Effects of a 4 - week internet - delivered mindfulness - based cancer recovery program on anxiety, depression, and mindfulness among patients with breast cancer

Abstract

Objectives: The efficacy of monotherapy in alleviating psychological disorders like anxiety and depression among breast cancer patients is suboptimal, necessitating effective psychosocial interventions. Mindfulness-based interventions have been shown to mitigate anxiety-depression symptoms and encourage beneficial behaviors. The online mindfulness-based cancer recovery (MBCR) offers flexibility and guides practice across various settings, facilitating full patient engagement. This study amis to analyze the impact of a 4-week internet-delivered mindfulness-based cancer recovery program on anxiety, depression, and mindfulness among Chinese patients with breast cancer, and to evaluate the degree of satisfaction breast cancer patients experienced after participating in this program.

Methods: This study utilized a two-armed, parallel, randomized controlled trial design. A total of 103 patients with breast cancer from June 2020 to January 2021 in the ward of Breast and Thyroid Surgery of a tertiary hospital in Changsha, Hunan Province were selected and randomly assigned to an intervention group (n=51) and a control group (n=52). The intervention group participated in an internet-delivered mindfulness-based cancer recovery program, which was delivered once a week for 4 weeks. Meanwhile, the control group received weekly group health education for 4 weeks. The outcomes of hospital anxiety and depression scale and mindfulness Attention Awareness Scale were evaluated at 3 distinct time points: Baseline (T1), postintervention (T2), and 1-month follow-up (T3). The satisfaction questionnaire of 4-week mindful cancer rehabilitation training program was used at T2 to evaluate patients' satisfaction with the intervention program. Generalized estimation equations were used to assess differences in anxiety, depression and mindfulness levels between groups before and after the intervention.

Results: There were no statistically significant differences in demographic data and outcome index scores between the 2 groups at T1 (all P>0.05), indicating that the 2 groups were comparable. The generalized estimating equation analyses showed that the intervention group had significantly better improvement in outcomes compared to the control group, particularly for anxiety (T2 β=-1.30, 95% CI -1.87 to -0.72; T3 β=-2.78, 95% CI -3.51 to -2.05) and depression (T2 β=-1.92, 95% CI -2.78 to -1.06; T3 β=-2.96, 95% CI -4.05 to -1.87; all P<0.001). Moreover, the mindfulness score in the intervention group was significantly higher than that in the control group at T2 (β=3.23, 95% CI 0.73 to 5.72) and T3 (β=8.06, 95% CI 4.37 to 11.75; both P<0.05). In addition, patients in the intervention group were satisfied with the 4-week mindfulness-based cancer recovery intervention and teaching/learning activities used to implement the program.

Conclusions: In patients with breast cancer, the 4-week internet-delivered mindfulness-based cancer recovery program, as a low-threshold, short-term mental health intervention, has a positive effect on reducing anxiety and depression and improving mindfulness levels. This program holds great promise as a tool for clinical nursing practice, given the high satisfaction and applicability.

Keywords: anxiety; breast cancer; depression; internet-based interventions; mindfulness.

Figure 1. CONSORT flow chart of the current study