Behavioral interventions improve depression symptoms among young breast cancer survivors
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Two behavioral intervention programs appeared to effectively reduce depression symptoms among a cohort of young breast cancer survivors, according to study results presented at the virtual San Antonio Breast Cancer Symposium.
Of note, researchers observed significant sustained reductions in depression-related symptoms such as fatigue and sleep disturbance with the mindfulness meditation intervention program.
“Younger breast cancer survivors represent a vulnerable population with well-documented side effects from breast cancer treatments and notable increases in depressive symptoms,” Patricia A. Ganz, MD, oncologist at Jonsson Comprehensive Cancer Center of University of California, Los Angeles, said during a presentation. “These lasting effects of breast cancer treatment can have a negative impact on the quality of life of these patients during the survivorship period.”
Ganz and colleagues conducted the randomized, multi-institution phase 3 Pathways to Wellness study to test the efficacy of two behavioral intervention programs in reducing depression symptoms among 247 survivors of early-stage breast cancer.
Researchers randomly assigned the women 1:1:1 to either a 6-week mindfulness meditation intervention group (n = 85; mean age, 44.5 years; 88% white), a survivorship education intervention group (n = 81; mean age, 45.8 years; 73% white) or a concurrent wait list control group (n = 81; mean age, 45.9 years; 82% white).
The mindfulness meditation intervention, led by formally trained instructors, included content on skill-building across six group sessions, as well as homework assignments. For the survivorship education intervention, participants were provided with a printed curriculum and annotated slides developed by study investigators that covered topics deemed relevant to young breast cancer survivors. The curriculum was delivered during 2-hour sessions led by oncology nurses, with ample time for questions and discussion among the group members, according to Ganz.
Eligible participants did not have metastatic disease and were not practicing meditation prior to the study. All had completed cancer treatment within 6 months to 5 years before study enrollment and endorsed at least mild depressive symptoms on the Patient Health Questionnaire depression scale. Follow-up assessments were conducted at baseline, after the intervention period, and at 3 months and 6 months after intervention.
Researchers gathered data on weight and height and assessed plasma for inflammatory markers at each follow-up visit. Symptoms of depression after the interventions, as measured by the Center for Epidemiologic Studies Depression (CES-D) scale, served as the primary outcome. Secondary outcomes included anxiety, fatigue, sleep disturbance and hot flashes.
Overall, 87% of participants completed the post-intervention assessment questionnaire. Eighteen women were excluded from the final analysis due to cancer recurrence or study withdrawal. The 6-month assessment included 83% of study participants.
Overall, study participants had high levels of depression, anxiety, fatigue, sleep disturbance and other symptoms at a mean 2.6 years after breast cancer diagnosis.
Results showed mindfulness meditation was associated with a significant decrease in depression symptoms after the intervention and at 3-month and 6-month follow-up (P < .01 for all) compared with the control group. The survivorship education intervention was associated with a significant decrease in CES-D scale after the intervention and at the 3-month follow-up (P < .01 for both).
Compared with controls, researchers observed a post-intervention decrease in anxiety in both intervention groups (P < .05 for both). However, this effect did not persist through follow-up, Ganz noted.
The mindfulness meditation intervention led to a significant decrease in fatigue severity, sleep disturbance and hot flashes, which persisted through the 6-month follow-up (P < .05 for all).
“Both interventions significantly reduced depression symptoms in the immediate post-treatment period compared with the control group. However, the mindfulness meditation participants had sustained significant reductions in depression symptoms,” Ganz said. “In addition, both interventions significantly reduced anxiety post-intervention, but this was not sustained. Further dissemination and evaluation of these interventions is warranted to address the unmet psychosocial needs of young breast cancer survivors. ... These women were 2.5 years out from their breast cancer diagnoses in well-resourced, urban environments, and were still suffering with depression. We need to screen for this and we need to provide some type of intervention.”
Perspective
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Kelly Yap, MD
This is unquestionably an important area of research. Younger women with breast cancer often have higher levels of distress than older women with breast cancer. The long-term psychological and physical ramifications of distress in this patient population, who will likely survive for many decades after their cancer diagnosis and treatment, can be phenomenal.
This study has shown the benefits of mindfulness and survivorship education. Unfortunately, there is a hint that the benefits may not be sustained. Longer follow-up is important. Perhaps a refresher course may be helpful.
One of the major challenges of disseminating these benefits is access. The rapid adoption of telemedicine due to the COVID-19 pandemic may lead the way to bringing the benefits of mindfulness and survivorship education to patients via virtual platforms. Another possible challenge would be cost, which hopefully can be mitigated if these interventions are reimbursable by insurance.
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Ganz P, et al. Abstract GS2-10. Presented at: San Antonio Breast Cancer Symposium (virtual meeting); Dec. 8-11, 2020.
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