Efficacy of an online mindfulness program (MindOnLine) to reduce fear of recurrence in people living with-and beyond-breast, prostate or colorectal cancer: a randomized controlled trial

Patricia M Livingston^{1

2

3}, Natalie Winter¹, Lahiru Russell², Eric O², Allan Ben Smith⁴, Helena Romaniuk⁵, Michael Jefford^{6

7}, Anna Ugalde¹, Afaf Girgis⁸, David W Austin^{2

9}, Cathrine Mihalopoulos¹⁰, Richard Chambers¹⁰, Jo Phipps-Nelson^{6

7}, Dishan Herath¹¹, Bodil Rasmussen^{1

3

12}, Kathryn Whitfield¹³, Maria Ftanou^{6

14}, Kirsten Pilatti¹⁵, Sally Sara¹⁶, Annie Wootten¹⁷, Mari Botti¹, Kate Gillan¹⁸, Madhu Singh¹⁹, David Campbell¹⁹, Brindha Pillay²⁰, Philip Dundee^{21

22}, Michael O'Callaghan²³, Sue M Evans²⁴, Liliana Orellana^{2

5}, Victoria M White⁹

Affiliations

¹ Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, Victoria, 3220, Australia.
² Faculty of Health, Deakin University, Geelong, Victoria, Australia.
³ Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
⁴ The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia.
⁵ Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
⁶ Department of Health Services Research, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁷ Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
⁸ South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, NSW, Australia.
⁹ School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
¹⁰ Monash University, Melbourne, Australia.
¹¹ Western Health Partnership, St Albans, Melbourne, Victoria, Australia.
¹² Faculty of Health Sciences, University of Southern Denmark, Denmark.
¹³ Community Based Health Services, Policy and Improvement | Commissioning and System Improvement, Department of Health, Melbourne, Victoria, Australia.
¹⁴ School of Population and Global Health, University of Melbourne, Victoria, Australia.
¹⁵ Breast Cancer Network Australia, Melbourne, Victoria, Australia.
¹⁶ Prostate Cancer Foundation Australia, Melbourne, Victoria, Australia.
¹⁷ Smiling Mind, Melbourne, Victoria, Australia.
¹⁸ Epworth HealthCare, Melbourne, Victoria, Australia.
¹⁹ Andrew Love Cancer Centre, Barwon Health, University Hospital, Geelong, Victoria, Australia.
²⁰ Psychosocial Oncology Program, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
²¹ Australian Prostate Centre, Melbourne, Victoria, Australia.
²² University of Melbourne, Melbourne, Victoria, Australia.
²³ Flinders Medical Centre, Bedford Park, SA, Australia.
²⁴ Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia.

PMID: 40756964
PMCID: PMC12318308
DOI: 10.1016/j.eclinm.2025.103373

Efficacy of an online mindfulness program (MindOnLine) to reduce fear of recurrence in people living with-and beyond-breast, prostate or colorectal cancer: a randomized controlled trial

Patricia M Livingston et al. EClinicalMedicine. 2025.

. 2025 Jul 25:86:103373.

doi: 10.1016/j.eclinm.2025.103373. eCollection 2025 Aug.

Authors

Affiliations

¹ Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, Victoria, 3220, Australia.
² Faculty of Health, Deakin University, Geelong, Victoria, Australia.
³ Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
⁴ The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia.
⁵ Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
⁶ Department of Health Services Research, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁷ Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
⁸ South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales, NSW, Australia.
⁹ School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
¹⁰ Monash University, Melbourne, Australia.
¹¹ Western Health Partnership, St Albans, Melbourne, Victoria, Australia.
¹² Faculty of Health Sciences, University of Southern Denmark, Denmark.
¹³ Community Based Health Services, Policy and Improvement | Commissioning and System Improvement, Department of Health, Melbourne, Victoria, Australia.
¹⁴ School of Population and Global Health, University of Melbourne, Victoria, Australia.
¹⁵ Breast Cancer Network Australia, Melbourne, Victoria, Australia.
¹⁶ Prostate Cancer Foundation Australia, Melbourne, Victoria, Australia.
¹⁷ Smiling Mind, Melbourne, Victoria, Australia.
¹⁸ Epworth HealthCare, Melbourne, Victoria, Australia.
¹⁹ Andrew Love Cancer Centre, Barwon Health, University Hospital, Geelong, Victoria, Australia.
²⁰ Psychosocial Oncology Program, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
²¹ Australian Prostate Centre, Melbourne, Victoria, Australia.
²² University of Melbourne, Melbourne, Victoria, Australia.
²³ Flinders Medical Centre, Bedford Park, SA, Australia.
²⁴ Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia.

PMID: 40756964
PMCID: PMC12318308
DOI: 10.1016/j.eclinm.2025.103373

Abstract

Background: Fear of cancer recurrence (FCR) is a prevalent and debilitating condition that effects around 60% of people living with cancer. It is severe, persistent, and imposes a significant financial burden on the healthcare system. Given FCR's profound impact on mental health and quality of life, adopting targeted interventions to mitigate its effects is essential. This study reports on the efficacy of MindOnLine, an online mindfulness program, for people living with-and beyond-breast, prostate or colorectal cancer, in reducing FCR, anxiety and depression.

Methods: Randomized controlled trial (1:1) comparing MindOnline with a waitlist group (ANZCTR: 12620000645954). Eligibility criteria: ≥18 years, living in Australia, completed active treatment/surveillance for stages 1-3 breast, prostate or CRC, within the last 5 years, had internet access, and a Fear of Cancer Recurrence Inventory (FCRI) severity score ≥13. MindOnLine was a self-directed, brief, online 9-week program, with a new module unlocked each week. The intervention incorporated education, mindfulness practices, and meditation, to promote awareness and emotion regulation. Data were captured at baseline, 9-weeks and 9-months post-randomization. Linear mixed models assessed MindOnLine's impact on the primary (FCRI total score) and secondary (anxiety (GAD-7), depression (PHQ-9)) outcomes.

Findings: Between October 2020 and June 2023, 434 participants randomized, of which 58% had breast, 26% prostate and 16% colorectal cancer; 70% were female; 50% were aged ≥60 years; and 67.5% resided in metropolitan areas. At 9-weeks, MindOnLine decreased the FCRI total score (-5.61, 95% CI [-8.61, -2.61], p < 0.001); anxiety (-1.29 [-2.15, -0.43], p = 0.003) and depression (-1.47 [-2.34, -0.61], p < 0.001) scores, compared to the waitlist group. Intervention effects were sustained at 9-months (FCRI: -5.06 [-8.61, -1.52]; p = 0.005; anxiety: -1.22 [-2.21, -0.24], p = 0.015; depression: -1.09 [-2.03, -0.16], p = 0.022).

Interpretation: Our findings demonstrate that a self-directed, brief, online mindfulness-based program mitigates moderate or severe fear of cancer recurrence. Further research is necessary to guide the development of future services, policies and practices by identifying how online mindfulness programs can be customized to effectively support diverse population groups, ensuring the programs are effective and accessible and impactful, regardless of their personal circumstances or geographical location.

Funding: This study was funded by the National Health and Medical Research Council (NHMRC) Partnership Grant ID APP1179317, with partner cash contributions from the Department of Health, Victoria, Epworth HealthCare and Western Health.

Keywords: Anxiety; Cancer; Depression; Fear of cancer recurrence; Mindfulness; Supportive care; Web-based platforms.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**Fig. 1**
**CONSORT diagram.** ∗the number of people who received the advertisement from social media and community groups is unknown.

See this image and copyright information in PMC

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Efficacy of an online mindfulness program (MindOnLine) to reduce fear of recurrence in people living with-and beyond-breast, prostate or colorectal cancer: a randomized controlled trial

Affiliations

Efficacy of an online mindfulness program (MindOnLine) to reduce fear of recurrence in people living with-and beyond-breast, prostate or colorectal cancer: a randomized controlled trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References