53:85-95. [PMID: 27720794 PMCID: PMC7771358 DOI: 10.1016/j.jpainsymman.2016.08.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/05/2016] [Accepted: 08/03/2016] [Indexed: 01/04/2023]
Abstract
CONTEXT Breast cancer survivors (BCS) face adverse physical and psychological symptoms, often co-occurring. Biologic and psychological factors may link symptoms within clusters, distinguishable by prevalence and/or severity. Few studies have examined the effects of behavioral interventions or treatment of symptom clusters. OBJECTIVES The aim of this study was to identify symptom clusters among post-treatment BCS and determine symptom cluster improvement following the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR(BC)) program. METHODS Three hundred twenty-two Stage 0-III post-treatment BCS were randomly assigned to either a six-week MBSR(BC) program or usual care. Psychological (depression, anxiety, stress, and fear of recurrence), physical (fatigue, pain, sleep, and drowsiness), and cognitive symptoms and quality of life were assessed at baseline, six, and 12 weeks, along with demographic and clinical history data at baseline. A three-step analytic process included the error-accounting models of factor analysis and structural equation modeling. RESULTS Four symptom clusters emerged at baseline: pain, psychological, fatigue, and cognitive. From baseline to six weeks, the model demonstrated evidence of MBSR(BC) effectiveness in both the psychological (anxiety, depression, perceived stress and QOL, emotional well-being) (P = 0.007) and fatigue (fatigue, sleep, and drowsiness) (P < 0.001) clusters. Results between six and 12 weeks showed sustained effects, but further improvement was not observed. CONCLUSION Our results provide clinical effectiveness evidence that MBSR(BC) works to improve symptom clusters, particularly for psychological and fatigue symptom clusters, with the greatest improvement occurring during the six-week program with sustained effects for several weeks after MBSR(BC) training. TRIAL REGISTRATION Name and URL of Registry: ClinicalTrials.gov. Registration number: NCT01177124.
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Affiliation(s)
- Richard R Reich
- Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
| | | | - Carissa B Alinat
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Kevin E Kip
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Carly Paterson
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Sophia Ramesar
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Heather S Han
- Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | | | | | - Manolete Moscoso
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Pinky Budhrani-Shani
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Steve Shivers
- University of South Florida Breast Health Clinical and Research Integrated Strategic Program, Tampa, Florida, USA
| | - Charles E Cox
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Matthew Goodman
- Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jong Park
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
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Lengacher CA, Reich RR, Paterson CL, Ramesar S, Park JY, Alinat C, Johnson-Mallard V, Moscoso M, Budhrani-Shani P, Miladinovic B, Jacobsen PB, Cox CE, Goodman M, Kip KE. Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. J Clin Oncol 2016; 34:2827-34. [PMID: 27247219 PMCID: PMC5012660 DOI: 10.1200/jco.2015.65.7874] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The purpose of this randomized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program in improving psychological and physical symptoms and quality of life among breast cancer survivors (BCSs) who completed treatment. Outcomes were assessed immediately after 6 weeks of MBSR(BC) training and 6 weeks later to test efficacy over an extended timeframe. PATIENTS AND METHODS A total of 322 BCSs were randomly assigned to either a 6-week MBSR(BC) program (n = 155) or a usual care group (n = 167). Psychological (depression, anxiety, stress, and fear of recurrence) and physical symptoms (fatigue and pain) and quality of life (as related to health) were assessed at baseline and at 6 and 12 weeks. Linear mixed models were used to assess MBSR(BC) effects over time, and participant characteristics at baseline were also tested as moderators of MBSR(BC) effects. RESULTS Results demonstrated extended improvement for the MBSR(BC) group compared with usual care in both psychological symptoms of anxiety, fear of recurrence overall, and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference (P < .01). Overall effect sizes were largest for fear of recurrence problems (d = 0.35) and fatigue severity (d = 0.27). Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC). CONCLUSION The MBSR(BC) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC) training, with generally small to moderate overall effect sizes.
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Affiliation(s)
- Cecile A Lengacher
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA.
| | - Richard R Reich
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Carly L Paterson
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Sophia Ramesar
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Jong Y Park
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Carissa Alinat
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Versie Johnson-Mallard
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Manolete Moscoso
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Pinky Budhrani-Shani
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Branko Miladinovic
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Paul B Jacobsen
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Charles E Cox
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Matthew Goodman
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
| | - Kevin E Kip
- Cecile A. Lengacher, Sophia Ramesar, Carissa Alinat, Manolete Moscoso, and Kevin E. Kip, University of South Florida College of Nursing; Jong Y. Park and Paul B. Jacobsen, H. Lee Moffitt Cancer Center and Research Institute; Branko Miladinovic and Charles E. Cox, University of South Florida Morsani College of Medicine, Tampa; Richard R. Reich, University of South Florida Sarasota-Manatee, Manatee; Versie Johnson-Mallard, University of Florida, College of Nursing, Gainesville, FL; Carly L. Paterson, National Cancer Institute, Rockville, MD; Pinky Budhrani-Shani, Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; and Matthew Goodman, University of Virginia, Charlottesville, VA
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