Mindfulness-Based Stress Reduction in Post-treatment Breast Cancer Patients: Immediate and Sustained Effects Across Multiple Symptom Clusters

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• 作者：Richard R. Reich ; PhD^a ; ^{rreich@sar.usf.edu} ; Cecile A. Lengacher ; RN ; PhD ; FAAN^b ; Carissa B. Alinat ; MSN ; BA ; ARNP^b ; Kevin E. Kip ; PhD ; FAHA^b ; Carly Paterson ; RN ; PhD^b ; Sophia Ramesar ; BS^b ; Heather S. Han ; MD^c ; Roohi Ismail-Khan ; MD^c ; Versie Johnson-Mallard ; PhD ; MSN ; MSMS ; ARNP-BC^d ; Manolete Moscoso ; PhD^b ; Pinky Budhrani-Shani ; RN ; PhD^e ; Steve Shivers ; PhD^f ; Charles E. Cox ; MD^g ; Matthew Goodman ; MD^h ; Jong Park ; MPH ; PhDⁱ
• 关键词：Breast cancer ; Mindfulness-Based Stress Reduction (MBSR) ; symptom cluster ; physical symptoms ; psychological symptoms ; post-treatment
• 刊名：Journal of Pain and Symptom Management
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：53
• 期：1
• 页码：85-95
• 全文大小：2011 K
• 卷排序：53

文摘

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.ObjectivesThe 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.MethodsThree hundred twenty-two Stage 0–III post-treatment BCS were randomly 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.ResultsFour 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.ConclusionOur 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 RegistrationName and URL of Registry: ClinicalTrials.gov. Registration number: NCT01177124.