Mindfulness based stress reduction – too stressed to participate?
Baseline characteristics of participants and
nonparticipants: Initial results from MICA a randomized controlled trial of MBSR among women treated for breast cancer (NC0090977)
Hanne Würtzen, cand.psych.aut., ph.d. student, Department of Psychosocial Cancer Research
Peter Elsass, professor, dr.med.
University of Copenhagen Henrik Flyger, ph.d., head
Department of Breast Surgery, Herlev Hospital Randi V. Karlsen, Project nurse,
Department of Psychosocial Cancer Research Christoffer Johansen, professor, dr.med.
Department of Psychosocial Cancer Research
Background
Women operated for breast cancer report elevated levels of anxiety and depression in treatment- and post-treatment phases
Kissane, 2004
MBSR is fund to alleviate symptoms of stress, reduce depression, anxiety and pain among patients with different chronic conditions
Grossmann, 2002 A nationwide cohort study of Danish patients treated for primary breast cancer found that 6% of the patients uses yoga and 3.4 % uses relaxation techniques in the post-treatment phase
Gundgaard Petersen, 2009
Definitions
Mindfulness: Awareness, present moment, without judgment
Mindfulness based stress reduction(MBSR):
• 8 weeks, weekly 2½ hour group-based sessions (20-30 participants)
• one full-day silent retreat
• 45 minutes daily homework on non-session days
• written course material on stress, mindfulness and yoga
• 4 instructor–recorded CDs instructing MBSR exercises and mindfulness meditation
• Home training log
• Standard clinical and oncological follow-up
Background 3
Review of mindfulness among cancer patients find positive
evidence of the effects of mindfulness-based interventions by a total of 13 studies limited by
• design (3 RCT/13 studies)
• sample (7/11 mixed diagnosis and stage of cancer)
• smaller sample sizes (mean(N=41))
• self-selection
• no systematic report of enrolment procedure
Shennan 2010
Background 4
Level of experienced Stress/distress
Degree of motivation for MBSR?
Purpose of presentation
To compare participants and non-participants with regard to demographic and clinical
variables, wellbeing and lifestyle
characteristics
No response/not interested
n=687
Included
Participants n=338
Included
Non-participants with baseline questionnaire n=183
Eligible patients invited to participate in MICA (N=1208)
Part of MICA data included in analysis
Results 1
Clinical
characteristics Participants (N=338)
participantsNon-
(N=183) pvalue Age at operation
years (SD) 54.1(10.5) 58.5(10.0) 0.0001 Tumor size mm
(SD) 23.0(56.5) 21.4(15.0) 0.6409
No of tumor positive lymph
nodes (SD) 1.9(4.1) 2.3(5.6) 0.3200
Estrogen receptor status negative
(SD) 0.9(0.4) 0.9(0.3) 0.3634
Radiation (SD) 0.8(0.4) 0.8(0.4) 0.816
Chemotherapy(SD) 0.5(0.5) 0.4(0.5) 0.029
Hormones (SD) 0.6(0.5) 0.6(0.5) 0.697
Months since diagnosis at
inclusion (SD) 7.6(5.0) 7.6(5.0) 0.9943
Results 2
Demographic characteristics
Participants (65%) (N=338)
Non-participants (35%)
(N=183) Pvalue Single (not
married/cohabiting) 0.2(0.4) 0.3(0.4) 0.428
Children <18y at home 0.2(0.2) 0.3(0.4) 0.009 Further and higher
education 0.5(0.5) 0.6(0.5) 0.001
Non-subsidized full-time
work 0.5(0.5) 0.5(0.5) 0.093
Lifestyle Participants
(N=338) Non-participants
(N=183) Pvalue
Smoker 0.1(0.4) 0.2(0.4) 0.889
Weekly servings
of alcohol>14 0.1(0.3) 0.1(0.3) 0.567
Dietary quality
(Inter99) 0.5(0.5) 0.5(0.5) 0.304
Physical activity<
30 minutes daily 0.3(0.5) 0.4(0.5) 0.272
Results 3
Wellbeing Participants
Mean(SD) Non-participants
Mean(SD) Pvalue Distress (GSI, SCL-90r) 0.5(0.3) 0.4(0.4) 0.246 Sleep disturbance (MOS) 31.8(20.9) 28.8(24.2) 0.0028
Anxiety (HADS) 10.5(1.9) 10.3(1.7) 0.0012
Depression (MDI) 11.2(7.8) 8.4(7.9) 0.0038
Well-being (WHO-5) 0.7(0.7) 0.8(0.4) 0.0000
Results 4
Better
wellbeing Poor
wellbeing
WHO-5 SCL-90r GSI
Hierarchy of distress captured by different scales?
HADS MDI
Participants Non-participants pvalue Wellbeing
(WHO-5<50) 44 (16%) 20 (13%) 0.391
Distress (SCL-90r
GSI>0.5) 129 (38%) 47(26%) 0.001
Depression
(CES-D>16) 89 (31%) 34 (21%) 0.021
Anxiety
(SCL-90r anxiety>0.46) 128 (38%) 49 (27%) 0.004 Anxiety
(HADS anxiety>11) 137 (48%) 61 (38%) 0.054 Depression
(HADS depression>11) 122 (44%) 89 (61%) 0.002 Moderate/major
Depression (MDI>25) 23 (8%) 9 (6%) 0.438
*due to missing data
Distress cases identified by different scales
Caseness (defined by cut-off score or above-norm levels) by participation
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
non-participants participants
Level of experienced Stress/distress
Level of motivation for MBSR
MICA
participation
Perhaps not motivated For MICA participation Perhaps to stressed to Participate in MICA
Conclusions
Participants and non-participants in our RCT share healthy life-style characteristics
Participation seems to be associated with younger age, chemotherapy, children at home - age-adjusted analysis must be performed
More distress cases participate
Some very distressed patients may benefit from face-to- face enrollment procedure
Acknowledgements
Mindfulness instructor, MSc psychology Antonia Sumbundu
Mindfulness instructor MSc psychology, Eva Broby Johansen Mindfulness instructor MSc psychology ,Robert Jørgensen
The Danish Cancer Society University of Copenhagen yogaudstyr.dk
Thank you for your attention!
