Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants’ Adherence to Home Practice

Figures & data

Table 1 Literature Summary

Study	Participants	Design	Intervention	Measurement of Home-Practice		Distress-Related Outcome Measure	Results	Average Home Practice (% Adherence)^a
Speca et al 2000^Citation21 Canada	90 patients with various cancer types [average age=51 years; 78% females; 38% breast cancer; mean of 15 years of formal education]	Waitlist RCT	MBCR [7 weekly 90-min sessions, home practice 45min/day was encouraged using a booklet and audiotape]	Home practice log		POMS and SOSI, administered at baseline and postintervention	After the intervention, patients in the treatment group had significantly lower scores on POMS-TMD (−65% vs −12%) and subscales of depression and anxiety, and stress (−30.7% vs −11.1%) than control subjects.	32 min/day (71%adherence)
Carlson et al 2007^Citation23 Canada	59 patients with early stage 0-II breast (n=49) or localized prostate (n=10) cancer [average age=54 years; 85% females; 64% married; average time since cancer diagnosis= 1.1 years; average of 14.7 years of formal education]	Single-group	MBCR [8 weekly 90 mins sessions, 3-h retreat, home practice 45 min/day]	Daily log collected each week during class		POMS, SOSI, and salivary cortisol, assessed pre- and post-intervention, and at 6- and 12-month follow-up.	Changes in POMS scores over the course of the intervention and follow-up were not significant. Stress scores showed a significant reduction (−19.3%) over the course of the intervention, which were maintained over the follow-up period. The average daily mean of cortisol values and overall slope of the diurnal rate did not change from pre- to post-intervention, but cortisol levels decreased significantly over the course of the follow-up.	37 min/day (82% adherence)
Lengacher et al 2009^Citation27 USA	85 breast cancer survivors [average ag= 57 years; 72% White; 56% employed; 78% some college education or more; 70% stage 0–I cancer, 30% stage II–III; average time since treatment completion=5 months)	Waitlist RCT	MBSR [6 weekly 2-h sessions, home practice 15–45 min/day using a manual and CD]	Daily diary		CARS, STAI, PSS, and CESD, assessed at baseline and postintervention.	MBSR participants exhibited greater improvements in fear of recurrence, anxiety and depression scores, relative to controls.	25.6 min/day (57% adherence)
Foley et al 2010^Citation32 Australia	115 participants with various cancer types [average age= 55.1 years; 77% females; 42% breast cancer; 44% employed]	Waitlist RCT	MBCT [8 weekly 2-h sessions, 5-hr retreat day, home practice up to 1-h/day using mindfulness recordings]	Daily diary collected at intervention end	HAM-D, HAM-S, and DASS, assessed at baseline, postintervention, and 3 months postintervention.		There were significant improvements in depression (d= 0.83), anxiety (d= 0.59), and stress (d=0.53) scores for MBCT participants compared with controls. Benefits were maintained at 3-month postintervention.	30 min/day (50% adherence)
Lengacher et al 2012^Citation28 USA	26 patients with advanced stage cancer [average age= 53 years; 69% female; 73% White; 69% married; 30% breast cancer; 63% some college education or more]	Single-group	MBSR [6 weekly 2-h sessions, home practice 15–45 min/day using a manual and CD]	Daily diary	CARS, STAI, and CESD, assessed at baseline and postintervention. Salivary cortisol and interleukin-6 were assessed pre- and post-MBSR session at 1, 3, and 6 weeks.		Following the 6-week MBSR program, patients showed improvements in stress and anxiety. Patients also had significant decreases in cortisol at Weeks 1 and 3 but not at Week 6. Salivary cortisol and interleukin-6 levels at Week 6 were lower overall (before/after an MBSR session), compared with Week 1.	14.3 min/day (31% adherence)
Hoffman et al 2012^Citation34 United Kingdom	114 females with stage 0-III breast cancer [average age=49 years; average time since treatment completion=9.2 months; average time since diagnosis= 17.4 months]	Waitlist RCT	MBSR [8 weekly 2–2.5 classes, 6-h retreat, 45 min/day home practice using a CD and manual]	Weekly record sheets	POMS, assessed at baseline, 8 and 12 weeks		There were statistically significant lower POMS-TMD scores in the experimental group than in the control group at postintervention (d= −0.5) and follow-up (d=−0.4). Similarly, there were lower POMS-anxiety subscale scores in the experimental group at postintervention (d= −0.4) and follow-up (d= −0.5).	21 min/day (46% adherence)
Campbell et al 2012^Citation25 Canada	70 female cancer survivors [average age= 53 years; 74% breast cancer; 87% White; average time since diagnosis=24 months, average time since treatment completion=13 months; average years of education= 14.6 years; 75% married or living with a partner; 10% metastatic disease]	Non-randomized waitlist trial	MBCR [8 weekly 90 min classes, 6-h retreat, home practice 45 min/day]	Daily log collected each week during class	RRQ-Rumination subscale, assessed at weeks 1 and 8		MBCR group participants had significantly lower rumination scores than controls pre-post intervention.	33 min/day (73% adherence)
Zernicke et al 2014^Citation24 Canada	62 underserved cancer survivors [73% females; 82% in a relationship; 92% White; 34% breast cancer; average age= 58 years; 34% retired or employed full time; 77% completed some type of postsecondary education]	Waitlist RCT	Online MBCR [8 weekly 2-hour synchronous group sessions, 6-h retreat, home practice 45 min/day using recordings and videos]	Daily log	POMS and C-SOSI, administered at baseline and postintervention.		MBCR participants exhibited significant improvements in POMS-TMD (d= 0.44) and stress (d=0.49) scores compared to waitlist controls.	21.4 min/day (47% adherence)
Labelle et al 2015^Citation22 Canada	211 patients with various cancer types [58% breast cancer; average age=52 years; 80% female; 92% White; 71% married; average years of education=15 years; 70% completed treatment; average time since diagnosis= 23 months]	Non-randomized waitlist trial	MBCR [8 weekly 90 min classes, 6-h retreat, home practice 45 min/day]	Daily log collected each week during class	POMS, RRQ, and PSWQ, assessed at baseline, weeks 4 and 8.		Relative to controls, MBCR participants demonstrated greater decreases in POMS (d= 0.52), rumination (d=0.68), and worry (d= 0.57) scores.	27.3 min/day (60% adherence)
Tamagawa et al 2015^Citation26 Canada	38 females with stage I (40%) or II [45%) breast cancer [average age=55 years; average time since diagnosis= 20 months; 61% employed; 63% married or cohabitating; average years of education= 15 years]	Single-group	MBCR [8 weekly 90 min classes, 6-h retreat, home practice 45 min/day using a program manual and two compact discs]	Daily log collected each week during class	POMS and PTGI, assessed at baseline and postintervention		Not reported (results published separately as part of a larger study)	20.6 min/day (45% adherence)
Johns et al 2015^Citation30 USA	35 patients with various cancer types [average age=58 years; 85% breast cancer; 94% females; 80% White; 71% college educated; 49% employed; 60% married, 60% had a comfortable income; average time since treatment completion= 51.3 months]	Waitlist RCT	MBSR [7 weekly 2-h classes, no retreat, and home practice 20 min/day]	Weekly log	GAD-7 and PHQ-8, assessed at baseline, postintervention, and 1-month follow-up		Compared to controls, MBSR participants reported significant reductions in depression at postintervention (d= −1.30) and follow-up (d=−1.71). Anxiety scores were lower for MBSR participants than controls at follow-up (d = −0.98) but not at postintervention.	35 min/day (>100% adherence)
Johannsen et al 2016^Citation35 Denmark	129 females with breast cancer [average age= 56.8 years; on average 40 months post- mastectomy or lumpectomy; 70% married; 43% employed; 69% more than 2 years of post-high school education]	Waitlist RCT	MBCT [8 weekly 90 min classes, no retreat, home practice 45 min/day using a CD]	Weekly homework records	HADS, assessed at baseline, 8 weeks, 3 and 6 months		Interactions between group and time were not significant, indicating no difference between groups.	24 min/day (53% adherence)
Johns et al 2016^Citation31 USA	71 patients with stage 0-III breast (n=60) or colorectal (n=11) cancer [average age= 56 years; 90% females; 70% White; 52.1% had a comfortable income; 54.9% married; average time since treatment completion= 2.4 years]	RCT with an active control group [psycho-educational support (PES)]	MBSR [8 weekly 2-h classes, no retreat, home practice 20 mins/day] vs a structurally equivalent PES program	Weekly log	GAD-7 and PHQ-8, assessed at baseline, postintervention, and 6 months later		Both groups exhibited significant improvements in anxiety (MBSR: postintervention d =−0.89, 6-month d =−0.74) and depression (MBSR: postintervention d=−1.05, 6-month d= −0.98) scores. Differences between groups were not significant.	MBSR: 16.8 min/day (84% adherence) PES: 13.2 min/day (66% adherence)
Lengacher et al 2018^Citation29 USA	15 stage 0‐III breast cancer survivors [average age= 57 years; 80% married; 93% White; average time since treatment completion= 10 months]	Single-group	Online asynchronous MBSR [6 weekly 2-h sessions, home practice 15–45 min/day using audio and video files]	Electronic practice diary	STAI, CESD, PSS, and CARS, assessed at baseline and postintervention		Following the program, participants reported significant improvements in anxiety (d=1.48), depression (d=1.62), stress (d=1.62), fear of recurrence overall (d=1.51), and fear of recurrence problems (d=1.31).	36 min/day (80% adherence)
Compen et al 2018^Citation33 Netherlands	245 patients with various cancer types [86% females; average age= 51.7 years; 62% breast cancer; 82% married; 68% high education]	Three-arm RCT (in-person MBCT vs online MBCT vs treatment as usual)	In-person MBCT [8 weekly 2.5-h group sessions, 6-h retreat, daily home practice using audio files] Online asynchronous MBCT [delivered individually and offered online material for 8 weeks, 6-h retreat, daily home practice]	Daily diary	HADS, FCRI, and RRQ-rumination subscale, assessed at baseline and postintervention		Compared with treatment as usual, both in-person and online MBCT groups exhibited significant improvements in HADS (d=0.45 and 0.71, respectively), fear of recurrence (d= 0.27 and 0.53, respectively), and ruminative thinking (d= 0.42 and 0.51, respectively) from baseline to postintervention.	All MBCT participants: 29.6 min/day ^bAdherence rate could not be calculated. In-person MBCT: 30.6 min/day Online MBCT: 28.7 min/day
Russell et al 2019^Citation41 Australia	69 patients with melanoma [54% females; average age= 54 years; 76% married; 39% university degree]	RCT (usual care control group)	6-week web-based asynchronous MBI program. Participants were asked to practice daily.	Weekly online home practice questionnaire	FCRI, administered at baseline and postintervention		Compared with controls, MBI participants exhibited significant improvements in FCR severity (d=1.01) from baseline to postintervention.	13.7 min/day ^bAdherence rate could not be calculated.
Huberty et al 2019^Citation39 USA	128 patients with myeloproliferative neoplasm [average age=58 years; 81% females; 96% white; 61% well-educated with a bachelor’s education or higher; 74% married]	4-group cross-over design RCT with a and an educational control group	8-week app-based MBI program of two meditation apps (10% Happier and Calm). Participants were asked to practice 10 min/day.	Smartphone app developers reported weekly practice data to the research team.	PROMISSF-anxiety and PROMISSF-depression, assessed at baseline, week 5, and week 9.		10% Happier app participants reported significant improvements in anxiety (d=−0.43) and depression (d=−0.38). No significant differences were found between baseline and postintervention scores for anxiety (d=−0.22) and depression (d=−0.29) among Calm app participants.	All study participants: 7.2 min/day (72% adherence) 10% Happier app: 4.4 min/day (44% adherence) Calm app: 10.1 min/day (100% adherence)
Donovan et al 2019^Citation40 USA	20 adolescents or young adults with sarcoma [57% females; average age=19 years; 65% white]	Single-group	4-week app-based MBI program. Participants were encouraged to practice daily.	Not specified	PCQL-32- Psychological Functioning subscale, administered at baseline and postintervention		Changes in psychological functioning were not statistically significant.	4 min/day ^bAdherence rate could not be calculated.
Poletti et al 2019^Citation36 Italy	20 patients with metastatic cancer [average age= 54 years; 85% females; 60% undergoing treatment]	Single-group	MBSR [8 weekly 2.5-h classes, 4.5-h retreat, home practice 30 min/day using a CD]	Home practice diary collected at intervention end	POMS, assessed at baseline, postintervention, and 2 and 4 months postintervention		POMST-TMD and POMS-depression subscale scores significantly improved postintervention. Benefits were maintained at 2- and 4-month follow-up.	19 min/day (63% adherence)
Park et al 2020^Citation37 Japan	74 females with stage I–III breast cancer [average age=53.7 years; 60% married; 46% employed]	Waitlist RCT	MBCT [8 weekly 2-h classes, no retreat, home practice 20–45 min/day using a compact disc]	Not specified	HADS and CARS, assessed at baseline, 8 and 12 weeks		MBCT participants reported significant improvements in HADS (d=1.17) and fear of recurrence (d: 0.43), compared with controls. Benefits were maintained at follow-up (4 weeks postintervention).	24 min/day (53% adherence)
Zhao et al 2020^Citation38 China	135 breast cancer survivors [average age= 53 years; 50% diploma or university degree; 93% married; average time since treatment completion= 2.3 years]	Waitlist RCT	MBCT [6 weekly 90-min classes, home practice 20–40 min/day using an audio tape and handouts]	Daily log	No distress measure was included in this study.		No distress measure was included in this study.	23.7 min/day (59% adherence)

Notes: ^aAdherence rate was calculated using the following formula: average number of minutes of actual home practice per day/prescribed number of minutes of home practice per day x 100. ^bStudies did not specify the length of assigned home practice, which precluded adherence rate calculation.

Abbreviations: POMS-TMD, Profile of Mood States – Total Mood Disturbance; HADS, Hospital Anxiety and Depression Scale; RRQ, Rumination–Reflection Questionnaire; GAD-7, Generalized Anxiety Disorder Scale; PHQ-8, Patient Health Questionnaire Depression Scale; CARS, Concerns About Recurrence Scale; FCRI, Fear of Cancer Recurrence Inventory; C-SOSI, Calgary Symptoms of Stress Inventory; SOSI, Symptoms of Stress Inventory; PSWQ, Penn State Worry Questionnaire; STAI, State-Trait Anxiety Inventory; CESD, Center for Epidemiological Studies Depression Scale; PSS, Perceived Stress Scale; HAM-D, Hamilton Depression Rating Scale; HAM-A, Hamilton Anxiety Rating Scale; DASS, Depression, Anxiety and Stress Scale; PTGI, Post-Traumatic Growth Inventory; PROMISSF, Patient Reported Outcomes Measurement Information System Short Form (8-item); PCQL-32, Pediatric Cancer Quality of Life Inventory.

Figure 1 PRISMA flow diagram of literature search process. Notes: PRISMA figure adapted from Liberati A, Altman D, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of clinical epidemiology. 2009;62(10). Creative Commons.

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