Eyes wide open: Tread carefully with mindfulness training during chemotherapy

Abstract

BACKGROUND: Many patients experience elevated distress when going through chemotherapy. Mindfulness-based interventions appear promising in cancer patients but have focused on post-treatment and survivorship phases; almost no research has been conducted in initial treatment. The current RCT contrasted a brief mindfulness-based therapy (bMBT) with relaxation therapy on reducing distress in first-time chemotherapy patients. METHOD: Sixty-eight people receiving adjuvant chemotherapy or first-line chemotherapy for metastatic disease at Auckland City Hospital, New Zealand between March and September 2013 were randomised to bMBT (n = 32) or relaxation groups (n = 36). In both conditions, participants attended 3 x 90 minute weekly sessions. Measures assessing mindfulness, distress and physical symptoms were completed at two time points – at enrolment and after the intervention. Intent to treat repeated measures ANOVAs assessed changes over time and the effects of the two interventions. RESULTS: Post-intervention, both groups reported increased mindfulness (FFMQ scores; F(1,66)=16.97, p = .000,gp2=0.205), less distress (Distress Thermometer; F(1,66)=5.50, p = .022, gp2=.077) and less anxiety (HADS anxiety; F(1,66)=10.80, p = 0.002,gp2=0.141). There was no time effect for depression (HADS depression; F(1,66) = 1.14, p = 0.290,gp2= 0.017) nor any group by time differences on these variables. However, bMBT (but not relaxation) participants reported increased physical symptom distress post-intervention (MSAS-SF physical subscale; F(1,66) = 5.91, p = 0.018, gp2=0.092). Randomization checks indicated the groups did not differ in terms of treatment or time since diagnosis, thus models did not control for these. However, co-varying these parameters produced no substantive change in the models. CONCLUSIONS: Overall mindfulness was increased in both groups, making the identification of group differences challenging. However, whilst distress declined overall in both mindfulness and relaxation groups, the mindfulness intervention predicted an increase of physical symptom distress. RESEARCH IMPLICATIONS: This study provides one of the few investigations of mindfulness into an initial cancer treatment context. The results highlight the importance of measuring different aspects of distress in this context. CLINICAL IMPLICATIONS: Given the increase in physical symptom distress in the mindfulness group, relaxation therapy may be the more appropriate intervention during chemotherapy. Although follow-up data are still being collected, caution is needed in advising interventions that encourage awareness of bodily experience during treatment.