Objective
Mindfulness‐based interventions (MBIs) are increasingly used within psycho‐oncology. Since the publication of the most recent comprehensive meta‐analysis on MBIs in cancer in 2012, the ...number of published trials has more than doubled. We therefore conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs), testing the efficacy of MBIs on measures of psychological distress (primary outcome) and other health outcomes in cancer patients and survivors.
Methods
Two authors conducted independent literature searches in electronic databases from first available date to 10 October 2018, selected eligible studies, extracted data for meta‐analysis, and evaluated risk of bias.
Results
Twenty‐nine independent RCTs (reported in 38 papers) with 3274 participants were included. Small and statistically significant pooled effects of MBIs on combined measures of psychological distress were found at post‐intervention (Hedges's g = 0.32; 95%CI: 0.22‐0.41; P < .001) and follow‐up (g = 0.19; 95%CI: 0.07‐0.30; P < .002). Statistically significant effects were also found at either post‐intervention or follow‐up for a range of self‐reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain (g: 0.20 to 0.51; p: <.001 to.047). Larger effects of MBIs on psychological distress were found in studies (a) adhering to the original MBI manuals, (b) with younger patients, (c) with passive control conditions, and (d) shorter time to follow‐up. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post‐intervention.
Conclusions
MBIs appear efficacious in reducing psychological distress and other symptoms in cancer patients and survivors. However, many of the effects were of small magnitude, suggesting a need for intervention optimization research.
To assess the efficacy of mindfulness-based cognitive therapy (MBCT) for late post-treatment pain in women treated for primary breast cancer.
A randomized 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 randomly 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 Questionnaire 2 (SF-MPQ-2), the Present Pain Intensity subscale (the McGill Pain Questionnaire), 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.
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.
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.
‘Complicated grief reactions’ is an umbrella term covering symptoms of prolonged grief disorder (PGS) and other post-loss complications, including symptoms of depression, anxiety, and posttraumatic ...stress (PTS). While PGS often co-occurs with symptoms of depression, anxiety, and PTS, no pooled prevalence estimates of their co-occurrence have yet been established.
The present systematic review and meta-analysis provided pooled prevalence estimates of co-occurrence of PGS and symptoms of depression, anxiety, and PTS based on the available literature, and examined possible moderators and risk of bias.
Based on the 23 included studies, the pooled prevalence estimates indicated that 70% of adults with PGS experienced one or more other type of complicated grief reaction, and 46% experienced two or more other types of complicated grief reactions. Estimates of PGS with co-occurring depression, anxiety, and PTS were 63%, 54%, and 49%, respectively. Heterogeneity was considerable (I2=92.5–95.6), and subsequent moderator-analyses showed that higher estimates of co-occurrence were found in studies with longer mean time since loss, and when co-occurrence was assessed with interviews compared with questionnaires.
The results should be considered preliminary due to high risk of bias of the included studies.
Co-occurring cases of PGS and other types of complicated grief reactions were more prevalent than ‘pure’ cases of PGS with no co-occurrence. More population-based studies of symptom co-occurrence in non-traumatic bereavement are needed.
Abstract
We conducted a systematic review and meta-analysis investigating the association between overweight and outcome in triple-negative breast cancer (TNBC) patients. We searched PubMed and ...Embase using variations of the search terms
triple-negative breast cancer (population), overweight and/or obesity (exposure), and prognosis (outcome)
. Based on the World Health Organization guidelines for defining overweight, we included longitudinal observational studies, which utilized survival statistics with hazard ratios (HRs) in our analysis. The included studies measured body mass index at the time of diagnosis of TNBC and reported disease-free survival and/or overall survival. Study quality was assessed with the Newcastle-Ottawa Scale and study data were extracted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist, independently by two authors. Random-effects models were used to combine the effect sizes (HRs), and the results were evaluated and adjusted for possible publication bias. Thirteen studies of 8,944 TNBC patients were included. The meta-analysis showed that overweight was associated with both shorter disease-free survival (HR = 1.26; 95%CI: 1.09–1.46) and shorter overall survival (HR = 1.29; 95%CI: 1.11c1.51) compared to normal-weight. Additionally, our Bayesian meta-analyses suggest that overweight individuals are 7.4 and 9.9 times more likely to have shorter disease-free survival and overall survival, respectively. In conclusion, the available data suggest that overweight is associated with shorter disease-free and overall survival among TNBC patients. The results should be interpreted with caution due to possible publication bias.
IntroductionOne in five breast cancer (BC) survivors are affected by persistent pain years after completing primary treatment. While the efficacy of psychological interventions for BC-related pain ...has been documented in several meta-analyses, reported effect sizes are generally modest, pointing to a need for optimisation. Guided by the Multiphase Optimization Strategy, the present study aims to optimise psychological treatment for BC-related pain by identifying active treatment components in a full factorial design.Methods and analysisThe study uses a 2×3 factorial design, randomising 192 women with BC-related pain (18–75 years) to eight experimental conditions. The eight conditions consist of three contemporary cognitive–behavioural therapy components, namely: (1) mindful attention, (2) decentring, and (3) values and committed action. Each component is delivered in two sessions, and each participant will receive either zero, two, four or six sessions. Participants receiving two or three treatment components will be randomised to receive them in varying order. Assessments will be conducted at baseline (T1), session by session, every day for 6 days following the first session in each treatment component, at post-intervention (T2) and at 12-week follow-up (T3). Primary outcomes are pain intensity (Numerical Rating Scale) and pain interference (Brief Pain Inventory interference subscale) from T1 to T2. Secondary outcomes are pain burden, pain quality, pain frequency, pain catastrophising, psychological distress, well-being and fear of cancer recurrence. Possible mediators include mindful attention, decentring, and pain acceptance and activity engagement. Possible moderators are treatment expectancy, treatment adherence, satisfaction with treatment and therapeutic alliance.Ethics and disseminationEthical approval for the present study was received from the Central Denmark Region Committee on Health Research Ethics (no: 1-10-72-309-40). Findings will be made available to the study funders, care providers, patient organisations and other researchers at international conferences, and published in international, peer-reviewed journals.Trial registration numberClinicalTrials.gov Registry (NCT05444101).
•ICD-11 PGD prevalence decreased from six (18.9%) to eleven months (13.4%) post-loss.•Indicated PGD at two repeated time-points resulted in prevalence rates ~10%.•Early PGD caseness emerged as ...predictor for later, probable ICD-11 PGD.•Multiple assessments may aid detection of genuinely prolonged grief reactions.•Further research is needed to inform application of the PGD duration criterion.
Background. Prolonged grief disorder (PGD), included in the ICD-11, encompasses a six-month duration criterion, but whether this covers ‘time since loss’ or ‘grief persistency’ is unclear. The study estimated prevalence and predictors of probable ICD-11 PGD using different applications of the duration criterion.
Methods. A register-sampled cohort of bereaved spouses completed self-report questionnaires at two (T1, N=847), six (T2, N=777), and eleven months (T3, N=753) post-loss. The duration criterion was operationalized as single-point PGD (meeting criteria minimally six months post-loss; T2 or T3) and dual-point PGD (meeting criteria at two assessments separated by months; T1+T2 or T2+T3).
Results. Single-point PGD prevalence rates (~15-20%) were significantly higher than dual-point prevalence rates (~10%). While single assessments of PGD varied between T2 and T3, the dual-point prevalence rates did not significantly differ. Early probable grief caseness emerged as the strongest predictor for later PGD.
Limitations. Without a structured clinical interview, only probable cases of PGD were identified. Caseness relied on a diagnostic algorithm, created by mapping items from different self-report questionnaires. Time frames between assessments did not cover an entire six-month period.
Conclusions. Momentarily assessed, six-month PGD symptomatology may represent a fluctuating, but remitting grief process for some individuals. Further research could test whether multiple diagnostic indicators during the first year of bereavement improve the identification of genuinely prolonged grief reactions.
Acceptance and mindfulness-based therapies have shown efficacy in the treatment of anxiety and depression. Arguably, acceptance and mindfulness-based therapies target core processes in anxiety and ...depression by increasing mindful attention, decentering, and acceptance. The present study identified randomized controlled trials of acceptance and mindfulness-based therapies for anxiety and depression. Specifically, we aimed to synthesize the indirect effect of the three putative mediators (i.e., mindful attention, decentering, acceptance) on anxiety and depression.
Electronic searches yielded 4989 unique records, which were screened for eligibility by two independent raters, resulting in the identification of 33 eligible studies (30 independent trials). The overall pooled mediating effect of mindful attention, decentering, and acceptance was small to medium (r = 0.145, p < .001). Type of mediation analysis emerged as the only statistically significant moderator. Specifically, studies using correlation-based mediation approaches showed statistically significant mediating effects, while studies using causal time-lag analyses did not yield statistically significant mediating effects. Mediator specificity could not be established.
In conclusion, putative mediators of acceptance and mindfulness-based therapies mediated treatment effects on anxiety and depression. Limitations in study number, designs, and statistical approaches employed restrict conclusions regarding specificity and causality.
•Mediators of acceptance and mindfulness-based therapies for anxiety and depression were examined in 33 studies.•Mindful attention, decentering, and acceptance were significant mediators of acceptance and mindfulness-based therapies.•The overall effect size found was small-to-medium and generally robust.•Study designs preclude conclusions on mediator specificity and temporal precedence.
Research suggests variation in how grief develops across time, and gender may account for some of this variation. However, gender differences in growth patterns of the newly codified ICD-11 prolonged ...grief disorder (PGD) are unknown. This study examined gender-specific variances in grief trajectories in a registry-sampled cohort of 857 spousal bereaved individuals (69.8% female). Participants completed self-report questionnaires of PGD symptoms at 2, 6, and 11 months post-loss. Using Growth Mixture Modeling, four PGD trajectories emerged: resilient characterized by low symptoms (64.4%), moderate-stable characterized by moderate symptoms (20.4%), recovery characterized by elevated symptoms showing a decrease over time (8.4%), and prolonged grief characterized by continuous elevated symptoms (6.8%). Similar proportions of men and women comprised the four trajectories. Gender influenced the parameter estimates of the prolonged grief trajectory as men evidenced more baseline symptoms (higher intercept) than women did and a decreasing symptom-level (negative slope), while women showed symptom-increase over time (positive slope). The prolonged grief trajectory captured the largest proportion of probable PGD cases in both genders. Low optimism and low mental health predicted membership in this class. Altogether, the absolute majority of both men and women followed a low-symptom resilient trajectory. While a comparable minority followed a high-symptom prolonged grief trajectory, men and women within this trajectory expressed varying symptom development. Men expressed prolonged grief as an acute, decreasing reaction, whereas women showed an adjourned, mounting grief reaction. This study suggests that gender may influence symptom development in highly distressed individuals across early bereavement.
•Heterogeneous trajectories of prolonged grief symptoms (PGS) were identified.•Resilience (low-symptom) was the modal response (~64%).•Low optimism and low mental health predicted a prolonged grief (high-symptom) class (~7%).•Males showed acute, decreasing PGS; females showed adjourned, increasing PGS.•Gender may influence PGS development across early bereavement.
While Cognitive Behavioral Therapy (CBT) is recommended as first-line treatment for depression, a significant minority do not show an adequate treatment response. Despite evidence for the efficacy of ...Mindfulness-Based Therapies (MBT) both in treating current depression and preventing relapse, it remains unknown whether MBT and CBT are equivalent in the treatment of current depression.
Five databases were searched for randomized controlled trials (RCTs) directly comparing MBT with CBT and including depression as primary or secondary outcome.
When pooling the results of 30 independent RCTs with a total of 2750 participants, MBT and CBT were statistically significantly equivalent at both post-intervention (Hedges's g = −0.009; p < .001) and follow-up (g = −0.033; p = .001). Supplementary Bayesian analyses provided further support for the alternative hypothesis of no difference between MBT and CBT. When exploring possible sources of heterogeneity, the differences at follow-up were smaller between CBT and mindfulness-based cognitive therapy (MBCT) than between CBT and mindfulness-based stress-reduction (MBSR) (Slope = 0.37;p = .022).
The currently available evidence suggests that that MBT and CBT are equally efficacious in treating current adult depression. It remains unclear whether the similar effects of the two intervention types are due to different mechanisms or common factors.
•We tested the equivalence of mindfulness-based therapy (MBT) and cognitive behavioral therapy (CBT) for treating depression.•Thirty randomized controlled trials of a total of 2705 participants were included.•MBT and CBT was statistically significantly equivalent in treating depression at both post-treatment and follow-up.
PDF
