Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors

Johns, Shelley A.; Brown, Linda F.; Beck‐Coon, Kathleen; Monahan, Patrick O.; Tong, Yan; Kroenke, Kurt

doi:10.1002/pon.3648

Cited by 162Cancer survivorship and careMindfulness and Compassion InterventionsCancer-related cognitive impairment studies

Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors

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Johns, Shelley A., Brown, Linda F., Beck‐Coon, Kathleen, Monahan, Patrick O., Tong, Yan, Kroenke, Kurt·2015·Psycho-Oncology

DOI 10.1002/pon.3648PMC PMC4331267

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Abstract

Objective: Cancer‐related fatigue (CRF) is one of the most common, persistent, and disabling symptoms associated with cancer and its treatment. Evidence‐based treatments that are acceptable to patients are critically needed. This study examined the efficacy of mindfulness‐based stress reduction (MBSR) for CRF and related symptoms. Method: A sample of 35 cancer survivors with clinically significant CRF was randomly assigned to a 7‐week MBSR‐based intervention or wait‐list control group. The intervention group received training in mindfulness meditation, yoga, and self‐regulatory responses to stress. Fatigue interference (primary outcome) and a variety of secondary outcomes (e.g., fatigue severity, vitality, disability, depression, anxiety, and sleep disturbance) were assessed at baseline, post‐intervention, and 1‐month follow‐up. Bonferroni correction was employed to account for multiple comparisons. Controls received the intervention after the 1‐month follow‐up. Participants in both groups were followed for 6 months after completing their respective MBSR courses to assess maintenance of effects. Results: Compared to controls, the MBSR group reported large post‐intervention reductions as assessed by effect sizes (d) in the primary outcome, fatigue interference (d = −1.43, p < 0.001), along with fatigue severity (d = −1.55, p < 0.001), vitality (d = 1.29, p < 0.001), depression (d = −1.30, p < 0.001), and sleep disturbance (d = −0.74, p = 0.001). Results were maintained or strengthened at 1‐month follow‐up, the point at which significant improvements in disability (d = −1.22, p < 0.002) and anxiety (d = −0.98, p = 0.002) occurred. Improvements in all outcomes were maintained 6 months after completing the course. MBSR adherence was high, with 90% attendance across groups and high rates of participant‐reported home practice of mindfulness. Conclusions: Mindfulness‐based stress reduction is a promising treatment for CRF and associated symptoms. Copyright © 2014 John Wiley & Sons, Ltd.

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Mindfulness practice has demonstrated improvements in uncertainty intolerance, fatigue, and sleep disturbance in other cancer patient samples.
“Mindfulness practice has demonstrated improvements in these areas in other cancer patient samples,19,42,43”
From Implementation Readiness and Initial Effects of a Brief Mindfulness Audio Intervention Compared With a Brief Music Control During Daily Radiation Therapy for Prostate Cancer: A Randomized Pilot Study. (2024) · cites this paper as [19]
The Results and Discussion report improvements in fatigue and sleep disturbance among persistently fatigued cancer survivors receiving mindfulness-based stress reduction. The paper does not report an outcome for intolerance of uncertainty, so it does not support that part of the attributed claim. No page numbers are available in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Among individuals with cancer, mindfulness-based interventions have been shown to improve depression, anxiety, fatigue, sleep, and overall physical functioning in randomized trials.
“Among individuals with cancer, mindfulness-based interventions have been shown to improve depression, anxiety, fatigue, sleep, and overall physical functioning in randomized trials [15, 23, 24]”
From Mindfulness, Experiential Avoidance, and Recovery From Hematopoietic Stem Cell Transplantation. (2019) · cites this paper as [23]
The Abstract Results report improvements in fatigue, depression, sleep disturbance, and, at one-month follow-up, anxiety and disability in a randomized trial. But the Methods define disability as interference with work, family, and social life, not a direct measure of physical functioning. The trial also enrolled cancer survivors with clinically significant fatigue, rather than individuals with cancer generally. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Pilot studies suggest that interventions with similar components to ACT, such as MBSR, may reduce fatigue interference and severity in post-treatment cancer survivors with persistent fatigue.
“results of pilot studies suggest that interventions with similar components to ACT, such as mindfulness-based stress reduction (MBSR), may reduce fatigue interference and severity in post-treatment cancer survivors with persistent fatigue [43,44].”
From Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial (2018) · cites this paper as [43]
A growing body of evidence supports the benefits of mindfulness as an effective treatment to improve mood and decrease symptoms of sleep disturbance and fatigue in cancer patients.
“A growing body of evidence supports the benefits of mindfulness as an effective treatment to improve mood and decrease symptoms of sleep disturbance and fatigue in cancer patients.12-19”
From Implementation Readiness and Initial Effects of a Brief Mindfulness Audio Intervention Compared With a Brief Music Control During Daily Radiation Therapy for Prostate Cancer: A Randomized Pilot Study. (2024) · cites this paper as [19]
An accepting, flexible approach to one's experience reduces distress and improves functioning and well-being.
“This accepting, flexible approach to one's experience has been found to reduce distress and improve functioning and well-being [21-24]”
From Mindfulness, Experiential Avoidance, and Recovery From Hematopoietic Stem Cell Transplantation. (2019) · cites this paper as [23]

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The Effect of Mind-Body Therapies on Insomnia: A Systematic Review and Meta-Analysis
Wang, X., Li, P., Pan, C., Dai, L.-S., Wu, Y., & Deng, Y. (2019) · Evidence-Based Complementary and Alternative Medicine · doi:10.1155/2019/9359807 · Cited by 77 · see citing works
“For patients whose insomnia is comorbid with physical diseases, MBTs might also be the adjuvant treatments [52].”
BackgroundResult
Comparing the Effects of Mindfulness-Based Cognitive Therapy and Sleep Psycho-Education with Exercise on Chronic Insomnia: A Randomised Controlled Trial
Wong, S. Y. S., Zhang, D., Chi-kwan, C. L., Yip, B. H. K., Chan, D. C.-C., Ling, Y.-M., Lo, C. S. L., Woo, D. M.-S., Sun, Y., Ma, H., et al. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000470847 · Cited by 76 · see citing works
Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients
Braden, B. B., Pipe, T. B., Smith, R., Glaspy, T. K., Deatherage, B. R., & Baxter, L. C. (2016) · Brain and Behavior · doi:10.1002/brb3.443 · Cited by 69 · see citing works
“2012), cancer (Lengacher et al. 2009; Johns et al. 2015), neurosurgery (Joo et al.”
Influential
Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials
Huberty, J., Eckert, R., Larkey, L., Kurka, J., Rodríguez De Jesús, S. A., Yoo, W., & Mesa, R. (2019) · JMIR Formative Research · doi:10.2196/12662 · Cited by 67 · see citing works
“Extensive research in recent decades demonstrates the benefits of mindfulness-based therapies for alleviating fatigue, anxiety, depression, and sleep disturbance in both cancer and noncancer populations [11-16].”
Web-based individual Mindfulness-Based Cognitive Therapy for cancer-related fatigue — A pilot study
Bruggeman-Everts, F. Z., van der Lee, M. L., & Meezenbroek, E. D. J. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.03.004 · Cited by 60 · see citing works
Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis
Ni, Y., Ma, L., & Li, J. (2021) · Journal of Diabetes Investigation · doi:10.1111/jdi.13439 · Cited by 59 · see citing works
Effects of a mindfulness‐based intervention on cancer‐related cognitive impairment: Results of a randomized controlled functional magnetic resonance imaging pilot study
der Gucht, K. V., Ahmadoun, S., Melis, M., de Cloe, E., Sleurs, C., Radwan, A., Blommaert, J., Takano, K., Vandenbulcke, M., Wildiers, H. P. M. W., et al. (2020) · Cancer · doi:10.1002/cncr.33074 · Cited by 57 · see citing works
The Quest for Mindful Sleep: a Critical Synthesis of the Impact of Mindfulness-Based Interventions for Insomnia
Garland, S. N., Zhou, E. S., Gonzalez, B. D., & Rodriguez, N. (2016) · Current Sleep Medicine Reports · doi:10.1007/s40675-016-0050-3 · Cited by 57 · see citing works
The mindfulness-based stress reduction program for improving sleep quality in cancer survivors: A systematic review and meta-analysis
Suh, H.-W., Jeong, H. Y., Hong, S., Kim, J. W., Yoon, S. W., Lee, J. Y., & Chung, S.-Y. (2021) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2021.102667 · Cited by 57 · see citing works
Yoga into Cancer Care
Agarwal, R. P., & Maroko-Afek, A. (2018) · International Journal of Yoga · doi:10.4103/ijoy.ijoy_42_17 · Cited by 57 · see citing works
Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques
Mehta, R., Sharma, K., Potters, L., Wernicke, A. G., & Parashar, B. (2019) · Cureus · doi:10.7759/cureus.4629 · Cited by 55 · see citing works
Integrating mindfulness in supportive cancer care: a cohort study on a mindfulness-based day care clinic for cancer survivors
Dobos, G., Overhamm, T., Büssing, A., Ostermann, T., Langhorst, J., Kümmel, S., Paul, A., & Cramer, H. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-015-2660-6 · Cited by 54 · see citing works
Yoga for the Management of Cancer Treatment-Related Toxicities
Lin, P., Peppone, L. J., Janelsins, M. C., Mohile, S. G., Kamen, C. S., Kleckner, I. R., Fung, C., Asare, M., Cole, C. L., Culakova, E., et al. (2018) · Current Oncology Reports · doi:10.1007/s11912-018-0657-2 · Cited by 54 · see citing works
The Impact of Yoga on Fatigue in Cancer Survivorship: A Meta-Analysis
Armer, J. S., & Lutgendorf, S. K. (2020) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkz098 · Cited by 54 · see citing works
Integrating Function‐Directed Treatments into Palliative Care
Cheville, A. L., Morrow, M. M. B., Smith, S. R., & Basford, J. R. (2017) · PM&R · doi:10.1016/j.pmrj.2017.07.073 · Cited by 54 · see citing works
“More specifically, a 42-patient pilot study of a fatigue-directed intervention leveraged extensive prior work and assessed the benefits of administering a behavioral intervention that integrated resistive and aerobic exercisewith mindfulness-based cognitive rehabilitation over 8 one-toone telephonic sessions to patien…”
Effects of Mindfulness-Based Therapy for Cancer Patients: A Systematic Review and Meta-analysis
Lin, L., Lin, L., Tzeng, G.-L., Huang, Y.-H., Tai, J.-F., Chen, Y., Wu, C.-J., Chen, P.-H., Lin, P., & Hung, P. (2022) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-022-09862-z · Cited by 52 · see citing works
Effects of mindfulness-based interventions on fatigue in cancer survivors: A systematic review and meta-analysis of randomized controlled trials
Johns, S. A., Tarver, W. L., Secinti, E., Mosher, C. E., Stutz, P. V., Carnahan, J. L., Talib, T. L., Shanahan, M. L., Faidley, M. T., Kidwell, K. M., et al. (2021) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2021.103290 · Cited by 48 · see citing works
Self-citation
Self-management support for cancer-related fatigue: A systematic review
Agbejule, O. A., Hart, N. H., Ekberg, S., Crichton, M., & Chan, R. J. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104206 · Cited by 48 · see citing works
Mindfulness Training Supports Quality of Life and Advance Care Planning in Adults With Metastatic Cancer and Their Caregivers: Results of a Pilot Study
Johns, S. A., Beck-Coon, K., Stutz, P. V., Talib, T. L., Chinh, K., Cottingham, A. H., Schmidt, K., Shields, C., Stout, M. E., Stump, T. E., et al. (2020) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909119862254 · Cited by 42 · see citing works
Self-citation
Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature
Park, S.-Y., & Lim, J.-W. (2022) · BMC Cancer · doi:10.1186/s12885-021-08909-y · Cited by 53 · see citing works
Investigating the Effect of Mindfulness-Based Training on Psychological Status and Quality of Life in Patients with Breast Cancer
Pouy, S., Peikani, F. A., Nourmohammadi, H., Sanei, P., Tarjoman, A., & Borji, M. (2018) · Europe PMC (PubMed Central) · doi:10.22034/apjcp.2018.19.7.1993 · Cited by 43 · see citing works
Meta-Analysis of Randomized Controlled Trials on Yoga, Psychosocial, and Mindfulness-Based Interventions for Cancer-Related Fatigue: What Intervention Characteristics Are Related to Higher Efficacy?
Haussmann, A., Schmidt, M. E., Illmann, M., Schröter, M., Hielscher, T., Cramer, H., Maatouk, I., Horneber, M., & Steindorf, K. (2022) · Cancers · doi:10.3390/cancers14082016 · Cited by 46 · see citing works
Mindfulness-based stress reduction for breast cancer survivors (MBSR(BC)): evaluating mediators of psychological and physical outcomes in a large randomized controlled trial
Lengacher, C. A., Gruss, L. F., Kip, K. E., Reich, R. R., Chauca, K. G., Moscoso, M. S., Joshi, A., Tinsley, S., Shani, B., Cousin, L., et al. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-021-00214-0 · Cited by 40 · see citing works
Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants’ Adherence to Home Practice
Baydoun, M., Moran, C., McLennan, A., Piedalue, K.-A. L., Oberoi, D. V., & Carlson, L. E. (2021) · Patient Preference and Adherence · doi:10.2147/ppa.s267064 · Cited by 38 · see citing works
Comprehensive Lifestyle Modification Intervention to Improve Chronic Disease Risk Factors and Quality of Life in Cancer Survivors
Golubić, M., Schneeberger, D. L., Kirkpatrick, K., Bar, J., Bernstein, A., Weems, F., Ehrman, J. P., Perko, J., Doyle, J., & Roizen, M. F. (2018) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2018.0193 · Cited by 38 · see citing works
Efeito da meditação no nível de estresse psicológico de mulheres com neoplasia mamária: revisão sistemática
Araújo, R. V., Fernandes, A. F. C., Nery, I. S., Andrade, E. M. L. R., Nogueira, L. T., & Azevedo, F. H. C. (2019) · Revista da Escola de Enfermagem da USP · doi:10.1590/s1980-220x2018031303529 · Cited by 36 · see citing works
Efficacy of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy for Anxiety, Depression, and Fatigue in Cancer Patients: A Randomized Clinical Trial
Sheikhzadeh, M., Zanjani, Z., & Baari, A. (2021) · Iranian Journal of Psychiatry · doi:10.18502/ijps.v16i3.6252 · Cited by 34 · see citing works
Cancer, sleep problems, and mind‐body medicine use: Results of the 2017 National Health Interview Survey
Voiß, P., Höxtermann, M. D., Dobos, G. J., & Cramer, H. (2019) · Cancer · doi:10.1002/cncr.32469 · Cited by 35 · see citing works
The project ENABLE Cornerstone randomized pilot trial: Protocol for lay navigator-led early palliative care for African-American and rural advanced cancer family caregivers
Hendricks, B. A., Lofton, C., Azuero, A., Kenny, M., Taylor, R. A., Huang, C.-H. S., Rocque, G. B., Williams, G. R., Dosse, C., Louis, K., et al. (2019) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2019.100485 · Cited by 34 · see citing works
“Consistent with other pilot intervention studies [44,45], �80% completion rates for intervention sessions and study assessments are being considered as evidence of feasibility.”
Result
Symptoms: Fatigue and Cognitive Dysfunction
Bower, J. E., & Ganz, P. A. (2015) · Advances in experimental medicine and biology · doi:10.1007/978-3-319-16366-6_5 · Cited by 33 · see citing works
Mindfulness, Experiential Avoidance, and Recovery From Hematopoietic Stem Cell Transplantation.
Larson, A. G., Morris, K. J., Juckett, M. B., Coe, C. L., Broman, A. T., & Costanzo, E. S. (2019) · Annals of Behavioral Medicine · doi:10.1093/abm/kay097 · Cited by 27 · see citing works
“Among individuals with cancer, mindfulness-based interventions have been shown to improve depression, anxiety, fatigue, sleep, and overall physical functioning in randomized trials [15, 23, 24].”
Background
Symptom burden and integrative medicine in cancer survivorship
Cutshall, S. M., Cha, S. S., Ness, S. M., Stan, D. L., Christensen, S. A., Bhagra, A., Price, K. A. R., Thompson, C. A., Hashmi, S. K., Chon, T. Y., et al. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-015-2666-0 · Cited by 31 · see citing works
Using mindfulness-based stress reduction to relieve loneliness, anxiety, and depression in cancer patients: A systematic review and meta-analysis
Yu, J., Han, M., Miao, F., & Hua, D. (2023) · Medicine · doi:10.1097/md.0000000000034917 · Cited by 34 · see citing works
“[19,21] Ten studies included patients with breast cancer only,[17–20,22,30,32–35,38] one included patients with thyroid cancer only,[21] and the remaining studies included patients with various types of cancers.[23,31,36,37] Patients with stage I–II, I–III, and I–IV cancers were included in 1,[32] 8,[18–20,33–35,37,38…”
Background
Effectiveness of therapy group in women with localized breast cancer
Pérez, A. B., Peris-Juan, C., & Santaballa, A. (2019) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2019.02.001 · Cited by 31 · see citing works
Effects of Internet Training in Mindfulness Meditation on Variables Related to Cancer Recovery
Messer, D. W., Horan, J. J., Larkey, L., & Shanholtz, C. E. (2019) · Mindfulness · doi:10.1007/s12671-019-01182-y · Cited by 29 · see citing works
“…(Piet, Wurtzen, & Zachariae, 2012), sleep disturbance (Lengacher et al., 2015; Shapiro, Bootzin, Fiueredo, Lopez, & Schwartz, 2003), fatigue (Johns et al., 2015; Speca, Carlson, Goodey & Angen, 2000), and physical complaints (Monti et al., 2006), and enhanced quality of life (Musial,…”
A mindfulness-based intervention for breast cancer patients with cognitive impairment after chemotherapy: study protocol of a three-group randomized controlled trial
der Gucht, K. V., Melis, M., Ahmadoun, S., Gebruers, A., Smeets, A., Vandenbulcke, M., Wildiers, H. P. M. W., Neven, P., Kuppens, P., Raes, F., et al. (2020) · Trials · doi:10.1186/s13063-020-4204-8 · Cited by 27 · see citing works
Nonpharmacological interventions for cancer-related fatigue: A comprehensive literature review
Zuo, S., Cheng, H., Wang, Z., Liu, T., Chen, S., Li, T., & Lü, L. (2023) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2023.100230 · Cited by 25 · see citing works
Mind over Malignancy: A Systematic Review and Meta-Analysis of Psychological Distress, Coping, and Therapeutic Interventions in Oncology
Pâslaru, A. M., Pleșea-Condratovici, A., Moroianu, L.-A., Isailă, O.-M., Rebegea, L. F., Pavel, L. L., & Ciubară, A. (2025) · Medicina · doi:10.3390/medicina61061086 · Cited by 29 · see citing works
“The studies targeted a wide range of cancer populations: Acute Myeloid Leukemia (AML) [46], Breast [41,49,64,66,68,77–79], Cervical [73], Colorectal [58], Endometrial [70], Esophageal [59], Gastric [74], Gynecological [41], Head and Neck [50], Leukemia [44,45], Lung [47,75], Melanoma [66], Prostate…”
African-American Cancer Survivors’ Use of Religious Beliefs to Positively Influence the Utilization of Cancer Care
Hamilton, J. B., Galbraith, K. V., Best, N. C., Worthy, V., & Moore, L. (2014) · Journal of Religion and Health · doi:10.1007/s10943-014-9948-6 · Cited by 23 · see citing works
“…and complementary therapies such as yoga and mindfulness-based stress reduction for the relief of symptoms associated with cancer and cancer treatment (Johns et al. 2014; Taso et al. 2014) and the benefit of secular music to the burden of disease (Burrai et al. 2014; Pauwels et al. 2014).”
Background
Functional Disability Among Older Versus Younger Adults With Advanced Non–Small-Cell Lung Cancer
Presley, C. J., Arrato, N. A., Janse, S., Shields, P. G., Carbone, D. P., Wong, M. L., Han, L., Gill, T. M., Allore, H. G., & Andersen, B. L. (2021) · JCO Oncology Practice · doi:10.1200/op.20.01004 · Cited by 23 · see citing works
“Importantly, psychologic symptoms are modifiable risk factors for which interventions exist, which could improve resiliency and prevent functional decline for patients with cancer.(42) Depression is the world’s leading cause of disability, yet depression, anxiety, and stress are often underrecognized and undertreated…”
Background
The effect of a single session of 30-min mindful breathing in reducing fatigue among patients with haematological cancer – a randomised controlled trial
Ng, D., Gan, G., Anuar, N. A., Tung, Y., Lai, N.-Z., Tan, Y., Said, S., Madihie, A., Chai, C., & Tan, S. (2021) · BMC Palliative Care · doi:10.1186/s12904-021-00855-7 · Cited by 16 · see citing works
Mind-Body Therapies for Sleep Disturbance among Patients with Cancer: A Systematic Review and Meta-analysis.
Han, J., Cheng, H.-L., Bi, L., & Molasiotis, A. (2023) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2023.102954 · Cited by 16 · see citing works
Being mindful of mindfulness interventions in cancer: A systematic review of intervention reporting and study methodology
Shaw, J. M., Sekelja, N., Frasca, D., Dhillon, H. M., & Price, M. A. (2018) · Psycho-Oncology · doi:10.1002/pon.4651 · Cited by 20 · see citing works
Effects of mindfulness-based stress reduction on adults with sleep disturbance: an updated systematic review and meta-analysis
Kim, S. M., Park, J. M., Seo, H., Kim, J., Noh, J., & Kim, H. L. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058032 · Cited by 19 · see citing works
Improving Psychosocial Functioning in Mastectomized Women Through a Mindfulness-Based Program: Flow Meditation.
Franco, C., Amutio, A., Mañas, I., Sánchez-Sánchez, L. C., & Mateos-Pérez, E. (2020) · International Journal of Stress Management · doi:10.1037/str0000120 · Cited by 18 · see citing works
Mindfulness Ased Stress Reduction Interventions for Cancer Related Fatigue: A Meta-Analysis and Systematic Review
He, J., Hou, J.-H., Qi, J., Zhang, T., Wang, Y., & Qian, M. (2020) · Journal of the National Medical Association · doi:10.1016/j.jnma.2020.04.006 · Cited by 18 · see citing works
The effect of interpersonal psychotherapy on quality of life among breast cancer patients with common mental health disorder: a randomized control trial at Tikur Anbessa Specialized Hospital
Belay, W., Kaba, M., Labisso, W. L., Wondemagegnehu, T., Sahile, Z., Zergaw, A., Ejigu, A., Baheretibeb, Y., Gufue, Z. H., & Haileselassie, W. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06508-y · Cited by 17 · see citing works
Comparison of Two Types of Meditation on Patients' Psychosocial Responses During Radiation Therapy for Head and Neck Cancer
Boxleitner, G., Jolie, S., Shaffer, D. C., Pasacreta, N., Bai, M., & McCorkle, R. C. (2017) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2016.0214 · Cited by 16 · see citing works
“15 Similar improvements in anxiety, depression, fatigue, and quality of life have occurred in women with breast cancer undergoing radiation therapy who participate in mindfulness meditation.”
Feasibility and Acceptability of Mindfulness-Based Group Visits for Smoking Cessation in Low-Socioeconomic Status and Minority Smokers with Cancer
Charlot, M., D'Amico, S., Luo, M., Gemei, A., Kathuria, H., & Gardiner, P. M. (2019) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2019.0016 · Cited by 16 · see citing works
The Effects of Upper Limb Exercise Through Yoga on Limb Swelling in Chinese Breast Cancer Survivors – A Pilot Study
Lai, Y., Hsieh, C. C., Huang, L.-S., Liu, W., Lin, S.-H., Wang, L.-L., Chen, S.-F., & Lin, C. (2015) · Rehabilitation Nursing · doi:10.1002/rnj.217 · Cited by 15 · see citing works
Genomic Variants Associated With Cancer-Related Fatigue: A Systematic Review
Tariman, J. D., & Dhorajiwala, S. (2016) · Clinical journal of oncology nursing · doi:10.1188/16.cjon.537-546 · Cited by 15 · see citing works
Integrative Medical Care Plus Mindfulness Training for Patients With Congestive Heart Failure: Proof of Concept
Kemper, K. J., Carmin, C., Mehta, B., & Binkley, P. (2016) · Journal of Evidence-Based Complementary & Alternative Medicine · doi:10.1177/2156587215599470 · Cited by 14 · see citing works
“Enhanced self-efficacy and group support could contribute to increased adherence with behavioral and medication recommendations, leading to improvements in symptoms and overall satisfaction with life.(43) Group medical visits offer an intriguing opportunity to deliver comprehensive cardiac rehabilitation training incl…”
Background
Comparative responsiveness and minimally important difference of fatigue symptom inventory (FSI) scales and the FSI-3 in trials with cancer survivors
Mosher, C. E., Secinti, E., Johns, S. A., Kroenke, K., & Rogers, L. Q. (2022) · Journal of Patient-Reported Outcomes · doi:10.1186/s41687-022-00488-1 · Cited by 14 · see citing works
Self-citation
A Mindfulness-Based Stress Reduction Program via Group Video Conferencing for Adults With Cerebral Palsy – A Pilot Study
Høye, H., Jahnsen, R. B., Løvstad, M., Hartveit, J. F., Sørli, H., Tornås, S., & Månum, G. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00195 · Cited by 14 · see citing works
“Studies of mindfulness-based interventions in patient groups such as cancer, fibromyalgia, irritable bowel syndrome, and osteoarthritis patients, have shown that the approach can positively influence symptoms, including pain (23–26), fatigue (27, 28), depression, negative affect, and anxiety (29, 30).”
Background
Psychosocial Interventions for the Treatment of Cancer-Related Fatigue: An Umbrella Review
Cedenilla, N., Arenillas, J. I. C., Valero, S. A., Guzmán, A. S., & Miralles, P. M. (2023) · Current Oncology · doi:10.3390/curroncol30030226 · Cited by 13 · see citing works
“• ⊕⊕ Low Cao 2016 U U U U L L L B Tang 2018 U U U U L L L B Johns 2015 L L L L L L L A Johns 2016 L L L L L L L A Lengacher 2016 L U U U L L L B Goedendorp, M.M., et al. [51] Internal validity (vanTulder,97).”
Background
Renewed: Protocol for a randomised controlled trial of a digital intervention to support quality of life in cancer survivors
Krusche, A., Bradbury, K. J., Corbett, T. K., Barnett, J., Stuart, B. L., Yao, G., Bacon, R., Böhning, D., Cheetham‐Blake, T. J., Eccles, D., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-024862 · Cited by 13 · see citing works
“Mindfulness-based interventions also effectively reduce cancer-related fatigue.(26) 27”
Background
The Effect of Meditation-Based Interventions on Patients with Fatigue Symptoms: A Systematic Review and Meta-Analysis
Requier, F., Demnitz‐King, H., Whitfield, T. J., Klimecki, O., Marchant, N. L., & Collette, F. (2023) · Psychologica Belgica · doi:10.5334/pb.1182 · Cited by 12 · see citing works
Effect of cognitive behavior therapy integrated with mindfulness on perceived pain and pain self-efficacy in patients with breast cancer
Nejat, H., Mozafari-Motlagh, M. R., Toozandehjani, H., & Samari, A. (2019) · Journal of Nursing and Midwifery Sciences · doi:10.4103/jnms.jnms_60_18 · Cited by 12 · see citing works
Qualitative exploration of a targeted school‐based mindfulness course in England
McGeechan, G., Richardson, C., Wilson, L., Allan, K., & Newbury‐Birch, D. (2018) · Child and Adolescent Mental Health · doi:10.1111/camh.12288 · Cited by 11 · see citing works
Acceptance and commitment therapy effectiveness for fear of cancer recurrence: A systematic review and meta-analysis.
Yuyan, Y., Jiaqi, L., Ting, W., Juan, X., Jinfeng, W., & Jing, L. (2025) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2025.102862 · Cited by 11 · see citing works
Kanser Tanısı Olan Kişilerde Kabul ve Kararlılık Terapisi Uygulamaları: Sistematik Bir Derleme
Baş, S., & Dirik, G. (2019) · Psikoloji Çalışmaları / Studies in Psychology · doi:10.26650/sp2019-0025 · Cited by 10 · see citing works
Different exercise interventions on quality of sleep in breast cancer survivors—a network meta-analysis of randomized controlled trials
Song, Q., Zhu, Y.-K., Liu, H., Liu, X., Jiang, Z.-D., Wang, Y., Xue, L.-Y., Yang, S., & Liu, X.-F. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1419613 · Cited by 11 · see citing works
Factors Associated with Self-Regulatory Fatigue in Chinese Older Patients with Coronary Heart Disease: A Cross-Sectional Survey
Ji, X., & Yu, H. (2023) · Patient Preference and Adherence · doi:10.2147/ppa.s400996 · Cited by 10 · see citing works
Mindfulness-Based Stress Reduction for Coronary Artery Disease Patients: Potential Improvements in Mastery and Depressive Symptoms
Lundgren, O., Garvin, P., Nilsson, L. E., Tornerefelt, V., Andersson, G., Kristenson, M., & Jonasson, L. (2021) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-021-09822-z · Cited by 10 · see citing works
Islamic Mindfulness-Based Caring as an Intervention to Manage Fatigue
Komariah, M., Hatthakit, U., Boonyoung, N., Ibrahim, K., Susilaningsih, F. S., Mediani, ‎. S., Rahayuwati, L., Hermayanti, Y., Pahria, T., & Arifin, H. (2023) · Journal of Holistic Nursing · doi:10.1177/08980101231180363 · Cited by 11 · see citing works
“Based on the reviewed literature, mindfulness has been shown to alleviate fatigue with minimal costs and side effects, and its implementation is easy (Johns et al., 2015).”
Mindfulness-Based Interventions and Sleep Among Cancer Survivors: a Critical Analysis of Randomized Controlled Trials
Christodoulou, G., & Black, D. S. (2017) · Current Oncology Reports · doi:10.1007/s11912-017-0621-6 · Cited by 8 · see citing works
The impact of mindfulness intervention on negative emotions and quality of life in malignant tumor patients: a systematic review and meta-analysis
Li, Z., Lei, D.-C., Ting, L., Yao, R., Wu, J., & Na, M. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1443516 · Cited by 7 · see citing works
Efficacy of mind‐body therapies for sleep disturbance in patients with early‐stage cancer: A systematic review and network meta‐analysis
Han, J., Shi, M., Bi, L., Wang, L.-L., & Cai, Y.-X. (2023) · Psycho-Oncology · doi:10.1002/pon.6187 · Cited by 5 · see citing works
“Different outcome scales were used to evaluate SD; the most frequently used scales were the PSQI (n = 22) and ISI (n= 9).(39,40,42,46,58,65,66,75,80) Subscales of quality‐of‐life measures such as the EORTC‐QLQ‐C30 (n = 5) and PROMIS (n = 3)(67,70,73) were used to assess SD.”
Method
Neuropsychological correlates of subjective fatigue in non-demented older adults and the moderating effect of physical activity
Banerjee, N., Slugh, M., Kaur, S., Sun-Suslow, N., McInerney, K., Sun, X., & Levin, B. E. (2019) · Aging Neuropsychology and Cognition · doi:10.1080/13825585.2019.1606889 · Cited by 7 · see citing works
“Of note, several efficacious interventions for fatigue have been identified, including pharmacological (Malaguarnera et al., 2008), mindfulness-based (Johns et al., 2015), yoga and exercise programs, and future studies may seek to examine their potential benefits for healthy cognitive aging.”
Background
Mindfulness Interventions in Breast Cancer Survivors: Current Findings and Future Directions
Haydon, M., Boyle, C., & Bower, J. (2018) · Current Breast Cancer Reports · doi:10.1007/s12609-018-0263-1 · Cited by 7 · see citing works
The effectiveness of mindfulness alone compared to exercise and mindfulness on fatigue in women with gynaecology cancer (GEMS): Protocol for a randomised feasibility trial
McCloy, K., Hughes, C., Dunwoody, L., Marley, J., Cleland, I., Cruciani, F., Saunders, C., & Gracey, J. (2023) · PLoS ONE · doi:10.1371/journal.pone.0278252 · Cited by 6 · see citing works
“This will involve 8 weeks of home-based formal and informal mindfulness practice which will include body scan, sitting, walking, mountain and loving-kindness practice [27,28,71].”
Background
Psychological Processes and Symptom Outcomes in Mindfulness-Based Stress Reduction for Cancer Survivors: A Pilot Study
Chinh, K., Mosher, C. E., Brown, L. F., Beck‐Coon, K., Kroenke, K., & Johns, S. A. (2020) · Mindfulness · doi:10.1007/s12671-019-01299-0 · Cited by 6 · see citing works
Self-citation
The effectiveness of online mindfulness-based cancer recovery program on psychological Variables of colorectal and stomach cancer patients: A randomized control trial
Yousefi, A., Arani, A. M., Ghadiany, M., Jafari, M., Lighvan, M. A., Asanjarani, B., & Isfeedvajani, M. S. (2022) · Medical Science · doi:10.54905/disssi/v26i120/ms55e2021 · Cited by 6 · see citing works
“In a similar vein, John et al., (2015) reported improvements in objective sleep parameters (e.g., fewer waking bouts and more sleep times) in 78% of the mindfulness group cancer patients (Johns et al., 2015).”
BackgroundMethod
Implementation Readiness and Initial Effects of a Brief Mindfulness Audio Intervention Compared With a Brief Music Control During Daily Radiation Therapy for Prostate Cancer: A Randomized Pilot Study.
Victorson, D., Mishra, K. K., Sauer, J., Langford, G., Maletich, C., Horowitz, B., Sauer, C., Sejpal, S. V., & Kalapurakal, J. (2024) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130241249140 · Cited by 5 · see citing works
“7 12-19 Mindfulness is de ﬁ ned as a quality of present moment awareness and attentional control characterized by curiosity, openness and acceptance 20 that can engender greater cognitive, affective, and physiological ﬂ exibility and self-regulation.”
Background
Development of an eHealth Mindfulness-Based Music Therapy Intervention for Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: Qualitative Study
Fleszar‐Pavlović, S. E., Esquives, B. S. N., Lovan, P., Brito, A. E., Sia, A. M., Kauffman, M. A., Lopes, M., Moreno, P. I., Koru‐Sengul, T., Gong, R., et al. (2025) · JMIR Formative Research · doi:10.2196/65188 · Cited by 5 · see citing works
Multidimensional perspectives on cancer therapy-induced cardiotoxicity: Characteristics, mechanisms, biomarkers, psychological stress effects, and treatment progress
Chen, H.-Y., Zhang, L.-J., Liu, M.-Y., Li, Y.-W., & Rao, P.-J. (2025) · Cancer Pathogenesis and Therapy · doi:10.1016/j.cpt.2025.12.003 · Cited by 6 · see citing works
Effects of a Mind-Body Medicine Group Program for Cancer Patients: A Retrospective Cohort Study
Schricker, S., Breßmer, F., Alscher, M. D., Löffler, C., Cramer, H., & Winkler, M. (2025) · Integrative Cancer Therapies · doi:10.1177/15347354251378056 · Cited by 5 · see citing works
“9 Adapted programs like Mindfulness-Based Cancer Recovery (MBCR) 14 demonstrate positive effects on stress, depression, and anxiety in patients with cancer 6,7,9,15 as well as on fatigue, 16 sleep quality, 17 immune response, and inflammation markers.”
Tumor-Fatigue-Sprechstunde der Bayerischen Krebsgesellschaft e.V.
Fischer, I., Rüffer, J. U., Besseler, M., Bojko, P., Heußner, P., Koller, M. T., Milani, V., Riedner, C., Rinas, N., Schlimok, G., et al. (2017) · Forum · doi:10.1007/s12312-016-0206-6 · Cited by 5 · see citing works
COMPLEMENTARY AND ALTERNATIVE MEDICINE
Trabulsy, P. (2019) · Cancer · doi:10.1002/9781119645214.ch27
Mindfulness-based Interventions Across the Cancer Continuum in the United States: A Scoping Review
Emerson, B., Reddy, M., Reiter, P. L., Shoben, A. B., Klatt, M. D., Chakraborty, S., & Katz, M. L. (2024) · American Journal of Health Promotion · doi:10.1177/08901171241227316 · Cited by 4 · see citing works
“…mindfulness, trait mind-fulness measures included: Mindful Attention Awareness Scale, 16,20,21,36,39,41,42 Five Facet Mindfulness Questionnaire, 21,24,26,35,43 Multidimensional Assessment of Interoceptive Awareness, 40 Interpersonal Mindfulness Scale, 36 Self-Compassion Scale, 21 and The…”
Method
Effects of a Mindfulness Program on Stress and Psychological Outcomes Among Cancer Survivors: a Quasi-Experimental Study
Klainin‐Yobas, P., Chng, W. J., Ang, E. N. K., López, V., Arunoda, P. D., & Lau, Y. (2022) · Mindfulness · doi:10.1007/s12671-022-01852-4 · Cited by 4 · see citing works

Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors
Johns, S. A., Brown, L. F., Beck-Coon, K., Talib, T. L., Monahan, P. O., Giesler, R. B., Tong, Y., Wilhelm, L., Carpenter, J. S., Von Ah, D., et al. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3220-4 · Cited by 112 · see citing works
Self-citation
Can Mindfulness Based Stress Reduction Meditation Affect Cancer-Related Fatigue?
Poure, P., & Nusinow, N. (2014) · Digital Commons @ Butler University (Butler University)
Mindfulness-based stress reduction can alleviate cancer- related fatigue: A meta-analysis
Xie, C., Dong, B., Wang, L., Jing, X., Wu, Y., Lin, L., & Tian, L. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.109916 · Cited by 84 · see citing works
Improvement of Cancer Related Fatigue in Breast and Colorectal Cancer Patients Taking Part in Mindfulness Based Stress Reduction Training Program
Gharagazloo, N. A., Booger, I. R., Asadi, J., & Vojdani, R. (2019) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 2 · see citing works
Psychological processes and symptom outcomes in cancer survivors following a mindfulness-based stress reduction intervention
Chinh, K. (2017) · Purdue e-Pubs (Purdue University System) · doi:10.7912/c20942

Authors: Johns, S. A., Brown, L. F., Beck‐Coon, K., Monahan, P. O., Tong, Y., & Kroenke, K.
Affiliations: Regenstrief Institute (US)
Indiana University School of Medicine (US)
Indiana University Indianapolis (US)
Corresponding author: Johns, Shelley A.
ORCID: Johns, Shelley A.
Monahan, Patrick O.
Tong, Yan
Kroenke, Kurt
Venue: Psycho-Oncology
Publisher: Wiley
Published: 2014-08-17
Volume: 24
Issue: 8
Pages: 885-893
ISSN: 1057-9249 (ISSN-L)
1099-1611
DOI: 10.1002/pon.3648
PMC: PMC4331267
OpenAlex: W1575958965
Semantic Scholar: 4acaf9b8dae82b6526f200b6a6be5b0fe06a95f8
Cited by: 161
References: 39
Citations by year: 2026: 5 · 2025: 17 · 2024: 9 · 2023: 12 · 2022: 13 · 2021: 14 · 2020: 10 · 2019: 24 · 2018: 20 · 2017: 12 · 2016: 13 · 2015: 11 · 2014: 1
FWCI: 5.96
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Psycho-Oncology (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
IUScholarWorks (Indiana University) (submittedVersion)
Funders: Walther Cancer Foundation (0079.01)
National Cancer Institute (R25 CA 117865-01A11)
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
Keywords: mindfulness-based stress reduction, cancer-related fatigue, cancer survivors, fatigue interference, fatigue severity, vitality, depression, anxiety, sleep disorders, disability, yoga, mindfulness meditation, maintenance of treatment effects
MeSH terms: Aged, Anxiety, Depression, Fatigue, Female, Persons with Disabilities, Disabled Persons, Humans, Male, Middle Aged, Neoplasms, Pilot Projects, Severity of Illness Index, Sleep Wake Disorders, Stress, Psychological, Waiting Lists, Yoga, Selection Bias, Treatment Outcome, Survivors, Sample Size, Meditation, Mindfulness

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Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors

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