Mindfulness in Cancer Care

1. Mindfulness in Cancer Care

2. Mindfulness in Cancer Care Christina Shennan Psychotherapist UKCP Dip MBAs cshennan@talktalk.net

3. Cancer and suffering • Cancer is frequently accompanied by psychological suffering, often long lasting (1) • 10–20% of patients go onto to develop psychiatric disorders of depression and anxiety (2) • Macmillan Cancer Support’s Worried Sick report (2006) found that more than 45% of patients with cancer found the emotional effects of the disease more difficult to deal with than the physical or practical effects (3)

4. Mindfulness • One of the rapidly emerging influences in the field of health care and psychological suffering is mindfulness (4) • Mindfulness is a means to free oneself from adding suffering to existing difficulty and pain (5)

5. What is mindfulness? • Mindfulness is about allowing and accepting rather than avoiding, suppressing or holding on to experience; “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (6).

6. Mindfulness in oncology Living in the moment, non-judgmentally, has particular resonance for many cancer patients, vulnerable to anxious preoccupation about past life style decisions and future illness and treatment (7)

7. Mindfulness in oncology • Most researched mindfulness intervention to date is MBSR • In 2000 Speca et al made some changes to MBSR to a suit cancer population

8. Mindfulness in oncology Reviews of early studies of MBSR with cancer patients have noted: • reductions in psychological distress • improvements in patient well being • benefited psychosocial function • enhanced coping • improvement in sleep and fatigue (8-12)

9. Mindfulness in oncology 2009 Cancer Experiences Collaborative (CECo) Scholarship Aim: to review the evidence for the use of mindfulness-based interventions in cancer care Reference Shennan, C., Payne, S. and Fenlon, D. , What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psycho-Oncology, n/a. doi: 10.1002/pon.1819

10. Results • 13 research papers 4 conference abstracts since 2007 • 13 papers • 3 Randomised Control Trials • 2 Non Randomised Control Trials • 5 Pre Post test design • 2 Qualitative studies

11. Participant groups • Mixed cancer diagnosis and stage • Gynaecological cancer • Early diagnosis breast cancer • Undergoing acute treatment • Post treatment breast cancer • Terminal cancer

12. Mindfulness Interventions • Mindfulness Based Stress Reduction • Mindfulness Based Cognitive Therapy • Psycho-educational programme with mindfulness component • Brief mindfulness training • One to one mindfulness instruction

13. Mindfulness Interventions Variations • Individual and group • Number of sessions 3-8 • Duration 3-12 weeks • Contact time 3-28 hours • Invited daily practice 5-60 minutes

14. Findings • Psychological Significant improvements in depression, anxiety and distress post intervention • Physical effects Positive effects on immune function and physiological sexual arousal • Quality of Life Overall findings for quality of life and well being show a trend for improvement

15. Conclusion • collective evidence supports the view that mindfulness is a promising intervention in cancer care, potentially across the cancer trajectory • need for more randomised control trials, longer follow-up, comparison groups and larger sample sizes in quantitative research studies, as well as a more diverse participant base • delivery of mindfulness in cancer care is not limited to MBSR and MBCT

16. Conclusion • More research is needed on ‘simplified’ mindfulness interventions, which may be appropriate for those who are sick, undergoing intensive treatment, or in terminal stages • Need for more qualitative research on participants’ experience • Research on the mindfulness facilitator is recommended

17. Croston House Cancer Help Mindfulness Programme 8 weeks of weekly 2 ½ hour sessions with one full practice day • Formal mindfulness practices • Body scan • Sitting meditation • Mindful movement • Mindful walking • Short practices • Poetry • Informal practices • Daily home practice supported by CDs and manual

18. Too stressed for stress reduction? • Taking the mindfulness based stress reduction programme can be stressful (JKZ) • Is the course right for me right now?

19. Orientation • Levels of distress • Support structures • Ability to sustain weekly class and home practice • Rigours of treatment • Shock • Coping strategy • Experience of teacher

20. Participants Croston House services are free of charge to anyone affected by a diagnosis of cancer • Patients with a diagnosis of cancer • Early diagnosis • Undergoing treatment • Survivorship • Palliative • Carers • Bereaved

21. Participants • Mainly female, white, in middle age • Age range from early 20s to 70s • Breast cancer the most common diagnosis

22. Findings Of the 19 participants that who completed pre and post questionnaires • WHO Well Being Scale 85% significant increase well being 15% non significant decrease • DASS21 S pre mild post normal A pre moderate post mild D pre moderate post normal

23. 0.3 = clinically useful 0.5 medium effect 0.8 large effect

24. Patient comments “This course has taught me to be kind to myself …has given me the knowledge to allow myself space and time and not to react instantly” “ It has given me tools for life - greatly heightened my awareness of how I am and to live life as much as possible in the present moment” “helping me feel more grounded” “I think it might have helped me turn the corner to get on with the rest of my life – to live for now and not in the past. I want to help myself”

25. “Before coming here I was very stressed, angry with myself, full of guilt feelings…I feel much calmer and able to cope and I sleep so much better than before which is a very positive thing for me” “How I respond to situations has changed, my perspective on my daily life is much more aware. Thanks.” “I know things are not going to improve much but feel I can go forward now rather than be angry and upset all the time”

26. “Realisation need to address issues that I do not understand but are causing me distress” “I appreciate the little and big things in life and value every moment. Feel a lot calmer about everyday life in general and very happy about getting some kind of control with my OCD” “I have slowed down, I have a more controlled pace where in the past I would have been overwhelmed”

27. Next programme 8 week programme 12 October – 30 November 2011 10.00 – 12.30 Wednesday Retreat Day 10.00 – 3.00 Saturday 19 November Monthly ongoing facilitated practice sessions Weekly self run drop in group

28. References 1. Ross L, Boesen EH, Dalton SO, Johansen C. Mind and cancer: does psychosocial intervention improve survival and psychological well-being? Eur J Cancer 2002;38(11):1447–1457. 2. Lloyd-Williams, M. (2006). Depression, Anxiety and Confusion. In M. Fallon & J. Hanks (Eds.), ABC of Palliative Care (Second Edition ed., pp. 36-39): Blackwell Publishing 3. Macmillan. Worried Sick—The Emotional Impact of Cancer. Macmillan Cancer Support, 2006. 4. Dryden W, Still A. Historical aspects of mindfulness and self-acceptance in psychotherapy. J Ration Emotive Cogn Behav Ther 2006;24(1):3–28. 5. Gunaratana H. Mindfulness in Plain English. Wisdom Publications: Boston, MA, 2002. 6. Baer R, Krietemeyer J. Overview of mindfulness and acceptance based treatment approaches. In Mindfulness Based Treatment Approaches; Clinician’s Guide to Evidence Base and Applications, Baer R (ed.). Elsevier Academic Press: Burlington, MA, 2006. 6. .Kabat-Zinn, J. (1994) Wherever You Go There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion. 7. Speca M, Carlson LE, Mackenzie MJ, Angen M. Mindfulness-based stress reduction (MBSR) as an intervention for cancer patients. In Mindfulness Based Treatment Approaches: Clinician’s Guide to Evidence Base and Applications, Baer R (ed.). Elsevier Academic Press: Burlington, MA, 2006. p. 239–261.

29. References 8. Ott MJ, Norris RL, Bauer-Wu S. Mindfulness Meditation for Oncology Patients: A Discussion and Critical Review. Integrative Cancer Therapies. 2006;5(2):98-108 9. Ledesma D, Kumano H. Mindfulness-based stress reduction and cancer: a meta-analysis. Psychooncology. 2009;18(6):571-9.DOI 10.1002/pon.1400 10. Smith JE, Richardson J, Hoffman C, Pilkington K. Mindfulness-based stress reduction as supportive therapy in cancer care: systematic review. Journal of Advanced Nursing. 2005;52(3):315-27 11. Matchim Y, Armer JM. Measuring the psychological impact of mindfulness meditation on health among patients with cancer: a literature review. Oncol Nurs Forum. 2007 Sep;34(5):1059-66.DOI 43M6322161585669 [pii] 12.Mackenzie MJ, Carlson L, Speca M. Mindfulness-Based Stress Reduction (MBSR) in Oncology. Rationale and Review. Evidence-Based Integrative Medicine. 2005;2(3)

30. Mindfulness in Cancer Care Christina Shennan Psychotherapist UKCP Dip MBAs cshennan@talktalk.net

31. Mindfulness in Cancer Care