The Impact of Mindfulness-Based Stress Reduction (MBSR) on Psychological Outcomes and Quality of Life in Patients With Lung Cancer: A Meta-Analysis

Abstract

Objective: The impact of the mindfulness-based stress reduction (MBSR) program on psychological outcomes and quality of life (QoL) in lung cancer patients remains unclear. This meta-analysis aimed to evaluate the effectiveness of the MBSR program on psychological states and QoL in lung cancer patients.

Methods: Eligible studies published before November 2021 were systematically searched from PubMed, EMBASE, Cochrane Library, PsycINFO, China National Knowledge Infrastructure (CNKI), and Wanfang databases. The risk of bias in eligible studies was assessed using the Cochrane tool. Psychological variables and QoL were evaluated as outcomes. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to grade the levels of evidence. Statistical analysis was conducted using RevMan 5.4 and STATA 14.0.

Results: A total of 17 studies involving 1,680 patients were included for meta-analysis eventually. MBSR program significantly relieved cancer-related fatigue (standard mean difference [SMD], -1.26; 95% confidence interval [CI], -1.69 to -0.82; moderate evidence) and negative psychological states (SMD, -1.35; 95% CI, -1.69 to -1.02; low evidence), enhanced positive psychological states (SMD, 0.91; 95% CI, 0.56-1.27; moderate evidence), and improved quality of sleep (MD, -2.79; 95% CI, -3.03 to -2.56; high evidence). Evidence on MBSR programs' overall treatment effect for QoL revealed a trend toward statistical significance (p = 0.06, low evidence).

Conclusion: Based on our findings, the MBSR program shows positive effects on psychological states in lung cancer patients. This approach should be recommended as a part of the rehabilitation program for lung cancer patients.

Systematic review registration: https://archive.org/details/osf-registrations-mwvbq-v1, identifier: 10.17605/OSF.IO/MWVBQ.

Keywords: lung cancer; meta-analysis; mindfulness-based stress reduction; physical and psychological wellbeing; quality of life.

Figure 1

PRISMA flowchart of study retrieval and selection process. CNKI, China National Knowledge Infrastructure.

Figure 2

Forest plot of comparative effectiveness between mindfulness-based stress reduction (MBSR) program and UC in terms of cancer-related fatigue (A) and negative psychological states (B). MBSR, mindfulness-based stress reduction; UC, usual care; R-PFS, Revised Piper Fatigue Scale; CFS, Cancer Fatigue Scale; SAS, Self-rating Anxiety Scale; SDS, Self-rating Depression Scale; HAMA, Hamilton Anxiety Scale; HAMD, Hamilton Depression Scale; SD, standard deviation.

Figure 3

Forest plot of comparative effectiveness between the MBSR program and UC in terms of positive psychological status. MBSR, mindfulness-based stress reduction; UC, usual care; SUPPH, strategies used by people to promote health.

Figure 4

Forest plot of comparative effectiveness between MBSR program and UC in terms of quality of sleep (A) and QoL (B). MBSR, mindfulness-based stress reduction; UC, usual care; PSQI, Pittsburgh sleep quality index; EORTC QLQ-C30, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire.

Figure 5

The hypothetical causal pathway of the MSBR program for improving psychological outcomes and QoL of lung cancer patients. MBSR, mindfulness-based stress reduction; QoL, quality of life. In this hypothetical causal pathway, the black unidirectional arrow indicated the causal relationship between two elements, and the red bidirectional arrow indicated the interrelationship of two elements. Destructive effects of stressors break a patient's psychosomatic balance by initiating negative psychological adjustment and then harming clinical outcomes. In contrast, implementation of the MBSR program may enhance positive psychological adjustment by triggering positive psychological sources (e.g., self-efficacy) to gradually restore the patient's psychosomatic balance and then improve clinical outcomes.