Mindfulness, meditation and cancer
A literature review
Dr Ian Gawler BVSc, MCounsHS. November 2020.

What do mindfulness and meditation-based techniques have to offer people affected by cancer and their carers?

Introduction

In 1967, Dr Ainslie Meares published a ground breaking book – Relief Without Drugs in which he advocated meditation as a therapy for a wide range of physical and psychological conditions.

In 1985, Dr Meares published an hypothesis in the Medical Journal of Australia in which he speculated intense meditation might actually reverse the progress of cancer. Fair to say there was strong opposition from his medical and scientific colleagues. However, at the time, I had been diagnosed with advanced secondary osteo-genic sarcoma (bone cancer) and had a prognosis of 3 to 6 months.

So, having agreed to test Dr Meares hypothesis and used his methods as a core element in my subsequent survival, and having taught those techniques (along with additions) to many thousands of people affected by cancer over 4 decades, I have lived long enough to see the place of meditation in cancer management go through the 19th century German philosopher Schopenhauer’s 3 stages of truth: First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident. Well, almost.

It seems reasonable to contend meditation has entered the mainstream in a general sense. It enjoys widespread acceptance and uptake. It is estimated that 200–500 million people meditate worldwide.

When it comes to cancer, the evidence regarding its contribution to improving quality of life for both patients, survivors and carers is compelling. Search scholarly articles for mindfulness and meditation and cancer, and around 1.5 million results appear. However, regarding the capacity to actually increase survival, while case reports and some small studies are positive, this is an area of little good quality research.

So, what follows is a summary of key research articles supporting the use of mindfulness, meditation and related practices for people affected by cancer. This is no PhD article and makes no claim to be comprehensive, but hopefully it does highlight some of the best of recent research in the field.


Evidence of benefit - key research articles

Short on time? Need the most important and latest findings?
Here they are, while much more detail follows…

1. Quality of life

The evidence strongly suggests meditation and mindfulness-based programs do improve quality of life – in person and online. Two recent meta-analyses of mindfulness programs for cancer patients and survivors have both reported improvements in pain, psychological distress, anxiety, depression, fear of cancer recurrence, and sleep quality. Of note, four of the 29 studies included were online programs where the online programs recorded similar benefits to face-to-face programs.

i) This 2020 review of 28 RCTs enrolling 3053 adults with cancer was published in the prestigious Journal of the American Medical Association. The findings? Mindfulness Based Interventions (MBIs) were associated with significant reductions in the severity of short-term and medium-term anxiety but not long-term. MBIs were associated with a reduction in the severity of depression in the short term and the medium term; as well as improved health-related quality of life in patients in the short term and the medium term. The study also found MBIs were associated with reductions in anxiety and depression up to 6 months postintervention in adults with cancer.

Oberoi S, et al. Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Aug 3;3(8).

ii) This 2019 review of 29 independent RCTs with 3274 participants found small and statistically significant effects of MBIs on combined measures of psychological distress. Statistically significant effects were also found at either post‐intervention or follow‐up for a range of self‐reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post‐intervention.

Cillessen, L et al. (2019). Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta-analysis of randomized controlled trials. Psycho-Oncology, 28(12).

2. Increased survival

Perhaps surprisingly, the volume of research directly investigating the role meditation and mindfulness might play in improving survival rates is way less than that examining quality of life benefits. However, some studies do show that improvements in quality of life are associated with life extension; perhaps most notably when depression is treated survival rates extend significantly.

One good direct example of possibilities is provided by the work of Prof Dean Ornish. For over a decade he has studied prostate cancer and the effects of lifestyle interventions on the progression of the disease. These long-term studies have consistently shown intensive lifestyle changes that include the regular practice of meditation decrease Prostate Specific Antigen (PSA) readings, increase telomere length, and slow the progression of prostate cancer.

Telomeres can be compared to small protective caps of DNA and protein at the end of each chromosome. The shortening of telomeres has been associated with a broad range of disease, including cancer, stroke, obesity, vascular dementia and cardiovascular disease. Research indicates that longer telomeres are associated with fewer illnesses and longer life.

After one year in this randomised study of 92 men, PSA levels had decreased by 4% in the lifestyle group and increased by 6% in the control group. After two years, 27% of patients in the control group had required treatment for cancer progression, but only 5% of the lifestyle group needed other treatment. It seems that the programme not only down-regulated gene expression for prostate cancer, it increased telomerase activity (telomerase being enzyme that lengthens and repairs telomeres).

Follow up after five years showed a significant increase in telomere length in participants who had adhered to the meditation and lifestyle changes. The control group underwent active surveillance only, and showed a notable decrease in telomere length.

Ornish commented in 2013 “larger randomised controlled trials are warranted to confirm this finding”. Remarkably, as yet, to my knowledge no further studies testing the impact of meditation and lifestyle interventions on cancer reversal have been reported.

Ornish D. Weidner G. Fair WR. et al. Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology. 2005;174(3).

Ornish et al. Journal of Urology 2005;174:1065-70..

Ornish D, Blackburn EH et al. Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study.Lancet Oncol. 2013 Sep 16.


Evidence of benefit - more details - in summary

Quality of life

1. By association

Earlier research into the general benefits of mindfulness, meditation and related practices indicated a range of physiological and psychological benefits, many of which have direct implications for cancer. As a result of this early research and independent of potential effects on survival, at the start of this century mindfulness and meditation became increasingly accepted as an evidence-based option to be offered to patients to improve their coping with cancer, to assist with symptom control and to foster a better quality of life.

A brief summary of these related benefits include

i) Improved sleep

Sephton S. Spiegel D. Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to disease? Brain Behav Immun. 2003;17(5):321-8.

ii) Elevation of melatonin levels

Mahmoud F. Sarhill N. Mazurczak MA. The therapeutic application of melatonin in supportive care and palliative medicine. Am J Hospice & Palliative Care. 2005;22(4):295-309.

iii) Improved pain control

Kabat-Zinn J et al. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985;8(2):163-90.

iv) Improvement of depression

Teasdale JD, Moore RG, Hayhurst H, et al. Metacognitive awareness and prevention of relapse in depression: empirical evidence. J Consult Clin Psychol. 2002;70(2):275-87.

v) Less anxiety, better coping

Tacon AM. Et al. Mindfulness meditation, anxiety reduction, and heart disease: a pilot study. Family & Comm Health. 2003;26(1):25-33.

Speca M, et al. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med. 2000;62(5):613-22.

vi) Improved immunity

Davidson RJ Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003;65(4):564-70.

vii) Spiritual factors

A review of 71 research articles indicated that imagery, meditation and group support activities may address spiritual health, resulting in beneficial outcomes of enhanced physical and emotional health and decreased cancer mortality.

Hawke SR et al. Review of spiritual health: definition, role, and intervention strategies in health promotion. Am J Health Promot. 1995 May-Jun;9(5):371-8.

viii) Telomere length and survival

These studies reported on the association between meditation, telomerase activity and increased telomere length (there is no drug known currently that can accomplish this).

Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol. 2008; 9: 1048‐ 1057.

Jacobs TL, Epel ES, Lin J, et al. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology. 2011; 36: 664‐ 681.

Quinn A. et al, Insight meditation and telomere biology: The effects of intensive retreat and the moderating role of personality Brain, Behavior, and Immunity, Volume 70, 2018, Pages 233-245.

2. Cancer specific research - meta-analyses

More recently, so much specific cancer-related research has been published investigating the role of mindfulness, meditation and related practices in cancer management, that meta-analysis are now common. Here are some of the more recent ones.

i) Clinical practice guidelines

These guidelines are provided to inform clinicians and patients about safe and effective evidence-based therapies as supportive care in patients treated for breast cancer by the American Society for Integrative Oncology Guidelines Working Group. They were developed using the Institute of Medicine’s guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. The search identified 4900 articles, of which 203 were eligible for analysis.

Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Meditation, stress management, yoga, massage, music therapy and energy conservation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B).

Greenlee, Heather et al. “Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer". Journal of the National Cancer Institute. Monographs vol. 2014,50 (2014): 346-58..

ii) Cancer related pain and meditation-based techniques

A systematic review in 2019 of 6 studies that met strict criteria was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. Study outcomes include improved pain severity, anxiety, stress, depression, and QoL.

Ngamkham S, Holden JE, Smith EL. A Systematic Review: Mindfulness Intervention for Cancer-Related Pain. Asia Pac J Oncol Nurs. 2019;6(2):161-169.

iii) Mindfulness and breast cancer specifically

This 2019 meta-analysis investigated 14 studies involving 1505 participants. It found statistically significant benefits for physiological function, cognitive function, fatigue, emotional wellbeing, anxiety, depression, stress, distress and mindfulness. Although the effects on pain, sleep quality, and global QoL were in the expected direction, they were not statistically significant based on insufficient evidence. The authors concluded the mindfulness-based program MBSR is worthy of being recommended to breast cancer patients as a complementary treatment or adjunctive therapy.

Zhang Q, Zhao H, Zheng Y. Effectiveness of mindfulness-based stress reduction (MBSR) on symptom variables and health-related quality of life in breast cancer patients-a systematic review and meta-analysis. Support Care Cancer. 2019 Mar; 27(3):771-781.

3. Cancer specific research - key papers

i) Depression and its impact on mortality

Depression affects many people diagnosed with cancer and left untreated it is associated with increased mortality. This study investigated 1790 patients within 3 months of lung cancer diagnosis. 38% had depression at baseline and an additional 14% developed new-onset depression during cancer treatment. Depression symptoms at baseline were significantly associated with a 17% higher risk of mortality and was most marked in young patients.

At 12 months of follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease and those with late-stage disease. Importantly, remission of depression symptoms is associated with a similar mortality rate as never having had depression.

Sullivan DR, Forsberg CW, Ganzini L, et al. Longitudinal changes in depression symptoms and survival among patients with lung cancer: a national cohort assessment. J Clin Oncol. 2016 Oct 3.

ii) Strong depression link with breast cancer mortality

This randomized trial on 125 women with metastatic breast cancer compared a treatment group to a control group that received educational materials. Median survival time was 53.6 months for women with decreasing depression scores over 1 year and 25.1 months for women with increasing CES-D scores. Neither demographic nor medical variables explained this association. The researchers commented : “Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with breast cancer in this sample”.

Giese-Davis J, Collie K, Rancourt KMS, Neri E, Kraemer HC, Spiegel D. Decrease in Depression Symptoms Is Associated With Longer Survival in Patients With Metastatic Breast Cancer: A Secondary Analysis. J Clin Oncol. 2011 February 1; 29(4): 413–420.

iii) Cortisol levels

This study demonstrated mindfulness and meditation can reduce cortisol levels in cancer patients – high cortisol levels being a sign of a poor prognosis – and improve quality of life.

Carlson LE. Speca M. Patel KD. Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29(4):448-74.

iv) Mindfulness in a group setting

This trial compared 2 empirically supported psychosocial group interventions, mindfulness‐based cancer recovery (MBCR) and supportive‐expressive group therapy (SET), with a minimal‐intervention control condition on mood, stress symptoms, quality of life, social support, and diurnal salivary cortisol in distressed breast cancer survivors. The mindfulness-based group resulted in the most psychosocial benefit, including improvements across a range of psychosocial outcomes. Both MBCR and SET resulted in healthier cortisol profiles over time compared with the control condition.

Carlson LE, Doll R, Stephen J, et al. Randomized controlled trial of mindfulness‐based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013; 31: 3119‐ 3126.

v) Short term intervention effective

Each patient in this study received an individual meditation consultation (60-minute initial visit and 30 minute follow-up visits). Participants recorded significant reductions from pre- to post- meditation session in physical, psychological and symptom distress component scores. All changes reached statistically and clinically significant thresholds. Researchers concluded that “a single meditation session resulted in acute relief in multiple self-reported symptoms with the greatest reduction in anxiety, fatigue & distress".

Chaoul, A., et al. (2014). An Analysis of Meditation Consultations in an Integrative Oncology Outpatient Clinic. The Journal of Alternative and Complementary Medicine, 20(5), A86-A86.

vi) Mental state and vigour

Where cancer patients learn mindfulness in their cancer management they were found to have significantly lower scores for low mood, depression, anxiety, anger, and confusion but they also had more vigour. They also had fewer overall physical and stress symptoms. Speca M, et al. Psychosom Med. 2000;62(5):613-22.

vii) Mindfulness and immunity

Among cancer patients, the significant improvements seen in overall quality of life, symptoms of stress, and sleep quality are associated with improvements in immunity with lower levels of the inflammatory hormones that can accelerate cancer growth. Carlson LE. Speca M. Patel KD. Goodey E. Psychosomatic Medicine. 2003;65(4):571-81..

People also show better immune response to vaccinations and increases in antibodies. Davidson RJ Psychosom Med. 2003;65(4):564-70.

viii) Meditation improves quality of life for breast cancer survivors

This study reported meditation was associated with significant decreases in depression, anxiety, perceived stress, and an increase in quality of life, satisfaction with life, post-traumatic growth and quality of sleep. Significantly, participants had a high attendance rate in the program, which speaks to the likelihood of the applicability of the meditation program on an outpatient basis.

Yun MR et al : The Effects of Mind Subtraction Meditation on Breast Cancer Survivors' Psychological and Spiritual Well-being and Sleep Quality: A Randomized Controlled Trial in South Korea. Cancer Nurs. 2017 Sep/Oct;40(5):377-385.

Online programs - increasingly well proven

i) Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions.

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114.

ii) How do online programs compare to face to face?

Mindfulness-based interventions are shown to be effective in reducing psychological distress in people affected by cancer. However, these interventions lack availability and flexibility, which may compromise participation in the intervention, especially for people experiencing symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via the internet. Here are 5 research reports demonstrating online programs have similar outcomes to in person programs.

This first study examined a randomised group of 245 heterogeneous patients with cancer affected by psychological distress. Compared with Treatment as Usual (TAU), MBCT and eMBCT were similarly effective in reducing that psychological distress. Also, both interventions reduced fear of cancer recurrence and rumination, and increased mental health-related quality of life, mindfulness skills, and positive mental health compared with TAU.

Compen F, Bisseling E, Schellekens M, et al. Face‐to‐face and internet‐based mindfulness‐based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: A multicenter randomized controlled trial. J Clin Oncol. 2018;36(23):2413‐2421.

This second study provides further evidence for the feasibility and efficacy of an online adaptation of a mindfulness-based program as it reported usage was associated with the reduction of mood disturbance and stress symptoms, as well as an increase in spirituality and mindfully acting with awareness compared with a treatment-as-usual waitlist.

Zernicke KA, Campbell TS, Speca M, McCabe‐Ruff K, Flowers S, Carlson LE. A randomized wait‐list controlled trial of feasibility and efficacy of an online mindfulness‐based cancer recovery program: The eTherapy for cancer applying mindfulness trial. Psychosom Med. 2014;76(4):257‐267.

This third study found nonusers had more fear of cancer recurrence at baseline than users. Regular users reported a larger reduction in psychological distress and more improvement of positive mental health (ie, emotional, psychological, and social well-being) after the intervention than other participants. The study showed that adherence was related to improved patient outcomes. The researchers recommended patients with strong fear of recurrence or low levels of conscientiousness should receive extra attention, as they are less likely to respectively start or complete eMBCT. Future research may focus on the development of flexible and adaptive eMBCT programs to fit individual needs.

Cillesen L; et al. Predictors and Effects of Usage of an Online Mindfulness Intervention for Distressed Cancer Patients: Usability Study. J Med Internet Res 2020;22(10):e17526).

Fourthly, this trial compared an online 6 week program to Treatment As Usual. It concluded online mindfulness instruction represents a widely accessible intervention for reducing psychological distress and its behavioural manifestations in cancer survivors, especially those who are unable to participate in in-person training. Effect sizes were all medium to large as well.

Messer D, Horan JJ, Larkey LK, Shanholtz CE. Effects of internet training in mindfulness meditation on variables related to cancer recovery. Mindfulness. 2019;10:2143–2151.

Finally, this study focused on the long-term effects of a RCT during the nine-month follow-up period. The study compared a mindfulness-based program delivered online with the same program delivered in person. Analyses revealed long-term reductions in psychological distress and rumination, and long-term increases in positive mental health and mental health-related quality of life in both interventions over the course of the nine-month follow-up. Furthermore, patients seemed to benefit more from the online program based on psychological distress levels, especially those patients with low levels of mindfulness skills and conscientiousness.

Cillessen L, et al, Consolidation and prediction of long-term treatment effect of group and online mindfulness-based cognitive therapy for distressed cancer patients. Acta Oncol. 2018 Oct; 57(10):1293-1302.

iii) Online fatigue relief

Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue (CCRF). Effective and easily accessible interventions are needed for these patients. This paper reports on the results of a 3-armed randomized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition. The study found both web-based interventions effective for managing fatigue severity.

Bruggeman‐Everts FZ, Wolvers MD, van de Schoot R, Vollenbroek‐Hutten MM, Van der Lee ML. Effectiveness of two web‐based interventions for chronic cancer‐related fatigue compared to an active control condition: Results of the “Fitter na kanker” randomized controlled trial. J Med Internet Res. 2017;19(10):e336.

iv) Online pain management

Chronic neuropathic pain (CNP) is a common condition cancer survivors experience. Mindfulness training may be one approach to address the psychosocial factors associated with CNP. An 8-week online mindfulness-based program was evaluated via interview. Participants reported an increase in perceived relaxation and calm, less pain and improved stress management.

Glynn BA, Khoo EL, MacLeay HML, Duong A, Cantave R, Poulin PA. Exploring Cancer Patients' Experiences of an Online Mindfulness-Based Program: A Qualitative Investigation. Mindfulness (N Y). 2020;11(7):1666-1677.

v) Future directions for Apps

This study investigated ways in which the current Calm app could be adapted to better fit cancer patients’ and survivors’ needs and preferences, including adding cancer-specific content, increasing the amount of content focusing on coping with strong emotions, developing communities for Calm users who are cancer patients and survivors, and including features that track cancer-related symptoms. Given differences in opinions about which features were desirable or would be useful, there is a clear need for future cancer-specific apps to be customizable (eg, ability to turn different features on or off). Although future research should address these topics in larger, more diverse samples, these data will serve as a starting point for the development of cancer-specific meditation apps and provide a framework for evaluating their effects.

Huberty J, Puzia M, Eckert R, Larkey L. Cancer Patients' and Survivors' Perceptions of the Calm App: Cross-Sectional Descriptive Study. JMIR Cancer. 2020;6(1):e16926. Published 2020 Jan 25.


Increased survival

Starting in 1976, Dr Ainslie Meares published multiple case reports of remarkable remissions following intensive meditation practice. I happened to feature in one of those reports. It strikes me as remarkable that while in recent years there has been a large body of research published that clearly attests to the many benefits to quality of life that follow from mindfulness and meditation practice amongst people affected by cancer, very few investigations have been made into the potential meditation might have to contribute to longer survival times, even cures.

It does seem highly likely that a better quality of life translates into longer survival times, and some studies do support this proposition. However, it remains for the future for serious outcome studies to be pursued. Here is a summary of what is available so far.

1. Case reports

i) Dr Ainslie Meares and intensive meditation

Meares published multiple case reports of remission from cancer following intensive meditation. Here are a few…

a) Breast cancer

Meares A. Med J of Aust. 1976, 2:184
Meares A. Med J of Aust. 1977, 2:132-133
Meares A. Med J of Aust. Correspondence, 10 Sept 1977

b) Osteo-genic sarcoma - Meares reported my own remission :

Meares A. Med J Aust, 1978, 2:433

ii) Books on “Spontaneous Remission”

In 1993, the Institute of Noetic Sciences published the groundbreaking Spontaneous Remission: An Annotated Bibliography. The authors, Caryle Hirshberg and Brendan O’Regan, defined spontaneous remission as “the disappearance, complete or incomplete, of a disease or cancer without medical treatment or treatment that is considered inadequate to produce the resulting disappearance of disease symptoms or tumor.” The book assembled the largest database of medically reported cases of spontaneous remission in the world, with more than 3,500 references from more than 800 journals in 20 different languages. All the documents in the bibliography are downloadable from here.

While the book was very well received, many who featured in it objected to being described as “spontaneous remissions” as they felt they had contributed largely to their own recoveries. In consequence, Caryle Hirschberg interviewed many of the people featured (including myself) and coined a new term as the title for her subsequent book “Remarkable Recoveries”, published in 1995 along with co-author Marc Barasch.

More recently, in 2014, Kelly Turner published Radical Remission: Surviving Cancer Against All Odds where she too interviewed many long-term cancer survivors and analysed what common measures they linked to their unexpected recoveries.

From my own work, 2 books have been published recording “Radical Remissions” or “Remarkable Recoveries” :

Inspiring People – Stories of Remarkable Recovery and Hope, Edited by Ian Gawler, 1995 in which 43 stories are recounted.

Surviving Cancer – Inspiring Stories of Hope and Healing, Edited by Paul Kraus, 2008 in which 28 stories are recounted.

Increased survival linked to related factors

i) Breast cancer survival associated with depression levels
See the Giese-Davis study above.

ii) Psychological and behavioural variables – a meta-analysis

This meta-analysis revealed stress-related psychosocial factors to be associated with a higher cancer incidence in initially healthy people, poorer survival in patients diagnosed with cancer, and higher cancer mortality. Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychological factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466–475.

3. OUTCOME STUDIES

i) Prostate cancer

Revisit the work of Prof Dean Ornish at the start of this article that reported reversal of prostate cancer.

ii) The complex case of group therapy, quality of life and survival

Spiegel reported in the Lancet 1989, that attending a group based upon emotional expression weekly for one year, doubled survival time for women with secondary breast cancer and some participants survived over 10 years.

Another trial was performed by Fawzy with 68 patients with early stage malignant melanoma. At 6-year follow-up those who had usual care plus stress management showed a halving of recurrence and much lower death rate (than the group with only the usual surgical management). Both groups also had their immune function monitored which showed that after being originally comparable, the stress management group had significantly better immune function after six months.

Other studies have also yielded promising results in terms of longer survival for liver, gastrointestinal malignancies, and lymphoma but others have shown equivocal or negative results. The last of these trials was a large-scale attempt to replicate the findings of Spiegel. The results of this trial were negative despite the fact that the effects of the intervention had a positive effect on quality of life and mental health.

Of the five negative or equivocal trials mentioned above only two reported a positive effect on mental health and quality of life while all the studies that showed a positive effect on survival reported improved mental health and quality of life. Therefore, the trend seen in eight out of these 10 cancer studies seems to be similar to the findings in studies of psycho-social support in heart disease; where a psychosocial intervention improves quality of life and mental health it has the ‘side-effect’ of prolonging survival, while if there is marginal or no long-term benefit on mood or quality of life there is no corresponding improvement in survival.


References for the above

Spiegel D et al. Lancet 1989;2:888-891.

Fawzy F. et al. Malignant melanoma; Effects of an early structured psychiatric intervention, coping and affective state on recurrence and survival six years later. Arch Gen Psych 1993;50:681-89.

Richardson JL, Shelton DR, Krailo M, Levine AM. The effect of compliance with treatment on survival among patients with hematologic malignancies. J Clin Oncol 1990;8:356-64.

Kuchler T. Henne-Bruns D. Rappat S. et al. Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial. Hepatogastroenterology. 1999;46:322-35.

Ratcliffe MA, Dawson AA, Walker LG. Eysenck Personality Inventory L-scores in patients with Hodgkin's disease and non-Hodgkin's lymphoma. Psycho-oncology 1995;4:39-45.

Cunningham AJ. Edmonds CV. Phillips C. et al. A prospective, longitudinal study of the relationship of psychological work to duration of survival in patients with metastatic cancer. Psychooncology 2000;9(4):323-39.

Edelman S. Lemon J. Bell DR. Kidman AD. Effects of group CBT on the survival time of patients with metastatic breast cancer. Psycho-Oncology. 1999;8(6):474-81.

Ilnyckyj A, Farber J, Cheang MC, Weinerman BH. A randomized controlled trial of psychotherapeutic intervention in cancer patients. Ann R Coll Physicians Surg Can 1994;27:93-6.

Linn MW, Linn BS, Harris R. Effects of counselling for late stage cancer patients. Cancer 1982;49:1048.

Goodwin PJ, Leszcz M, Ennis M, et al. The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 2001;345:1719-26.

Conclusion

My sense is if Dr Meares were still alive he would be delighted with how far meditation has come since his pioneering days. There is now a solid evidence base for mindfulness and meditation being used to help people affected by cancer (including their carers) to overcome both the associated symptoms of cancer such as stress, anxiety, depression, pain management and fatigue as well as to assist in their treatment and recovery.

Also, there is good evidence online mindfulness - based programs like our own Allevi8 App have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.