Mindfulness in cancer treatment: time to stop and think

Breathe deeply and focus on the moment: mindfulness now appears everywhere as a technique to improve well-being, including in health care.

Mindfulness training is often suggested for cancer patients to reduce high levels of anxiety and distress associated with diagnosis, treatment and anticipation of possible disease recurrence. But two questions persist: does mindfulness work and, if so, for whom?

A new Australian study of men with advanced prostate cancer, published in the Journal of Clinical Oncology, suggests mindfulness training offers no benefit in this particular setting.

What is mindfulness?

Mindfulness as a meditative practice originally derived from the Buddhist tradition, and refers broadly to a way of paying attention to the present experience from moment to moment.

Moving away from its religious origins, mindfulness has been applied in the secular arena over the past two decades, including in diverse contexts such as health and well-being, employee happiness, school room management and even military training.

Early drivers of the mindfulness wave centred around a desire to enhance the human condition, ease suffering and make the world a better place. Now the practice appears to be increasingly shaped by commercial interests and “naive realism”, where clinicians apply intuition rather than evidence to assess effectiveness.

Meditation and mindfulness is now a billion dollar industry with almost a quarter of employers in the US offered mindfulness training. A prominent UK report recently recommended mindfulness training be pioneered as a useful practice in the health, education and criminal justice systems.

Mindfulness and cancer

Mindfulness targeted at improving health and well-being, and helping individuals cope more effectively with chronic illness, has also advanced rapidly. Influential health care organisations have supported this movement, including the National Health Service in the UK, and the National Institutes of Health in the US.

In cancer, mindfulness-based therapies are often suggested as a supportive care option for patients. Mindfulness as the core component of these two approaches centres around teaching open awareness of the present experience and a focus on behaviour.

The behaviour element encourages the individual to conduct self observation of habits, and to become less reactive to difficult or unpleasant experiences. This is proposed to create a sense of calmness and composure – often referred to as equanimity – about the illness experience.

Mindfulness-based cognitive therapy also includes an explicit focus on the link between thoughts and mood. This is important in cancer, where fears about the cancer recurring and uncertainty about the future are often problematic and can drive distress.

While mindfulness approaches intuitively seem well matched to the cancer context, to date the research in this area has been limited by variable study quality and a focus on breast cancer patients.

Mindfulness in advanced prostate cancer

Our group recently conducted the first effectiveness trial of mindfulness-based approaches in men with prostate cancer.

For nine months we followed 189 men with advanced prostate cancer to assess whether mindfulness-based cognitive therapy led to any improvements over time. The men had prostate cancer that had spread, or was resistant to hormone treatment.

Men received their usual medical care, and in addition were randomly allocated to receive self-help booklets, or an eight week telephone mindfulness-based cognitive therapy group program delivered by highly trained and closely supervised mindfulness-based cognitive therapists. On average the patients were 70 to 71 years of age.

We found mindfulness-based cognitive therapy did not improve the men’s well-being in comparison to their usual medical management. Men receiving mindfulness-based cognitive therapy reported no reduction in psychological distress, no lessening of anxiety about testing for prostate specific antigen – a measure of tumour progression and response to treatment – and no lowering of distress related to their cancer.

Men receiving therapy also reported no improvement in quality of life nor post-traumatic growth, a term that encompasses positive psychological change as a result of their cancer.

Although well-being did not change, many men did describe the program as helpful in terms of not feeling alone, learning meditation and breathing exercises, understanding the meaning of well-being and perceived control of thoughts and health.

More quality evidence is needed

Mindfulness-based approaches have been shown to be helpful for women with breast cancer. It is not clear why mindfulness-based cognitive therapy did not produce measurable benefits for the men in this study. We speculate the acceptability and usefulness of mindfulness may be strongly influenced by contextual issues, such as gender, age, education, and perhaps even the specific nature of the illness challenge.

Importantly, this new study raises further questions about the widespread application of mindfulness across multiple settings as a therapeutic intervention for all people in all situations. Popular culture and commercial interests have embraced mindfulness, and the advance into divergent aspects of life has been rapid.

We suggest more quality evidence is needed about the potential for mindfulness to do good across multiple settings. In parallel, we support the broader conversation about the application and commercialisation of a practice derived from eastern philosophical tradition outside of its original intent.