Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. Effects of a Psychoeducational Intervention in Patients With Breast Cancer Undergoing Chemotherapy Supportive-expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial. Improvements in Emotion Regulation Following Mindfulness Meditation: Effects on Depressive Symptoms and Perceived Stress in Younger Breast Cancer Survivors Randomized controlled trial of mindfulness-based stress reduction (MBSR) on posttraumatic growth of Chinese breast cancer survivors Brief cognitive-behavioral and relaxation training interventions for breast cancer: A randomized controlled trial. Cognitively-Based Compassion Training (CBCT®) in Breast Cancer Survivors: A Randomized Clinical Trial Study Mindfulness and its efficacy for psychological and biological responses in women with breast cancer The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Depression, Anxiety and Quality of Life in Long-Term Survivors of Malignant Melanoma: A Register-Based Cohort Study Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis Does a community-based stress management intervention affect psychological adaptation among underserved black breast cancer survivors? A randomised controlled trial of support group intervention after breast cancer treatment: Results on anxiety and depression Feasibility of Cognitively-Based Compassion Training (CBCT) for breast cancer survivors: a randomized, wait list controlled pilot study A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. Quality of life among women diagnosed with breast Cancer: A randomized waitlist controlled trial of commercially available mobile app‐delivered mindfulness training Cognitive-behavioural stress management enhances adjustment in women with breast cancer. A Brief Intervention for Fatigue Management in Breast Cancer Survivors Long-term quality of life after breast cancer: a French registry-based controlled study A Controlled Trial of Group Cognitive Behavior Therapy for Irish Breast Cancer Patients Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional survey. Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. A psychosocial group intervention for Japanese women with primary breast carcinoma Efficacy of Mindfulness-Based Cognitive Therapy on Late Post-Treatment Pain in Women Treated for Primary Breast Cancer: A Randomized Controlled Trial. A comparison of heterogeneity variance estimators in combining results of studies. Beneficial Effect of Mindfulness-Based Art Therapy in Patients with Breast Cancer-A Randomized Controlled Trial. Effects of a Nurse-Led Cognitive-Behavior Therapy on Fatigue and Quality of Life of Patients With Breast Cancer Undergoing Radiotherapy: An Exploratory Study Mindfulness-Based Stress Reduction in Post-treatment Breast Cancer Patients: Immediate and Sustained Effects Across Multiple Symptom Clusters.
PURPOSE The purpose of this r and omized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer ( MBSR[BC ] ) program in improving psychological and physical symptoms and quality of life among breast cancer survivors ( BCSs ) who completed treatment . Outcomes were assessed immediately after 6 weeks of MBSR(BC ) training and 6 weeks later to test efficacy over an extended timeframe . PATIENTS AND METHODS A total of 322 BCSs were r and omly assigned to either a 6-week  MBSR(BC ) program ( n = 155 ) or a usual care group ( n = 167 ) . Psychological ( depression , anxiety , stress , and fear of recurrence ) and physical symptoms ( fatigue and pain ) and quality of life ( as related to health ) were assessed at baseline and at 6 and 12 weeks . Linear mixed models were used to assess MBSR(BC ) effects over time , and participant characteristics at baseline were also tested as moderators of MBSR(BC ) effects . RESULTS Results demonstrated extended improvement for the MBSR(BC ) group compared with usual care in both psychological symptoms of anxiety , fear of recurrence overall , and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference ( P < .01 ) . Overall effect sizes were largest for fear of recurrence problems ( d = 0.35 ) and fatigue severity ( d = 0.27 ) . Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC ) . CONCLUSION The MBSR(BC ) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC ) training , with generally small to moderate overall effect sizes Background : Compelling evidence has yet to be published regarding the positive effect of psychoeducational interventions ( PEIs ) on psychological distress in patients with breast cancer . The impact of PEIs on self-efficacy , resilience , and quality of life is also unclear . Purpose : The aim of this study was to assess the effects of a PEI on anxiety , depression , disease-specific care knowledge , self-efficacy , resilience and quality of life in patients with breast cancer during and after chemotherapy . The intervention was administered before and during five rounds of chemotherapy treatment . Methods : A r and omized controlled trial was conducted . Patients with breast cancer ( N = 40 ) were r and omly assigned to either the experimental or control group . The experimental group participated in PEI , a brief and highly structured program consisting of two parts : ( a ) an educational manual that addressed depression , anxiety , disease-specific care knowledge , self-efficacy , and resilience and ( b ) a self- assessment of learning . The control group received only traditional pamphlet education . Data were collected at four time points : before the first chemotherapy session ( T1 ) , during the third chemotherapy session ( T2 ) , during the fifth chemotherapy session ( T3 ) , and at 2 weeks after the final chemotherapy session ( T4 ) . Results : Anxiety , depression , resilience , and quality of life in the experimental group showed significant differences at T4 . Significant differences became apparent at T2 for knowledge and at T3 for self-efficacy . The effects of knowledge , resilience , and quality of life remained significant when group and time interactions were included in the model , showing a positive relationship between PEI and the variables of knowledge , resilience , and quality of life . Conclusions / Implication s for Practice : Face-to-face PEI for patients with breast cancer is potentially effective in improving knowledge , resilience , and quality of life during and after chemotherapy . In the current study , PEI significantly improved disease care techniques , reduced chemotherapy-related discomfort , and improved quality of life for participants in the experimental group OBJECTIVE The aim is to evaluate the effectiveness of a manualized 12-week supportive-expressive group therapy program among primary breast cancer patients treated in community setting s , to determine whether highly distressed patients were most likely to benefit and whether therapist 's training or experience was related to outcome . METHOD Three hundred and fifty-three women within one year of diagnosis with primary breast cancer were r and omly assigned to receive supportive-expressive group therapy or to an education control condition . Participants were recruited from two academic centers and nine oncology practice s , which were members of NCI 's Community Clinical Oncology Program ( CCOP ) and were followed over 2 years . RESULTS A 2x2x19 analysis of variance was conducted with main effects of treatment condition , cohort , and baseline distress and their interactions . There was no main effect for treatment condition after removing one subject with an extreme score .  Highly distressed women did not derive a greater benefit from treatment . Therapist training and psychotherapy experience were not associated with a treatment effect . CONCLUSIONS This study provides no evidence of reduction in distress as the result of a brief supportive-expressive intervention for women with primary breast cancer . Future studies might productively focus on women with higher initial levels of distress Objective : Mindfulness meditation reduces psychological distress among individuals with cancer . However , mechanisms for intervention effects have not been fully determined . This study tested emotion regulation strategies as mediators of intervention effects in a sample of younger women treated for breast cancer , a group at risk for psychological distress . We focused on two distinct strategies targeted by the intervention — rumination and self-kindness— and further examined the broader construct of mindfulness as a potential mediator . Method : Women ( n = 71 ) with Stage 0-III breast cancer diagnosed at or before age 50 who had completed cancer treatment were r and omly assigned to a 6-week mindfulness intervention or wait-list control group . Assessment s occurred at study entry , postintervention , and a 3-month follow-up . Results : In single mediator analyses , increases in self-kindness ( CIB [ −7.83 , −1.93 ] ) , decreases in rumination ( CIB [ −5.05 , −.31 ] ) , and increases in mindfulness ( CIB [ −6.58 , −.82 ] ) each mediated reductions in depressive symptoms from pre- to postintervention . Increases in self-kindness also mediated reductions in perceived stress ( CIB [ −5.37 , −.62 ] ) from pre- to postintervention , and increases in self-kindness ( CIB [ −5.67 , −.22 ] ) and in mindfulness ( CIB [ −5.51 , −.16 ] ) each mediated intervention effects on perceived stress from preintervention to 3-month follow-up . In multiple mediator analysis , only self-kindness mediated intervention effects on depressive symptoms from pre- to postintervention ( CIB [ −6.41 , −.61 ] ) , and self-kindness and mindfulness together mediated intervention effects on perceived stress from preintervention to follow-up ( CIB [ −6.77 , −.35 ] ) . Conclusions : Self-kindness played a consistent role in reducing distress in younger women with breast cancer . The efficacy of this understudied emotion regulation strategy should be evaluated in other clinical population Abstract Breast cancer ( BC ) patients in China suffered from a variety of psychology stress such as perceived stress and anxiety , posttraumatic growth ( PTG ) as a positive factor could promote their psychology health and quality of life . This study aim ed to investigate the efficacy of mindfulness-based stress reduction ( MBSR ) on promoting PTG , decreasing perceived stress and anxiety of Chinese BC patients . A r and omized controlled trial of 60 BC patients ( Stages I – III ) was conducted . They were r and omly divided to the 8-week MBSR group or usual care ( UC ) group . PTG inventory , Perceived Stress Scale of Chinese version ( CPSS ) and State Trait Anxiety Inventory ( STAI ) evaluated the PTG level , perceived stress and anxiety at three times(before intervention-T1 , after intervention-T2 and follow up at 3 months-T3 ) . A repeated- measures analysis of variance model was used to compare each outcome measure of two groups at the three times . There was one patient discontinued the intervention and one lose to follow up in MBSR group , finally 58 BC patients completed the research . There was no difference between two groups before the intervention . The results showed significant improvements in MBSR group comparing with the UC group that PTG level was much higher after the 8-week intervention and the follow up ( F = 34.73 , p < .00 ) . At the same time , CPSS ( F = 14.41 , p < .00 ) and STAI ( F = 15.24 , p < .00 ) scores were significant decreased at T2 and T3 . The results showed that MBSR promoted the level of PTG and decreased perceived stress and anxiety state of Chinese BC patients , and the results persisted at three months after intervention . The research preliminary proved that MBSR was suitable to Chinese BC patients .  MBSR should be recommending to BC survivors in China OBJECTIVE Women with breast cancer ( BCa ) report elevated distress postsurgery . Group-based cognitive-behavioral stress management ( CBSM ) following surgery improves psychological adaptation , though its key mechanisms remain speculative . This r and omized controlled dismantling trial compared 2 interventions featuring elements thought to drive CBSM effects : a 5-week cognitive-behavioral training ( CBT ) and 5-week relaxation training ( RT ) versus a 5-week health education ( HE ) control group . METHOD Women with stage 0-III BCa ( N = 183 ) were r and omized to CBT , RT , or HE condition 2 - 10 weeks postsurgery . Psychosocial measures were collected at baseline ( T1 ) and postintervention ( T2 ) . Repeated- measures analyses of variance ( ANOVAs ) tested whether CBT and RT treatments improved primary measures of psychological adaptation and secondary measures of stress management re source perceptions from pre- to postintervention relative to HE . RESULTS Both CBT and RT groups reported reduced depressive affect . The CBT group reported improved emotional well-being/ quality of life and less cancer-specific thought intrusions . The RT group reported improvements on illness-related social disruption . Regarding stress management re sources , the CBT group reported increased reliability of social support networks , while the RT group reported increased confidence in relaxation skills . Psychological adaptation and stress management re source constructs were unchanged in the HE control group . CONCLUSIONS Nonmetastatic breast cancer patients participating in 2 forms of brief , 5-week group-based stress management intervention after surgery showed improvements in psychological adaptation and stress management re sources compared with an attention-matched control group . Findings provide preliminary support suggesting that using brief group-based stress management interventions may promote adaptation among nonmetastatic breast cancer patients Context . Breast cancer ( BC ) requires a significant psychological adaptation once treatment is finished . There is growing evidence of how compassion training enhances psychological and physical well-being , however , there are very few studies analyzing the efficacy of compassion-based Interventions on BC survivors . Objective . To study the efficacy of the Cognitively-Based Compassion Training ( CBCT ) protocol in a BC survivor sample on quality of life , psychological well-being , fear of cancer recurrence , self-compassion , and compassion domains and mindfulness facets . Furthermore , enrollment , adherence , and satisfaction with the intervention were also analyzed . Methods . A r and omized clinical trial was design ed . Participants ( n = 56 ) were r and omly assigned to CBCT ( n = 28 ) or a treatment-as-usual control group ( TAU  ; n = 28 ) . Pre-post intervention and 6-month follow-up measures took place to evaluate health-related quality of life , psychological well-being ; psychological stress , coping strategies , and triggering cognitions ; self-compassion and compassion ; and mindfulness in both intervention and wait-list groups . Results . Accrual of eligible participants was high ( 77 % ) , and the drop-out rate was 16 % .  Attendance to  CBCT sessions was high and practice off sessions exceeded expectations ) . CBCT was effective in diminishing stress caused by FCR , fostering self-kindness and common humanity , and increasing overall self-compassion scores , mindful observation , and acting with awareness skillsets . Conclusion . CBCT could be considered a promising and potentially useful intervention to diminish stress caused by FCR and enhance self-kindness , common humanity , overall self-compassion , mindful observation , and acting with awareness skillsets . Nevertheless , future r and omized trials are needed and a process of deeper cultural adaptation required Many breast cancer survivors have to deal with a variety of psychological and physiological sequelae including impaired immune responses . The primary purpose of this r and omized controlled trial was to determine the efficacy of a mindfulness‐based stress reduction ( MBSR ) intervention for mood disorders in women with breast cancer . Secondary outcomes were symptom experience , health status , coping capacity , mindfulness , posttraumatic growth , and immune status . This RTC assigned 166 women with breast cancer to one of three groups :  MBSR ( 8 weekly group sessions of MBSR ) , active controls ( self‐instructing MBSR ) and non‐MBSR . The primary outcome measure was the Hospital Anxiety and Depression Scale . Secondary outcome measures were : Memorial Symptom Assessment Scale , SF‐36 , Sense of Coherence , Five Facets of Mindfulness Question naire , and Posttraumatic Growth Index . Blood sample s were analyzed using flow cytometry for NK‐cell activity ( FANKIA ) and lymphocyte phenotyping ; concentrations of cytokines were determined in sera using commercial high sensitivity IL‐6 and IL‐8 ELISA ( enzyme‐linked immunosorbent assay ) kits . Results provide evidence for beneficial effects of MBSR on psychological and biological responses . Women in the MBSR group experienced significant improvements in depression scores , with a mean pre‐MBSR HAD‐score of 4.3 and post‐MBSR score of 3.3 ( P = 0.001 ) , and compared to non‐MBSR ( P = 0.015 ) . Significant improvements on scores for distress , symptom burden , and mental health were also observed . Furthermore , MBSR  facilitated coping capacity as well as mindfulness and posttraumatic growth . Significant benefits in immune response within the MBSR group and between groups were observed . MBSR have potential for alleviating depression , symptom experience , and for enhancing coping capacity , mindfulness and posttraumatic growth , which may improve breast cancer survivorship . MBSR also led to beneficial effect on immune function ; the clinical implication s of this finding merit further research Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Aim The purpose of the study was to determine anxiety and depression , quality of life , and their determinants in long-term survivors of malignant melanoma . Methods In a state cancer registry a cohort of survivors of malignant melanoma was contacted via the physician registered . Of 1302 contactable patients , 689 ( 52.2 % ) completed a question naire  including the Patient Health Question naire with generalized anxiety ( GAD-7 ) and depression ( PHQ-9 ) and the EORTC Quality of Life Question naire ( EORTC QLQ 30 ) . Based on multiple regression analysis , predictors of quality of life and distress were identified . Comparison data were assessed in two waves of representative face-to-face household surveys of the adult German population . Results An average of 8.4 ( 5.7 to 12.2 ) years after diagnosis , distress was higher in women compared to men and in middle adulthood ( vs. older patients ) . Symptoms were higher in women than in men , and there was a decline of functioning and increase of symptoms across the age range of both genders . Compared to the general population , there were slightly increased depression and anxiety ( only women ) , but no impaired global quality of life . Yet , survivors evidence d functional decline and more physical symptoms . Distress and reduced quality of life were consistently predicted by lack of social support , fear of recurrence , pessimism and self-blame . Distress was increased by a family history of melanoma , and additional mental and somatic diseases . Conclusion Overall , long-term survivors have adjusted well achieving a global quality of life comparable to the general population . Yet , compromised functional dimensions , physical symptoms and distress indicate the need for integrating psychooncological screening into oncological follow-up , which might be guided by predictors such as family history or social support . Further prospect i ve study is needed to determine the course of adaptation to the disease and corroborate the risk factors identified BACKGROUND We conducted a r and omised , controlled trial of cognitive-existential group therapy ( CEGT ) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer . METHODS Women were r and omised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes . Assessment s , independently done at baseline , 6 and 12 months , included a structured psychiatric interview and vali date d question naires covering mood , attitudes to cancer , family relationships , and satisfaction with therapy . RESULTS Three hundred and three of 491 ( 62 % ) eligible patients participated over 3 years .  Distress was high pre-intervention : 10 % were diagnosed as suffering from major depression , 27 % from minor depression and 9 % from anxiety disorders . On an intention-to-treat analysis , there was a trend for those receiving group therapy ( n=154 ) to have reduced anxiety ( p=0.05 , 2-sided ) compared to controls ( n=149 ) . Women in group therapy also showed a trend towards improved family functioning compared to controls ( p=0.07 , 2-sided ) . The women in the groups reported greater satisfaction with their therapy ( p<0.001 , 2-sided ) , appreciating the support and citing better coping , self-growth and increased knowledge about cancer and its treatment . They valued the CEGT therapy . Overall effect size for the group intervention was small ( d=0.25 ) , with cancer recurrence having a deleterious effect in three of the 19 therapy groups . Psychologists as a discipline achieved a moderate mean effect size ( d=0.52 ) . CONCLUSION CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer . Interaction effects between group members and therapists are relevant to outcome . Group-as-a-whole effects are powerful , but the training and experience of the therapist is especially critical to an efficacious outcome Purpose After cancer treatment , it is desirable to maintain or regain a high quality of life ( QoL ) and the ability to accomplish everyday tasks well . Therefore , we substantiated the scarce knowledge regarding long-term QoL after breast cancer , burdensome problems , and unmet needs for more support . Methods Disease-free breast cancer survivors ( n = 190 ) who had participated in two r and omized controlled exercise trials during primary treatment were followed up to 5 years post-diagnosis .  QoL-related functions and symptoms ( EORTC QLQ-C30/-BR23 ) , health problems , and support needs were assessed . EORTC-QLQ scores were compared with age-matched normative values from the general population in Germany . Results QoL-related functions and symptoms in patients during cancer treatment were worse compared to healthy references , but largely improved over time . Yet , cognitive function and sleep were still significantly impaired at 5-year follow-up . Other common long-term problems included sexual issues ( 45 % of survivors ) , hot flashes ( 38 % ) , pain ( 34 % ) , fatigue ( 24 % ) , and polyneuropathy ( 21 % ) . Regression analyses indicated fatigue having the strongest impact on global QoL. Support needs were expressed mainly for menopausal disorders ( 43 % ) , physical performance ( 39 % ) , sleep problems ( 38 % ) , arthralgia ( 37 % ) , cognitive problems ( 36 % ) , weight problems ( 32 % ) , and fatigue ( 31 % ) . Conclusions While QoL in disease-free breast cancer survivors 5 years post-diagnosis was largely comparable to the general population on average , still many survivors suffered from adverse effects . There appears to be a need for ongoing screening and support regarding fatigue , sleep problems , cognitive problems , arthralgia/pain , menopausal/sexual symptoms , physical performance , and weight problems during and several years following breast cancer therapy BACKGROUND In this r and omized trial , Project CARE , we examined whether participation in a cognitive-behavioral stress management and breast cancer wellness and education program improved psychological outcomes among a sample of underserved black breast cancer survivors . METHODS Both complementary medicine interventions were 10-sessions , manualized , group-based , and were culturally adapted for black women in the community from evidence -based interventions . Participants were 114 black women ( mean age = 51.1 , 27 - 77 years ) who had completed breast cancer treatment 0 - 12 months before enrollment ( stages 0-IV , mean time since cancer diagnosis = 14.1 months ) . Women were enrolled upon completion of curative treatment  ( ie , surgical , chemotherapy , radiation oncology ) and  r and omized to receive cognitive-behavioral stress management or cancer wellness and education program . RESULTS There was a remarkable 95 % retention rate from baseline to 6-month follow-up . Participants in both conditions showed statistically significant improvement on indices of psychological well-being , including overall quality of life ( Functional Assessment of Cancer Therapy-Breast ) , intrusive thoughts ( Impact of Event Scale-Revised ) , depressive symptoms ( Center for Epidemiologic Studies -Depression ) , and stress levels ( Perceived Stress Scale ) over the 6-month postintervention follow-up ( all repeated measures analysis of variance within-subjects time effects : P < .05 , except for overall mood ; Profile of Mood States-Short Version ) . Contrary to hypotheses , however , condition × time effects were not statistically significant . CONCLUSIONS Findings suggest that improvements in multiple measures over time may have been due to intensive training in stress management , extensive provision of breast cancer information , or participation in an ongoing supportive group of individuals from a similar racial background . Implication s bear on decisions about appropriate control groups , the timing of intervention delivery during the treatment trajectory , and perceived support from the research team Abstract Background . Previous studies have demonstrated that between 20 and 30 % of women treated for breast cancer have measurable signs of anxiety and depression compared with 6 % in a population of healthy women . Depression has been proposed as a predictive factor for recurrence and survival . The aim of the present study was to evaluate if psychosocial support intervention could influence anxiety and depression during the first year after diagnosis . Material and methods . Newly diagnosed breast cancer patients were r and omised between April 2002 and November 2007 and stratified by adjuvant chemotherapy .  Of 382 eligible patients , 191 + 191 patients were r and omised to intervention group or control group , respectively . Control patients were subjected to st and ard follow-up routines . The Intervention group had support intervention at the Foundation Lustgården Mälardalen . The rehabilitation lasted one week on a residential basis followed by four days of follow-up two months later . We used the Swedish version of the HAD scale with a cut-off value greater than 10 for clinical symptoms of depression and anxiety . Results . Support group intervention  lowered anxiety over time ( p < 0.001 ) but depression was unaffected ( p = 0.610 ) . Conclusion . This prospect i ve r and omised trial of support group intervention in a large homogenous group of breast cancer women showed a statistically significant effect on lowering anxiety over time . No statistically significant effect of intervention could be seen on depression Purpose This study assessed the feasibility of a meditation-based program called Cognitively-Based Compassion Training ( CBCT ) with breast cancer survivors . Enrollment and participant satisfaction with a novel intervention , adherence to program requirements , and differences between the intervention group and wait list controls on self-report measures were also assessed . Additionally , cortisol , a stress-related endocrine biomarker , was assessed . Methods Participants ( n = 33 ) were r and omly assigned to CBCT or the wait list . CBCT provided eight weekly , 2-h classes and a “ booster ” CBCT session 4 weeks later . CBCT participants were expected to attend classes and meditate between classes at least three times per week . Pre-/post-intervention and follow-up question naires measured symptom change ( depression , intrusive thoughts , perceived stress , fear of cancer recurrence , fatigue/vitality , loneliness , and quality of life ) . Saliva sample s were collected at the same periods to assess the slope of diurnal cortisol activity . Results Enrollment , class attendance , home practice time , and patient satisfaction exceeded expectations . Compared to controls , post-intervention , the CBCT group showed suggestions of significant improvements in depression , avoidance of intrusive thoughts , functional impairment associated with fear of recurrence , mindfulness , and vitality/fatigue . At follow-up , less perceived stress and higher mindfulness were also significant in the CBCT group . No significant changes were observed on any other measure including diurnal cortisol activity . Conclusions Within the limits of a pilot feasibility study , results suggest that CBCT is a feasible and highly satisfactory intervention potentially beneficial for the psychological well-being of breast cancer survivors . However , more comprehensive trials are needed to provide systematic evidence . Relevance CBCT may be very beneficial for improving depression and enhancing well-being during breast cancer survivorship Goals of workThe effects of psychosocial group interventions on improving quality of life ( QOL ) for patients with recurrent breast cancer are not well known . The objective of this study was to assess the feasibility of a psychosocial group intervention in Japanese women with first recurrence of breast cancer . Patients and method The subjects were consecutively selected from among patients who were diagnosed with a first recurrence of breast cancer . We conducted a 6-week psychosocial group intervention .  QOL was assessed using the Profile of Mood States ( POMS ) , the Impact of Event Scale — Revised , the Mental Adjustment to Cancer ( MAC ) scale , and the European Organization for Research and the Treatment of Cancer ( EORTC ) Quality of Life Question naire — Cancer 30/Breast module 23 ( QLQ-C30/Br23 ) at baseline then immediately and 3 and 6 months after completion of the intervention . Results Among 58 eligible patients , written consent was obtained from 28 ( 48 % ) , and the final evaluation was conducted on 19 subjects . The repeated measured analysis of variance ( ANOVA ) revealed a significant change in tension – anxiety , depression – dejection , anger – hostility and total mood disturbance on the POMS , helplessness/hopelessness on the MAC scale , and body image and future perspective on the QLQ-C30/Br23 . Dunnett ’s test revealed a significant difference in these scores between baseline and 3 months after the intervention but no difference between baseline and 6 months after the intervention . Conclusion These results suggested the possibility of a short-term effectiveness of the intervention ; however the results were inconclusive because of selected small sample BACKGROUND Many women with breast cancer need psychological help to cope more effectively after treatment . Cognitive and behavioural techniques are not yet well established in France . A multi-site r and omized study was conducted to evaluate the effects of a psycho-educational group intervention in this population . METHODS Two hundred and three patients , recruited after primary treatment , were r and omly assigned either to a treatment group ( psycho-educational intervention ) or to a waiting-list control group . The 8-week programme of 2 h sessions comprised of thematic discussion s , information and training in stress management techniques . Evaluation at baseline , after 8 sessions , and 1 month after programme completion , included evaluations using the STAI , POMS , MAC , EORTC QLQ-C30 and EORTC QLQ-BR23 breast module scales . RESULTS We observed a significant reduction in anxiety ( STAI , POMS ) among group participants , a reduction in anger , depression and fatigue ( POMS ) , a significant improvement in vigor and interpersonal relationships ( POMS ) , in emotional and role functioning , in health status and fatigue level ( EORTC QLQ-C30 ) . In contrast , coping strategies ( MAC ) were not significantly different between groups . No group-related negative effects were observed and the global satisfaction levels were very high . CONCLUSION This study demonstrates the feasibility and effectiveness of a psycho-educational intervention , which can accelerate the reduction of those negative affects which are present at the end of treatment . It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support , widely proposed in France , and should now be tested in groups with other types of cancer and at other disease phases OBJECTIVE The primary objective was to evaluate the efficacy of commercially available mobile app-delivered mindfulness training ( AMT ) , compared with waitlist control ( WC ) , on quality of life ( QOL ) among women diagnosed with breast cancer . The secondary outcome was dispositional mindfulness . Enrollment , app utilization , and study completion are reported as feasibility objectives . METHODS Women diagnosed with breast cancer ≤5 years ( n = 112 ) were r and omized to  AMT ( n = 57 ) or WC  ( n = 55 ) , over 8 weeks , with 4 weeks of follow-up . We conducted linear mixed effects models to examine group by observation interactions on QOL and dispositional mindfulness at baseline , during intervention ( 5-weeks ) , post-intervention ( 9-weeks ) , and follow-up ( 12-weeks post-baseline ) . RESULTS Participants assigned to AMT  reported higher QOL , compared with those assigned to WC , from baseline through follow-up t(258.40 ) = 3.09 , P < 0.01 , 95 % CI [ 2.71 , 11.90 ] . Participants assigned to AMT also reported higher dispositional mindfulness , compared with those assigned to WC , from baseline through follow-up t(268.44 ) = 2.04 , P = 0.04 , 95 % CI [ 0.01 , 0.57 ] . App utilization data was obtained from 34 participants . Fewer participants assigned to AMT completed all study assessment s , compared with participants assigned to WC , ( χ21 = 7.07 , P = 0.008 ) . CONCLUSIONS Findings suggest commercially available AMT may proffer some benefit to women seeking to enhance their QOL following breast cancer diagnosis OBJECTIVE This r and omized controlled trial examines whether a briefer cognitive-behavioural ( CBT ) stress management intervention than the norm can reduce stress and distress and enhance benefit finding in women with breast cancer . It further aims to identify characteristics of those women most likely to benefit from the intervention . DESIGN AND METHOD A r and omized controlled trial was conducted to assess the efficacy of a psychological intervention .  Women ( N = 355 ) who had undergone surgery for breast cancer 4 months earlier , the majority of whom were currently undergoing adjuvant therapy , completed question naires assessing global and cancer-specific stress , depression , anxiety , optimism and benefit finding . They were r and omly assigned to a 5-week group cognitive-behavioural stress management ( CBSM ) programme plus st and ard care or st and ard care only . Re assessment occurred post-intervention and 12 months later . RESULTS Analyses of variance revealed that patients who received the intervention showed significant lowering of global stress and anxiety and increased benefit finding compared to controls . These differences , however , were not maintained at 12 months . Effects of the intervention were moderated by stress such that women with high global stress at baseline showed greater reduction in both stress and anxiety . CONCLUSIONS A CBSM intervention , which was briefer than the norm ( 5 weeks vs. 9 - 20 weeks ) , had beneficial effects on adjustment for women with breast cancer and was particularly effective for those with increased global stress . Screening on this basis may facilitate optimal and cost-effective psychological treatment The purpose of this r and omized control trial was to verify the effectiveness of a brief group intervention that combines stress management psycho-education and physical activity ( ie , independent variable ) intervention in reducing fatigue and improving energy level , quality of life ( mental and physical ) , fitness ( VO2submax ) , and emotional distress ( ie , dependent variables ) in breast cancer survivors . This study applied Lazarus and Folkman stress-coping theoretical framework , as well as Salmon 's unifying theory of physical activity . Eighty-seven French-speaking women who had completed their treatments for nonmetastatic breast cancer at a university hospital in Quebec City , Canada , were r and omly assigned to either the group intervention ( experimental ) or the usual-care ( control ) condition . Data were collected at baseline , postintervention , and at 3-month follow-up . The 4-week group intervention was cofacilitated by 2 nurses . Results showed that participants in the intervention group showed greater improvement in fatigue , energy level , and emotional distress at 3-month follow-up , and physical quality of life at postintervention , compared with the participants in the control group . These results suggest that a brief psycho-educational group intervention focusing on active coping strategies and physical activity is beneficial to cancer survivors after breast cancer treatments Population -based studies on quality of life ( QOL ) of long-term breast cancer survivors are quite recent and insufficient attention has been paid to the effect of time since diagnosis . We compared long-term QOL of population -based breast cancer survivors 5 , 10 , and 15 years after diagnosis with that of healthy controls . Breast cancer survivors were r and omly selected from three population -based cancer registries ( Bas-Rhin , Calvados and Doubs , France ) along with healthy controls , stratified for age and place of residence , r and omly selected from electoral rolls . Participants completed five self-administered question naires : the European Organization for Research and Treatment of Cancer Quality of Life Question naire Core 30 ( EORTC QLQ-C30 ) ,  Short Form-36 ( SF-36 ) , Spielberger State-Trait Anxiety Inventory ( STAI ) , Multidimensional Fatigue Inventory ( MFI ) and a  life conditions question naire . An analysis of variance was used to compare QOL scores of breast cancer survivors by period ( 5 , 10 , or 15 years ) of diagnosis with those of controls , adjusted for sociodemographic data and comorbidities . Six hundred and fifty-two cases and 1,188 controls participated in the study . For many QOL scales , scores were significantly different between cancer survivors and controls . A clinical ly significant difference was evidence d for the fatigue scales , the SF36 physical functioning , role-physical , and role-emotional scales , with more favorable results for controls . Differences decreased with time and 15-year cancer survivors were generally not different from controls . Scores were particularly influenced by age and mean household income . More efforts should be made , specifically during the first 5 to 10 years after diagnosis , to help women with breast cancer to overcome their impairment in QOL The aim of this study was to evaluate a manualized cognitive behavioral group intervention for early-stage breast cancer patients . Sixty-nine women were recruited at an Irish specialist oncology hospital and assigned to a 6-week cognitive behavior therapy ( CBT ) program or an educational control group . Participants were assessed at baseline , 6 weeks , and 6-month follow-up . Groups × Time ( 2 × 3 ) ANOVAs showed that the program did not lead to greater improvement on st and ardized measures of coping , quality of life , or mood compared with the control group . Regression analyses showed that maladaptive coping and distress at baseline were predictive of psychological adjustment at follow-up . Level of distress was also predictive of quality of life at follow-up . Repeated measures ANOVAs of data from cases in the intervention group showed that patients who completed the program showed significant improvement in problem severity , impact of problems , coping ability , and goal attainment from pre- to posttreatment , and these gains were maintained at follow-up for problem severity and impact of problems , but not for coping ability or goal attainment . Participation in the program did not lead to less health service usage during the period from baseline to follow-up , compared with the educational control group . A controlled trial provided limited evidence for the effectiveness of brief cognitive behavior intervention  in enhancing psychological adjustment of early-stage breast cancer patients with non clinical ly significant levels of psychological distress . Future research should evaluate the effectiveness of the program for patients with elevated levels of psychological distress and limited coping re sources OBJECTIVE To determine the prevalence of psychological morbidity and describe quality of life in women with early-stage breast cancer . DESIGN Cross-sectional descriptive study ( 3 months after conservative breast surgery or mastectomy ) of patients from nine general hospitals in Melbourne , Victoria , October 1994 to March 1997 . PARTICIPANTS 303 women with early-stage breast cancer entering a r and omised trial of adjuvant psychological group therapy ; mean age , 46 years ( SD , 8) . MAIN OUTCOME MEASURES Diagnostic and Statistical Manual of Mental Health (DSM)-IV psychiatric diagnoses generated by the Monash Interview for Liaison Psychiatry ; quality -of-life data based on the the European Organization for Research and Treatment of Cancer quality -of-life question naire (QLQ)-C30 ( core ) and QLQ-BR23 ( breast module ) instruments . RESULTS 45 % of the women ( 135/303 ) had a psychiatric disorder ; 42 % ( 127 ) of the sample had depression or anxiety , or both ; there was minor depression in 82 ( 27.1 % ) , an anxiety disorder in 26 ( 8.6 % ) , major depression in 29 ( 9.6 % ) and a phobic disorder in 21 ( 6.9 % ) . 20 % of women ( 61 ) had more than one disorder . On quality -of-life measures nearly one-third of the women felt less attractive and most had lost interest in sexual activity . There was substantial distress about hair loss . Symptoms of lymphoedema were described by 13 women ( 4.3 % ) . Breast conservation surgery was associated with a better body image ( P<0.01 ) . CONCLUSION Women recently diagnosed with early-stage breast cancer have high rates of psychiatric and psychological disturbance . Quality of life is substantially affected . Clinicians should actively explore their patients ' psychological adjustment to enable early recognition and treatment of these disorders This study compared the efficacy of 3 16-week treatments for  depression  in 63 patients with multiple sclerosis ( MS ) and major depressive disorder ( MDD ) :  individual cognitive-behavioral therapy ( CBT ) , supportive-expressive group therapy ( SEG ) . and the antidepressant sertraline . Significant reductions were seen from pre- to posttreatment in all measures of depression . Intent-to-treat and completers analyses using the Beck Depression Inventory ( BDI ; A. T. Beck , C. H. Ward . M. Medelson . J. Mock , & J. Erbaugh , 1961 ) and MDD diagnosis found that CBT and sertraline were more effective than SEG at reducing depression . These results were largely supported by the BDI-18 , which eliminates BDI items confounded with MS . However , the Hamilton Rating Scale for Depression ( M. Hamilton , 1960 ) did not show consistent differences between treatments . Reasons for this inconsistency are discussed . These findings suggest that CBT or sertraline is more likely to be effective in treating MDD in MS compared with supportive group treatments To the authors ' knowledge , there had been no evidence for the efficacy of psychosocial intervention among Japanese cancer patients . The objective of this study was to determine the effect of a psychosocial group intervention in reducing psychologic distress and enhancing coping in this population in a r and omized controlled trial PURPOSE To assess the efficacy of mindfulness-based cognitive therapy ( MBCT ) for late post-treatment pain in women treated for primary breast cancer . METHODS A r and omized wait list-controlled trial was conducted with 129 women treated for breast cancer reporting post-treatment pain ( score ≥ 3 on pain intensity or pain burden assessed with 10-point numeric rating scales ) . Participants were r and omly assigned to a manualized 8-week MBCT program or a wait-list control group . Pain was the primary outcome and was assessed with the Short Form McGill Pain Question naire 2 ( SF-MPQ-2 ) , the Present Pain Intensity subscale ( the McGill Pain Question naire ) , and perceived pain intensity and pain burden ( numeric rating scales ) . Secondary outcomes were quality of life ( World Health Organization-5 Well-Being Index ) , psychological distress ( the Hospital Depression and Anxiety Scale ) , and self-reported use of pain medication . All outcome measures were assessed at baseline , postintervention , and 3-month and 6-month follow-up . Treatment effects were evaluated with mixed linear models . RESULTS Statistically significant time × group interactions were found for pain intensity ( d = 0.61 ; P = .002 ) , the Present Pain Intensity subscale ( d = 0.26 ; P = .026 ) , the SF-MPQ-2 neuropathic pain subscale ( d = 0.24 ; P = .036 ) , and SF-MPQ-2 total scores ( d = 0.23 ; P = .036 ) . Only pain intensity remained statistically significant after correction for multiple comparisons . Statistically significant effects were also observed for quality of life ( d = 0.42 ; P = .028 ) and nonprescription pain medication use ( d = 0.40 ; P = .038 ) . None of the remaining outcomes reached statistical significance . CONCLUSION MBCT showed a statistically significant , robust , and durable effect on pain intensity , indicating that MBCT may be an efficacious pain rehabilitation strategy for women treated for breast cancer . In addition , the effect on neuropathic pain , a pain type reported by women treated for breast cancer , further suggests the potential of MBCT but should be considered preliminary For r and om effects meta- analysis , seven different estimators of the heterogeneity variance are compared and assessed using a simulation study . The seven estimators are the variance component type estimator ( VC ) , the method of moments estimator ( MM ) , the maximum likelihood estimator ( ML ) , the restricted maximum likelihood estimator ( REML ) , the empirical Bayes estimator ( EB ) , the model error variance type estimator ( MV ) , and a variation of the MV estimator ( MVvc ) . The performance of the estimators is compared in terms of both bias and mean squared error , using Monte Carlo simulation . The results show that the REML and especially the ML and MM estimators are not accurate , having large biases unless the true heterogeneity variance is small . The VC estimator tends to overestimate the heterogeneity variance in general , but is quite accurate when the number of studies is large . The MV estimator is not a good estimator when the heterogeneity variance is small to moderate , but it is reasonably accurate when the heterogeneity variance is large . The MVvc estimator is an improved estimator compared to the MV estimator , especially for small to moderate values of the heterogeneity variance . The two estimators MVvc and EB are found to be the most accurate in general , particularly when the heterogeneity variance is moderate to large BACKGROUND Mindfulness-based art therapy ( MBAT ) induces emotional relaxation in cancer patients and is a treatment known to improve psychological stability . The objective of this research was to evaluate the treatment effects of MBAT for breast cancer patients . METHODS Overall , 24 breast cancer patients were selected as subjects of the study . Two groups , the MBAT group and control group with 12 patients each , were r and omly assigned . The patients in the MBAT group were given 12 sessions of treatments . To measure depression and anxiety , low scales of the personality assessment inventory ( PAI ) was used . Health-related quality of life was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTCQLQ-C30 ) . The treatment results were analyzed using analysis of covariance ( ANCOVA ) and two-way repeated measures analysis of variance ( ANOVA ) . RESULTS The results showed that depression and anxiety decreased significantly and health-related quality of life improved significantly in the MBAT group . In the control group , however , there was no significant change . CONCLUSIONS MBAT can be seen as an effective treatment method that improves breast cancer patients ׳  psychological stability and quality of life . Evaluation of treatment effects using program development and large-scale research for future clinical application is needed Background : Radiotherapy can have multiple adverse effects , including patient complaints of persistent fatigue and low quality of life .  Cognitive-behavior therapy ( CBT ) has alleviated fatigue and improved QOL of cancer patients ; however , little is known about the effects of nurse-led CBT on breast cancer patients undergoing radiotherapy . Objective : The purpose of this study was to analyze the effects of a nurse-led CBT program on fatigue and QOL of patients with breast cancer undergoing radiotherapy . Methods : This study was performed using a quasi-experimental pretest/posttest design , with a nonequivalent control group . The participants were patients with breast cancer ( N = 71 : experimental group = 35 , control group = 36 ) undergoing radiotherapy at P University Hospital in Korea . The experimental group received a 6-week intervention program that included cognitive restructuring , education about the disease and medical treatment , relaxation therapy , and rehabilitation exercise . Results : After the 6-week intervention , the level of fatigue increased in patients in both groups . However , the increase in the experimental group was lower than that in the control group . Quality of life of the experimental group was significantly higher than that of the control group . Conclusions : The nurse-led CBT seemed to control fatigue level and improve QOL . Therefore , the use of nurse-led CBT for patients with breast cancer undergoing radiotherapy must be promoted . Implication s for Practice : Active involvement of experienced nurses in the counseling program should be considered . In addition , further research must be conducted into the implementation of the nurse-led cognitive-behavioral intervention to a broader spectrum of patients CONTEXT Breast cancer survivors ( BCS ) face adverse physical and psychological symptoms , often co-occurring . Biologic and psychological factors may link symptoms within clusters , distinguishable by prevalence and /or severity . Few studies have examined the effects of behavioral interventions or treatment of symptom clusters . OBJECTIVES The aim of this study was to identify symptom clusters among post-treatment BCS and determine symptom cluster improvement following the Mindfulness-Based Stress Reduction for Breast Cancer ( MBSR(BC ) ) program . METHODS Three hundred twenty-two Stage 0-III post-treatment BCS were r and omly assigned to either a six-week MBSR(BC ) program or usual care .  Psychological ( depression , anxiety , stress , and fear of recurrence ) , physical ( fatigue , pain , sleep , and drowsiness ) , and cognitive symptoms and quality of life were assessed at baseline , six , and 12 weeks , along with demographic and clinical history data at baseline . A three-step analytic process included the error-accounting models of factor analysis and structural equation modeling . RESULTS Four symptom clusters emerged at baseline : pain , psychological , fatigue , and cognitive . From baseline to six weeks , the model demonstrated evidence of MBSR(BC ) effectiveness in both the psychological ( anxiety , depression , perceived stress and QOL , emotional well-being ) ( P = 0.007 ) and fatigue ( fatigue , sleep , and drowsiness ) ( P < 0.001 ) clusters . Results between six and 12 weeks showed sustained effects , but further improvement was not observed . CONCLUSION Our results provide clinical effectiveness evidence that MBSR(BC ) works to improve symptom clusters , particularly for psychological and fatigue symptom clusters , with the greatest improvement occurring during the six-week program with sustained effects for several weeks after MBSR(BC ) training . TRIAL REGISTRATION Name and URL of Registry : Clinical Trials.gov . Registration number : NCT01177124
Breast cancer is the most prevalent oncological disease among women , and it represents the second oncological cause of death .
Many studies have considered the quality of life in people with breast cancer because this condition has high comorbidity with mental distress , anxiety , affective disorders and depression .
Psychological interventions can reduce the stressful consequences of both the diagnosis and the medical treatments of breast cancer .
However , different methods ( e.g. , group or individual therapy ) and focus ( e.g. , improving personal skills or increasing emotional well-being ) do not help to identify which type of psychological therapy can be more effective in improving quality of life in patients with breast cancer .
This study was aim ed to systematic ally review and compare , by means of a meta- analysis , the efficacy of cognitive behavioural , supportive-expressive or psycho-educational treatments in women with breast cancer , focusing on anxiety , depression , mood and quality of life as outcomes .