Roxanne Nelson

November 14, 2011

November 14, 2011 — Mindfulness training might prove beneficial for patients who are undergoing hematopoietic stem cell transplantation (HSCT), according to researchers who conducted a randomized trial of the intervention. Although an intent-to-treat analysis did not reveal long-term group differences, there were significant immediate improvements in symptoms and mood in patients who underwent the training, compared with those who didn't.

Patients undergoing HSCT experience considerable pain and emotional and physical challenges. "It's a very toxic treatment; even with advances, the toxicity is still very high," explained lead author Susan Bauer-Wu, PhD, RN, associate professor of nursing at Emory University, Atlanta, Georgia. "It's a very extensive treatment; patients are in the hospital for about 3 weeks and the mortality is about 40%. So there is a lot of fear and uncertainty."

Dr. Bauer-Wu presented the study results here at the 8th International Conference of the Society for Integrative Oncology.

Mindfulness-Based Stress Reduction

The mindfulness-based stress reduction (MBSR) was developed at the University of Massachusetts Medical School, with the goal of helping people move toward greater balance and control in their lives.

The program describes mindfulness as a way of learning "to relate directly to whatever is happening in your life, a way of taking charge of your life, a way of doing something for yourself that no one else can do for you — consciously and systematically working with your own stress, pain, illness, and the challenges and demands of everyday life."

According to researchers at the University of Massachusetts, published research over the course of 2 decades has shown that the majority of people who complete the course report a number of benefits, including lasting decreases in physical and psychological symptoms, an increased ability to relax, reduced pain and an enhanced ability to cope with pain that may not dissipate, more energy and enthusiasm for life, and improvements in self-esteem.

"Mindfulness-based stress reduction is a very popular program and is available around the world, on every continent except Antarctica," explained Dr. Bauer-Wu. "There are tens of thousands of people who have been trained in it."

She emphasized, however, that the program used in the HSCT trial was not MBSR, it was just modeled after it. "MBSR is an 8-week group intervention program. Because these patients are in isolation and are very sick, we tailored it," she said. "But many of these session parallel what is taught in the MBSR program."

Short-Term Results Seen

In this multicentered randomized controlled trial, Dr. Bauer-Wu and colleagues evaluated the longitudinal and short-term effects of mindfulness meditation training in 241 cancer patients who were hospitalized for HSCT.

The cohort was randomized to 1 of 3 groups: mindfulness training (n = 84), nurse education/attention control (n = 80), and usual care (n = 77). The mindfulness intervention involved individual sessions with an instructor (before hospitalization and twice weekly while in the hospital), with "homework" practice with a mediation CD between the sessions.

The sessions in the mindfulness and nurse/attention groups were 30 minutes. All instructors were either RNs or physicians trained in MBSR, but they did not work in the unit in which the patients received their HSCT treatment, Dr. Bauer-Wu emphasized.

The short-term effects were measured with visual analog scales. Heart and respiratory rates were measured before and after each intervention session, and 30 minutes apart in usual care group. Standardized measures of psychological functioning, perceived stress, physical symptoms, quality of life, and spirituality were completed at 8 time points, from prehospitalization until 6 months after HSCT.

The team also looked at biologic stress markers, and medication use and complications were monitored over 6 months.

The intent-to-treat analysis revealed no longitudinal differences in any of the measures. However, significant immediate improvements in symptoms and mood were identified in the mindfulness group but not in the 2 other groups.

Those in "the mindfulness group had significantly less pain, were happier over time, were more relaxed, and had a lower respiratory rate," said Dr. Bauer-Wu.

Significant group differences were identified in the short-term effects. Patients in the mindfulness group had greater decreases in tension (P < .001), unhappiness (P < .001), pain (P = .006), and respiratory rate (P = .001) than those in the other 2 groups.

There was also a practice effect, she explained. "Those who spent more time with the instructor had less psychological distress at discharge. More practice time was associated with being less depressed at 6 months."

The authors observed significant associations between the number of sessions and distress (P = .009) and depression (P = .020) on the day of discharge, and between the amount of time listening to CDs and depression (P = .009) at 6 months.

Dr. Bauer-Wu noted that even though the intent-to-treat analysis revealed no significant group differences, perceived stress appeared to be different 6 months after transplantation. "There was also significant improvement in the short term in the mindfulness group," she said, but not the other 2 groups."

The researchers note that there were dose–response effects and considerable variability in patient practice, but Dr. Bauer-Wu explained that they did not carry out any subgroup analyses. If they had targeted only patients who were the most depressed or stressed, the findings might have been different, she said.

Dr. Bauer-Wu questioned whether a randomized controlled trial, despite being the gold standard, is the best design for this kind of intervention. "We may need to look at patient selection more closely because some people may just be going through the motions and not really getting into it," Dr. Bauer-Wu pointed out. "It's a limitation. We did not look at expectancy either, which I also think is really important."

This study, along with others being presented at the conference, "gave me a better sense of what we need to do as a next step," said Gary Deng, MD, who is from the Memorial Sloan-Kettering Cancer Center in New York City, and president of the Society for Integrative Oncology.

The effect size in some of these studies is small, but "I don't really see that as much of a problem," he told Medscape Medical News. "The interventions are low risk, and we have to consider the patient as a whole and what's important to them."

8th International Conference of the Society for Integrative Oncology. Abstract 3. Presented November 10, 2011.

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