Mindfulness-Based Stress Reduction Superior to Supportive-Expressive Therapy for Distressed Survivors of Breast Cancer


Key Points

  • Mindfulness-based cancer recovery was shown in to be superior to supportive-expressive group therapy in decreasing symptoms of stress and improving overall quality of life and social support among distressed survivors of stage I to III breast cancer.
  • Patients in the intervention groups had more normative cortisol profiles compared to the control group.
  • Accumulating evidence indicates that mindfulness-based cancer recovery should be a routine part of comprehensive care for patients in need.

Mindfulness-based cancer recovery was shown in to be superior to supportive-expressive group therapy decreasing symptoms of stress and improving overall quality of life and social support among survivors of stage I to III breast cancer who were distressed, according to a study reported in Journal of Clinical Oncologyby Linda E. Carlson, PhD, of the Division of Psychosocial Oncology at the University of Calgary, and colleagues.“Improvements were clinically meaningful,” the study authors stated.

Mindfulness-based cancer recovery is the researchers’ adaptation of mindfulness-based stress reduction. Both mindfulness-based stress reduction and supportive-expressive group therapy are “two of the most…well-validated group interventions for cancer support,” the authors noted, “but the two have never been directly compared.” In the current trial, 271 patients were randomly assigned in a 2:2:1 allocation ratio to either mindfulness-based cancer recovery, supportive-expressive group therapy, or a 1-day stress management control program. In order to be eligible for inclusion, study participants must have completed all treatments, except hormonal or trastuzumab (Herceptin) therapy, at least 3 months before.

Therapeutic Focus Differs By Treatment Modality

Group format, size, structure, and contact hours were similar in both mindfulness-based cancer recovery and supportive-expressive group therapy. However, while supportive-expressive group therapies focused on group support and emotional expression, mindfulness-based cancer recovery revolved around mindfulness meditation, yoga practice, and sustaining mindful awareness in everyday life. “The two treatment modalities are distinct in their content, focus, and theoretical underpinnings,” the authors wrote.

“Women in [mindfulness-based cancer recovery] improved more over time on stress symptoms compared with women in both the [supportive expressive group therapy] (P = .009) and control (P = .024) groups,” reported the authors. Compared to patients in the control group and supportive-expressive group therapy group, patients in the mindfulness-based cancer recovery group experienced greater improvements in quality of life (P = .005) and in social support (P = .012), respectively.

More Normative Cortisol Profiles in Intervention Groups

In addition, diurnal salivary cortisol slopes, as measured from saliva samples collected by participants for 3 days before randomization and 3 days after intervention completion, were maintained over time for both interventions but became flatter for the control group. “Because abnormal or flattened cortisol profiles have been related to both poorer psychological functioning and shorter survival time in breast, lung, and renal cell carcinoma, this finding may point to the potential for these psychosocial interventions to improve biologic processes related to both patient-reported outcomes and more objective indices,” the researchers wrote, noting that more research is necessary to fully understand the clinical meaning of these parameters in primary breast cancer.

“[Mindfulness-based cancer recovery] helps facilitate development of positive emotional regulation strategies such as acceptance and gently extinguishes unhelpful strategies including worry, rumination, and experiential avoidance…The result is often a sense of heightened control, calm, peace, and serenity, even in the face of the many uncontrollable elements of cancer,” the authors stated.

“Given this continually growing evidence of efficacy [of mindfulness-based cancer recovery],” the authors concluded, “cancer treatment centers should consider providing such interventions to needy patients as a routine part of comprehensive clinical care.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.