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Effectiveness of mindfulness-based stress reduction (MBSR) for breast cancer – a systematic review and meta-analysis
126
Poster Presentations / European Journal of Integrative Medicine 4S (2012) 124–201
on one of the essential steps in cutaneous wound healing – the migration of fibroblasts. Methods: VALE was extracted by supercritical CO2 extraction containing 10.2% OA. Appropriate non-toxic concentrations of VALE and OA were determined with the mouse embryo fibroblast cell line NIH/3T3 by the WST-1 test. Cells were incubated with different concentrations of either VALE or OA for 24 and 48 h at 37 ◦ C. We show that at higher concentrations, all tested compounds displayed a dose-dependent, anti-proliferative, cytotoxic activity. IC50 values of OA were 16.9 g ml–1 (SD 0.1) after 24 h and 15.7 (SD 0.2) g ml–1 for 48 h, respectively. In contrast, VALE had a clearly lower antiproliferative effect, with IC50 values of 1173 (SD 353) g ml–1 after 24 h and 667 (SD 224) g ml–1 after 48 h, respectively. The influence of VALE and OA on the migratory activity of NIH/3T3 fibroblasts was determined by a wound-healing assay. Cells were incubated overnight and an artificial wound was created on the cell monolayer before cells were treated with either VALE (0.1–2000 g ml–1 ) or OA (0.1–50 g ml–1 ) for 24 h at 37 ◦ C. Results: Non-toxic concentrations of VALE (1 and10 g ml–1 ) and the corresponding concentrations of OA (0.1 and1 g ml–1 ) induced a highly significant (P < 0.001) stimulation of NIH/3T3 fibroblast migration into the wound area. At higher concentrations, a dose-dependent inhibition of migration was observed. Results indicate that VALE was able to a stimulate the migratory activity of fibroblasts in vitro and that OA might be the main active component of VALE contributing to this stimulatory activity. Conclusion: These findings are a first step in the ongoing process to investigate the underlying mechanisms of VALE in wound healing in vivo, which has recently been reported.
100 patients with prostate cancer were recruited. Tumour and disease parameters as well as religious affiliation were documented. The interviews were carried out using a German version of the Assessment of Chronic Illness Therapy-Spiritual Wellbeing Scale (FACIT-Sp) questionnaire for spiritual well-being. According to the recommendations of the American College of Physicians, additional questions in terms of a ‘spiritual history’ were asked. Quality of life (QoL) was assessed by the Short Form Health Survey (SF-12) questionnaire. Results: Overall, 28% of patients were Catholics and 72% were Protestants. General spiritual practices included prayer in 62% of cases, meditation in 31%, reading of religious texts in 27% and contemplation in 22%. The majority of patients (74%) would characterise themselves as more or less religious and 70% would integrate their religiosity in cancer coping. The FACIT-Sp showed a mean value of 32.74. Gender, tumour type and tumour stage had no influence, but there was significant influence of age. There was a strong correlation between higher religiosity/spirituality and QoL. Conclusion: Spirituality and religiosity play a major role for cancer patients in different stages of their disease. Spirituality cannot extend life or heal cancer, but it can improve QoL and patients’ personal condition. Spirituality and religiosity cannot be prescribed, but can be used as an available resource. Many patients expected spiritual support from their health-care professionals or complained that their spiritual needs were not adequately considered. The correlation of spirituality with QoL that has implications for pastoral care. http://dx.doi.org/10.1016/j.eujim.2012.07.766 PP-007
http://dx.doi.org/10.1016/j.eujim.2012.07.765
Effectiveness of mindfulness-based stress reduction (MBSR) for breast cancer – a systematic review and meta-analysis
PP-006
Lauche Romy, Cramer Holger, Paul Anna, Dobos Gustav
Spirituality and the search for the holistic as a resource of coping in oncology
University of Duisburg-Essen, Chair of Complementary and Integrative Medicine, Essen, Germany
Micke Oliver 1 , Mücke Ralph 2 , Büntzel Jens 3
Background: Mindfulness-based stress reduction, a standardised interventional programme based on meditation and mindfulness, is used at increasing intervals to help patients with breast cancer to cope with the disease-specific psychological complaints. Aim: This study aimed to systematically evaluate and metaanalyse the existing evidence for mindfulness-based stress reduction in patients with breast cancer. Methods: The following databases were searched for literature in October 2011: CAMBASE, the Cochrane Library, EMBASE, MEDLINE and PsycInfo. Randomised controlled trials (RCTs) that compared MBSR to controls were included. Primary outcomes were quality of life and other psychological parameters. Safety data were assessed as secondary outcome. Risk of bias was assessed using the Cochrane risk of bias tool. For each outcome, standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated, if at least two
1 Franziskus
Hospital, Bielefeld, Germany Hospital, Lemgo 3 Südharz Hospital, Nordhausen, Germany 2 Lippe
Background: Within the scope of the life-threatening disease cancer, which can affect patients’ corporal and existential identity, many patients look for help, sense and support from transcendental and metaphysic treatments complementary to conventional cancer treatment. Returning to spirituality and religiosity after tumour diagnosis is of growing importance for cancer patients. Despite epistemological, science and religion–theoretic issues, spirituality is coming into the focus of the scientific oncology community. Methods: A total of 200 patients from two different well-circumscribed patient collectives were evaluated using standardised interviews before the commencement of radiation treatment. 100 consecutive patients with breast cancer and
Poster Presentations / European Journal of Integrative Medicine 4S (2012) 124–201
studies assessing this outcome were available. Heterogeneity was determined calculating I2. Results: Four RCTs with a total of 548 subjects were included. Two RCTs used the usual care for comparison, one RCT a free choice stress management programme and one three-arm RCT compared MBSR to usual care and nutrition education. Meta-analysis revealed short-term evidence of MBSR for depression (SMD = –0.40, 95% CI: –0.59 to –0.20, P < 0.0001, I2 = 0%) and anxiety (SMD = –0.46 95% CI: –0.66 to 0.26, P < 0.00001, I2 = 0%) but no long-term evidence for both variables. Safety data were poorly reported but the available data suggest that MBSR is not associated with serious adverse events. Conclusions: There is some evidence of short-term effectiveness of MBSR in improving psychological health in breast cancer patients. More RCTs are required for conclusive judgement of effectiveness. http://dx.doi.org/10.1016/j.eujim.2012.07.767 PP-008 Efficacy of preoperative hypnosis in breast cancer surgery – a systematic review and meta-analysis Cramer Holger, Lauche Romy, Langhorst Jost, Dobos Gustav University of Duisburg-Essen, Chair of Complementary and Integrative Medicine, Essen, Germany Objectives: Hypnosis has been used since antiquity to assist in healing and coping after surgical interventions. Aim: The aim of this systematic review was to assess and meta-analyse the efficacy of preoperative hypnosis in patients undergoing either diagnostic or therapeutic breast cancer surgery. Methods: MEDLINE, PsycINFO, EMBASE, CAMBASE and the Cochrane Library were screened through February 2012. Randomised controlled trials (RCTs) comparing preoperative hypnosis to control conditions were analysed when they assessed pre-, peri- and/or postoperative pain, distress and/or nausea in patients undergoing diagnostic or therapeutic breast cancer surgery. Surgery time, recovery time, analgesics use and safety were defined as secondary outcome measures. For each outcome, mean differences (MDs) or standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated, if at least two studies assessing this outcome were available. Risk of bias was assessed using the risk of bias tool recommended by the Cochrane Back Review Group. Results: Four RCTs with low risk of bias with a total of 550 patients were included. One RCT compared hypnosis to standard care, two RCTs compared hypnosis to attention control and one three-arm RCT compared hypnosis to standard care and attention control. No evidence was found for effects on postoperative pain (SMD = –0.45, 95% CI –1.34, 0.43, P = 0.32). Strong evidence was found for effects on postoperative distress (SMD = –0.75, 95% CI –1.45, –0.05, P = 0.04) and moderate evidence for shorter surgery time in the hypnosis groups compared to attention control groups (MD = –7.16 min, 95%
127
CI –13.06 min, –1.26 min, P = 0.02). No group differences in adverse events were reported between groups. Discussion: This systematic review found strong evidence for reduced postoperative distress and moderate evidence for shortened surgery time in patients undergoing breast cancer surgery after preoperative hypnosis. While more RCTs are needed, a limited recommendation can be made in favour of the use of preoperative hypnosis in breast cancer surgery based on the current data. http://dx.doi.org/10.1016/j.eujim.2012.07.768 PP-009 Use of a basic breathing meditation technique to attenuate perioperative stress prior to cancer resection – findings of a pilot study Büssing Arndt 1 , Janko Annina 2 , Kopf Andreas 2 1 Charité University Medicine, Campus Benjamin Franklin Pain
Clinic and Palliative Treatment, Herdecke, Germany 2 Pain Clinic and Palliative Treatment, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany Background: To attenuate perioperative psychological stress in cancer patients, we developed a basic meditation technique focussing consciously on the process of breathing that can be performed by the patients at the bedside without any previous experience in meditation or assistance by an instructor. This breathing meditation can be supplemented with self-chosen affirmations that may help to focus on the breathing process and to assure hope and confidence, and thus decreasing distress and increasing positive mood states. Methods: To test the efficacy of such a breathing meditation, a study of 100 women with breast cancer was conducted. Using standardised questionnaires and visual analogue scales, patients’ perceived stress (PSS), anxiety (Amsterdam preoperative anxiety and information scale visual analogue scale, APAIS VAS), mood states (POMS/ASTS, VAS) and pain (VAS) were measured prior to surgery, at the morning of the operation and 1 day later. Here, findings of a pilot study with 21 patients are reported, focussing on the use and perceived benefit of this self-administered intervention. Results: The day after their surgery, most patients stated that they had used the mediation technique prior to surgery (11 often, three very often, five rarely and two not), and that it was beneficial to attenuate their perioperative stress (stated ‘very helpful’ in nine patients, ‘somewhat helpful’ in eight and ‘not helpful’ in three patients). Eight reported the use of specific affirmations, in most cases own phrasings (i.e., “Peace, Warmth, Peace,” Beloved ones at home,” “Quietness within me,” “I will become healthy,” “I am completely peaceful,” “Lord, give me the power to defeat this illness,” etc.). Conclusion: This self-administered, low-threshold breathing-meditation technique to attenuate preoperative distress can be used whenever the patient feels anxious or stressed. Results from this pilot study indicate that this basic intervention was in fact used by several patients, and was
Poster Presentations / European Journal of Integrative Medicine 4S (2012) 124–201
on one of the essential steps in cutaneous wound healing – the migration of fibroblasts. Methods: VALE was extracted by supercritical CO2 extraction containing 10.2% OA. Appropriate non-toxic concentrations of VALE and OA were determined with the mouse embryo fibroblast cell line NIH/3T3 by the WST-1 test. Cells were incubated with different concentrations of either VALE or OA for 24 and 48 h at 37 ◦ C. We show that at higher concentrations, all tested compounds displayed a dose-dependent, anti-proliferative, cytotoxic activity. IC50 values of OA were 16.9 g ml–1 (SD 0.1) after 24 h and 15.7 (SD 0.2) g ml–1 for 48 h, respectively. In contrast, VALE had a clearly lower antiproliferative effect, with IC50 values of 1173 (SD 353) g ml–1 after 24 h and 667 (SD 224) g ml–1 after 48 h, respectively. The influence of VALE and OA on the migratory activity of NIH/3T3 fibroblasts was determined by a wound-healing assay. Cells were incubated overnight and an artificial wound was created on the cell monolayer before cells were treated with either VALE (0.1–2000 g ml–1 ) or OA (0.1–50 g ml–1 ) for 24 h at 37 ◦ C. Results: Non-toxic concentrations of VALE (1 and10 g ml–1 ) and the corresponding concentrations of OA (0.1 and1 g ml–1 ) induced a highly significant (P < 0.001) stimulation of NIH/3T3 fibroblast migration into the wound area. At higher concentrations, a dose-dependent inhibition of migration was observed. Results indicate that VALE was able to a stimulate the migratory activity of fibroblasts in vitro and that OA might be the main active component of VALE contributing to this stimulatory activity. Conclusion: These findings are a first step in the ongoing process to investigate the underlying mechanisms of VALE in wound healing in vivo, which has recently been reported.
100 patients with prostate cancer were recruited. Tumour and disease parameters as well as religious affiliation were documented. The interviews were carried out using a German version of the Assessment of Chronic Illness Therapy-Spiritual Wellbeing Scale (FACIT-Sp) questionnaire for spiritual well-being. According to the recommendations of the American College of Physicians, additional questions in terms of a ‘spiritual history’ were asked. Quality of life (QoL) was assessed by the Short Form Health Survey (SF-12) questionnaire. Results: Overall, 28% of patients were Catholics and 72% were Protestants. General spiritual practices included prayer in 62% of cases, meditation in 31%, reading of religious texts in 27% and contemplation in 22%. The majority of patients (74%) would characterise themselves as more or less religious and 70% would integrate their religiosity in cancer coping. The FACIT-Sp showed a mean value of 32.74. Gender, tumour type and tumour stage had no influence, but there was significant influence of age. There was a strong correlation between higher religiosity/spirituality and QoL. Conclusion: Spirituality and religiosity play a major role for cancer patients in different stages of their disease. Spirituality cannot extend life or heal cancer, but it can improve QoL and patients’ personal condition. Spirituality and religiosity cannot be prescribed, but can be used as an available resource. Many patients expected spiritual support from their health-care professionals or complained that their spiritual needs were not adequately considered. The correlation of spirituality with QoL that has implications for pastoral care. http://dx.doi.org/10.1016/j.eujim.2012.07.766 PP-007
http://dx.doi.org/10.1016/j.eujim.2012.07.765
Effectiveness of mindfulness-based stress reduction (MBSR) for breast cancer – a systematic review and meta-analysis
PP-006
Lauche Romy, Cramer Holger, Paul Anna, Dobos Gustav
Spirituality and the search for the holistic as a resource of coping in oncology
University of Duisburg-Essen, Chair of Complementary and Integrative Medicine, Essen, Germany
Micke Oliver 1 , Mücke Ralph 2 , Büntzel Jens 3
Background: Mindfulness-based stress reduction, a standardised interventional programme based on meditation and mindfulness, is used at increasing intervals to help patients with breast cancer to cope with the disease-specific psychological complaints. Aim: This study aimed to systematically evaluate and metaanalyse the existing evidence for mindfulness-based stress reduction in patients with breast cancer. Methods: The following databases were searched for literature in October 2011: CAMBASE, the Cochrane Library, EMBASE, MEDLINE and PsycInfo. Randomised controlled trials (RCTs) that compared MBSR to controls were included. Primary outcomes were quality of life and other psychological parameters. Safety data were assessed as secondary outcome. Risk of bias was assessed using the Cochrane risk of bias tool. For each outcome, standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated, if at least two
1 Franziskus
Hospital, Bielefeld, Germany Hospital, Lemgo 3 Südharz Hospital, Nordhausen, Germany 2 Lippe
Background: Within the scope of the life-threatening disease cancer, which can affect patients’ corporal and existential identity, many patients look for help, sense and support from transcendental and metaphysic treatments complementary to conventional cancer treatment. Returning to spirituality and religiosity after tumour diagnosis is of growing importance for cancer patients. Despite epistemological, science and religion–theoretic issues, spirituality is coming into the focus of the scientific oncology community. Methods: A total of 200 patients from two different well-circumscribed patient collectives were evaluated using standardised interviews before the commencement of radiation treatment. 100 consecutive patients with breast cancer and
Poster Presentations / European Journal of Integrative Medicine 4S (2012) 124–201
studies assessing this outcome were available. Heterogeneity was determined calculating I2. Results: Four RCTs with a total of 548 subjects were included. Two RCTs used the usual care for comparison, one RCT a free choice stress management programme and one three-arm RCT compared MBSR to usual care and nutrition education. Meta-analysis revealed short-term evidence of MBSR for depression (SMD = –0.40, 95% CI: –0.59 to –0.20, P < 0.0001, I2 = 0%) and anxiety (SMD = –0.46 95% CI: –0.66 to 0.26, P < 0.00001, I2 = 0%) but no long-term evidence for both variables. Safety data were poorly reported but the available data suggest that MBSR is not associated with serious adverse events. Conclusions: There is some evidence of short-term effectiveness of MBSR in improving psychological health in breast cancer patients. More RCTs are required for conclusive judgement of effectiveness. http://dx.doi.org/10.1016/j.eujim.2012.07.767 PP-008 Efficacy of preoperative hypnosis in breast cancer surgery – a systematic review and meta-analysis Cramer Holger, Lauche Romy, Langhorst Jost, Dobos Gustav University of Duisburg-Essen, Chair of Complementary and Integrative Medicine, Essen, Germany Objectives: Hypnosis has been used since antiquity to assist in healing and coping after surgical interventions. Aim: The aim of this systematic review was to assess and meta-analyse the efficacy of preoperative hypnosis in patients undergoing either diagnostic or therapeutic breast cancer surgery. Methods: MEDLINE, PsycINFO, EMBASE, CAMBASE and the Cochrane Library were screened through February 2012. Randomised controlled trials (RCTs) comparing preoperative hypnosis to control conditions were analysed when they assessed pre-, peri- and/or postoperative pain, distress and/or nausea in patients undergoing diagnostic or therapeutic breast cancer surgery. Surgery time, recovery time, analgesics use and safety were defined as secondary outcome measures. For each outcome, mean differences (MDs) or standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated, if at least two studies assessing this outcome were available. Risk of bias was assessed using the risk of bias tool recommended by the Cochrane Back Review Group. Results: Four RCTs with low risk of bias with a total of 550 patients were included. One RCT compared hypnosis to standard care, two RCTs compared hypnosis to attention control and one three-arm RCT compared hypnosis to standard care and attention control. No evidence was found for effects on postoperative pain (SMD = –0.45, 95% CI –1.34, 0.43, P = 0.32). Strong evidence was found for effects on postoperative distress (SMD = –0.75, 95% CI –1.45, –0.05, P = 0.04) and moderate evidence for shorter surgery time in the hypnosis groups compared to attention control groups (MD = –7.16 min, 95%
127
CI –13.06 min, –1.26 min, P = 0.02). No group differences in adverse events were reported between groups. Discussion: This systematic review found strong evidence for reduced postoperative distress and moderate evidence for shortened surgery time in patients undergoing breast cancer surgery after preoperative hypnosis. While more RCTs are needed, a limited recommendation can be made in favour of the use of preoperative hypnosis in breast cancer surgery based on the current data. http://dx.doi.org/10.1016/j.eujim.2012.07.768 PP-009 Use of a basic breathing meditation technique to attenuate perioperative stress prior to cancer resection – findings of a pilot study Büssing Arndt 1 , Janko Annina 2 , Kopf Andreas 2 1 Charité University Medicine, Campus Benjamin Franklin Pain
Clinic and Palliative Treatment, Herdecke, Germany 2 Pain Clinic and Palliative Treatment, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany Background: To attenuate perioperative psychological stress in cancer patients, we developed a basic meditation technique focussing consciously on the process of breathing that can be performed by the patients at the bedside without any previous experience in meditation or assistance by an instructor. This breathing meditation can be supplemented with self-chosen affirmations that may help to focus on the breathing process and to assure hope and confidence, and thus decreasing distress and increasing positive mood states. Methods: To test the efficacy of such a breathing meditation, a study of 100 women with breast cancer was conducted. Using standardised questionnaires and visual analogue scales, patients’ perceived stress (PSS), anxiety (Amsterdam preoperative anxiety and information scale visual analogue scale, APAIS VAS), mood states (POMS/ASTS, VAS) and pain (VAS) were measured prior to surgery, at the morning of the operation and 1 day later. Here, findings of a pilot study with 21 patients are reported, focussing on the use and perceived benefit of this self-administered intervention. Results: The day after their surgery, most patients stated that they had used the mediation technique prior to surgery (11 often, three very often, five rarely and two not), and that it was beneficial to attenuate their perioperative stress (stated ‘very helpful’ in nine patients, ‘somewhat helpful’ in eight and ‘not helpful’ in three patients). Eight reported the use of specific affirmations, in most cases own phrasings (i.e., “Peace, Warmth, Peace,” Beloved ones at home,” “Quietness within me,” “I will become healthy,” “I am completely peaceful,” “Lord, give me the power to defeat this illness,” etc.). Conclusion: This self-administered, low-threshold breathing-meditation technique to attenuate preoperative distress can be used whenever the patient feels anxious or stressed. Results from this pilot study indicate that this basic intervention was in fact used by several patients, and was