Mindfulness-based stress reduction in patients with differentiated thyroid cancer receiving radioactive iodine therapy: a randomized controlled trial

Figures & data

Table 1 Concise content of the 8-week MBSR program

Week 1

Content summary: MBSR theory, intervention process, and corresponding requirements were introduced to the patients in an easy-to-understand manner. Mindful breathing training was explained and patients encouraged to practice it.

Week 2

Content summary: The meaning of sitting meditation, which emphasized breathing as a primary object of attention, was explained, and patients were guided to enter into and practice sitting meditation and nonjudgmental awareness of things with music being played at the same time.

Week 3

Content summary: Walking meditation and its key points were introduced to explore the relationship between motion and emotion. Patients were encouraged to expand their mindfulness practice to walking.

Week 4

Content summary: The meaning and requirements of body scan, which allows the body to experience the self-motion perception feedback of every part of the body, were explained, and patients were encouraged to practice it.

Week 5

Content summary: Yoga-based stretches, which included lying and standing postures, were taught. Given that some patients’ upper limb movement might be compromised due to surgical brachial plexus damage, gentle and appropriate stretches were encouraged to suit their capability.

Week 6

Content summary: Mindfulness listening, thinking, and emotions were introduced, and patients were guided and encouraged to practice it.

Week 7

Content summary: Nonjudgmental awareness was explained, and patients were encouraged to practice it with music played at the same time without being interrupted by the surrounding environment.

Week 8

Content summary: Patients were encouraged to internalize the practice sessions and develop a pattern suiting their personal situations. It was empathized that meditation was a useful method to maintain individual well-being and week 8 was the first week of being on their own to develop a lifetime program of MBSR.

Abbreviation: MBSR, mindfulness-based stress reduction.

Figure 1 The relationship of time schedule between RIT procedure and MBSR intervention.

Abbreviations: MBSR, mindfulness-based stress reduction; RIT, radioactive iodine therapy.

Table 2 Comparison of demographic and clinical characteristics

	MBSR intervention group (n=49)	UC group (n=53)	P-value
Age, mean ± SD	43.32±10.99	42.38±12.60	0.6899
Gender, n (%)			0.8307
Female	34	38
Male	15	15
Marital status, n (%)			0.7409
Married	35	37
Single	4	6
Residence, n (%)			1.0000
Urban	34	37
Rural	15	16
Educational level, n (%)			0.8354
Middle school or lower	16	19
High school or higher	33	34
Employment status, n (%)			0.6960
Employed	27	27
Unemployed	22	26
Religion, n (%)			0.6189
Yes	11	9
No	38	44
TNM stage, n (%)			0.7677
I	25	27
II	8	7
III	11	14
IV	5	6
RAI dose, mean ± SD	113.5±26.7	109.7±24.9	0.5870

Abbreviations: MBSR, mindfulness-based stress reduction; UC, usual care.

Figure 2 Flow diagram of patient randomization and retention.

Abbreviations: MBSR, mindfulness-based stress reduction; UC, usual care.

Table 3 Comparison of QoL, depression, and anxiety outcome across time points

Measurement	UC group (n=53)			MBSR intervention group (n=49)		Between-groups effect size, adjusting for baseline
	Mean	SD		Mean	SD	Cohen’s d
Physical function
T1 (baseline)	72.14	15.11		76.27	18.94
T2	67.34	11.65		74.61	17.96	0.21
T3	77.09	16.10		85.72	12.30	0.31
Role function
T1 (baseline)	74.20	12.81		71.04	21.76
T2	58.55	11.86		68.40	12.79	1.17
T3	66.61	10.49		74.63	12.76	0.34
Emotional function
T1 (baseline)	69.23	22.04		71.18	18.38
T2	51.93	14.62		63.49	13.78	−0.03
T3	56.57	16.10		74.12	9.50	1.17
P*			0.012
Cognitive function
T1 (baseline)	71.00	19.62		73.69	16.30
T2	61.81	19.86		69.56	13.97	0.29
T3	70.62	18.25		77.81	16.30	0.26
Social function
T1 (baseline)	65.22	23.71		63.77	24.95
T2	56.11	17.08		65.81	18.49	0.86
T3	62.05	14.34		74.35	17.68	0.63
Fatigue
T1 (baseline)	18.67	12.24		20.51	11.32
T2	55.73	24.33		37.28	14.89	1.0
T3	30.99	20.45		22.95	12.01	−0.69
P*			0.037
Pain
T1 (baseline)	21.67	19.15		23.10	17.08
T2	22.64	17.52		18.79	12.18	−0.35
T3	15.78	10.38		13.84	8.67	−0.55
Nausea and vomiting
T1 (baseline)	4.83	6.77		5.04	6.80
T2	13.09	12.29		8.19	10.81	−0.44
T3	5.65	6.96		5.14	7.87	−0.09
Global QoL
T1 (baseline)	69.54	15.27		66.61	10.85
T2	49.47	10.92		62.67	10.32	1.61
T3	56.95	10.03		72.33	13.36	1.56
P*			0.015
Dyspnea
T1 (baseline)	16.64	16.25		15.87	13.00
T2	8.52	8.74		7.77	9.22	0.01
T3	7.97	8.02		7.91	6.93	0.10
Sleep disturbance
T1 (baseline)	16.59	17.63		18.84	18.89
T2	43.55	19.60		26.34	15.91	−1.14
T3	19.28	16.40		13.30	11.76	−0.20
Appetite loss
T1 (baseline)	11.74	15.21		10.27	13.56
T2	18.19	15.85		18.60	15.80	0.12
T3	19.31	19.34		16.07	9.80	−0.11
Constipation
T1 (baseline)	18.24	16.01		19.18	13.83
T2	10.73	9.27		11.02	8.20	−0.07
T3	11.03	7.57		9.19	6.46	−0.39
Diarrhea
T1 (baseline)	15.62	23.47		13.69	20.51
T2	15.73	20.14		10.44	12.96	−0.18
T3	7.94	8.06		5.77	5.60	−0.03
Finance impact
T1 (baseline)	28.32	33.78		24.29	21.24
T2	38.26	30.75		33.23	21.64	0.03
T3	39.34	22.89		35.51	18.56	0.01
Self-rating depression
T1 (baseline)	54.36	9.81		53.60	8.61
T2	73.64	11.22		60.52	9.73	−1.19
T3	62.64	12.27		46.31	8.05	−0.83
P*			0.027
Self-rating anxiety
T1 (baseline)	58.72	8.65		59.58	9.62
T2	77.37	14.50		65.24	11.08	−1.0
T3	60.44	10.83		48.97	9.82	−0.86
P*			0.043

Notes:

* If the difference between UC group and MBSR intervention group is significant, the P value is provided in the middle column of the table. TI, assessment immediately before the start of MBSR; T2, assessment immediately after RIT hospitalization is concluded; T3, assessment 3 months after RIT hospitalization.

Abbreviations: MBSR, mindfulness-based stress reduction; QoL, quality of life; UC, usual care.