title: Mindfulness-Based Cognitive Therapy in Advanced Prostate Cancer: A Randomized Controlled Trial.
abstract: Purpose Advanced prostate cancer (PC) is associated with substantial psychosocial morbidity. We sought to determine whether mindfulness-based cognitive therapy (MBCT) reduces distress in men with advanced PC. Methods Men with advanced PC (proven metastatic and/or castration-resistant biochemical progression) were randomly assigned to an 8-week, group-based MBCT intervention delivered by telephone (n = 94) or to minimally enhanced usual care (n = 95). Primary intervention outcomes were psychological distress, cancer-specific distress, and prostate-specific antigen anxiety. Mindfulness skills were assessed as potential mediators of effect. Participants were assessed at baseline and were followed up at 3, 6, and 9 months. Main statistical analyses were conducted on the basis of intention to treat. Results Fourteen MBCT groups were conducted in the intervention arm. Facilitator adherence ratings were high (> 93%). Using random-effects mixed-regression models, intention-to-treat analyses indicated no significant changes in intervention outcomes or in engagement with mindfulness for men in MBCT compared with those receiving minimally enhanced usual care. Per-protocol analyses also found no differences between arms in outcomes or engagement, with the exception of the mindfulness skill of observing, which increased over time for men in MBCT compared with usual care ( P = .032). Conclusion MBCT in this format was not more effective than minimally enhanced usual care in reducing distress in men with advanced PC. Future intervention research for these men should consider approaches that map more closely to masculinity.
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Chambers
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Stefano
authors.initials: S
authors.lastname: Occhipinti
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Foley
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Clutton
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Legg
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Martin
authors.initials: M
authors.lastname: Berry
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Stockler
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Mark
authors.initials: M
authors.lastname: Frydenberg
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gardiner
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lepore
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Davis
authors.affiliation: Suzanne K. Chambers, Stefano Occhipinti, Melissa Legg, and David P. Smith, Griffith University, Gold Coast; Suzanne K. Chambers, Samantha Clutton, Melissa Legg, Cancer Council Queensland; Robert A. Gardiner, University of Queensland, Brisbane; Suzanne K. Chambers, University of Southern Queensland, Toowoomba, Queensland; Suzanne K. Chambers, Prostate Cancer Foundation of Australia; Suzanne K. Chambers, Stefano Occhipinti, Samantha Clutton, Melissa Legg, Martin Berry, Martin R. Stockler, Mark Frydenberg, Robert A. Gardiner, Ian D. Davis, and David P. Smith, Australian and New Zealand Urogenital and Prostate Cancer Trials Group; Elizabeth Foley, Mind Potential; Martin R. Stockler, and David P. Smith, University of Sydney; David P. Smith, Cancer Council New South Wales, Sydney; Martin Berry, Central Coast Cancer Centre, Gosford; Martin R. Stockler, Concord Repatriation General Hospital, Concord, New South Wales; Suzanne K. Chambers, Robert A. Gardiner, Edith Cowan University, Perth, Western Australia; Mark Frydenberg, Monash Health; Mark Frydenberg, Ian D. Davis, Monash University; Ian D. Davis, Eastern Health, Melbourne, Victoria, Australia; and Stephen J. Lepore, Temple University, Philadelphia, PA.
authors.forename: David P
authors.initials: DP
authors.lastname: Smith
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D017281:Cost of Illness; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D064866:Mindfulness; D010353:Patient Education as Topic; D064129:Prostatic Neoplasms, Castration-Resistant / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D011615:Psychotherapy, Group; D011788:Quality of Life; D019114:Remote Consultation; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome