Evaluating the Effects of Mindfulness-Based Self-Help via an OTT Platform on Breast Cancer Patients Undergoing Radiotherapy: A Prospective Nonrandomized Controlled Trial

Hyejo Ryu; Si Nae You; Sohee Oh; Bora Kim; Jeong-Hyun Kim; In Ah Kim

doi:10.4143/crt.2024.955

Articles

Page Path: HOME > J Korean Cancer Assoc > Ahead-of print articles > Article

Original Article Evaluating the Effects of Mindfulness-Based Self-Help via an OTT Platform on Breast Cancer Patients Undergoing Radiotherapy: A Prospective Nonrandomized Controlled Trial: Hyejo Ryu^1,a), Si Nae You¹, Sohee Oh², Bora Kim³, Jeong-Hyun Kim^4,, In Ah Kim^1,5,; DOI: https://doi.org/10.4143/crt.2024.955
Published online: November 25, 2024

¹Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

²Medical Research Collaborating Center, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea

³Sunflower Center of Southern Gyeonggi for Women and Children Victims of Violence, Suwon, Korea

⁴Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea

⁵Department of Radiation Oncology and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

Correspondence: In Ah Kim, Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 13620, Korea
Tel: 82-31-787-7651 E-mail: inah228@snu.ac.kr

Co-correspondence: Jeong-Hyun Kim, Department of Psychiatry, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam 13620, Korea
Tel: 82-31-787-2025 E-mail: retrial3@hanmail.net

a)Present address: Department of Radiation Oncology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea

• Received: October 1, 2024 • Accepted: November 20, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

1,124 Views
48 Download

Full Article

Download PDF

Abstract

Purpose
Previous research showed the benefits of mindfulness meditation on the mental health and quality of life of breast cancer patients. Traditionally, these programs relied on in-person interactions, but the coronavirus disease 2019 pandemic necessitated alternative delivery methods. This study evaluated the effectiveness and feasibility of a mindfulness-based self-help (MBSH) program via Netflix for breast cancer patients undergoing radiotherapy.
Materials and Methods
This prospective nonrandomized controlled study assigned patients to a control or MBSH group based on age and preference. The MBSH group watched episodes of “Headspace Guide to Meditation” on Netflix and practiced guided meditation at least twice per week for four weeks. Participants completed questionnaires assessing depression, anxiety, stress, insomnia, mindfulness, mental adjustment to cancer, and quality of life at weeks 0 and 8. Data were analyzed using a two-way repeated measures ANOVA.
Results
Ninety-six patients participated, with 84 eligible for final analysis (44 control, 40 MBSH). Intention-to-treat analysis revealed a significant improvement in depression (f=4.306, p=0.041). Half of the experimental group (n=20) adhered to the study protocol. At week 8, the experimental group showed significant improvement compared to the control group in cognitive avoidance (f=8.530, p=0.005) and positive attitude (f=5.585, p=0.021), both indicative of adaptive coping strategies.
Conclusion
This study firstly investigated the effect and feasibility of a Netflix-based MBSH program for breast cancer patients undergoing radiotherapy. Findings suggest MBSH on Netflix can improve mental health and adaptive mental adjustment, highlighting the potential of self-help mindfulness interventions to enhance the well-being of cancer patients and need for further research.
Key words: Mindfulness, Mental health, Quality of life, Meditation, Breast neoplasms

Introduction

According to a 2020 cancer registry report, breast cancer was the most frequently diagnosed cancer among women in South Korea, with a crude incidence rate of 96.5 per 100,000 women and an annual increase of approximately 4.1% [1]. Despite high curability, approximately 50% of women with early breast cancer experience depression, anxiety, or both within the first year of diagnosis. These rates decline to 25% in subsequent years, reaching 15% in the fifth year [2]. Such findings highlight the ongoing psychological challenges that persist for a significant proportion of patients with breast cancer beyond the initial diagnosis period.

To address the need for complementary therapies for such patients, researchers have examined the use of mindfulness-based interventions. These interventions help patients enhance their quality of life, reduce stress and anxiety, and build resilience by cultivating present-moment focus, acceptance, and self-compassion. Previous studies have demonstrated the effectiveness of mindfulness-based interventions in supporting patients with breast cancer in coping with emotional distress and anxiety [3-5]. However, the extensive time and resource requirements of in-person sessions rendered these interventions impractical during the coronavirus disease 2019 (COVID-19) outbreak, as quarantine measures resulted in the cancellation or restriction of traditional class-based mindfulness programs that rely on personal contact and group settings.

During the quarantine period, the accessibility of mindfulness interventions for patients with cancer improved through alternative approaches such as the Headspace program on Netflix. Available as a series of short episodes, this program has widened the reach of mindfulness practices, including for patients with breast cancer. Mindfulness-based self-help (MBSH) programs delivered through streaming services represented a novel way to adapt to the circumstances engendered by the pandemic. Therefore, this study aimed to assess the effectiveness and feasibility of utilizing the Headspace program on Netflix to deliver self-guided mindfulness meditation to patients with breast cancer undergoing radiotherapy.

Materials and Methods

1. Study design

This experiment was a prospective nonrandomized controlled trial. Individuals were recruited from radiation oncology departments and were required to have met the following inclusion criteria: diagnosed with stage 0-III breast cancer, at least 20 years old, female, able to communicate in Korean, receiving adjuvant radiotherapy, and having an Eastern Cooperative Oncology Group performance score of 1 or lower. Those with a history of psychiatric diagnosis, suicidal tendencies, or double primary cancer were excluded. To minimize age-related bias, we ensured an equivalent number of participants in the experimental and control cohorts for age categories < 40, 40-49, and ≥ 50.

2. Procedure

Enrollment was open from August 1, 2021 to May 1, 2022. Participants were assigned to the control or experimental group based on their age group and preference. To access the mindfulness meditation program called Headspace Guide to Meditation (https://www.netflix.com/kr/title/81280926) and participate in the MBSH group, access to a Netflix account was necessary. Participants in the MBSH group could use their own accounts or a one-month free trial account provided by Netflix. Participants were instructed to watch Headspace Guide to Meditation sessions from week 1 to week 4 (1 month), twice per week. Variables were measured at two-time points: week 0 (pre) and week 8 (post). The pretest was carried out on the enrollment day. Participants completed the same questionnaires 1 month after 4-week MBSH session (week 8), which were administered during their regular one-month follow-up visit to the radiation oncology clinic. Compliance was based on participants’ self-reported frequency of meditation practice during the study period.

The Headspace Guide to Meditation streaming on Netflix consisted of eight 20-minute episodes, each of which focused on different aspects of mindfulness, including breathing exercises, body scanning, recognizing present emotions, and visualizing mental images. Although participants were advised to follow the episodes in order, they were free to choose when to view each episode.

Each session covered techniques and principles followed by a guided meditation exercise. The show included narration, animated visuals, and calming music, and was available in English and Korean with subtitles.

3. Outcome measures

The primary outcome measure was the Hospital Anxiety-Depression Scale (HADS) which measures anxiety and depression symptoms [6]. Secondary outcome measures were the Perceived Stress Scale gauging perceptions of stress and ability to manage stress [7], the Insomnia Severity Index measuring the severity of insomnia [8], and the Mental Health Continuum Short Form (MHC-SF) assessing emotional, social, and psychological well-being [9]. The Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) uses 10 items to evaluate cognitive and affective mindfulness [10]. The mini-Mental Adjustment to Cancer (mini-MAC) comprises four subscales: helplessness/hopelessness, anxious preoccupation, cognitive avoidance (CA), and positive attitude (PA) [11].

The primary analysis followed the intention-to-treat (ITT) principle, whereby all participants were included regardless of protocol adherence. Additionally, a per-protocol (PP) analysis was conducted, including only those participants who met the protocol requirement for meditation practice.

4. Sample size

Based on previous data [12] regarding the mean difference of HADS between the control and experimental groups, a sample size of 64 participants was calculated as detecting a medium effect size of 0.4 with 95% power and a 5% type I error. To account for potential dropouts, we planned to enroll 48 patients in each arm, resulting in a total of 96 participants.

5. Statistical analysis

Demographic and clinical measurements were presented as means with standard deviations (SD) for continuous variables. Categorical variables were listed as both a number and percentage. To compare categorical variables between the two groups, either a chi-square test or Fisher’s exact test were performed depending on the sample size. A paired t test and a two-way repeated measures analysis of variance (ANOVA) test were conducted to compare self-reported data within and between groups at baseline and 8 weeks. A two-sided p-value of less than 0.05 was considered statistically significant for all analyses. All analyses were conducted using SPSS ver. 25 (IBM Corp.) and Stata/SE ver. 17.0 (StataCorp.).

Results

1. Baseline characteristics

A total of 96 female participants were enrolled in the study, with 84 eligible for the ITT analysis (44 in the control and 40 in the experimental group) (Fig. 1). In the MBSH group, the compliance rate was 50%, with 20 participants meeting the minimum meditation practice requirement. Consequently, 20 participants in the MBSH group and 44 participants in the control group were eligible for PP analysis.

The baseline demographic and clinical characteristics of the 84 participants are presented in Table 1. All variables were well balanced between the two groups. No significant difference was observed in age group distribution between the groups (p=0.157). Overall, 4.4% and 10.0% in the control and MBSH groups, respectively, reported a history of psychiatric disorder. In addition, 70.5% of participants in the intervention group and 80.0% in the control group were within 0-6 months following their breast cancer diagnosis. No significant differences were observed in stage or molecular type between the groups. The control and MBSH groups exhibited similar baseline characteristics in terms of surgery, systemic therapy, and radiation therapy. S1 Table lists the baseline characteristics of the 64 participants in the PP sample, with no significant differences between the two groups at baseline.

2. Outcome measures

Table 2 presents the means and SD of the outcome measures by group and time of the ITT group. The two-way repeated measures ANOVA revealed a significant group×time interaction effect on depression (f=4.306, p=0.041). The control group exhibited no significant change (6.5±4.2 vs. 6.2±3.7, p=0.534), while the experimental group displayed a significant improvement in depression (6.7±3.5 vs. 5.2±2.7, p=0.007).

S2 Table presents the results of the PP analysis. The two-way repeated measures ANOVA revealed a significant group×time interaction for CA (f=8.530, p=0.005) and PA (f=5.585, p=0.021), reflecting adaptive coping strategies within the mini-MAC scale. For CA, the control group exhibited no significant change (26.0±3.8 vs. 25.6±4.3, p=0.201), whereas the experimental group displayed a significant increase (27.1±3.6 vs. 28.9±4.1, p=0.009). Similarly, for PA, the control group showed no significant change (10.1±2.5 vs. 10.1±2.3, p=0.814), while the experimental group exhibited a significant increase (9.3±2.9 vs. 10.74±2.5, p=0.026). Both results indicate an improvement in adaptive adjustment to cancer.

Discussion

To the best of our knowledge, this is the first study to investigate the effect of MBSH via Netflix streaming in patients with breast cancer undergoing adjuvant radiotherapy during the COVID-19 pandemic. The study was conducted during the COVID-19 quarantine period in South Korea. Participants were assigned according to whether they had a Netflix account during the radiotherapy treatment period. We measured differences in depression, anxiety, stress, insomnia, well-being, mindfulness, and adjustment scales across time and groups.

In terms of the main findings, MBSH was effective in reducing depressive symptoms in ITT analysis. Moreover, it positively influenced mental adjustment to cancer by promoting better coping strategies in PP analysis. Specifically, CA and PA, two of the four subscales of the Mini-MAC scale, exhibited a significant improvement following the MBSH intervention. This highlights the effectiveness of MBSH in enhancing psychological resilience among patients with breast cancer. It is noteworthy that CA, generally considered a negative coping strategy in Western populations, may be perceived as an adaptive mechanism in Eastern societies. This may be because, in contrast to Europeans, CA enables the person in Korean society to escape from a threatening situation and high intrusion. This cultural difference suggests that interventions like MBSH might need to be tailored to accommodate diverse cultural perspectives on coping [11].

Our intervention program was based on Headspace, a mindfulness meditation application. This is one of the most popular programs offering guided mindfulness meditation sessions, with options to choose the topic and length. Numerous randomized studies using Headspace have been conducted, with at least 40% demonstrating improvement in depression, mindfulness, well-being, stress, and anxiety in the general population [13]. Regarding patients with cancer, Kubo et al. [14] conducted a study to assess the practicality and effectiveness of a mobile or online-based Headspace program in enhancing their quality of life and alleviating distress. They reported a significant improvement in quality of life among 97 patients with cancer after an 8-week program utilizing Headspace.

With the increasing popularity of streaming platforms, Headspace content has become available on Netflix since 2021, reaching a wider user base. We utilized the Headspace program due to its wide popularity and accessibility through mobile phone, websites, and television. Although Headspace has not been tested specifically with patients with breast cancer, several studies have explored the effects of other mobile application-based interventions on improving mental health among individuals diagnosed with breast cancer. BorjAlilu et al.’s [15] recent systemic review of seven randomized trials confirmed the positive impact of mobile apps on various aspects such as stress, depression, anxiety, self-efficacy, social support, resiliency, and coping with breast cancer. Despite variations in mobile applications and intervention durations ranging between 6 and 24 weeks, mental health interventions delivered through mobile apps could serve as a viable alternative to traditional face-to-face psychological sessions [16-20]. This is particularly relevant for women with breast cancer who may face unique challenges in managing their mental health. Few studies have examined the effectiveness of psychosocial interventions in patients with breast cancer during the radiotherapy treatment period. Among those that have, Henderson et al. [21] reported a significant improvement in 16 psychosocial outcomes among 40 participants receiving radiotherapy during the study period. Similarly, Kim et al. [22] performed a study on women receiving radiation therapy for breast cancer and reported significant improvements in anxiety, fatigue, and quality of life. Because this research was conducted in 2013, the pre-pandemic era, the intervention was on-site and involved in-person meditation therapy sessions during a 6-week radiation therapy period [22]. Given these results, the finding in this study that mental health can be improved through mindfulness meditation training via easily accessible OTT platforms is potentially significant. The radiation therapy is a psychologically challenging experience which could be exacerbated by social distancing due to COVID-19 pandemic for cancer patients. Thus, incorporating these easily accessible mindfulness services could be a valuable strategy to enhance the mental well-being of breast cancer patients during radiotherapy, particularly under the condition that patients are not easily accessible to the mindfulness-based intervention in person.

By leveraging the innovative Headspace platform, we aimed to address the psychological and emotional challenges faced by patients with breast cancer in an accessible and engaging manner, offering a unique approach to support their well-being. The study thus opens new avenues for integrating digital platforms into the comprehensive care of breast cancer. Another strength of our study lies in its independence from any conflict of interest as we did not receive any support or funding from the intervention program, thus ensuring the objectivity of our findings.

However, our study has a few limitations which need to be addressed. First, we did not assess the long-term effects. Secondly, the compliance rate was lower than that of intervention in person as we expected. The study required participants to watch the 20-minute meditation episodes at least twice a week. However, many participants failed to adhere to the program for various reasons such as a lack of time, COVID-19 infection, difficulty in incorporating the practice into their daily routines, or a lack of motivation. The low compliance rate may have compromised the overall effectiveness of the intervention, necessitating caution in interpreting the results. Thirdly, this study was not a randomized trial; participants were assigned to groups based on their preference, which could cause selection bias. Furthermore, because the Headspace program was developed within a Western cultural context, its efficacy and impact could differ within the Asian population, even with the availability of Korean translation.

Future research therefore needs to incorporate the potential ways to improve compliance among participants. Meditation can feel difficult and unfamiliar to beginners, so it is necessary to provide the accessory methods to improve compliance. Providing incentives for completing the program, personalized guidance, automated reminder, and follow-up calls to encourage and motivate participants could be effective to increase adherence to home assignments [23].

In conclusion, our study suggests that MBSH on the Netflix platform holds promise in improving mental health and quality of life outcomes for patients with breast cancer under the COVID pandemic situation. To the best of our knowledge, this is the first study to explore the potential benefits of mindfulness-based self-guided practice via an OTT platform and the results highlight the potential of self-help mindfulness interventions to enhance the well-being of such patients, particularly under the condition that patients are not easily accessible to the mindfulness-based intervention in person. Additional systematic study incorporating enhanced adherence strategies is needed to clarify the whole benefits of mindfulness-based self-guided practice via OTT platform.

Electronic Supplementary Material

Supplementary materials are available at Cancer Research and Treatment website (https://www.e-crt.org).

crt-2024-955_S1_Table.pdf

crt-2024-955_S2_Table.pdf

NOTES

Ethical Statement

All participants were provided with a thorough explanation of the study and voluntarily signed an informed consent form prior to participation. This study protocol was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No. B-2106-690-301).

Author Contributions

Conceived and designed the analysis: Ryu H, Kim JH, Kim IA.

Collected the data: Ryu H, You SN, Kim B, Kim JH, Kim IA.

Contributed data or analysis tools: Ryu H, You SN, Oh S, Kim B, Kim JH, Kim IA.

Performed the analysis: Ryu H, You SN, Oh S, Kim B, Kim JH, Kim IA.

Wrote the paper: Ryu H, Kim JH, Kim IA.

Funding acquisition: Kim IA.

Conflict of Interest

Conflict of interest relevant to this article was not reported.

Funding

This work was supported by grants from the National Research Foundation of Korea (No. 2023R1A2C3003782) to In Ah Kim.

Fig. 1.

Flow chart of the study. ITT, intention-to-treat; PP, per-protocol.

Table 1.

Baseline characteristics of 84 participants in intention-to-treat sample

Characteristic	Control (n=44)	MBSH (n=40)	p-value
Age group (yr)
< 40	3 (6.8)	7 (17.5)	0.157
40-49	23 (52.3)	23 (57.5)
≥ 50	18 (40.9)	10 (25.0)
Education
High school	15 (34.1)	8 (20.0)	0.230
College	29 (65.9)	32 (80.0)
Religion
Yes	23 (52.3)	27 (67.5)	0.231
No	21 (47.7)	13 (32.5)
Marital status
Married	35 (79.5)	27 (67.5)	0.315
Unmarried	9 (20.5)	13 (32.5)
Menopausal status
Pre	31 (70.5)	34 (85.0)	0.183
Post	13 (29.5)	6 (15.0)
Psychiatric history
Yes	42 (95.5)	36 (90.0)	0.418
No	2 (4.5)	4 (10.0)
Time since diagnosis (mo)
0-6	31 (70.5)	34 (85.0)	0.183
> 6	13 (29.5)	6 (15.0)
Clinical stage
0	7 (15.9)	4 (10.0)	0.581
1	20 (45.5)	15 (37.5)
2	12 (27.3)	16 (40.0)
3	5 (11.4)	5 (12.5)
Luminal type
A	20 (45.5)	16 (41.0)	0.706
B	16 (36.4)	15 (38.5)
HER2	3 (6.8)	1 (2.6)
TNBC	5 (11.4)	7 (17.9)
Bilateral
No	44 (100)	38 (95.0)	0.224
Yes	0	2 (5.0)
Type of surgery
Breast conserving	29 (65.9)	29 (72.5)	0.677
Total mastectomy	15 (34.1)	11 (27.5)
Axilla surgery
None	10 (22.7)	10 (25.0)	0.658
Sentinel node biopsy	19 (43.2)	20 (50.0)
ALND	15 (34.1)	10 (25.0)
Reconstruction
No	32 (72.7)	33 (82.5)	0.419
Yes	12 (27.3)	7 (17.5)
Chemotherapy
None	22 (50.0)	16 (40.0)	0.607
Adjuvant	11 (25.0)	10 (25.0)
Adj and neoadjuvant	9 (20.5)	13 (32.5)
Neoadjuvant	2 (4.5)	1 (2.5)
Hormonal therapy
No	9 (20.5)	8 (20.0)	> 0.99
Yes	35 (79.5)	32 (80.0)
Herceptin therapy
No	36 (81.8)	34 (85.0)	0.922
Yes	8 (18.2)	6 (15.0)
RT field
Breast	22 (50.0)	24 (60.0)	0.262
Breast and regional node	22 (50.0)	16 (40.0)
RT dose (Gy)
42.5-52.56	27 (61.4)	28 (70.0)	0.406
55-60	17 (38.6)	12 (30.0)
RT fraction number
16-21	33 (75.0)	36 (90.0)	0.073
25-30	11 (25.0)	4 (10.0)

Values are presented as number (%). ALND, axillary lymph node dissection; HER2, human epidermal growth factor receptor 2; MBSH, mindfulness-based self-help; RT, radiotherapy; TNBC, triple negative breast cancer.

Table 2.

Two-way repeated measure ANOVA and paired T-test for control and mindfulness-based self-help (MBSH) groups in intention-to-treat sample (n=84)

Outcome	Control (n=44)			MBSH (n=40)			Two-way repeated measure ANOVA
Outcome	Pre	Post	p-value	Pre	Post	p-value	Group (F, P)	Time (F, P)	Time×Group (F, P)
Perceived Stress Scale	17.4±6.6	16.7±7.2	0.171	16.4±6.2	13.6±4.5	0.001*	2.887, 0.093	9.249, 0.003*	3.099, 0.082
Hospital Anxiety Depression	13.7±7.5	13.0±7.5	0.685	14.0±5.9	11.0±5.1	< 0.001*	0.413, 0.522	9.690, 0.003*	3.640, 0.060
Depression	6.5±4.2	6.2±3.7	0.534	6.7±3.5	5.2±2.7	0.007*	0.267, 0.607	9.799, 0.002*	4.306, 0.041*
Anxiety	7.2±3.9	6.9±4.3	0.793	7.2±3.1	5.9±3.1	0.001*	0.446, 0.506	5.921, 0.017*	1.847, 0.178
Insomnia Severity Index	8.7±4.6	9.1±4.9	1.000	9.4±4.8	8.9±5.0	0.389	0.079, 0.780	0.009, 0.926	1.077, 0.302
Quality of life	31.1±13.3	31.9±14.2	0.530	35.3±12.3	37.7±12.6	0.257	3.633, 0.060	2.032, 0.158	0.476, 0.492
Emotional QOL	6.6±3.7	7.0±4.0	0.412	7.5±2.7	8.9±3.1	0.009*	4.244, 0.043*	6.561, 0.012*	1.532, 0.219
Social QOL	9.6±5.1	10.3±5.3	0.268	11.4±5.1	11.8±4.9	0.538	2.454, 0.121	1.493, 0.225	0.101, 0.751
Psychologic QOL	14.9±6.2	14.6±6.3	0.710	16.4±5.7	17.1±5.9	0.646	2.935, 0.090	0.153, 0.696	0.771, 0.382
Mindfulness	26.4±5.4	27.0±5.1	0.252	26.9±4.9	27.7±6.0	0.338	0.343, 0.560	1.947, 0.167	0.025, 0.875
Awareness	10.1±2.2	10.4±2.1	0.351	10.1±2.3	10.7±2.9	0.196	0.095, 0.759	4.017, 0.048*	0.372, 0.543
Attention	11.1±2.6	11.3±2.5	0.449	11.7±2.4	11.4±2.8	0.567	0.493, 0.484	0.000, 0.996	0.749, 0.389
Acceptance	5.2±1.6	5.3±1.2	0.913	5.2±1.2	5.6±1.3	0.038*	0.258, 0.613	2.384, 0.126	1.392, 0.241
Mini-MAC	70.0±6.3	67.8±6.3	0.010	69.3±7.2	66.8±6.1	0.011*	0.428, 0.515	12.410, 0.001	0.021, 0.885
Helplessness-hopelessness	13.5±4.5	12.6±3.9	0.091	12.3±3.6	11.5±3.7	0.108	2.418, 0.124	4.549, 0.036*	0.040, 0.842
Anxiety preoccupation	20.5±4.9	19.7±4.3	0.115	19.4±4.8	17.8±4.8	0.001*	2.501, 0.118	11.670, 0.001*	1.342, 0.250
Cognitive avoidance	26.0±3.8	25.6±4.3	0.201	26.6±4.0	27.2±4.9	0.438	1.695, 0.197	0.065, 0.800	1.926, 0.169
Positive attitude	10.1±2.5	10.1±2.3	0.814	9.0±2.6	9.7±2.7	0.196	2.604, 0.110	2.357, 0.129	1.677, 0.199

Values are presented as mean±standard deviation. MBSH, mindfulness-based self-help; mini-MAC, mini-mental adjustment to cancer; QOL, quality of life. An asterisk (*) indicates statistical significance with a p-value less than 0.05.

REFERENCES

1. Kang MJ, Jung KW, Bang SH, Choi SH, Park EH, Yun EH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2020. Cancer Res Treat. 2023;55:385–99. Article PubMed PMC PDF
2. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005;330:702.Article PubMed PMC
3. Hoffman CJ, Ersser SJ, Hopkinson JB, Nicholls PG, Harrington JE, Thomas PW. Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. J Clin Oncol. 2012;30:1335–42. Article PubMed
4. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121:1231–40. Article PubMed
5. Monti DA, Peterson C, Kunkel EJ, Hauck WW, Pequignot E, Rhodes L, et al. A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psychooncology. 2006;15:363–73. Article PubMed
6. Oh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc. 2016;38:289–96.
7. Lee J, Shin C, Ko YH, Lim J, Joe SH, Kim S, et al. The reliability and validity studies of the Korean version of the perceived stress scale. Korean J Psychosom Med. 2015;20:127–34.
8. Cho YW, Song ML, Morin CM. Validation of a Korean version of the insomnia severity index. J Clin Neurol. 2014;10:210–5. Article PubMed PMC
9. Lim YJ, Ko YG, Shin HC, Cho Y. Psychometric evaluation of the Mental Health Continuum-Short Form (MHC-SF) in South Koreans. Korean J Psychol Gen. 2012;31:369–86.
10. Cho Y. The reliability and validity of a Korean version of the cognitive and affective mindfulness scale-revised. Korean J Clin Psychol. 2009;28:667–93. Article
11. Kang JI, Chung HC, Kim SJ, Choi HJ, Ahn JB, Jeung HC, et al. Standardization of the Korean version of Mini-Mental Adjustment to Cancer (K-Mini-MAC) scale: factor structure, reliability and validity. Psychooncology. 2008;17:592–7. Article PubMed
12. Kim SH, Kim YH, Kim HJ, Lee SH, Yu SO. The effect of laughter therapy on depression, anxiety, and stress in patients with breast cancer undergoing radiotherapy. J Korean Oncol Nurs. 2009;9:155–62.
13. O’Daffer A, Colt SF, Wasil AR, Lau N. Efficacy and conflicts of interest in randomized controlled trials evaluating headspace and calm Apps: systematic review. JMIR Ment Health. 2022;9:e40924Article PubMed PMC
14. Kubo A, Kurtovich E, McGinnis M, Aghaee S, Altschuler A, Quesenberry C Jr, et al. A randomized controlled trial of mHealth mindfulness intervention for cancer patients and informal cancer caregivers: a feasibility study within an integrated health care delivery system. Integr Cancer Ther. 2019;18:1534735419850634.Article PubMed PMC PDF
15. BorjAlilu S, Karbakhsh M, Lotfi M, Haghshenas E, Kaviani A. Mobile applications to promote mental health among breast cancer patients: a rapid review: mobile Apps to promote mental health. Arch Breast Cancer. 2023;10:103–13.
16. Chow PI, Showalter SL, Gerber M, Kennedy EM, Brenin D, Mohr DC, et al. Use of mental health apps by patients with breast cancer in the United States: pilot pre-post study. JMIR Cancer. 2020;6:e16476Article PubMed PMC
17. Zhu J, Ebert L, Liu X, Chan SW. A mobile application of breast cancer e-support program versus routine Care in the treatment of Chinese women with breast cancer undergoing chemotherapy: study protocol for a randomized controlled trial. BMC Cancer. 2017;17:291.Article PubMed PMC PDF
18. Borosund E, Ehlers SL, Varsi C, Clark MM, Andrykowski MA, Cvancarova M, et al. Results from a randomized controlled trial testing StressProffen: an application-based stress-management intervention for cancer survivors. Cancer Med. 2020;9:3775–85. Article PubMed PMC PDF
19. Cairo J, Williams L, Bray L, Goetzke K, Perez AC. Evaluation of a mobile health intervention to improve wellness outcomes for breast cancer survivors. J Patient Cent Res Rev. 2020;7:313–22. Article PubMed PMC
20. Chang YC, Chiu CF, Wang CK, Wu CT, Liu LC, Wu YC. Short-term effect of internet-delivered mindfulness-based stress reduction on mental health, self-efficacy, and body image among women with breast cancer during the COVID-19 pandemic. Front Psychol. 2022;13:949446.Article PubMed PMC
21. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hebert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12:404–13. Article PubMed PDF
22. Kim YH, Kim HJ, Ahn SD, Seo YJ, Kim SH. Effects of meditation on anxiety, depression, fatigue, and quality of life of women undergoing radiation therapy for breast cancer. Complement Ther Med. 2013;21:379–87. Article PubMed
23. Reangsing C, Punsuwun S, Keller K. Effects of mindfulness-based interventions on depression in patients with breast cancer: a systematic review and meta-analysis. Integr Cancer Ther. 2023;22:15347354231220617.Article PubMed PMC PDF

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

PubReader
ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Evaluating the Effects of Mindfulness-Based Self-Help via an OTT Platform on Breast Cancer Patients Undergoing Radiotherapy: A Prospective Nonrandomized Controlled Trial

DOI: https://doi.org/10.4143/crt.2024.955

XML Download

Abstract
Introduction
Materials and Methods
Results
Discussion
Electronic Supplementary Material
NOTES
REFERENCES

Effectiveness of Self-Assessment, TAilored Information, and Lifestyle Management for Cancer Patients’ Returning to Work (START): A Multi-center, Randomized Controlled Trial

Evaluating the Effects of Mindfulness-Based Self-Help via an OTT Platform on Breast Cancer Patients Undergoing Radiotherapy: A Prospective Nonrandomized Controlled Trial

Fig. 1. Flow chart of the study. ITT, intention-to-treat; PP, per-protocol.

Fig. 1.

Evaluating the Effects of Mindfulness-Based Self-Help via an OTT Platform on Breast Cancer Patients Undergoing Radiotherapy: A Prospective Nonrandomized Controlled Trial

Characteristic	Control (n=44)	MBSH (n=40)	p-value
Age group (yr)
< 40	3 (6.8)	7 (17.5)	0.157
40-49	23 (52.3)	23 (57.5)
≥ 50	18 (40.9)	10 (25.0)
Education
High school	15 (34.1)	8 (20.0)	0.230
College	29 (65.9)	32 (80.0)
Religion
Yes	23 (52.3)	27 (67.5)	0.231
No	21 (47.7)	13 (32.5)
Marital status
Married	35 (79.5)	27 (67.5)	0.315
Unmarried	9 (20.5)	13 (32.5)
Menopausal status
Pre	31 (70.5)	34 (85.0)	0.183
Post	13 (29.5)	6 (15.0)
Psychiatric history
Yes	42 (95.5)	36 (90.0)	0.418
No	2 (4.5)	4 (10.0)
Time since diagnosis (mo)
0-6	31 (70.5)	34 (85.0)	0.183
> 6	13 (29.5)	6 (15.0)
Clinical stage
0	7 (15.9)	4 (10.0)	0.581
1	20 (45.5)	15 (37.5)
2	12 (27.3)	16 (40.0)
3	5 (11.4)	5 (12.5)
Luminal type
A	20 (45.5)	16 (41.0)	0.706
B	16 (36.4)	15 (38.5)
HER2	3 (6.8)	1 (2.6)
TNBC	5 (11.4)	7 (17.9)
Bilateral
No	44 (100)	38 (95.0)	0.224
Yes	0	2 (5.0)
Type of surgery
Breast conserving	29 (65.9)	29 (72.5)	0.677
Total mastectomy	15 (34.1)	11 (27.5)
Axilla surgery
None	10 (22.7)	10 (25.0)	0.658
Sentinel node biopsy	19 (43.2)	20 (50.0)
ALND	15 (34.1)	10 (25.0)
Reconstruction
No	32 (72.7)	33 (82.5)	0.419
Yes	12 (27.3)	7 (17.5)
Chemotherapy
None	22 (50.0)	16 (40.0)	0.607
Adjuvant	11 (25.0)	10 (25.0)
Adj and neoadjuvant	9 (20.5)	13 (32.5)
Neoadjuvant	2 (4.5)	1 (2.5)
Hormonal therapy
No	9 (20.5)	8 (20.0)	> 0.99
Yes	35 (79.5)	32 (80.0)
Herceptin therapy
No	36 (81.8)	34 (85.0)	0.922
Yes	8 (18.2)	6 (15.0)
RT field
Breast	22 (50.0)	24 (60.0)	0.262
Breast and regional node	22 (50.0)	16 (40.0)
RT dose (Gy)
42.5-52.56	27 (61.4)	28 (70.0)	0.406
55-60	17 (38.6)	12 (30.0)
RT fraction number
16-21	33 (75.0)	36 (90.0)	0.073
25-30	11 (25.0)	4 (10.0)

Outcome	Control (n=44)			MBSH (n=40)			Two-way repeated measure ANOVA
Outcome	Pre	Post	p-value	Pre	Post	p-value	Group (F, P)	Time (F, P)	Time×Group (F, P)
Perceived Stress Scale	17.4±6.6	16.7±7.2	0.171	16.4±6.2	13.6±4.5	0.001*	2.887, 0.093	9.249, 0.003*	3.099, 0.082
Hospital Anxiety Depression	13.7±7.5	13.0±7.5	0.685	14.0±5.9	11.0±5.1	< 0.001*	0.413, 0.522	9.690, 0.003*	3.640, 0.060
Depression	6.5±4.2	6.2±3.7	0.534	6.7±3.5	5.2±2.7	0.007*	0.267, 0.607	9.799, 0.002*	4.306, 0.041*
Anxiety	7.2±3.9	6.9±4.3	0.793	7.2±3.1	5.9±3.1	0.001*	0.446, 0.506	5.921, 0.017*	1.847, 0.178
Insomnia Severity Index	8.7±4.6	9.1±4.9	1.000	9.4±4.8	8.9±5.0	0.389	0.079, 0.780	0.009, 0.926	1.077, 0.302
Quality of life	31.1±13.3	31.9±14.2	0.530	35.3±12.3	37.7±12.6	0.257	3.633, 0.060	2.032, 0.158	0.476, 0.492
Emotional QOL	6.6±3.7	7.0±4.0	0.412	7.5±2.7	8.9±3.1	0.009*	4.244, 0.043*	6.561, 0.012*	1.532, 0.219
Social QOL	9.6±5.1	10.3±5.3	0.268	11.4±5.1	11.8±4.9	0.538	2.454, 0.121	1.493, 0.225	0.101, 0.751
Psychologic QOL	14.9±6.2	14.6±6.3	0.710	16.4±5.7	17.1±5.9	0.646	2.935, 0.090	0.153, 0.696	0.771, 0.382
Mindfulness	26.4±5.4	27.0±5.1	0.252	26.9±4.9	27.7±6.0	0.338	0.343, 0.560	1.947, 0.167	0.025, 0.875
Awareness	10.1±2.2	10.4±2.1	0.351	10.1±2.3	10.7±2.9	0.196	0.095, 0.759	4.017, 0.048*	0.372, 0.543
Attention	11.1±2.6	11.3±2.5	0.449	11.7±2.4	11.4±2.8	0.567	0.493, 0.484	0.000, 0.996	0.749, 0.389
Acceptance	5.2±1.6	5.3±1.2	0.913	5.2±1.2	5.6±1.3	0.038*	0.258, 0.613	2.384, 0.126	1.392, 0.241
Mini-MAC	70.0±6.3	67.8±6.3	0.010	69.3±7.2	66.8±6.1	0.011*	0.428, 0.515	12.410, 0.001	0.021, 0.885
Helplessness-hopelessness	13.5±4.5	12.6±3.9	0.091	12.3±3.6	11.5±3.7	0.108	2.418, 0.124	4.549, 0.036*	0.040, 0.842
Anxiety preoccupation	20.5±4.9	19.7±4.3	0.115	19.4±4.8	17.8±4.8	0.001*	2.501, 0.118	11.670, 0.001*	1.342, 0.250
Cognitive avoidance	26.0±3.8	25.6±4.3	0.201	26.6±4.0	27.2±4.9	0.438	1.695, 0.197	0.065, 0.800	1.926, 0.169
Positive attitude	10.1±2.5	10.1±2.3	0.814	9.0±2.6	9.7±2.7	0.196	2.604, 0.110	2.357, 0.129	1.677, 0.199

Table 1. Baseline characteristics of 84 participants in intention-to-treat sample

Table 2. Two-way repeated measure ANOVA and paired T-test for control and mindfulness-based self-help (MBSH) groups in intention-to-treat sample (n=84)