Prior to receiving behavioral interventions, more than half of participating young survivors of breast cancer were considered clinically depressed. That number dropped to 30% after participants received mindfulness meditation and survivorship education classes.
Data presented at the 2020 San Antonio Breast Cancer Symposium demonstrated that younger women treated for breast cancer experienced a reduction in depressive symptoms after participating in mindfulness meditation and survivorship education classes.
“Younger breast cancer survivors represent a vulnerable population, with well-documented side effects from breast cancer treatments and notable increases in depressive symptoms,” lead study author Dr. Patricia A. Ganz said during a virtual presented of the phase 3 results. “These lasting effects of breast cancer treatments can have a negative impact on quality of life in the survivorship period.”
Ganz, associate director for population science research at the UCLA Jonsson Comprehensive Cancer Center, presented data from the randomized, multi-institutional phase 3 Pathway to Wellness trial. The authors evaluated the efficacy of mindfulness meditation and survivorship education classes — both aimed to target depressive symptoms in younger breast cancer survivors — compared with a concurrent waitlist control group.
Both interventions consisted of six-week programs conducted for two hours each week. Participants were provided with a series of educational seminars, with discussions of life after breast cancer.
The intervention programs had a standard curriculum that was manually documented and recorded throughout the study.
Mindfulness Awareness Practices (MAPS) sessions included:
Survivorship education included:
Patients were screened by phone and included in the study if they were 50 years or younger with a diagnosis of stage 0-3 breast cancer, between six months and five years after their primary treatment, had no metastatic disease, were not already practicing meditation, had a minimum level of depressive symptoms and were willing to be randomized and able to participate in the six-week program.
Measuring depressive symptoms at post-intervention (defined as a Center for Epidemiologic Studies Depression scale score of 16 or greater) served as the study’s main goal. Additional endpoints of interest included anxiety, fatigue, sleep disturbance and hot flashes. Assessments were conducted before the interventions started, post-intervention and at three- and six-month post-intervention follow-ups.
Of the 247 patients (median age, 45.4 years; 82% white), 85 were analyzed under the MAPS intervention, 81 with survivorship education and 81 who were in the waitlist control group.
Most patients were married (75%) and employed full time (68%). On average, patients were 2.6 years out from their breast cancer diagnosis, with more than half having undergone a mastectomy (56%) or received chemotherapy (57%) or radiation (65%). Moreover, 66% reported receiving endocrine therapy during the study period.
At baseline, all three groups reported mean Center for Epidemiologic Studies Depression scores above 16, with over 50% of participants scoring in the clinically depressed range before the intervention. However, after intervention, the researchers saw a significant decline in depression for both the MAPS and survivorship education groups, with only 30% of women scoring in the clinically depressed range. These scores were sustained at three months in both cohorts and at six months in the MAPS cohort.
Anxiety, sleep disturbance and hot flashes significantly improved in both intervention groups; however, fatigue severity only improved significantly in the MAPS cohort. Of note, improvement in these areas was not sustainable in either group.
“The Pathways to Wellness participants have high levels of depression, anxiety, fatigue, sleep disturbance and other symptoms an average of 2.6 years after diagnosis,” Ganz concluded. “Interventions significantly reduced depression, with additional reductions in other symptoms only in the MAPS group. … Further dissemination and evaluation of these interventions is warranted to address the unmet psychosocial needs of young breast cancer survivors.”
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