Are mindfulness-based therapies effective in improving physical health, psychological health and quality of life among patients with breast cancer?
Date of publication of the systematic review: June 2016
Design
Systematic review of 7 randomized controlled trials (RCTs).
Participants
951 patients with a clinical diagnosis of non-metastatic breast cancer regardless of current treatment status. The reviewers did not report mean age and gender proportion of the participants.
Intervention
Weekly standard mindfulness-based stress reduction (MBSR) program and mindful awareness practices (MAPs) program were used as interventions. Duration of treatment ranged from 6 to 8 weeks.
Comparator
Comparison: Mindfulness-based therapies (MBT) versus waiting list or no treatment.
Major Outcomes
Outcome 1: Anxiety as measured at the end of intervention;
Outcome 2: Depression as measured at the end of intervention;
Outcome 3: Fear of recurrence as measured at the end of intervention;
Outcome 4: Fatigue as measured at the end of intervention;
Outcome 5: Emotional well-being as measured at the end of intervention;
Outcome 6: Physical function as measured at the end of intervention;
Outcome 7: Physical health as measured at the end of intervention.
Settings
The reviewers did not state whether the study was performed in inpatient or outpatient settings.
Comparison    MBT versus waiting list or no treatment
Main Results
Compared to waiting list or no treatment, MBT showed significant effects in reducing anxiety (standardized mean difference (SMD): -0.31, 95% CI: -0.46 to -0.16), depression (SMD: -1.13, 95% CI: -1.85 to -0.41), fear of recurrence (SMD: -0.71, 95% CI: -1.05 to -0.38) and fatigue (SMD: -0.88, 95% CI: -1.71 to -0.05). MBT also improved emotional well-being (SMD: 0.39, 95% CI: 0.19 to 0.58), physical function (SMD: 0.42, 95% CI: 0.19 to 0.65) and physical health (SMD: 0.31, 95% CI: 0.08 to 0.54). However, considerable heterogeneity exists for the outcomes of depression and fatigue.
Comparison: MBT versus waiting list or no treatment in patients with breast cancer
Outcomes No. of studies (Total number of participants) Mean value/No. of participants Heterogeneity test (I2) SMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 4 (681) Not reported/327 Not reported/354 18% -0.31 (-0.46 to -0.16) Moderate
2 5 (737) Not reported/360 Not reported/377 95% -1.13 (-1.85 to -0.41) Moderate
3 2 (147) Not reported/75 Not reported/72 0% -0.71 (-1.05 to -0.38) Moderate
4 3 (320) Not reported/155 Not reported/165 89% -0.88 (-1.71 to -0.05) Low
5 3 (404) Not reported/195 Not reported/209 0% 0.39 (0.19 to 0.58) Moderate
6 2 (294) Not reported/142 Not reported/152 0% 0.42 (0.19 to 0.65) Moderate
7 2 (295) Not reported/142 Not reported/153 12% 0.31 (0.08 to 0.54) Moderate
Keys: SMD: standardized mean difference; CI: confidence intervals.
Comparison    MBT versus waiting list or no treatment
Main Results
Compared to waiting list or no treatment, MBT showed significant effects in reducing anxiety (standardized mean difference (SMD): -0.31, 95% CI: -0.46 to -0.16), depression (SMD: -1.13, 95% CI: -1.85 to -0.41), fear of recurrence (SMD: -0.71, 95% CI: -1.05 to -0.38) and fatigue (SMD: -0.88, 95% CI: -1.71 to -0.05). MBT also improved emotional well-being (SMD: 0.39, 95% CI: 0.19 to 0.58), physical function (SMD: 0.42, 95% CI: 0.19 to 0.65) and physical health (SMD: 0.31, 95% CI: 0.08 to 0.54). However, considerable heterogeneity exists for the outcomes of depression and fatigue.
Comparison: MBT versus waiting list or no treatment in patients with breast cancer
Outcomes 1 2 3 4 5 6 7
No. of studies (Total number of participants) 4 (681) 5 (737) 2 (147) 3 (320) 3 (404) 2 (294) 2 (295)
Mean value/No. of participants Intervention Not reported/327 Not reported/360 Not reported/75 Not reported/155 Not reported/195 Not reported/142 Not reported/142
Comparator Not reported/354 Not reported/377 Not reported/72 Not reported/165 Not reported/209 Not reported/152 Not reported/153
SMD (95% CI) -0.31 (-0.46 to -0.16) -1.13 (-1.85 to -0.41) -0.71 (-1.05 to -0.38) -0.88 (-1.71 to -0.05) 0.39 (0.19 to 0.58) 0.42 (0.19 to 0.65) 0.31 (0.08 to 0.54)
Overall quality of evidence* Moderate Moderate Moderate Low Moderate Moderate Moderate
Keys: SMD: standardized mean difference; CI: confidence intervals.
Conclusion
Benefits
Compared to waiting list or no treatment, MBT showed significant effects in reducing anxiety, depression, fear of recurrence and fatigue. MBT also improved emotional well-being, physical function and physical health. For all outcomes except outcome 4, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. For outcome 4, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
None of the included trials report on adverse events.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/27261975
The synopsis is based on the following article:
Zhang J, Xu R, Wang B, Wang J. Effects of mindfulness-based therapy for patients with breast cancer: A systematic review and meta-analysis. Complementary therapies in medicine. 2016 Jun 1;26:1.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.