Restricted accessResearch articleFirst published online 2024-4
Effectiveness of eHealth mindfulness-based interventions on cancer-related symptoms among cancer patients and survivors: A systematic review and meta-analysis
This review aimed to synthesize the best available evidence concerning the effectiveness of electronic health, mindfulness-based interventions (eHealth-MBIs) on anxiety, depression, mindfulness and quality of life (QoL) among cancer patients/survivors.
Methods
Published and unpublished studies were retrieved from 10 electronic databases. Two independent authors screened and selected articles, extracted data using a standardized form and appraised the studies with the Cochrane risk of bias assessment tool. Meta-analyses were performed using a random-effect model with Review Manager (REVMAN). Standardized mean differences (SMDs) were used to determine intervention effects. Narrative syntheses were conducted for studies not suitable for meta-analyses. Heterogeneity was identified through I2 and chi-square statistics. Subgroup analyses were performed based on types of controls, age groups and gender. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess overall quality.
Results
In total, 18 studies were included. The eHealth-MBIs improved primary outcomes of anxiety (SMD = −0.28) and depression (SMD = −0.24), among cancer patients/survivors with small effect sizes. Effects for the secondary outcomes of QoL (SMD = 0.25) and mindfulness (SMD = 0.29) were observed at short-term follow-up assessments but not at post-intervention. Overall quality was rated as low for the primary and very low for the secondary outcomes.
Conclusion
The eHealth-MBIs can be offered as a cost-effective and accessible alternative for cancer patients and survivors in healthcare settings. Future research may further explore the effectiveness of eHealth-MBIs based on different types of MBIs, cancer types, modes of delivery and other outcomes such as stress and post-traumatic growth.
BrayFFerlayJSoerjomataramI,et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin2018; 68: 394–324.
2.
National Cancer Institute. NCI Dictionary of Cancer Terms. [Cited 2021 March 1] Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cancer
3.
BubisLDDavisLMaharA, et al.Symptom burden in the first year after cancer diagnosis: An analysis of patient-reported outcomes. J Clin Oncol2018; 36: 1103–1111.
4.
LoscalzoMClarkKPalS,et al.Role of biopsychosocial screening in cancer care. Cancer J2013; 19: 414–420.
5.
SurboneAAnnunziataMASantoroA,et al.Cancer patients and survivors: changing words or changing culture?Ann Oncol2013; 24: 2468–2471.
6.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.Washington, DC: Author, 2013, 10.1176/appi.books.9780890425596
7.
Nayak MGGVidyasagarMSMathewS,et al.Quality of life among cancer patients. Indian J Palliat Care2017; 23: 445–450.
8.
Kabat-ZinnJMassionAOKristellerJ, et al.Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry1992; 149: 936–943.
9.
BernsteinAHadashYLichtashY,et al.Decentering and related constructs: a critical review and metacognitive processes model. Perspect Psychol Sci2015; 10: 599–617.
10.
AdairKCFredricksonBLCastro-SchiloL,et al.Present with you: does cultivated mindfulness predict greater social connection through gains in decentering and reductions in negative emotions?Mindfulness (N Y)2017; 9: 737–749.
11.
Hayes-SkeltonSALeeCS. Decentering in mindfulness and cognitive restructuring for social anxiety: An experimental study of a potential common mechanism. Behav Modif2020; 44: 817–840.
12.
KesselRGechtJForkmannT,et al.Exploring the relationship of decentering to health-related concepts and cognitive and metacognitive processes in a student sample. BMC Psychol2016; 4: 1–10. 10.1186/s40359-016-0115-6
13.
YoungKSVeldenAMVDCraskeMG,et al.The impact of mindfulness-based interventions on brain activity: a systematic review of functional magnetic resonance imaging studies. Neurosci Biobehav Rev2018; 84: 424–433.
14.
TsangSCMokESLamSC,et al.The benefit of mindfulness-based stress reduction to patients with terminal cancer. J Clin Nurs2012; 21: 2690–2696.
15.
ThaseMEHowlandRH. Biological processes in depression: an updated review and integration. In: BeckhamEELeberWR (eds) Handbook of Depression. New York: Guilford Press, 1995, pp.213–279.
16.
XunlinNGLauYKlainin-YobasP. The effectiveness of mindfulness-based interventions among cancer patients and survivors: a systematic review and meta-analysis. Support Care Cancer2019; 28: 1563–1578.
17.
HofmannSGGómezAF. Mindfulness-based interventions for anxiety and depression. Psychiatr Clin N Am2017; 40: 739–749.
18.
Kabat-ZinnJ. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness; The Mindfulness-Based Stress Reduction (Mbsr) Program Used in Medical Centers Worldwide. New York: Bantam Books, 2013.
19.
SegalZVWilliamsJMGTeasdaleJD,et al.Mindfulness-Based Cognitive Therapy for Depression. New York: The Guilford Press, 2018.
20.
AlsubaieMAbbottRDunnB,et al.Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: a systematic review. Clin Psychol Rev2017; 55: 74–91.
21.
CarlsonLE. Mindfulness-based interventions for coping with cancer. Ann N Y Acad Sci2016; 1373: 5–12.
22.
HarrisR. Act Made Simple: An Easy-to-Read Primer on Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Publications, 2009.
23.
McCrackenLMVowlesKE. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol2014; 69: 178–187.
24.
BarbabellaFMelchiorreMGQuattriniS,et al. (eds.). How Can eHealth Improve Care for People With Multimorbidity in Europe?The Netherlands: European Observatory on Health Systems and Policies, 2017.
25.
GaddiACapelloFMancaM. Ehealth, Care and Quality of Life. Switzerland: Springer, 2014.
26.
NekhlyudovLDuijtsSHudsonSV, et al.Addressing the needs of cancer survivors during the COVID-19 pandemic. J Cancer Surviv2020; 14: 601–606.
27.
CillessenLJohannsenMSpeckensAEM,et al.Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta-analysis of randomized controlled trials. Psychooncology2019; 28: 2257–2269.
28.
FordCGVowlesKESmithB,et al.Mindfulness and meditative movement interventions for men living with cancer: a meta-analysis. Ann Behav Med2019; 54: 360–373.
29.
SchellLKMonsefI,WöckelA, et al.Mindfulness-based stress reduction for women diagnosed with breast cancer. Cochrane Database Syst Rev2019; 3: CD011518.
30.
ZhangQZhaoHZhengY. Effectiveness of mindfulness-based stress reduction (MBSR) on symptom variables and health-related quality of life in breast cancer patients-a systematic review and meta-analysis. Support Care Cancer2018; 27: 771–781.
31.
ZhangXLiuDLiY,et al.Effects of mindfulness-based interventions on quality of life of women with breast cancer: a systematic review. J Comp Eff Res2019; 8: 829–840.
32.
MatisJSvetlakMSlezackovaA,et al.Mindfulness-based programs for patients with cancer via eHealth and mobile health: systematic review and synthesis of quantitative research. J Med Internet Res2020; 22: e20709.
33.
MuradMHChuHLinL,et al.The effect of publication bias magnitude and direction on the certainty in evidence. BMJ Evid Based Med2018; 23: 84–86.
34.
LiGZengJTianJ,et al.Multiple uses of forest plots in presenting analysis results in health research: a tutorial. J Clin Epidemiol2020; 117: 89–98.
35.
AzevedoNPGravasSde la RosetteJ. Mobile health in urology: the good, the bad and the ugly. J Clin Med2020; 9: 1016.
36.
HigginsJThomasJChandlerJ,et al. (Eds.). Cochrane Handbook for Systematic Reviews of Interventions version 6.0. [cited 2019]. Available from https://training.cochrane.org/handbook
37.
SchünemannHBrożekJGuyattG,et al.(Eds.). GRADE handbook for grading quality of evidence and strength of recommendations. [cited 2021 February 12]. Available from https://gdt.gradepro.org/app/handbook/handbook.html
38.
CohenJ. Statistical Power Analysis for the Behavioral Sciences. 2nd ed.Mahwah, NJ: L. Erlbaum Associates, 1988.
39.
TufanaruCMunnZStephensonM,et al.Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness. Int J Evid Based Health2015; 13: 196–207.
40.
MoherDLiberatiATetzlaffJ,et al.PRISMA Group preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med2009; 6: e1000097.
41.
AltschulerARosenbaumEGordonP,et al.Audio recordings of mindfulness-based stress reduction training to improve cancer patients’ mood and quality of life—a pilot feasibility study. Support Care Cancer2011; 20: 1291–1297.
42.
AtreyaCEKuboABornoHT, et al.Being present: a single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers. PLoS One2018; 13: e0199423.
43.
CampoRABluthKSantacroceSJ, et al.A mindful self-compassion videoconference intervention for nationally recruited posttreatment young adult cancer survivors: feasibility, acceptability, and psychosocial outcomes. Support Care Cancer2017; 25: 1759–1768.
44.
ChambersSKOcchipintiSFoleyE, et al.Mindfulness-based cognitive therapy in advanced prostate cancer: a randomized controlled trial. J Clin Oncol2017; 35: 291–297.
45.
GrewalNKSAryaRMalikR,et al.Implementing a tablet-guided mindfulness meditation intervention to reduce anxiety in women receiving radiotherapy for breast cancer. Int J Radiat Oncol Biol Phys2019; 105: E588. 10.1016/j.ijrobp.2019.06.1181
46.
HathiramaniSPettengellRMoirH,et al.Relaxation versus exercise for improved quality of life in lymphoma survivors—A randomised controlled trial. J Cancer Surviv2021; 15: 470–480.
47.
HubertyJEckertRLarkeyL,et al.Smartphone-based meditation for myeloproliferative neoplasm patients: feasibility study to inform future trials. JMIR Form Res2019; 3: e12662.
48.
KuboAKurtovichEMcGinnisM, et al.Pilot pragmatic randomized trial of mHealth mindfulness-based intervention for advanced cancer patients and their informal caregivers. Psychooncology2020: 1-11. 10.1002/pon.5557
49.
LengacherCAReichRRRamesarS, et al.Feasibility of the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program for symptom improvement among breast cancer survivors. Psychooncology2018; 27: 524–531.
50.
McGowanD. Mindfulness and self-compassion in individuals diagnosed with breast cancer: Examining dispositional factors influencing wellbeing and evaluating an online mindfulness-based stress reduction programme (eMBSR) Doctoral dissertation, Griffith University; 2019. http://hdl.handle.net/10072/389546
51.
MilburyKLiYDurraniS,et al.Mindfulness-based intervention as a supportive care strategy for patients with metastatic non-small cell lung cancer and their spouses: results of a three-arm pilot randomized controlled trial. Oncologist2020; 25: e1794–e1802.
52.
MosherCESecintiELi, HirshAT, et al.Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial. Support Care Cancer2018; 26: 1993–2004.
53.
MosherCESecintiEHirshAT, et al.Acceptance and commitment therapy for symptom interference in advanced lung cancer and caregiver distress: a pilot randomized trial. J Pain Symptom Manag2019; 58: 632–644.
54.
NissenERO'ConnorMKaldoV,et al.Internet-delivered mindfulness-based cognitive therapy for anxiety and depression in cancer survivors: a randomized controlled trial. Psychooncology2019; 29: 68–75.
55.
Price-BlackshearMAPratscherSDOylerDL, et al.Online couples mindfulness-based intervention for young breast cancer survivors and their partners: a randomized-control trial. J Psychosocial Oncol2020; 38: 592–611.
56.
RosenKDPaniaguaSMKazanisW,et al.Quality of life among women diagnosed with breast cancer: a randomized waitlist-controlled trial of commercially available mobile app-delivered mindfulness training. Psychooncology2018; 27: 2023–2030.
57.
RussellLUgaldeAOrellanaL,et al.A pilot randomised controlled trial of an online mindfulness-based program for people diagnosed with melanoma. Support Care Cancer2019; 27: 2735–2746.
58.
ZernickeKACampbellTSSpecaM,et al.A randomized wait-list controlled trial of feasibility and efficacy of an online mindfulness-based cancer recovery program. Psychosom Med2014; 76: 257–267.
59.
DruckerAMFlemingPChanAW. Research techniques made simple: Assessing risk of bias in systematic reviews. J Investig Dermatol2016; 136: e109–e114.
60.
MuellerKFMeerpohlJJBrielM, et al.Methods for detecting, quantifying, and adjusting for dissemination bias in meta-analysis are described. J Clin Epidemiol2016; 80: 25–33.
61.
OberoiSYangJWoodgateRL, et al.Association of mindfulness-based interventions with anxiety severity in adults with cancer: a systematic review and meta-analysis. JAMA Netw2020; 3: e2012598.
62.
Kabat-ZinnJ. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Philadelphia, PA: Hachette Books 1994.
63.
FeldmanGGreesonJSenvilleJ. Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts. Behav Res Ther2010; 48: 1002–1011.
64.
Hayes-SkeltonSGrahamJ. Decentering as a common link among mindfulness, cognitive reappraisal, and social anxiety. Behav Cogn Psychother2013; 41: 317–328.
65.
ChoHRyuSNohJ,et al.The effectiveness of daily mindful breathing practices on test anxiety of students. PLoS One2016; 11: e0164822.
66.
RaglanGBSchmidtLASchulkinJ. The role of glucocorticoids and corticotropin-releasing hormone regulation on anxiety symptoms and response to treatment. Endocr Connect2017; 6: R1–R7.
67.
FongTCHoRT. Mindfulness facets predict quality of life and sleep disturbance via physical and emotional distresses in Chinese cancer patients: a moderated mediation analysis. Psychooncology2020; 29: 894–901.
68.
ForsytheLPKentEEWeaverKE, et al.Receipt of psychosocial care among cancer survivors in the United States. J Clin Oncol2013; 31: 1961–1969.
69.
YousafOGrunfeldEAHunterMS. A systematic review of the factors associated with delays in medical and psychological help-seeking among men. Health Psychol Rev2013; 9: 264–276.
70.
AndersonTSureshMFarbNA. Meditation benefits and drawbacks: empirical codebook and implications for teaching. J Cogn Enhanc2019; 3: 207–220.
71.
TanniouJvan der TweelITeerenstraS,et al.Subgroup analyses in confirmatory clinical trials: time to be specific about their purposes. BMC Med Res Methodol2016; 16: 20.
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