Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial

Abstract

Background: Premenopausal women diagnosed with breast cancer are at risk for psychological and behavioral disturbances after cancer treatment. Targeted interventions are needed to address the needs of this vulnerable group.

Methods: This randomized trial provided the first evaluation of a brief, mindfulness-based intervention for younger breast cancer survivors designed to reduce stress, depression, and inflammatory activity. Women diagnosed with early stage breast cancer at or before age 50 who had completed cancer treatment were randomly assigned to a 6-week Mindful Awareness Practices (MAPS) intervention group (n = 39) or to a wait-list control group (n = 32). Participants completed questionnaires before and after the intervention to assess stress and depressive symptoms (primary outcomes) as well as physical symptoms, cancer-related distress, and positive outcomes. Blood samples were collected to examine genomic and circulating markers of inflammation. Participants also completed questionnaires at a 3-month follow-up assessment.

Results: In linear mixed models, the MAPS intervention led to significant reductions in perceived stress (P = .004) and marginal reductions in depressive symptoms (P = .094), as well as significant reductions in proinflammatory gene expression (P = .009) and inflammatory signaling (P = .001) at postintervention. Improvements in secondary outcomes included reduced fatigue, sleep disturbance, and vasomotor symptoms and increased peace and meaning and positive affect (P < .05 for all). Intervention effects on psychological and behavioral measures were not maintained at the 3-month follow-up assessment, although reductions in cancer-related distress were observed at that assessment.

Conclusions: A brief, mindfulness-based intervention demonstrated preliminary short-term efficacy in reducing stress, behavioral symptoms, and proinflammatory signaling in younger breast cancer survivors.

Keywords: breast cancer; inflammation; mindfulness; premenopausal; stress.

Figure 1

CONSORT diagram

Figure 2

Adjusted means for perceived stress (A) and depressive symptoms (B) in the intervention group and controls. Linear mixed regression analyses revealed significant reductions in stress and marginally significant reductions in depressive symptoms in the MAPS group vs. controls from baseline to post-intervention. These effects were not maintained at the three-month follow-up.

Figure 3

(A) Transcriptional profiling of PBMC samples showed a significantly greater decline in a 19-transcript composite of pro-inflammatory genes in the MAPS group vs. controls. (B) Bioinformatics analysis of transcription factor activity indicated reduced activity of the pro-inflammatory transcription factor NF-κB and increased activity of the anti-inflammatory glucocorticoid receptor (GR) in the MAPS group vs. controls. Analyses also indicated increased activity of interferon-related transcription factors (IRF) but no significant difference in CREB activity. (C) Transcript origin analyses identified genes down-regulated in intervention participants as originating primarily from monocytes and dendritic cells, and up-regulated genes as originating predominately from B lymphocytes.