It’s a cruel irony of cancer — the diagnosis, symptoms and treatment of it each cause extreme stress for patients and, at the same time, studies suggest increased stress can make it easier for cancer to progress.
Identifying and Targeting Stressors
The National Comprehensive Cancer Network developed a Distress Thermometer and Problems List which can help patients and their clinical care team assess the amount and types of stress they are facing. This tool can pinpoint stressors which can, in turn, aid in the development of targeted strategies to reduce the stress load on a cancer patient.
But given that cancer is itself a stressor, what can a patient do to reduce the negative impact of stress on the body? While pharmacologic intervention may be necessary in some instances, there are a variety of ways to address stress through other means. Interventions such as massage therapy, acupuncture, psychotherapy, guided imagery and relaxation may all be useful tools. There are also multiple “mind-body” practices that have been shown to modify biological, physiological or psychosocial processes and improve quality of life. These practices include meditation as well as movement-based yoga, tai chi and qi gong.
One of the most well-studied non-pharmacological interventions for cancer patients is “mindfulness-based stress reduction.”
Mindfulness-based Stress Reduction
Mindfulness-based stress reduction, or MBSR, is a structured intervention program that helps patients cope with the physical and emotional challenges of cancer through the development and practice of mindfulness. Whereas we may find we react immediately to situations, dwell on the past or worry about the future, mindfulness practice cultivates purposeful, nonjudgmental, moment-to-moment awareness.
A 2013 randomized controlled trial involving 336 Danish women with stage I-III breast cancer tested whether an MBSR program would improve quality of life. Researchers found, “The 8-week group based MBSR intervention had clinically meaningful, statistically significant effects on depression and anxiety after 12 months' follow-up, and medium-to-large effect sizes.”
A 2020 meta-analysis looked at mindfulness-based interventions (MBIs) to assess whether they were associated with reductions in anxiety of adult cancer patients. The review found, “significant reductions in the severity of short-term anxiety,” as well as a reduction in medium-term anxiety. MBIs were also associated with a reduction in the severity of depression in the short term and the medium term as well as improved health-related quality of life in patients in both the short and medium terms.
A typical MBSR program may involve weekly sessions, lasting for a period of eight weeks or so, along with group discussions, meditation, gentle yoga and other activities. Participants also practice mindfulness meditation at home and learn to incorporate mindfulness into their everyday lives.
A More Focused MBSR Approach
Because of the effectiveness of MBSR generally and in cancer patients specifically, clinicians and practitioners have adapted the program in multiple ways to tailor it to specific conditions and stressors. Mindfulness-based cancer recovery, or MBCR, is grounded in the principles of MBSR but features shorter sessions and focuses on the unique experiences of people with cancer.
A 2013 randomized controlled trial assigned 271 distressed breast cancer survivors (stages I-III) to one of three groups — MBCR, supportive-expressive group therapy and a control. MBCR was found to be superior for improving stress levels, quality of life and social support. Both MBCR and supportive-expressive group therapy resulted in more normative diurnal cortisol profiles than in the control group.
Research is ongoing into how and why MBSR has positive impacts in both general and cancer populations. A 2016 study leveraging brain scans found mindfulness meditation training caused a reduction in Ievels of interleukin 6 (IL-6) as well as changes in functional connectivity in the brain.
Accessing MBSR and MBCR Programs
Mindfulness-based practices can help patients manage the stress of coping with cancer by providing both psychological and physiological benefits. Reach out to the patient support services at your treatment center to see if they have MBSR or MBCR programs available. You can also learn more about MBCR at this website, where creators Linda Carlson and Michael Speca offer multiple resources including their book, Mindfulness-Based Cancer Recovery. For more general MBSR programming, online courses are available from many providers such as Emindful, Palouse Mindfulness and MBSR Training.