title: Mindfulness-Based Stress Reduction in Post-treatment Breast Cancer Patients: Immediate and Sustained Effects Across Multiple Symptom Clusters.
abstract: Breast cancer survivors (BCS) face adverse physical and psychological symptoms, often co-occurring. Biologic and psychological factors may link symptoms within clusters, distinguishable by prevalence and/or severity. Few studies have examined the effects of behavioral interventions or treatment of symptom clusters.
  
  
  
  The aim of this study was to identify symptom clusters among post-treatment BCS and determine symptom cluster improvement following the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR(BC)) program.
  
  
  
  Three hundred twenty-two Stage 0-III post-treatment BCS were randomly assigned to either a six-week MBSR(BC) program or usual care. Psychological (depression, anxiety, stress, and fear of recurrence), physical (fatigue, pain, sleep, and drowsiness), and cognitive symptoms and quality of life were assessed at baseline, six, and 12 weeks, along with demographic and clinical history data at baseline. A three-step analytic process included the error-accounting models of factor analysis and structural equation modeling.
  
  
  
  Four symptom clusters emerged at baseline: pain, psychological, fatigue, and cognitive. From baseline to six weeks, the model demonstrated evidence of MBSR(BC) effectiveness in both the psychological (anxiety, depression, perceived stress and QOL, emotional well-being) (P = 0.007) and fatigue (fatigue, sleep, and drowsiness) (P < 0.001) clusters. Results between six and 12 weeks showed sustained effects, but further improvement was not observed.
  
  
  
  Our results provide clinical effectiveness evidence that MBSR(BC) works to improve symptom clusters, particularly for psychological and fatigue symptom clusters, with the greatest improvement occurring during the six-week program with sustained effects for several weeks after MBSR(BC) training.
  
  
  
  Name and URL of Registry: ClinicalTrials.gov. Registration number: NCT01177124.
authors.affiliation: Moffitt Cancer Center and Research Institute, Tampa, Florida, USA. Electronic address: rreich@sar.usf.edu.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Reich
authors.affiliation: College of Nursing, University of South Florida, Tampa, Florida, USA.
authors.forename: Cecile A
authors.initials: CA
authors.lastname: Lengacher
authors.affiliation: College of Nursing, University of South Florida, Tampa, Florida, USA.
authors.forename: Carissa B
authors.initials: CB
authors.lastname: Alinat
authors.affiliation: College of Nursing, University of South Florida, Tampa, Florida, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Kip
authors.affiliation: College of Nursing, University of South Florida, Tampa, Florida, USA.
authors.forename: Carly
authors.initials: C
authors.lastname: Paterson
authors.affiliation: College of Nursing, University of South Florida, Tampa, Florida, USA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Ramesar
authors.affiliation: Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Han
authors.affiliation: Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors.forename: Roohi
authors.initials: R
authors.lastname: Ismail-Khan
authors.affiliation: College of Nursing, University of Florida, Gainesville, Florida, USA.
authors.forename: Versie
authors.initials: V
authors.lastname: Johnson-Mallard
authors.affiliation: College of Nursing, University of South Florida, Tampa, Florida, USA.
authors.forename: Manolete
authors.initials: M
authors.lastname: Moscoso
authors.affiliation: Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA.
authors.forename: Pinky
authors.initials: P
authors.lastname: Budhrani-Shani
authors.affiliation: University of South Florida Breast Health Clinical and Research Integrated Strategic Program, Tampa, Florida, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Shivers
authors.affiliation: Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Cox
authors.affiliation: Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Jong
authors.initials: J
authors.lastname: Park
mesh_terms: D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology*; D003071:Cognition / Q000502:physiology; D005221:Fatigue / Q000523:psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome
keywords: Breast cancer; Mindfulness-Based Stress Reduction (MBSR); physical symptoms; post-treatment; psychological symptoms; symptom cluster