Mindfulness-based psychosocial interventions and psychological wellbeing in cancer survivorship: a meta-analysis

Abstract

Purpose: Among cancer survivors, mindfulness-based interventions appear promising in decreasing distress for cancer patients, but little attention has been paid to the ultimate mindfulness goal of increasing psychological wellbeing. This meta-analysis aims to summarise and synthesise available evidence concerning the effectiveness of MBIs on positive psychological outcomes reflecting key aspects of psychological wellbeing in heterogeneous cancer patients.

Methods: A literature search of mindfulness-based randomised clinical trials in cancer survivors was conducted across six electronic databases. Two reviewers independently screened studies and extracted data. Meta-analyses were conducted using R; standardised mean difference (SMD) was used to determine intervention effect. Moderators examined included therapeutic orientation, control group type, treatment modality, treatment target, heterogeneous vs. homogeneous cancer type, and facet of wellbeing.

Results: Thirty-one studies were included (N = 2651). Those who received mindfulness-based interventions reported significantly higher eudaimonic, hedonic, and social wellbeing than respondents in control groups (SMD = 0.599). Interventions were equally effective across therapeutic orientation, control group type, treatment modality and treatment target. There were trend level differences favouring homogeneous cancer diagnosis groups over heterogeneous diagnosis groups.

Conclusion: MBIs provide an effective treatment for increasing psychological wellbeing in cancer survivors. This finding has important implications for clinical practice.

Keywords: Cancer; meta-analysis; mindfulness; positive psychology; survivorship; well-being.

Fig 1

PRISMA flow diagram of reviewed articles

Fig 2

Forest plot of effect sizes. Note. PTGI-SF = Posttraumatic Growth Inventory – Short Form; PROMIS-SRS = Patient-Reported Outcomes Measurement Information System – Social Role Satisfaction; PROMIS-ES = Patient-Reported Outcomes Measurement Information System – Emotional Support; PROMIS-PAW = Patient-Reported Outcomes Measurement Information System – Positive Affect + Wellbeing Shortform; SCS-SK = Self-Compassion Scale – Self-Kindness; FACT-SWB = Functional Assessment of Cancer Therapy – Social Wellbeing; FACT-EWB = Functional Assessment of Cancer Therapy – Emotional Wellbeing; WHOQOL-BREF PD = World Health Organization Quality of Life Psychological Domain; WHOQOL-BREF SRD = World Health Organization Quality of Life Social Relationships Domain; PTGI = Posttraumatic Growth Inventory; SCS = Self Compassion Scale; WHO-5 = World Health Organization Wellbeing Index; LOT-R = Life Orientation Test – Revised; LiSat-9 = Life Satisfaction Questionnaire 9; PERMA-P = PERMA Profiler; Spirituality = 2 proprietary spirituality Likert questions; SWSS = Satisfaction with Life Scale; PANAS-PA = Positive and Negative Affect Schedule – Positive Affect; FACIT-M/P = Functional Assessment of Chronic Illness Therapy – Meaning/Peace; FACIT-Sp = Functional Assessment of Chronic Illness Therapy – Spirituality; PSOM = Positive States of Mind; PTGI-NP = Posttraumatic Growth Inventory – New Possibilities; PTGI-RO = Posttraumatic Growth Inventory – Relating to Others; PTGI-PS = Posttraumatic Growth Inventory – Personal Strength; PTGI-AL = Posttraumatic Growth Inventory – Appreciation of Life; PTGI-SC = Posttraumatic Growth Inventory – Spiritual Change; PCQ-SE = Psychological Capital Questionnaire – Self-Efficacy; PCQ-H = Psychological Capital Questionnaire – Hope; PCQ-R = Psychological Capital Questionnaire – Resilience; PCQ-O = Psychological Capital Questionnaire – Optimism; MHC-SF = Mental Health Continuum – Short Form; MHS = Miller Hope Scale

Fig 3

Cook’s Distance plot for effect sizes; y-intercept represents value of 0.06, equivalent to (4/n) where n = 66 effect sizes