Cochrane
Library
Cochrane Database of Systematic Reviews
Mindfulness-based stress reduction for women diagnosed with
breast cancer (Review)
Schell LK, Monsef I, Wöckel A, Skoetz N
Schell LK, Monsef I, Wöckel A, Skoetz N.
Mindfulness-based stress reduction for women diagnosed with breast cancer.
Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD011518.
DOI: 10.1002/14651858.CD011518.pub2.
www.cochranelibrary.com
Mindfulness-based stress reduction for women diagnosed with breast cancer (Review)
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
, Cochrane Trusted evidence.
Informed decisions.
Library Better health. Cochrane Database of Systematic Reviews
TABLE OF CONTENTS
HEADER......................................................................................................................................................................................................... 1
ABSTRACT..................................................................................................................................................................................................... 1
PLAIN LANGUAGE SUMMARY....................................................................................................................................................................... 2
SUMMARY OF FINDINGS.............................................................................................................................................................................. 4
BACKGROUND.............................................................................................................................................................................................. 6
OBJECTIVES.................................................................................................................................................................................................. 6
METHODS..................................................................................................................................................................................................... 6
RESULTS........................................................................................................................................................................................................ 9
Figure 1.................................................................................................................................................................................................. 10
Figure 2.................................................................................................................................................................................................. 14
Figure 3.................................................................................................................................................................................................. 16
Figure 4.................................................................................................................................................................................................. 16
Figure 5.................................................................................................................................................................................................. 17
Figure 6.................................................................................................................................................................................................. 17
Figure 7.................................................................................................................................................................................................. 18
DISCUSSION.................................................................................................................................................................................................. 18
AUTHORS' CONCLUSIONS........................................................................................................................................................................... 19
ACKNOWLEDGEMENTS................................................................................................................................................................................ 20
REFERENCES................................................................................................................................................................................................ 21
CHARACTERISTICS OF STUDIES.................................................................................................................................................................. 27
DATA AND ANALYSES.................................................................................................................................................................................... 59
Analysis 1.1. Comparison 1 MBSR vs usual care (short-term), Outcome 1 Quality of life................................................................. 59
Analysis 1.2. Comparison 1 MBSR vs usual care (short-term), Outcome 2 Fatigue........................................................................... 60
Analysis 1.3. Comparison 1 MBSR vs usual care (short-term), Outcome 3 Anxiety........................................................................... 60
Analysis 1.4. Comparison 1 MBSR vs usual care (short-term), Outcome 4 Depression..................................................................... 60
Analysis 1.5. Comparison 1 MBSR vs usual care (short-term), Outcome 5 Quality of sleep............................................................. 61
Analysis 2.1. Comparison 2 MBSR vs usual care (medium-term), Outcome 1 Quality of life............................................................ 61
Analysis 2.2. Comparison 2 MBSR vs usual care (medium-term), Outcome 2 Fatigue...................................................................... 61
Analysis 2.3. Comparison 2 MBSR vs usual care (medium-term), Outcome 3 Anxiety...................................................................... 62
Analysis 2.4. Comparison 2 MBSR vs usual care (medium-term), Outcome 4 Depression............................................................... 62
Analysis 2.5. Comparison 2 MBSR vs usual care (medium-term), Outcome 5 Quality of sleep........................................................ 63
Analysis 3.1. Comparison 3 MBSR vs usual care (long-term), Outcome 1 Quality of life.................................................................. 63
Analysis 3.2. Comparison 3 MBSR vs usual care (long-term), Outcome 2 Anxiety............................................................................ 63
Analysis 3.3. Comparison 3 MBSR vs usual care (long-term), Outcome 3 Depression...................................................................... 64
Analysis 4.1. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 1 Quality of 64
life...........................................................................................................................................................................................................
Analysis 4.2. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 2 Fatigue......... 64
Analysis 4.3. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 3 Anxiety......... 65
Analysis 4.4. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 4 Depression..... 65
Analysis 4.5. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 5 Quality of 65
sleep.......................................................................................................................................................................................................
Analysis 5.1. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 1 Quality 66
of life......................................................................................................................................................................................................
Analysis 5.2. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 2 Fatigue...... 66
Analysis 5.3. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 3 Anxiety...... 67
Analysis 5.4. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 4 67
Depression.............................................................................................................................................................................................
Analysis 5.5. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 5 Quality 67
of sleep..................................................................................................................................................................................................
Analysis 6.1. Comparison 6 Sensitivity analysis: low risk of bias for sequence generation (long-term), Outcome 1 Anxiety.......... 68
Analysis 6.2. Comparison 6 Sensitivity analysis: low risk of bias for sequence generation (long-term), Outcome 2 Depression...... 68
Mindfulness-based stress reduction for women diagnosed with breast cancer (Review) i
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
, Cochrane Trusted evidence.
Informed decisions.
Library Better health. Cochrane Database of Systematic Reviews
Analysis 7.1. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 1 Quality 69
of life......................................................................................................................................................................................................
Analysis 7.2. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 2 Fatigue..... 69
Analysis 7.3. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 3 Anxiety..... 69
Analysis 7.4. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 4 69
Depression.............................................................................................................................................................................................
Analysis 7.5. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 5 Quality 70
of sleep..................................................................................................................................................................................................
Analysis 8.1. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 1 Quality 70
of life......................................................................................................................................................................................................
Analysis 8.2. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 2 71
Fatigue...................................................................................................................................................................................................
Analysis 8.3. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 3 71
Anxiety....................................................................................................................................................................................................
Analysis 8.4. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 4 71
Depression.............................................................................................................................................................................................
Analysis 8.5. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 5 Quality 71
of sleep..................................................................................................................................................................................................
Analysis 9.1. Comparison 9 Sensitivity analysis: unclear risk of bias for sequence generation (long-term), Outcome 1 Quality 72
of life......................................................................................................................................................................................................
Analysis 9.2. Comparison 9 Sensitivity analysis: unclear risk of bias for sequence generation (long-term), Outcome 2 Anxiety...... 72
Analysis 9.3. Comparison 9 Sensitivity analysis: unclear risk of bias for sequence generation (long-term), Outcome 3 73
Depression.............................................................................................................................................................................................
Analysis 10.1. Comparison 10 Sensitivity analysis: fixed effect model for QoL, Outcome 1 Quality of life medium-term............... 73
Analysis 11.1. Comparison 11 Sensitivity analysis: no imputation of missing data (short-term), Outcome 1 Quality of life........... 74
Analysis 11.2. Comparison 11 Sensitivity analysis: no imputation of missing data (short-term), Outcome 2 Fatigue.................... 74
Analysis 11.3. Comparison 11 Sensitivity analysis: no imputation of missing data (short-term), Outcome 3 Anxiety.................... 74
Analysis 11.4. Comparison 11 Sensitivity analysis: no imputation of missing data (short-term), Outcome 4 Depression.............. 74
Analysis 12.1. Comparison 12 Sensitivity analysis: no imputation of missing data (medium-term), Outcome 1 Quality of life....... 75
Analysis 12.2. Comparison 12 Sensitivity analysis: no imputation of missing data (medium-term), Outcome 2 Depression......... 75
Analysis 12.3. Comparison 12 Sensitivity analysis: no imputation of missing data (medium-term), Outcome 3 Fatigue............... 76
Analysis 12.4. Comparison 12 Sensitivity analysis: no imputation of missing data (medium-term), Outcome 4 Anxiety............... 76
Analysis 13.1. Comparison 13 Sensitivity analysis: < 30% missing data from participants, Outcome 1 Depression long-term....... 77
Analysis 14.1. Comparison 14 Sensitivity analysis: change data (short-term), Outcome 1 Quality of life....................................... 77
Analysis 14.2. Comparison 14 Sensitivity analysis: change data (short-term), Outcome 2 Anxiety................................................. 77
Analysis 14.3. Comparison 14 Sensitivity analysis: change data (short-term), Outcome 3 Depression........................................... 78
Analysis 14.4. Comparison 14 Sensitivity analysis: change data (short-term), Outcome 4 Quality of sleep.................................... 78
Analysis 15.1. Comparison 15 Sensitivity analysis: change data (long-term), Outcome 1 Anxiety................................................... 78
Analysis 15.2. Comparison 15 Sensitivity analysis: change data (long-term), Outcome 2 Depression............................................ 79
ADDITIONAL TABLES.................................................................................................................................................................................... 79
APPENDICES................................................................................................................................................................................................. 87
CONTRIBUTIONS OF AUTHORS................................................................................................................................................................... 96
DECLARATIONS OF INTEREST..................................................................................................................................................................... 97
SOURCES OF SUPPORT............................................................................................................................................................................... 97
DIFFERENCES BETWEEN PROTOCOL AND REVIEW.................................................................................................................................... 97
NOTES........................................................................................................................................................................................................... 98
INDEX TERMS............................................................................................................................................................................................... 98
Mindfulness-based stress reduction for women diagnosed with breast cancer (Review) ii
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
, Cochrane Trusted evidence.
Informed decisions.
Library Better health. Cochrane Database of Systematic Reviews
[Intervention Review]
Mindfulness-based stress reduction for women diagnosed with breast
cancer
Lisa K Schell1, Ina Monsef1, Achim Wöckel2, Nicole Skoetz3
1Cochrane Haematological Malignancies, Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University
Hospital Cologne, Cologne, Germany. 2Department of Gynaecology and Obstetrics, University Hospital of Würzburg, Würzburg, Germany.
3Cochrane Cancer, Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne,
Cologne, Germany
Contact address: Nicole Skoetz, Cochrane Cancer, Department I of Internal Medicine, University of Cologne, Faculty of Medicine and
University Hospital Cologne, Kerpener Str. 62, Cologne, 50937, Germany. .
Editorial group: Cochrane Breast Cancer Group.
Publication status and date: New, published in Issue 3, 2019.
Citation: Schell LK, Monsef I, Wöckel A, Skoetz N. Mindfulness-based stress reduction for women diagnosed with breast cancer.
Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD011518. DOI: 10.1002/14651858.CD011518.pub2.
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ABSTRACT
Background
Breast cancer is the most common cancer in women. Diagnosis and treatment may drastically affect quality of life, causing symptoms
such as sleep disorders, depression and anxiety. Mindfulness-based stress reduction (MBSR) is a programme that aims to reduce stress
by developing mindfulness, meaning a non-judgmental, accepting moment-by-moment awareness. MBSR seems to benefit patients with
mood disorders and chronic pain, and it may also benefit women with breast cancer.
Objectives
To assess the effects of mindfulness-based stress reduction (MBSR) in women diagnosed with breast cancer.
Search methods
In April 2018, we conducted a comprehensive electronic search for studies of MBSR in women with breast cancer, in the Cochrane Central
Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and two trial registries (World Health Organization's International Clinical Trials
Registry Platform (WHO ICTRP) and ClinicalTrials.gov). We also handsearched relevant conference proceedings.
Selection criteria
Randomised clinical trials (RCTs) comparing MBSR versus no intervention in women with breast cancer.
Data collection and analysis
We used standard methodological procedures expected by Cochrane. Using a standardised data form, the review authors extracted data
in duplicate on methodological quality, participants, interventions and outcomes of interest (quality of life, fatigue, depression, anxiety,
quality of sleep, overall survival and adverse events). For outcomes assessed with the same instrument, we used the mean difference (MD)
as a summary statistic for meta-analysis; for those assessed with different instruments, we used the standardised mean difference (SMD).
The effect of MBSR was assessed in the short term (end of intervention), medium term (up to 6 months after intervention) and long term
(up to 24 months after intervention).
Main results
Fourteen RCTs fulfilled our inclusion criteria, with most studies reporting that they included women with early breast cancer. Ten RCTs
involving 1571 participants were eligible for meta-analysis, while four studies involving 185 participants did not report usable results.
Mindfulness-based stress reduction for women diagnosed with breast cancer (Review) 1
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Library
Cochrane Database of Systematic Reviews
Mindfulness-based stress reduction for women diagnosed with
breast cancer (Review)
Schell LK, Monsef I, Wöckel A, Skoetz N
Schell LK, Monsef I, Wöckel A, Skoetz N.
Mindfulness-based stress reduction for women diagnosed with breast cancer.
Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD011518.
DOI: 10.1002/14651858.CD011518.pub2.
www.cochranelibrary.com
Mindfulness-based stress reduction for women diagnosed with breast cancer (Review)
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
, Cochrane Trusted evidence.
Informed decisions.
Library Better health. Cochrane Database of Systematic Reviews
TABLE OF CONTENTS
HEADER......................................................................................................................................................................................................... 1
ABSTRACT..................................................................................................................................................................................................... 1
PLAIN LANGUAGE SUMMARY....................................................................................................................................................................... 2
SUMMARY OF FINDINGS.............................................................................................................................................................................. 4
BACKGROUND.............................................................................................................................................................................................. 6
OBJECTIVES.................................................................................................................................................................................................. 6
METHODS..................................................................................................................................................................................................... 6
RESULTS........................................................................................................................................................................................................ 9
Figure 1.................................................................................................................................................................................................. 10
Figure 2.................................................................................................................................................................................................. 14
Figure 3.................................................................................................................................................................................................. 16
Figure 4.................................................................................................................................................................................................. 16
Figure 5.................................................................................................................................................................................................. 17
Figure 6.................................................................................................................................................................................................. 17
Figure 7.................................................................................................................................................................................................. 18
DISCUSSION.................................................................................................................................................................................................. 18
AUTHORS' CONCLUSIONS........................................................................................................................................................................... 19
ACKNOWLEDGEMENTS................................................................................................................................................................................ 20
REFERENCES................................................................................................................................................................................................ 21
CHARACTERISTICS OF STUDIES.................................................................................................................................................................. 27
DATA AND ANALYSES.................................................................................................................................................................................... 59
Analysis 1.1. Comparison 1 MBSR vs usual care (short-term), Outcome 1 Quality of life................................................................. 59
Analysis 1.2. Comparison 1 MBSR vs usual care (short-term), Outcome 2 Fatigue........................................................................... 60
Analysis 1.3. Comparison 1 MBSR vs usual care (short-term), Outcome 3 Anxiety........................................................................... 60
Analysis 1.4. Comparison 1 MBSR vs usual care (short-term), Outcome 4 Depression..................................................................... 60
Analysis 1.5. Comparison 1 MBSR vs usual care (short-term), Outcome 5 Quality of sleep............................................................. 61
Analysis 2.1. Comparison 2 MBSR vs usual care (medium-term), Outcome 1 Quality of life............................................................ 61
Analysis 2.2. Comparison 2 MBSR vs usual care (medium-term), Outcome 2 Fatigue...................................................................... 61
Analysis 2.3. Comparison 2 MBSR vs usual care (medium-term), Outcome 3 Anxiety...................................................................... 62
Analysis 2.4. Comparison 2 MBSR vs usual care (medium-term), Outcome 4 Depression............................................................... 62
Analysis 2.5. Comparison 2 MBSR vs usual care (medium-term), Outcome 5 Quality of sleep........................................................ 63
Analysis 3.1. Comparison 3 MBSR vs usual care (long-term), Outcome 1 Quality of life.................................................................. 63
Analysis 3.2. Comparison 3 MBSR vs usual care (long-term), Outcome 2 Anxiety............................................................................ 63
Analysis 3.3. Comparison 3 MBSR vs usual care (long-term), Outcome 3 Depression...................................................................... 64
Analysis 4.1. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 1 Quality of 64
life...........................................................................................................................................................................................................
Analysis 4.2. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 2 Fatigue......... 64
Analysis 4.3. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 3 Anxiety......... 65
Analysis 4.4. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 4 Depression..... 65
Analysis 4.5. Comparison 4 Sensitivity analysis: low risk of bias for sequence generation (short-term), Outcome 5 Quality of 65
sleep.......................................................................................................................................................................................................
Analysis 5.1. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 1 Quality 66
of life......................................................................................................................................................................................................
Analysis 5.2. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 2 Fatigue...... 66
Analysis 5.3. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 3 Anxiety...... 67
Analysis 5.4. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 4 67
Depression.............................................................................................................................................................................................
Analysis 5.5. Comparison 5 Sensitivity analysis: low risk of bias for sequence generation (medium-term), Outcome 5 Quality 67
of sleep..................................................................................................................................................................................................
Analysis 6.1. Comparison 6 Sensitivity analysis: low risk of bias for sequence generation (long-term), Outcome 1 Anxiety.......... 68
Analysis 6.2. Comparison 6 Sensitivity analysis: low risk of bias for sequence generation (long-term), Outcome 2 Depression...... 68
Mindfulness-based stress reduction for women diagnosed with breast cancer (Review) i
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
, Cochrane Trusted evidence.
Informed decisions.
Library Better health. Cochrane Database of Systematic Reviews
Analysis 7.1. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 1 Quality 69
of life......................................................................................................................................................................................................
Analysis 7.2. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 2 Fatigue..... 69
Analysis 7.3. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 3 Anxiety..... 69
Analysis 7.4. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 4 69
Depression.............................................................................................................................................................................................
Analysis 7.5. Comparison 7 Sensitivity analysis: unclear risk of bias for sequence generation (short-term), Outcome 5 Quality 70
of sleep..................................................................................................................................................................................................
Analysis 8.1. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 1 Quality 70
of life......................................................................................................................................................................................................
Analysis 8.2. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 2 71
Fatigue...................................................................................................................................................................................................
Analysis 8.3. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 3 71
Anxiety....................................................................................................................................................................................................
Analysis 8.4. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 4 71
Depression.............................................................................................................................................................................................
Analysis 8.5. Comparison 8 Sensitivity analysis: unclear risk of bias for sequence generation (medium-term), Outcome 5 Quality 71
of sleep..................................................................................................................................................................................................
Analysis 9.1. Comparison 9 Sensitivity analysis: unclear risk of bias for sequence generation (long-term), Outcome 1 Quality 72
of life......................................................................................................................................................................................................
Analysis 9.2. Comparison 9 Sensitivity analysis: unclear risk of bias for sequence generation (long-term), Outcome 2 Anxiety...... 72
Analysis 9.3. Comparison 9 Sensitivity analysis: unclear risk of bias for sequence generation (long-term), Outcome 3 73
Depression.............................................................................................................................................................................................
Analysis 10.1. Comparison 10 Sensitivity analysis: fixed effect model for QoL, Outcome 1 Quality of life medium-term............... 73
Analysis 11.1. Comparison 11 Sensitivity analysis: no imputation of missing data (short-term), Outcome 1 Quality of life........... 74
Analysis 11.2. Comparison 11 Sensitivity analysis: no imputation of missing data (short-term), Outcome 2 Fatigue.................... 74
Analysis 11.3. Comparison 11 Sensitivity analysis: no imputation of missing data (short-term), Outcome 3 Anxiety.................... 74
Analysis 11.4. Comparison 11 Sensitivity analysis: no imputation of missing data (short-term), Outcome 4 Depression.............. 74
Analysis 12.1. Comparison 12 Sensitivity analysis: no imputation of missing data (medium-term), Outcome 1 Quality of life....... 75
Analysis 12.2. Comparison 12 Sensitivity analysis: no imputation of missing data (medium-term), Outcome 2 Depression......... 75
Analysis 12.3. Comparison 12 Sensitivity analysis: no imputation of missing data (medium-term), Outcome 3 Fatigue............... 76
Analysis 12.4. Comparison 12 Sensitivity analysis: no imputation of missing data (medium-term), Outcome 4 Anxiety............... 76
Analysis 13.1. Comparison 13 Sensitivity analysis: < 30% missing data from participants, Outcome 1 Depression long-term....... 77
Analysis 14.1. Comparison 14 Sensitivity analysis: change data (short-term), Outcome 1 Quality of life....................................... 77
Analysis 14.2. Comparison 14 Sensitivity analysis: change data (short-term), Outcome 2 Anxiety................................................. 77
Analysis 14.3. Comparison 14 Sensitivity analysis: change data (short-term), Outcome 3 Depression........................................... 78
Analysis 14.4. Comparison 14 Sensitivity analysis: change data (short-term), Outcome 4 Quality of sleep.................................... 78
Analysis 15.1. Comparison 15 Sensitivity analysis: change data (long-term), Outcome 1 Anxiety................................................... 78
Analysis 15.2. Comparison 15 Sensitivity analysis: change data (long-term), Outcome 2 Depression............................................ 79
ADDITIONAL TABLES.................................................................................................................................................................................... 79
APPENDICES................................................................................................................................................................................................. 87
CONTRIBUTIONS OF AUTHORS................................................................................................................................................................... 96
DECLARATIONS OF INTEREST..................................................................................................................................................................... 97
SOURCES OF SUPPORT............................................................................................................................................................................... 97
DIFFERENCES BETWEEN PROTOCOL AND REVIEW.................................................................................................................................... 97
NOTES........................................................................................................................................................................................................... 98
INDEX TERMS............................................................................................................................................................................................... 98
Mindfulness-based stress reduction for women diagnosed with breast cancer (Review) ii
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
, Cochrane Trusted evidence.
Informed decisions.
Library Better health. Cochrane Database of Systematic Reviews
[Intervention Review]
Mindfulness-based stress reduction for women diagnosed with breast
cancer
Lisa K Schell1, Ina Monsef1, Achim Wöckel2, Nicole Skoetz3
1Cochrane Haematological Malignancies, Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University
Hospital Cologne, Cologne, Germany. 2Department of Gynaecology and Obstetrics, University Hospital of Würzburg, Würzburg, Germany.
3Cochrane Cancer, Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne,
Cologne, Germany
Contact address: Nicole Skoetz, Cochrane Cancer, Department I of Internal Medicine, University of Cologne, Faculty of Medicine and
University Hospital Cologne, Kerpener Str. 62, Cologne, 50937, Germany. .
Editorial group: Cochrane Breast Cancer Group.
Publication status and date: New, published in Issue 3, 2019.
Citation: Schell LK, Monsef I, Wöckel A, Skoetz N. Mindfulness-based stress reduction for women diagnosed with breast cancer.
Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD011518. DOI: 10.1002/14651858.CD011518.pub2.
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
ABSTRACT
Background
Breast cancer is the most common cancer in women. Diagnosis and treatment may drastically affect quality of life, causing symptoms
such as sleep disorders, depression and anxiety. Mindfulness-based stress reduction (MBSR) is a programme that aims to reduce stress
by developing mindfulness, meaning a non-judgmental, accepting moment-by-moment awareness. MBSR seems to benefit patients with
mood disorders and chronic pain, and it may also benefit women with breast cancer.
Objectives
To assess the effects of mindfulness-based stress reduction (MBSR) in women diagnosed with breast cancer.
Search methods
In April 2018, we conducted a comprehensive electronic search for studies of MBSR in women with breast cancer, in the Cochrane Central
Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and two trial registries (World Health Organization's International Clinical Trials
Registry Platform (WHO ICTRP) and ClinicalTrials.gov). We also handsearched relevant conference proceedings.
Selection criteria
Randomised clinical trials (RCTs) comparing MBSR versus no intervention in women with breast cancer.
Data collection and analysis
We used standard methodological procedures expected by Cochrane. Using a standardised data form, the review authors extracted data
in duplicate on methodological quality, participants, interventions and outcomes of interest (quality of life, fatigue, depression, anxiety,
quality of sleep, overall survival and adverse events). For outcomes assessed with the same instrument, we used the mean difference (MD)
as a summary statistic for meta-analysis; for those assessed with different instruments, we used the standardised mean difference (SMD).
The effect of MBSR was assessed in the short term (end of intervention), medium term (up to 6 months after intervention) and long term
(up to 24 months after intervention).
Main results
Fourteen RCTs fulfilled our inclusion criteria, with most studies reporting that they included women with early breast cancer. Ten RCTs
involving 1571 participants were eligible for meta-analysis, while four studies involving 185 participants did not report usable results.
Mindfulness-based stress reduction for women diagnosed with breast cancer (Review) 1
Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
