Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer.
Open accessAbstract
Objective: Women with metastatic breast cancer (MBC) report high levels of disease-related symptoms including pain, fatigue, psychological distress, and sleep disturbance. Mindfulness may be particularly relevant to women with MBC given the high symptom burden and psychological toll of this disease; however, the topic is understudied among this patient population. Therefore, we aimed to test the associations between mindfulness and patient-reported symptoms among a sample of women with MBC.Methods: Sixty-four women with MBC completed baseline questionnaires of mindfulness (Five Facet Mindfulness Questionnaire-Short Form [FFMQ-SF]) and symptoms of pain severity and interference, fatigue, psychological distress, and sleep disturbance as part of a randomized controlled trial of a Mindful Yoga intervention. Correlational analyses of data collected at baseline tested associations between the five mindfulness facets (observing, describing, acting with awareness, nonjudging, and nonreactivity) and patient-reported measures of symptoms.Results: Overall, higher mindfulness was associated with lower symptom levels including lower pain severity, pain interference, fatigue, anxiety, depression, and sleep disturbance. However, degree of association varied by mindfulness facet. Nonreactivity, nonjudging, and describing showed the most frequent associations and largest effect sizes across symptoms, while observing showed the least frequent associations and lowest effect sizes.Conclusions: Mindfulness-and in particular nonreactivity, nonjudging, and describing-may be a personal resource for women with MBC in coping with complex symptoms of this life-threatening illness. Findings are discussed relative to their implications for interventions aimed at increasing mindfulness in this vulnerable population.
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Claims the paper makes
17 of 45 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Mindful nonreactivity and emotional numbing are negatively correlated constructs.
“evidence suggests that mindful nonreactivity and emotional numbing are negatively correlated constructs,8, 17”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [8] source
The Results and Discussion (p. 15) report correlations between nonreactivity and alexithymia and dissociation, but do not identify either as emotional numbing or report a correlation with emotional numbing. A search for emotional numbing and related terms found no passage establishing the claimed relationship. (LLM, conf=0.73)
Experimental — accuracy not yet measured - cites [17] source
- Findingown data
Acting with awareness had its strongest correlation with anxiety (r < −.40).
“The acting with awareness scale was most strongly correlated with anxiety (r<−.40).”
Quote in the paperNot a substantial claim - Findingown data
Nonreactivity was the only mindfulness facet significantly associated with all measured outcomes.
“The mindfulness nonreactivity scale was the only facet that was significantly related to all outcome measures.”
- Also stated in: § Conclusions · plain
“Of the five subscales, only nonreactivity was significantly associated with less symptom burden across all symptoms measured.”
Quote in the paperSubstantial claim - Also stated in: § Conclusions · plain
- Findingown data
The intercorrelations among mindfulness facets in this sample were moderate positive relationships.
“the intercorrelations among the facets in this sample demonstrated moderate positive relationships”
Quote in the paperNot a substantial claim - Findingown data
Nonjudging had its strongest correlation with anxiety (r < −.50).
“The nonjudging scale was most strongly correlated with anxiety (r<−.50).”
Quote in the paperNot a substantial claim
- Findingown data
The study's findings supported the hypotheses that nonreactivity and nonjudging would show some of the strongest associations with symptoms and observing the least.
“Our findings supported our hypotheses that nonreactivity and nonjudging facets would demonstrate some of the strongest associations with patient-reported symptoms, while the observing facet demonstrated the least.”
Quote in the paperSubstantial claim - Findingown data
Contrary to the study's predictions, describing, not acting with awareness, showed strong associations with patient symptoms.
“However, contrary to our predictions, the describing facet – not the acting with awareness facet – showed strong associations with patient symptoms as well.”
Quote in the paperSubstantial claim - Findingown data
Nonreactivity had its strongest correlations with anxiety and depression (r < −.50).
“The nonreactivity scale was most strongly correlated to anxiety and depression (r<−.50).”
Quote in the paperNot a substantial claim - Findingown data
Higher observing was associated with less depression.
“Patients who reported a greater tendency to notice and attend to present-moment internal and external stimuli reported significantly less depression.”
Quote in the paperSubstantial claim - Findingown data
Describing had its strongest correlations with anxiety and depression (r < −.45).
“The describing scale was most strongly correlated with anxiety and depression (r<−.45)”
Quote in the paperNot a substantial claim - Findingown data
The strength of association between mindfulness and symptoms differed across the five mindfulness facets.
“However, degree of association varied by mindfulness facet.”
- Also stated in: § Mindfulness Associations with Symptom Levels · plain
“Further, the strength of associations differed across facets.”
- Also stated in: § Conclusions · plain
“we found that the facets varied in their degree of association with patient-reported symptoms”
Quote in the paperSubstantial claim - Also stated in: § Mindfulness Associations with Symptom Levels · plain
- Study design and conductreasoning
The study's correlational design cannot establish causality between mindfulness and symptoms.
“First, this study used correlational methods, thus causality between mindfulness and symptoms of interest cannot be established.”
Quote in the paperSubstantial claim - Premisecitation
There are very few psychosocial interventions targeting patients with MBC.
“As there are very few psychosocial interventions targeting patients with MBC,33 our findings suggest a potentially clinically important role of mindfulness-based interventions for patients with MBC and potentially other advanced cancers.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [33] source
- Study design and conductreasoning
The study sample may have been unique because participants were willing and able to enroll in a yoga-based intervention trial, limiting generalizability.
“Further, our study sample may have been unique, given their willingness and ability to enroll in a yoga-based intervention trial, and thus generalizability may be limited.”
Quote in the paperNot a substantial claim - Premisecitation
HPA dysregulation is associated with early mortality among patients with MBC.
“as HPA dysregulation is associated with early mortality among patients with MBC,34”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] source
- Interpretationown data
The overall pattern suggests that mindfulness facets had consistent but distinct associations with lower symptom levels across common symptoms in women with MBC.
“the overall pattern of our findings suggests that the mindfulness facets reflected consistent – but distinct – associations with lower symptom levels across a variety of common symptoms reported by women with MBC.”
Quote in the paperSubstantial claim - Interpretationown data
These results extend previous knowledge of positive associations between mindfulness and lower symptom levels to advanced disease patients.
“These results extend the previous knowledge of the positive associations of mindfulness with lower symptom levels to this unique population of advanced disease patients.”
Quote in the paperSubstantial claim - Interpretationreasoning
Women who endorsed greater nonjudgement may have reframed their symptoms as relatively normal rather than avoiding them.
“It may be that women who endorsed greater nonjudgement may have reframed their symptoms of distress, pain, and fatigue as relatively normal given their circumstances, rather than trying to avoid these experiences.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Nonreactivity may be particularly useful for women with MBC in noticing and stepping back from distressing thoughts and feelings.
“For women with MBC, nonreactivity may be particularly useful for noticing and stepping back from – as opposed to getting overtaken by – distressing thoughts and feelings.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Mindfulness, particularly nonreactivity, may hold relevance to psychoneuroendocrine pathways of clinical outcomes for MBC patients.
“mindfulness – and in particular, nonreactivity – may hold relevance to psychoneuroendocrine pathways of clinical outcomes for these patients.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [34] source
- May combine two claims. 26
- Classified as probably not a substantial claim. 22
May combine two claims.
Study design and conductreasoningThe sample had somewhat low baseline symptom levels, which is unusual among advanced cancer populations, and the intervention study demands may have prevented patients with higher symptom burden from enrolling.
“Given that our sample was experiencing somewhat low levels of symptoms at baseline, which is unusual among advanced cancer populations, the intervention study demands (i.e. 12 in-person study visits) may have prevented patients with higher symptom burden from enrolling.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [32] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataAll mindfulness subscales were significantly intercorrelated except observing with nonjudging, which was non-significant.
“All subscales were significantly intercorrelated with the exception of observing with nonjudging (non-significant), which is consistent with previous findings among non-meditating samples.”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [13] source
The Results (Confirmatory Factor Analyses; page not provided) report that, before MBCT, observing and nonjudging had a nonsignificant covariance in the 39-item FFMQ, while the other facet covariances were significant. The claim omits that this pattern was specific to that version and time point: the 15-item version had another nonsignificant covariance before MBCT, and all facet covariances were significant after MBCT. (LLM, conf=0.90)
Experimental — accuracy not yet measured - cites [14] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe BPI is widely used with cancer patients, has evidence of reliability and validity, and is considered the preferred method for assessing pain endpoints.
“This measure is widely used with cancer patients, has evidence of reliability and validity, and is considered the preferred method of assessing pain endpoints.”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [18] source
The Introduction describes the BPI as frequently used in clinical trials, and the BPI Conceptual Framework section says it was designed to assess pain in cancer. The Discussion finds that its measurement properties can meet FDA draft-guidance expectations for reliability and validity and support its use as a pain endpoint. It does not call the BPI the preferred method for assessing pain endpoints. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [19]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Interpretationown dataThe intercorrelations among facets suggest each facet captures distinct but related aspects of mindfulness, consistent with FFMQ measure development.
“suggesting that each of the facets were capturing distinct, but related, aspects of mindfulness, which is consistent with the FFMQ measure development.8, 9, 17”
Quote in the paperNot a substantial claim1 of 3 sources checkedMay combine two claims.
PremisecitationThere is a paucity of research investigating mindfulness among patients with MBC, with studies generally including small numbers or excluding metastatic patients.
“there is a paucity of research investigating mindfulness among patients with MBC, with studies generally including small numbers or excluding metastatic patients from their samples.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [4] source
- cites [10] source
The Discussion reports that only three eligible randomized trials were found, and Study Characteristics states that none included patients with metastatic breast cancer. This supports the paucity of evidence for metastatic patients, but the cited passages do not establish that the studies generally had small patient samples; the paper’s reference to a small number concerns trials, not participants. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationAmong cancer samples, nonreactivity, acting with awareness, and nonjudging have been found to relate to positive psychological outcomes, including decreased anxiety and depression and improved mood and stress levels.
“nonjudging, acting with awareness, and nonreactivity have been found to relate to positive psychological outcomes among cancer samples, including improved mood and stress levels, as well as decreased anxiety and depression.11, 12, 15”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [11] source
- cites [12] source
The Relation Between Mindfulness, Stress, and Mood Outcomes section links nonjudging and acting with awareness to improvements in mood or stress, including anxiety and depression subscales. The Discussion says the nonreacting scale showed no relation to any outcome measure in this study, although it notes an association with psychological improvement at three-month follow-up in another study. No page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [15] source
The Discussion (page unavailable) reports that acting with awareness, nonjudging, and nonreactivity before stem cell transplantation were associated with less depression and anxiety during recovery. The paper does not report improved mood and stress levels for those specific facets, although the Introduction describes a broader association between mindfulness and less stress in another cancer sample. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMindfulness is considered multidimensional, including five key facets: observing, describing, acting with awareness, nonjudging, and nonreactivity.
“Theoretically, mindfulness is considered to be multidimensional, including five key facets of observing, describing, acting with awareness, nonjudging, and nonreactivity7–9.”
Quote in the paperNot a substantial claim1 of 3 sources checkedClassified as probably not a substantial claim.
PremisecitationPrior research suggests that mindfulness facets may vary in their strength and direction of association with patient-reported symptoms.
“given prior research suggesting that the mindfulness facets may vary in their strength and direction of association with patient-reported symptoms,8, 9, 11–14”
Quote in the paperSubstantial claim3 of 6 sources checked- cites [8] source
The Results and Discussion (p. 15) report that the observe facet was positively associated with psychological symptoms, contrary to predictions, while the General Discussion (p. 17) says four other facets were associated with symptoms in the expected direction. This supports variation in direction, and the regression results (p. 15) show differing predictive contributions. The paper notes its reliance on student samples, however, so it does not establish these associations specifically for patient-reported symptoms in patients. (LLM, conf=0.83)
Experimental — accuracy not yet measured - cites [9] source
- cites [11] source
- cites [12] source
The Discussion (page unavailable) reports differential associations: nonjudging was linked to improved mood, acting with awareness to improved stress symptoms, and nonreacting to neither outcome. This supports variation in the strength of associations with patient-reported outcomes, but the cited passages do not show mindfulness facets having associations in opposite directions with symptoms. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [13] source
- cites [14] source
Classified as probably not a substantial claim.
PremisecitationWomen with MBC experience difficult disease- and treatment-related symptoms that negatively affect quality of life, including pain, fatigue, sleep disturbance, and psychological distress.
“Women with MBC suffer from difficult disease- and treatment-related symptoms that negatively impact quality of life, including psychological distress, sleep disturbance, fatigue, and pain.3, 4”
Quote in the paperSubstantial claim1 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMindfulness has been associated with lower levels of psychological symptoms in non-metastatic breast cancer patients and other oncology populations.
“While mindfulness has been associated with lower levels of psychological symptoms in non-metastatic breast cancer patients10 and other oncology populations,11, 12”
Quote in the paperNot a substantial claim2 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe observing subscale is associated with maladaptive psychological functioning and is not highly correlated with other mindfulness facets, but only among people with little meditation experience.
“a number of studies have found that the observing subscale is associated with maladaptive psychological functioning (e.g. thought suppression, mood disturbance) and is not highly correlated with the other mindfulness facets, but only among people with little meditation experience.8, 9, 13, 14”
Quote in the paperNot a substantial claim2 of 4 sources checked- cites [8] source
The Results and Discussion (p. 15) report that observing was positively correlated with psychological symptoms and thought suppression, but those correlations were nonsignificant in participants with meditation experience. The Results (p. 12) identify a meditation-related difference in observing’s correlation with nonjudging; most correlations with the other mindfulness facets did not differ by meditation experience, so the claim overgeneralizes that part. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [9] source
- cites [13] source
The Five Facet Mindfulness Questionnaire section reports that observing correlated positively with psychological symptoms in nonmeditators but negatively in meditators; the Discussion and Implications sections say observing relates less well to other facets in people with little meditation experience. The cited paper does not identify thought suppression or mood disturbance as the specific outcomes, and its own study did not measure participants’ prior meditation experience. Page numbers were unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [14] source
May combine two claims.
Findingown dataActing with awareness was significantly associated with lower sleep disturbance, depression, and anxiety, but not with pain or fatigue.
“The mindfulness acting with awareness scale was significantly associated with distress and sleep, but not pain and fatigue. Patients who reported more often acting with awareness (e.g., focusing their attention on their present activity, as opposed to being on “auto-pilot”) reported significantly lower anxiety, depression, and sleep disturbance.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataNo mindfulness facet showed a positive relationship with higher symptom burden, and every facet was negatively associated with at least one symptom.
“Overall, every facet was negatively associated with at least one symptom, and none of the facets showed a positive relationship to higher symptom burden.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataDescribing was significantly associated with lower sleep disturbance, depression, anxiety, fatigue, and pain interference, but not with pain severity.
“The mindfulness describing scale was significantly associated with all measures except pain severity. Patients who reported a greater tendency to label their sensations, thoughts, and emotions with words reported significantly lower pain interference, fatigue, anxiety, depression, and sleep disturbance.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataNonreactivity, nonjudging, and describing showed the most frequent and largest associations with symptoms, while observing showed the fewest and weakest associations.
“Nonreactivity, nonjudging, and describing showed the most frequent associations and largest effect sizes across symptoms, while observing showed the least frequent associations and lowest effect sizes.”
- Also stated in: § Mindfulness Associations with Symptom Levels · plain
“The mindfulness facets of nonreactivity, nonjudging, and describing showed the most frequent and strongest associations (medium to large effect sizes) across symptoms, while observing showed the least number of significant associations and had relatively low effect sizes.”
Quote in the paperSubstantial claim- Also stated in: § Mindfulness Associations with Symptom Levels · plain
May combine two claims.
Findingown dataAmong the symptom measures, anxiety and depression were related to the greatest number of mindfulness facets and had the largest effect sizes.
“Among the symptom measures, depression and anxiety were related to the greatest number of mindfulness facets and showed the largest effect sizes across the other symptom measures.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataObserving was significantly associated only with depressive symptoms and not with sleep disturbance, fatigue, pain, or anxiety.
“The mindfulness observing scale was only significantly associated with depressive symptoms; there were no significant associations between the observing subscale and anxiety, pain, fatigue, or sleep disturbance.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataIn 64 women with metastatic breast cancer, higher overall mindfulness was associated with lower baseline levels of sleep disturbance, fatigue, depression, anxiety, pain interference, and pain severity.
“Overall, higher mindfulness was associated with lower symptom levels including lower pain severity, pain interference, fatigue, anxiety, depression, and sleep disturbance.”
- Also stated in: § Mindfulness Associations with Symptom Levels · plain
“Overall, there were significant associations between all five mindfulness facets and a number of the symptom measures, such that higher mindfulness was correlated to lower levels of pain severity and interference, fatigue, anxiety, depression, and sleep disturbance.”
- Also stated in: § Conclusions · hedged
“Findings from this study indicate that, among patients with metastatic breast cancer, greater mindfulness was significantly associated with lower levels of symptoms including pain severity and interference, fatigue, anxiety, depression, and sleep disturbance.”
Quote in the paperSubstantial claim- Also stated in: § Mindfulness Associations with Symptom Levels · plain
May combine two claims.
Findingown dataHigher nonreactivity was associated with lower sleep disturbance, depression, anxiety, fatigue, pain interference, and pain severity.
“Patients who reported higher levels of nonreactivity (e.g., the ability to allow thoughts and emotions to come and go without getting carried away with them) also reported significantly lower pain severity, pain interference, fatigue, anxiety, depression, and sleep disturbance.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataNonjudging was significantly associated with lower depression, anxiety, fatigue, pain interference, and pain severity, but not with sleep disturbance.
“The mindfulness nonjudging scale was significantly associated with all measures except sleep disturbance. Patients who reported higher levels of nonjudging scale also reported significantly lower pain severity, pain interference, fatigue, anxiety, and depression.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataIn this sample, the BFI had excellent internal consistency (alpha=0.96).
“In this current sample, BFI showed excellent internal consistency (Cronbach alpha=0.96).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataIn this sample, BPI pain interference and pain severity subscales had good to excellent internal consistency (alpha=0.94 and 0.87, respectively).
“In this current sample, BPI subscales showed good to excellent internal consistency (Cronbach alpha: pain severity=0.87; pain interference=0.94).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataThe study used Spearman correlations because the data did not fully meet the assumptions required for Pearson correlations.
“Non-parametric (i.e., Spearman) correlations were used since the data did not fully meet assumptions necessary to compute Pearson correlations.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataIn this sample, the PSQI had questionable to acceptable internal consistency (alpha=0.69).
“In this current sample, PSQI showed questionable to acceptable internal consistency (Cronbach alpha=0.69).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe PSQI has been widely used with breast cancer patients, with reported total-scale internal consistency of 0.78.
“The scale has been widely used with breast cancer patients with internal consistency for the total scale reported as 0.78.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [22] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe HADS has evidence of reliability, validity, and responsiveness among cancer patients.
“The HADS is a 14-item, two-domain (depression and anxiety) scale with evidence of reliability, validity, and responsiveness among cancer patients.”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe BFI has shown good evidence of concurrent and discriminant validity and excellent internal consistency (alpha=0.96).
“This measure has also shown good evidence of concurrent and discriminant validity as well as excellent internal consistency (Cronbach alpha=0.96.).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataIn this sample, internal consistency for the five FFMQ-SF facets ranged from acceptable to good, with Cronbach alphas of 0.78 for observing, 0.77 for describing, 0.86 for acting with awareness, 0.79 for nonjudging, and 0.73 for nonreactivity.
“In this current sample, the five facets showed acceptable to good internal consistency (Cronbach alpha: observing=0.78; describing=0.77; acting with awareness=0.86; nonjudging=0.79; nonreactivity=0.73).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataIn this sample, the HADS anxiety and depression subscales had good to excellent internal consistency (alpha=0.88 and 0.81, respectively).
“In this current sample, HADS showed good to excellent internal consistency (Cronbach alpha: depression subscale=0.81; anxiety subscale=0.88).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationThe FFMQ-SF has demonstrated reliability and validity and sensitivity to change in adults with anxiety, depression, and chronic illness.
“The FFMQ-SF has demonstrated reliability and validity as well as sensitivity to change in samples of adults with anxiety and depression as well as chronic illness.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] source
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
Interpretationown dataMindfulness-based interventions may have a clinically important role for patients with MBC and potentially other advanced cancers.
“our findings suggest a potentially clinically important role of mindfulness-based interventions for patients with MBC and potentially other advanced cancers.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Interpretationnone givenNonjudging may be particularly challenging for patients with advanced cancer due to the common misconception that a positive attitude is critical to a good prognosis.
“This is notable given that nonjudging may be particularly challenging for patients with advanced cancer due to the common misconception that a positive attitude is critical to a good prognosis.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningDescribing internal experiences may be particularly important for women with MBC as they make meaning of their diagnosis and communicate with others.
“Among women with MBC, describing internal experiences and emotions may be of particular importance as they search to make meaning of their diagnosis of a life-limiting illness and communicate their experiences to friends, family, and medical professionals.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationNonreactivity may promote a balanced calm mental response, lowering sympathetic arousal, HPA axis dysregulation, and downstream immune dysregulation.
“Such nonreactivity may promote a more balanced and calm mental response to typically distressing stimuli, thus lowering sympathetic nervous system arousal, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and downstream immune dysregulation.27”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [27] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationreasoningObserving items may capture elements of behavioral activation, which may relate to fewer depressive symptoms in advanced disease.
“the items on this facet may be capturing elements of behavioral activation, which may relate to fewer depressive symptoms among those with advanced disease.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningTaking a nonjudgmental attitude may have helped women tolerate anxiety symptoms and increased their ability to cope.
“taking a nonjudgmental attitude towards these experiences may have helped women tolerate anxiety symptoms and increased their ability to cope with them.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
PremisecitationMindfulness can be conceptualized as both a trainable skill and a dispositional trait that varies between individuals.
“Mindfulness can be conceptualized not only as a trainable skill, but as a dispositional trait that varies from individual to individual.6”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] source
May combine two claims.
Interpretationown dataHigher baseline mindfulness may be considered a personal resource among women with MBC, associated with better functioning across several symptom domains.
“Our findings indicate that higher baseline levels of mindfulness may be considered a personal resource among women with MBC, which was associated with better functioning across several common symptom domains.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningActing with awareness may be a key skill for redirecting attention to the present moment and connecting with valued life domains.
“Acting with awareness may be a key skill for redirecting attention to the present moment and connecting with valued life domains rather than getting pulled into distressing thoughts of uncertainty.”
Quote in the paperNot a substantial claim
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The FFMQ-SF subscales have demonstrated strong internal consistency in cancer survivors and have been related to health outcomes.
“In research with cancer survivors, these subscales have demonstrated strong internal consistency [29] and have been related to health outcomes [30, 31].”
From Symptom experiences in post-treatment cancer survivors: associations with acceptance and commitment therapy constructs. (2021) · cites this paper as [31]
Cancer-related worry and mindfulness are cognitive strategies linked to distress in cancer patients.
“Other cognitive strategies associated with distress in cancer patients include cancer-related worry22 and mindfulness.23”
From Psychological flexibility, distress, and coping in ovarian cancer survivors. (2026) · cites this paper as [23]
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“As this sample was comprised of patients not currently engaged in yoga or meditation practices, these findings are consistent with previous literature noting that observing differentially relates to other mindfulness subscales and psychological outcomes among nonmeditators.(8,9,13,14) Nevertheless, patients who report…”
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“78.(22) In this current sample, PSQI showed questionable to acceptable internal consistency (Cronbach alpha=.”
BackgroundDiurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival
Sephton, S. E. (2000) · Journal of the National Cancer Institute · doi:10.1093/jnci/92.12.994 · Cited by 1,082 · see citing works
Bohlmeijer, E., ten Klooster, P. M., Fledderus, M., Veehof, M., & Baer, R. (2011) · Assessment · doi:10.1177/1073191111408231 · Cited by 990 · see citing works
The influence of bio-behavioural factors on tumour biology: pathways and mechanisms
Antoni, M. H., Lutgendorf, S. K., Cole, S. W., Dhabhar, F. S., Sephton, S. E., McDonald, P. G., Stefanek, M., & Sood, A. K. (2006) · Nature Reviews Cancer · doi:10.1038/nrc1820 · Cited by 981 · cited 1× · see citing works
“Such physiological processes are thought to be mechanisms by which meditation interventions produce beneficial outcomes.(27,28) In light of these results, it is worth noting that “nonreactive” responses such as emotional numbing or avoidance may occur in instances of high stress such as coping with a breast cancer dia…”
BackgroundMindfulness mediates the physiological markers of stress: Systematic review and meta-analysis
Pascoe, M. C., Thompson, D. R., Jenkins, Z. M., & Ski, C. F. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.08.004 · Cited by 579 · cited 2× · see citing works
“Such physiological processes are thought to be mechanisms by which meditation interventions produce beneficial outcomes.(27,28) In light of these results, it is worth noting that “nonreactive” responses such as emotional numbing or avoidance may occur in instances of high stress such as coping with a breast cancer dia…”
BackgroundEstimation of the Number of Women Living with Metastatic Breast Cancer in the United States
Mariotto, A. B., Etzioni, R., Hurlbert, M. S., Penberthy, L. T., & Mayer, M. (2017) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-16-0889 · Cited by 533 · see citing works
Gu, J., Strauss, C., Crane, C., Barnhofer, T., Karl, A., Cavanagh, K., & Kuyken, W. (2016) · Psychological Assessment · doi:10.1037/pas0000263 · Cited by 431 · cited 4× · see citing works
“Further, a number of studies have found that the observing subscale is associated with maladaptive psychological functioning (eg, thought suppression and mood disturbance) and is not highly correlated with the other mindfulness facets, but only among people with little meditation experience.(8,9,13,14) In other words,…”
BackgroundResultInfluentialde Bruin, E. I., Topper, M., Muskens, J. G. A. M., Bögels, S. M., & Kamphuis, J. H. (2012) · Assessment · doi:10.1177/1073191112446654 · Cited by 316 · cited 4× · see citing works
“Further, a number of studies have found that the observing subscale is associated with maladaptive psychological functioning (eg, thought suppression and mood disturbance) and is not highly correlated with the other mindfulness facets, but only among people with little meditation experience.(8,9,13,14) In other words,…”
BackgroundResultInfluentialBränström, R., Kvillemo, P., Brandberg, Y., & Moskowitz, J. T. (2010) · Annals of Behavioral Medicine · doi:10.1007/s12160-010-9168-6 · Cited by 312 · cited 4× · see citing works
“Indeed, greater skills in describing have been associated with fewer psychological distress symptoms among cancer patients.(11,15) Among women with MBC, describing internal experiences and emotions may be of particular importance as they search to make meaning of their diagnosis of a life-limiting illness and communic…”
BackgroundResultInfluentialBaer, R. A. (2011) · Contemporary Buddhism · doi:10.1080/14639947.2011.564842 · Cited by 279 · see citing works
Mindfulness-Based Stress Reduction for Breast Cancer—A Systematic Review and Meta-Analysis
Cramer, H., Lauche, R., Paul, A., & Dobos, G. (2012) · Current Oncology · doi:10.3747/co.19.1016 · Cited by 256 · cited 1× · see citing works
“While mindfulness has been associated with lower levels of psychological symptoms in nonmetastatic breast cancer patients(10) and other oncology populations,(11,12) there is a paucity of research investigating mindfulness among patients with MBC, with studies generally including small numbers or excluding metastatic p…”
BackgroundPsychological interventions for women with metastatic breast cancer
Mustafa, M., Carson-Stevens, A., Gillespie, D., & Edwards, A. G. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004253.pub4 · Cited by 244 · see citing works
Atkinson, T. M., Mendoza, T. R., Sit, L., Passik, S., Scher, H. I., Cleeland, C., & Basch, E. (2010) · Pain Medicine · doi:10.1111/j.1526-4637.2009.00774.x · Cited by 224 · cited 1× · see citing works
“This measure is widely used with cancer patients, has evidence of reliability and validity, and is considered the preferred method of assessing pain endpoints.(18,19) In this current sample, BPI subscales showed good to excellent internal consistency (Cronbach alpha: pain severity=.”
MethodSymptom structure of PTSD following breast cancer
Cordova, M. J., Studts, J. L., Hann, D. M., Jacobsen, P. B., & Andrykowski, M. A. (2000) · Journal of Traumatic Stress · doi:10.1023/a:1007762812848 · Cited by 183 · cited 1× · see citing works
“In light of these results, it is worth noting that “nonreactive” responses such as emotional numbing or avoidance may occur in instances of high stress such as coping with a breast cancer diagnosis.(29) However, evidence suggests that mindful nonreactivity and emotional numbing are negatively correlated constructs,(8,…”
BackgroundPosttraumatic Stress Disorder Symptoms After Bone Marrow Transplantation for Breast Cancer
Jacobsen, P. B., Widows, M. R., Hann, D. M., Andrykowski, M. A., Kronish, L. E., & Fields, K. K. (1998) · Psychosomatic Medicine · doi:10.1097/00006842-199805000-00026 · Cited by 158 · cited 1× · see citing works
“However, evidence suggests that mindful nonreactivity and emotional numbing are negatively correlated constructs,(8,17) with emotional numbing/avoidance being associated worse psychological and physical symptoms.(30,31) Our findings suggest that building the ability to be nonreactive to one's thoughts and feelings may…”
BackgroundSymptom Management in Metastatic Breast Cancer
Irvin, W., Muss, H. B., & Mayer, D. K. (2011) · The Oncologist · doi:10.1634/theoncologist.2011-0159 · Cited by 112 · cited 1× · see citing works
“Women with MBC suffer from difficult disease- and treatmentrelated symptoms that negatively impact quality of life, including psychological distress, sleep disturbance, fatigue, and pain.(3,4) These symptoms can have a significant impact on social, occupational, and emotional functioning; thus, there is a need for und…”
BackgroundGarland, S. N., Tamagawa, R., Todd, S. C., Speca, M., & Carlson, L. E. (2013) · Integrative Cancer Therapies · doi:10.1177/1534735412442370 · Cited by 91 · cited 2× · see citing works
“Indeed, other studies among cancer patients have found that those who were more nonjudgmental towards themselves endorsed fewer symptoms of anxiety and depression.(12,15) However, we found that greater nonjudgement among women with MBC not only was associated with fewer psychological symptoms but also extended to fewe…”
BackgroundPorter, L. S., Carson, J. W., Olsen, M., Carson, K. M., Sanders, L., Jones, L., Westbrook, K., & Keefe, F. J. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-04710-7 · Cited by 68 · see citing works
Self-citationMeasurement of coping and stress responses in women with breast cancer
Compas, B. E., Beckjord, E., Agocha, B., Sherman, M. L., Langrock, A., Grossman, C. I., Dausch, B., Glinder, J., Kaiser, C., Anderson‐Hanley, C., et al. (2006) · Psycho-Oncology · doi:10.1002/pon.999 · Cited by 55 · cited 1× · see citing works
“However, evidence suggests that mindful nonreactivity and emotional numbing are negatively correlated constructs,(8,17) with emotional numbing/avoidance being associated worse psychological and physical symptoms.(30,31) Our findings suggest that building the ability to be nonreactive to one's thoughts and feelings may…”
BackgroundJohannsen, M., O’Connor, M., O’Toole, M. S., Jensen, A. B., & Zachariae, R. (2018) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000510 · Cited by 41 · cited 1× · see citing works
“Indeed, nonreactivity has emerged as a potentially strong facet of mindfulness in relationship to selfreported symptoms among cancer patients in other studies.(11,15,26) For women with MBC, nonreactivity may be particularly useful for noticing and stepping back from—as opposed to getting overtaken by— distressing thou…”
BackgroundMindful Yoga for women with metastatic breast cancer: design of a randomized controlled trial
Carson, J. W., Carson, K. M., Olsen, M. K., Sanders, L. L., & Porter, L. S. (2017) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-017-1672-9 · Cited by 36 · cited 1× · see citing works
“The aim of the current study was to examine the strength and direction of baseline associations between mindfulness facets and patient-reported symptoms including pain, fatigue, psychological distress, and sleep disturbance in a sample of women with MBC who participated in a randomized controlled trial of a Mindful Yo…”
BackgroundSelf-citationAssessment of mindfulness and closely related constructs: Introduction to the special issue.
Baer, R. (2016) · Psychological Assessment · doi:10.1037/pas0000309 · Cited by 31 · 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 · cited 5× · see citing works
“Acting with awareness was also strongly related to less anxiety and depression, a finding which has been previously noted among other cancer samples.(11,15) This subscale reflects an ability to be aware of the present moment as one takes action, thus avoiding “autopilot” tendencies or mental time-travel to the future…”
BackgroundResultInfluentialLiving with Metastatic Breast Cancer
Ganz, P. A., & Stanton, A. L. (2015) · Advances in Experimental Medicine and Biology · doi:10.1007/978-3-319-16366-6_16 · Cited by 15 · see citing works
The rapid assessment of fatigue severity in cancer patients
Mendoza, T. R., Wang, X. S., Cleeland, C. S., Morrissey, M., Johnson, B. A., Wendt, J. K., & Huber, S. L. (1999) · Cancer · doi:10.1002/(sici)1097-0142(19990301)85:5 · Cited by 1 · see citing works
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Oberoi, S., Yang, J., Woodgate, R. L., Niraula, S., Banerji, S., Israels, S. J., Altman, G., Beattie, S., Rabbani, R., Askin, N., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.12598 · Cited by 127 · see citing works
Liu, W., Liu, J., Ma, L., & Chen, J. (2022) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-022-04167-y · Cited by 141 · see citing works
“Although mind–body therapies are commonly used by breast cancer patients, and some small-scale studies (Carson et al. 2017; Porter et al. 2019; Zimmaro et al. 2020) have proved their safety, feasibility, and initial benefits, standardized and rigorous methods are needed to assess their clinical effectiveness and mecha…”
BackgroundLi, H., Wu, J., Ni, Q., Zhang, J., Wang, Y., & He, G. (2021) · Nursing Research · doi:10.1097/nnr.0000000000000499 · Cited by 48 · see citing works
Meta-analysis of effects of yoga exercise intervention on sleep quality in breast cancer patients
Zhu, J., Chen, X., Zhen, X., Zheng, H., Chen, H., Chen, H., Liao, H., Zhu, J., Wang, C., Zheng, Z., et al. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1146433 · Cited by 37 · see citing works
“Yoga combines posture, breathing and meditation, focuses not only on the practice of posture but also on mental practice, and emphasizes not only physical but also mental relaxation, allowing participants to better regulate their emotions (32, 33).”
BackgroundChang, Y., Tseng, T. A., Lin, G., Hu, W., Wang, C.-K., & Chang, Y. (2023) · BMC Women s Health · doi:10.1186/s12905-023-02486-x · Cited by 35 · see citing works
Tian, X., Yi, L.-J., Liang, C.-S.-S., Gu, L., Peng, C., Chen, G., & Herrera, M. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.901247 · Cited by 33 · see citing works
Lewson, A. B., Johns, S. A., Krueger, E., Chinh, K., Kidwell, K. M., & Mosher, C. E. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-020-05854-7 · Cited by 29 · see citing works
Mosher, C. E., Krueger, E., Secinti, E., & Johns, S. A. (2021) · Psycho-Oncology · doi:10.1002/pon.5712 · Cited by 21 · see citing works
“These subscales have demonstrated good internal consistency and predicted health outcomes in previous research with advanced cancer patients.(15) Acting with Awareness and Nonjudging subscales were combined to assess mindfulness for the current analysis, as they were correlated in our sample (r = 0.”
BackgroundResultChinh, K., Secinti, E., Johns, S., Hirsh, A., Miller, K., Schneider, B., Storniolo, A. M., Mina, L., Newton, E., Champion, V., et al. (2020) · Oncology Nursing Forum · doi:10.1188/20.onf.739-752 · Cited by 17 · see citing works
Hatchard, T., Mioduszewski, O., Khoo, E.-L., Romanow, H., Shergill, Y., Tennant, E., Leeming, A., Fang, Z., Poulin, P., & Smith, A. M. (2021) · Mindfulness · doi:10.1007/s12671-020-01546-9 · Cited by 21 · see citing works
“The FFMQ has been found to have adequate to good reliability, with alpha coefficients ranging from .75 to .91 and has been used to assess mindfulness in women with breast cancer (Zimmaro et al. 2020).”
MethodArefian, M., & Asgari-Mobarakeh, K. (2024) · Pain Management Nursing · doi:10.1016/j.pmn.2024.04.012 · Cited by 18 · see citing works
Living with Advanced Breast Cancer: A Descriptive Analysis of Survivorship Strategies
Grimm, M., Radcliff, L., Giles, M. B., Nash, R. R., Holley, E. E., Panda, S., Brophy, L., Williams, N. O., Cherian, M. A., Stover, D. G., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11143992 · Cited by 16 · see citing works
“) and subsequently referred for appropriate mental health services [24].”
BackgroundThe Role of Trait Mindfulness in the Association between Loneliness and Psychological Distress
Coutts-Smith, J., & Phillips, W. J. (2023) · Mindfulness · doi:10.1007/s12671-023-02184-7 · Cited by 13 · see citing works
Arefian, M., & Asgari, K. (2025) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2025.102881 · Cited by 13 · see citing works
Allostatic load and risk of invasive breast cancer among postmenopausal women in the U.S.
Wang, F., Skiba, M. B., Follis, S., Liu, N., Bidulescu, A., Mitra, A. K., Mouton, C. P., Qi, L., & Luo, J. (2023) · Preventive Medicine · doi:10.1016/j.ypmed.2023.107817 · Cited by 12 · see citing works
Mindfulness Meditation as Psychosocial Support in the Breast Cancer Experience: A Case Report
Iannopollo, L., Cristaldi, G., Borgese, C., Sommacal, S., Silvestri, G., & Serpentini, S. (2022) · Behavioral Sciences · doi:10.3390/bs12070216 · Cited by 10 · see citing works
“A large body of research shows the effectiveness of these Mindfulness-based interventions in reducing symptoms such as anxiety [15], depression [16], substance abuse [17], eating disorders [18], and chronic pain [19], and in improving well-being and Quality of Life [20].”
BackgroundInfluentialBibi, R., Maneewat, K., Sangchan, H., & Sae‐Sia, W. (2022) · Belitung Nursing Journal · doi:10.33546/bnj.2022 · Cited by 10 · see citing works
“259 procedure, early or delayed complications can occur (Zimmaro et al., 2020).”
BackgroundWomack, D. M., Kennedy, R., Chamberlin, S. R., Rademacher, A., & Sliney, C. D. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.11.018 · Cited by 12 · see citing works
Deng, H., Yang, T., Hu, Y., Liu, J., Chou, H., Jiang, Y., & Shen, Q. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09180-8 · Cited by 10 · see citing works
Esquives, B. S. N., Walsh, E. A., Penedo, F. J., Thomas, J. L., Horner, F. S., Torzewski, J. B., Gradishar, W. J., Victorson, D. E., & Moreno, P. I. (2023) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2023.2254754 · Cited by 12 · 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
“…patients with advanced breast cancer (ABC) experience cancer-related fatigue (CRF) (Hsieh et al., 2019; Kinkead et al., 2018; Wang et al., 2018; Zimmaro et al., 2020) In addition, these patients may have physical and psychological comorbidities that increase fatigue and complicate its…”
Janusek, L. W., Tell, D., & Mathews, H. L. (2021) · Western Journal of Nursing Research · doi:10.1177/0193945920932290 · Cited by 7 · see citing works
“Similarly, in women with metastatic breast cancer, greater dispositional mindfulness was found to be associated with fewer cancer-related symptoms, including lower pain severity, pain interference, fatigue, anxiety, depression, and sleep disturbance, with stronger symptom effect sizes for nonreactivity, nonjudgment, a…”
BackgroundInfluentialRe-imagining metastatic breast cancer care delivery: a patient-partnered qualitative study
Roberson, M. L., Henricks, A., Woods, J., Glenn, L. K., Maués, J., James, D., & Reid, S. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-08201-8 · Cited by 7 · see citing works
The association between trait mindfulness and sleep problems: A three-level meta-analysis
Lu, L., & Ran, G. (2024) · Journal of Health Psychology · doi:10.1177/13591053241253483 · Cited by 6 · see citing works
“…to note that previous studies examining the association between trait mindfulness and sleep problems have shown differences in sample characteristics, publication characteristics, and assessment research design characteristics (Kemper et al., 2015; Teoh and Wong, 2023; Zimmaro et al., 2020).”
Preliminary validation of the Cognitive Affective Mindfulness Scale–Revised in cancer populations
Snyder, S., Secinti, E., Chinh, K., Wu, W., Johns, S. A., & Mosher, C. E. (2024) · Psycho-Oncology · doi:10.1002/pon.6260 · Cited by 6 · see citing works
Fatigue and Sleep Disturbance among Breast Cancer Patients during Treatment in Saudi Arabia
Alsharif, F. H., Shibily, F., Almutairi, W. M., Alsaedi, A., Alsubaie, T., Alshuaibi, B., & Turkistani, A. (2022) · Nursing Research and Practice · doi:10.1155/2022/1832346 · Cited by 6 · see citing works
“&e degree of association, however, varied by mindfulness facet [16].”
BackgroundInfluentialBonhof, C. S., van de Poll-Franse, L. V., de Hingh, I. H. J. T., Vreugdenhil, G., & Mols, F. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-07340-8 · Cited by 6 · see citing works
Kim, J. Y., Kim, M. J., Lee, E. B., et al. (2022) · Journal of Breast Cancer · doi:10.4048/jbc.2022.25.e40 · Cited by 6 · see citing works
“The concomitant anxiety and depression associated with a cancer diagnosis may render individuals more susceptible to pain [28,29].”
BackgroundTsai, C.-C., Chan, H., Lien, W.-L., Chu, H.-Y., & Chen, M. (2024) · Applied Nursing Research · doi:10.1016/j.apnr.2024.151799 · Cited by 5 · see citing works
Breast Cancer: A Review on Quality of Life, Body Image and Environmental Sustainability
Soares, L., & Silva, L. C. C. (2023) · World Journal of Cancer and Oncology Research · doi:10.31586/wjcor.2023.826 · Cited by 5 · see citing works
The sharks are circling: a qualitative study of living with metastatic breast cancer
Visovsky, C. M., Marshall, V. K., Moreno, M., Advani, P. P., Mussallem, D. M., & Tofthagen, C. (2023) · Journal of Cancer Survivorship · doi:10.1007/s11764-023-01476-0 · Cited by 6 · see citing works
“…evidence-based interventions to address the specific symptom and QOL issues of women with MBC [16] During MBC treatment, patients can encounter several emotions, such as sadness, anxiety, frustration, uncertainty about the future, and a loss of control, which can be difficult to cope with [19, 20].”
Komariah, M., Firdaus, M. K. Z. H., Aryal, K. P., & Latif, M. A. (2021) · Jurnal Keperawatan Padjadjaran · doi:10.24198/jkp.v9i1.1592 · Cited by 5 · see citing works
“Moreover, many studies have reported that the impact of advanced breast cancer patients enduring cancer-related-fatigue (CRF) is extensive (Hsieh et al., 2019; Kinkead et al., 2018; Zimmaro et al., 2019)).”
BackgroundZimmaro, L. A., Moss, A., Reibel, D. K., Handorf, E. A., Reese, J. B., & Fang, C. Y. (2021) · Behavioral Sciences · doi:10.3390/bs11100139 · Cited by 4 · see citing works
“Given that the various mindfulness subscales can differentially relate to psychosocial outcomes [50,51], future research should more deeply explore how mindfulness skills can be enhanced in telephone-based MBSR programs, as well as within healthcare employees.”
Self-citationCuñado-Pradales, R., Soto‐Ruiz, N., Escalada‐Hernández, P., Martín‐Rodríguez, L. S., & García‐Vivar, C. (2024) · Cancer Nursing · doi:10.1097/ncc.0000000000001401 · Cited by 4 · see citing works
The Moderating Effects of Cognitive Processes on Pain-related Outcomes
Torres, N. D., Newman, A. K., Day, M. A., Chan, J. F., Friedly, J. L., & Jensen, M. P. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.01.348 · Cited by 3 · see citing works
Renna, M. E., Madison, A. A., Peng, J., Shrout, M. R., Lustberg, M. B., Ramaswamy, B., Wesolowski, R., VanDeusen, J. B., Williams, N. O., Sardesai, S. D., et al. (2023) · PubMed Central · doi:10.1093/abm/kaad032 · Cited by 3 · see citing works
Joshi, A. M., Mehta, S. A., Dhakate, N. G., & Mehta, A. O. (2023) · Yoga Mimamsa · doi:10.4103/ym.ym_41_23 · Cited by 3 · see citing works
Kahraman-Erkus, O., Ar-Karci, Y., & Gençöz, T. (2023) · Chronic Illness · doi:10.1177/17423953231168014 · Cited by 2 · see citing works
“Particularly, metastatic cancer is associated with increased mortality, 3,4 treatment failures, 5 psychological symptoms, 6 – 8 perceived symptom severity, 9 – 11 and caregiver burden.”
BackgroundKrok, D., Telka, E., & Moroń, M. (2025) · Journal of Religion and Health · doi:10.1007/s10943-025-02358-8 · Cited by 3 · see citing works
The Effect of Mindful Yoga on Fatigue in Women with Breast Cancer: A Quasi-experimental Study
Azimi, M., Falsafinejad, M. R., Khodabakhshi‐Koolaee, A., & Jouybari, L. M. (2025) · Jundishapur Journal of Chronic Disease Care · doi:10.5812/jjcdc-151438 · Cited by 2 · see citing works
“One such therapy is mindful yoga, which emphasizes present awareness, specific body positions, regular breathing, and meditation, along with the conscious reception of thoughts, feelings, and actions to reduce physical and psychological fatigue (8, 9).”
Alfieri, S., Murru, L., Bosisio, M., Gangeri, L., Monfredini, M., Capri, G., Lozza, L., & Borreani, C. (2024) · Journal of Cancer Education · doi:10.1007/s13187-024-02449-2 · Cited by 2 · see citing works
“…etc. was considered useful because enabled patients to better orient themselves in the swirl of events and emotions they were experiencing ( 15 ); (9) the group dimension allowed patients to discover that life and experiences are shared by other women and allow them to consider that they…”
Ando, M., Ito, S., Matsuo, Y., & Kukihara, H. (2022) · Open Journal of Social Sciences · doi:10.4236/jss.2022.1013016 · Cited by 2 · see citing works
Malik, M., Ali, M. K., Ali, K., Berndt, A., & Jiwani, R. B. (2026) · Mental Health and Social Inclusion · doi:10.1108/mhsi-01-2026-0015 · Cited by 1 · see citing works
Progress in the Application of Mindfulness Therapy in Patients with Malignant Tumors
翟, 笑. (2024) · Advances in Clinical Medicine · doi:10.12677/acm.2024.1451553 · Cited by 1 · see citing works
The Sharks Are Circling: A Qualitative Study of Living with Metastatic Breast CancerPreprint
Visovsky, C. M., Marshall, V. K., Moreno, M., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2833645/v1 · Cited by 1 · see citing works
Thanasansomboon, B., Choemprayong, S., Parinyanitikul, N., Tanlamai, U., Wisessathorn, M., & Patarapongsant, Y. (2022) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2022.06.002 · Cited by 1 · see citing works
“The key goal of MBC therapy is to prolong survival, with an emphasis on restricting treatmentrelated toxicity as far as possible [3]; however, the key issues and problems faced by patients with MBC are emotional and psychological [4].”
BackgroundReflection on Supportive Care Elements During the Metastatic Breast Cancer Journey
Roesch, E. E., & Abraham, J. (2021) · JCO Oncology Practice · doi:10.1200/op.20.01036 · Cited by 1 · see citing works
Klaus-Karwisch, S., Otto, S., Werthmann, P. G., Lederer, A., Mihaljevic, A. L., Treiber, F., Cihlar, L., Leins, K., Mayer, B., & Kramer, K. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1913126
Xiong, H., Luan, Q., Li, W., Tian, P., Ning, J., & Han, Z. (2026) · BMJ Open · doi:10.1136/bmjopen-2026-121992
“5 7–9 These symptoms rarely occur in isolation; instead, they may accumulate or interact over time, increasing the overall burden experienced by patients.”
Psychological Resources in Adults with Cancer: A Systematic Review of Quantitative Studies
Bridou, M., & Robieux, L. (2026) · Cancers · doi:10.3390/cancers18152525
Zhong, D., Chen, Z., Liu, X., Yu, M., Gao, J., Xie, R., Chen, M., Tang, M., & Mao, Y. (2026) · Research Square · doi:10.21203/rs.3.rs-9430022/v1
Renna, M. E., Broich, K., Johal, S. K., Wilbourne, F. N., Kaeppler, A. K., & Shrout, M. R. (2026) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2026.2661039
Kashyap, S. D., Singh, S., Sethi, R., & Agarwal, V. (2026) · Indian Journal of Clinical Cardiology · doi:10.1177/26324636261448352
Well-Being in Breast Cancer Survivors
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Psychological flexibility, distress, and coping in ovarian cancer survivors.
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Self-citation
- Authors
- Zimmaro, L. A., Carson, J. W., Olsen, M. K., Sanders, L. L., Keefe, F. J., & Porter, L. S.
- Affiliations
- Fox Chase Cancer Center (US)
- Oregon Health & Science University (US)
- Durham VA Health Care System (US)
- Duke Medical Center (US)
- Corresponding author
- Porter, Laura S.
- Venue
- Psycho-Oncology
- Publisher
- Wiley
- Published
- 2019-10-17
- Volume
- 29
- Issue
- 2
- Pages
- 263-270
- ISSN
- 1057-9249 (ISSN-L)
- 1099-1611
- PMC
- PMC7002241
- OpenAlex
- W2972446835
- Cited by
- 62
- References
- 33
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 7 · 2023: 14 · 2022: 13 · 2021: 7 · 2020: 5 · 2018: 1
- FWCI
- 7.29
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Psycho-Oncology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Complementary and Integrative Health (R01 AT007572)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- mindfulness, metastatic breast cancer, pain, fatigue, psychological distress, sleep disorders, non-reactivity, non-judgment, description, observation, Five Facet Mindfulness Questionnaire, symptom burden, mindful yoga, coping
- MeSH terms
- Psychological Distress, Adaptation, Psychological, Adult, Anxiety, Breast Neoplasms, Depression, Fatigue, Female, Humans, Middle Aged, Pain, Sleep Wake Disorders, Mindfulness
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