Cited by 117Cancer survivorship and careMindfulness and Compassion InterventionsCancer, Stress, Anesthesia, and Immune Response

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Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT)

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Lengacher, Cecile A., Shelton, Melissa M., Reich, Richard R., Barta, Michelle K., Johnson-Mallard, Versie, Moscoso, Manolete S., Paterson, Carly, Ramesar, Sophia, Budhrani, Pinky, Carranza, Irina, Lucas, Jean, Jacobsen, Paul B., Goodman, Matthew J., Kip, Kevin E.·2014·Journal of Behavioral Medicine

DOI 10.1007/s10865-012-9473-6PMC PMC3627743

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Abstract

To investigate the mechanism(s) of action of mindfulness based stress reduction (MBSR(BC)) including reductions in fear of recurrence and other potential mediators. Eighty-two post-treatment breast cancer survivors (stages 0-III) were randomly assigned to a 6-week MBSR(BC) program (n = 40) or to usual care group (UC) (n = 42). Psychological and physical variables were assessed as potential mediators at baseline and at 6 weeks. MBSR(BC) compared to UC experienced favorable changes for five potential mediators: (1) change in fear of recurrence problems mediated the effect of MBSR(BC) on 6-week change in perceived stress (z = 2.12, p = 0.03) and state anxiety (z = 2.03, p = 0.04); and (2) change in physical functioning mediated the effect of MBSR(BC) on 6-week change in perceived stress (z = 2.27, p = 0.02) and trait anxiety (z = 1.98, p = 0.05). MBSR(BC) reduces fear of recurrence and improves physical functioning which reduces perceived stress and anxiety. Findings support the beneficial effects of MBSR(BC) and provide insight into the possible cognitive mechanism of action.

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Mindfulness-based psychosocial interventions and psychological wellbeing in cancer survivorship: a meta-analysis
Telles, R., Whitney, B. M., Froelich, S., & Lutgendorf, S. K. (2024) · Health Psychology Review · doi:10.1080/17437199.2024.2336014 · Cited by 19
Investigation of Factors Influencing the Fear of Cancer Recurrence in Breast Cancer Patients Using Structural Equation Modeling: A Cross‐Sectional Study
Guo, H.-T., Wang, S., Zhang, C.-F., Zhang, H.-J., Wei, M.-X., Wu, Y. C., & Su, C.-X. (2022) · International Journal of Clinical Practice · doi:10.1155/2022/2794408 · Cited by 16
“Disease uncertainty, social support, and coping strategies have been reported as some of the essential infuencing factors for FCR in breast cancer patients [7].”
The effectiveness of mindfulness-based intervention on perceived stress and perception of disease in patients with acute coronary syndrome
Nasiri, Z., Alavi, M., Ghazavi, Z., & Rabiei, K. (2020) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_660_19 · Cited by 16
“Journal of Education and Health Promotion | Volume 9 | May 2020 5 the benefits of mindfulness training to effectively manage perceived stress.[28,29] Our findings are also consistent with the results of the research conducted by Radmehr and Yousefvand,[30] supporting the reduction of perceived stress in patients with…”
Result
Teaching mindfulness meditation to adults with severe speech and physical impairments: An exploratory study
Goodrich, E., Wahbeh, H., Mooney, A. R., Miller, M., & Oken, B. (2014) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2014.970201 · Cited by 19
“…improve factors relevant to successful BCI use such as anxiety (Bohlmeijer, Prenger, Taal, & Cuijpers, 2010; Hofmann, Sawyer, Witt, & Oh, 2010; Lengacher et al., 2012; Speca, Carlson, Goodey, & Angen, 2000), attention (Lutz et al., 2009), depression and negative affect (Anderson, Lau, Segal,…”
Background
[Effects of Psychoeducational Intervention for Cancer Survivors: A Systematic Review and Meta-Analysis].
Park, J. H., & Bae, S. (2017) · Journal of Korean Academy of Nursing · doi:10.4040/jkan.2017.47.2.143 · Cited by 11
Dyadic stress of breast cancer survivors and their caregivers: Are there differences by sexual orientation?
Boehmer, U., Stokes, J. E., Bazzi, A. R., Winter, M. R., & Clark, M. A. (2018) · Psycho-Oncology · doi:10.1002/pon.4836 · Cited by 16
“psychological well-being (32), was associated with increased stress.”
A Case Study of Individually Delivered Mindfulness-Based Cognitive Behavioral Therapy for Severe Health Anxiety
Luberto, C. M., Magidson, J. F., & Blashill, A. J. (2017) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2016.10.001 · Cited by 15
“…training is a cognitive-behavioral treatment approach that facilitates cognitive decentering and is an efficacious treatment for reducing anxiety and medical symptoms (e.g., Faramarzi, Yazdani, & Barat, 2015; Ferszt et al., 2015; Lengacher et al., 2014; Schoultz, Atherton, & Watson, 2015).”
Background
Childhood adversity and cortisol habituation to repeated stress in adulthood
Appelmann, H. M., Manigault, A. W., Shorey, R. C., & Zoccola, P. M. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.105118 · Cited by 15
Effects of mindfulness-based interventions on quality of life of women with breast cancer: a systematic review
Zhang, X., Liu, D., Li, Y., Ye, Z., Zhang, B., Wang, X., & Wang, G. (2019) · Journal of Comparative Effectiveness Research · doi:10.2217/cer-2019-0053 · Cited by 14
Integrative Review of the Supportive Care Needs of Asian and Caucasian Women with Breast Cancer
Levesque, J. V., Girgis, A., Koczwara, B., Kwok, C., Singh‐Carlson, S., & Lambert, S. (2015) · Current Breast Cancer Reports · doi:10.1007/s12609-015-0186-z · Cited by 14
Autonomic modulation with mindfulness‐based stress reduction in chronic kidney disease: a randomized controlled trial
Jeong, J., Hu, Y., Zanuzzi, M., DaCosta, D. R., Sabino‐Carvalho, J. L., Li, S., & Park, J. (2024) · The Journal of Physiology · doi:10.1113/jp287321 · Cited by 14
“…the Mindfulness-Based Stress Reduction (MBSR) programme is an 8 week structured mindfulness meditation training programme that has been extensively studied and has demonstrated beneficial effects on CV outcomes in patient populations (Lakhan & Schofield, 2013; Lengacher et al., 2012, 2014).”
Mindfulness in Follow-Up Care After Breast Cancer: Can It Prevent Recurrence
Modica, C., & Hoenig, K. (2018) · Breast Care · doi:10.1159/000488716 · Cited by 12
Factors Associated with Poor Quality of Life in Breast Cancer Survivors: A 3-Year Follow-Up Study
Kim, S. H., & Jo, H.-Y. (2023) · Cancers · doi:10.3390/cancers15245809 · Cited by 11
“For example, in a randomized controlled trial among 322 BCSs, Lengacher et al. [32] found that a 6-week MBSR program signiﬁcantly reduced anxiety and fear of recurrence.”
Background
Mediating effects of rumination on insomnia in cancer survivors: Influences of cancer‐related fatigue, fear of recurrence, and psychological distress
Amani, O., Mazaheri, M. A., Malekzadeh, M., Zarani, F., & Choolabi, R. H. (2024) · Cancer Medicine · doi:10.1002/cam4.70189 · Cited by 11
“56,57 In addition to CBT-I, metacognitive therapy (MCT) can be particularly beneficial for cancer survivors experiencing high levels of rumination.”
Background
Mindfulness for the self-management of negative coping, rumination and fears of compassion in people with cancer: An exploratory study
Williams, S., Clarke, S., & Edginton, T. (2023) · Cancer Reports · doi:10.1002/cnr2.1761 · Cited by 10
“Research into the efficacy of MBSR and breast cancer suggests participants reported an increased ability to cope, manage and find meaning(22) and a reduction in fear of recurrence.(23) In addition, a systematic review and meta-analysis of MBSR studies in a broader cancer population reported evidence for reliable impro…”
Background
Fear-focused Self-compassion Therapy for young breast cancer patients' fear of cancer recurrence: Study protocol of a randomized controlled trial
Wei, L., Yang, X., Sun, S., Yu, Y., Xie, J., Zhao, J., Wang, X., Zhu, L., & Yao, J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.941459 · Cited by 11
The Comparative Effect of Reduced Mindfulness-Based Stress on Heart Rate Variability among Patients with Breast Cancer
Wang, S., Chang, Y., Hu, W., Chang, Y., & Lo, C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116537 · Cited by 10
“On the other hand, previous RCTs have demonstrated that a 6-week MBSR program was beneficial for health and resulted in significant improvements in psychological symptoms, fear of recurrence, and quality of life in breast cancer survivors compared with UC [42,43].”
Background
Developing content for an interprofessional training on fear of cancer recurrence (FCR): Key informant interviews of healthcare professionals, researchers and cancer survivors
Berrett‐Abebe, J., Cadet, T. J., Vitello-Cicciu, J. M., & Maramaldi, P. (2018) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2018.1443987 · Cited by 9
Study protocol of the BLANKET trial: a cluster randomised controlled trial on the (cost-) effectiveness of a primary care intervention for fear of cancer recurrence in cancer survivors
Luigjes-Huizer, Y. L., van der Lee, M. L., de Wit, N. J., & Helsper, C. W. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-032616 · Cited by 8
Helping Patients to Help Themselves after Breast Cancer Treatment
Fenlon, D., Khambhaita, P., & Hunter, M. S. (2015) · Clinical Oncology · doi:10.1016/j.clon.2015.05.002 · Cited by 8
“Mindfulness approaches have a great deal of potential in cancer care at different stages of illness [58].”
Background
El rol de mindfulness en la regulación emocional de la depresión
Moscoso, M. S., & Lengacher, C. A. (2017) · Mindfulness & Compassion · doi:10.1016/j.mincom.2017.08.002 · Cited by 11
Self-citation
Effectiveness of a Pilot Mindfulness Program in Volunteers of a Breast Cancer Association
Cucarella, S. P., & Giannini, M. C. (2016) · Journal of Evidence-Based Complementary & Alternative Medicine · doi:10.1177/2156587215602408 · Cited by 7
“The practice of mindfulness is not only used to treat patients but has also served to help reduce stress in medical staff, volunteers, and caregivers.(12-14) It has been observed that workers who have direct or indirect contact with the problems of the patients have an increased vulnerability to present compassion fat…”
Background
Abordaje de la ansiedad en pacientes diagnosticados de cáncer
Algar, M. J. M., & García, P. B. (1970) · Psicooncología · doi:10.5209/psic.54434 · Cited by 7
Mindfulness Interventions in Breast Cancer Survivors: Current Findings and Future Directions
Haydon, M. D., Boyle, C. C., & Bower, J. E. (2018) · Current Breast Cancer Reports · doi:10.1007/s12609-018-0263-1 · Cited by 7
Mindfulness, autorregulación emocional y reducción de estrés: ¿ciencia o ficción?
Moscoso, M. S. (2019) · Revista Mexicana de Investigación en Psicología · doi:10.32870/rmip.v10i2.459 · Cited by 10
Self-citation
Check the relation sexual satisfaction with marital stress, marital satisfaction and psychological symptoms of coronary artery bypass graft heart patients
Nekounam, A., Etemadi, S., & Tehrani, S. P. (2019) · Shenakht Journal of Psychology and Psychiatry · doi:10.29252/shenakht.6.2.16 · Cited by 6
A Randomized Clinical Trial of Mindfulness-Based Stress Reduction Program Among Breast Cancer Survivors Post-Treatment: Evaluating Mediators of Cognitive Improvement
Lengacher, C. A., Hülür, G., Wang, J. R., Reich, R. R., Meng, H., Park, J. Y., Kip, K. E., Morgan, S. P., Joshi, A., Tinsley, S., et al. (2024) · Journal of Integrative and Complementary Medicine · doi:10.1089/jicm.2024.0493 · Cited by 6
Self-citation
Psychosocial Interventions for Improving the Quality of Life in Breast Cancer Survivors: A Literature Review
Widiasih, R., Ermiati, Jayanti, T. N., & Rais, Y. (2019) · IOP Conference Series Earth and Environmental Science · doi:10.1088/1755-1315/248/1/012056 · Cited by 5
“(2014) use Mindfulness-Based Stress Reduction (MBSR) which has been developed by Kabat-Zinn (1982) [7].”
BackgroundMethod
The mediating role of medical coping modes between anxiety and fear of progression in patients with cervical intraepithelial neoplasia grade 3: a cross-sectional survey
Jin, X., Liu, X., & Huang, H. (2025) · BMC Psychology · doi:10.1186/s40359-025-03323-6 · Cited by 4
Factors affecting the fear of recurrence in Breast cancer patients
Kussainova, D., Tursynbekova, A., Аимбетова, Г. Е., Bagiyarova, F., & Kaidarova, D. (2024) · Research Journal of Pharmacy and Technology · doi:10.52711/0974-360x.2024.00049 · Cited by 4
Estado emocional en mujeres con cáncer de mama: variación experimentada después de una sesión psico-oncológica basada en el counselling y la psicología positiva
Sánchez, L. V., Font, A., & Vela, L. C. (1970) · Psicooncología · doi:10.5209/psic.54433 · Cited by 4
Right Place, Right Time: Preferences of Women with Ovarian Cancer for Delivery of CAM Education
Ebbert, J., Donovan, K. A., Lengacher, C. A., Fabri, D., Reich, R. R., Daley, E. M., Thompson, E. L., & Wenham, R. M. (2015) · Medicines · doi:10.3390/medicines2030236 · Cited by 4
“Use of CAM therapies at first occurrence of disease may mitigate stress-related symptoms related to fear of disease recurrence [40].”
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Practical non-pharmacological interventions to improve quality of life for cancer patients and caregivers
Gonçalves, S. D. (2025) · Exploration of Medicine · doi:10.37349/emed.2025.1001355 · Cited by 4
Effectiveness of mindfulness-based interventions on quality of life in women breast cancer survivors: a systematic review and meta-analysis
do Amaral, P. G. T., Tosello, G. T., Filho, P. P. P. D. [. S., Nahás, E. A. P., & Buttros, D. D. A. B. (2026) · The Breast · doi:10.1016/j.breast.2026.104701 · Cited by 3
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Personal Resources and Total Pain: Exploring the Multiple Mediation of Fear of Recurrence, Meaning-Making, and Coping in Posttreatment Cancer Patients
Krok, D., Telka, E., & Moroń, M. (2024) · Annals of Behavioral Medicine · doi:10.1093/abm/kaae029 · Cited by 4
Mindfulness-based interventions in oncology: A scoping review of outcomes and applications
Chen, C.-Y., Li, S., Li, X.-X., & Zhou, B. (2025) · World Journal of Clinical Cases · doi:10.12998/wjcc.v13.i24.106864 · Cited by 4
“For instance, a randomized trial on MBSR in women with breast cancer reported improvements in natural killer (NK) cell activity and cytokine profiles, alongside reductions in depression[29].”
Be Kind to Yourself: Testing Self-Compassion, Fear of Recurrence, and Generalized Anxiety in Women with Cancer Within a Multiple-Mediation Model
Krok, D., Telka, E., & Skalski‐Bednarz, S. B. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14134696 · Cited by 3
“…of self-J compassion-based interventions among cancer patients has demonstrated that employing techniques grounded in self-compassionate attitudes is associated with a reduction in fear of cancer recurrence in both breast cancer survivors [9,10] and a general sample of adult cancer patients [11].”
Bioelectrical Impedance Assessment in a Patient with Breast Cancer: A Case Report on the Effect of Integrative Therapies on Cellular Homeostasis
Marino, G., Pace, G., Sabato, L., Sichetti, M., & Mecca, M. (2025) · Nutrients · doi:10.3390/nu17152506 · Cited by 2
Cognitive-behavioral and mindfulness-based therapies for mental health and quality of life of breast cancer patients: a meta-analysis of randomized controlled trials
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Mindfulness Based Therapy in Cancer Patients: Meta-Analysis
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Mindfulness-Based Stress Reduction Enhances Quality of Life and Positive Psychological Traits Among Head and Neck Cancer Patients: Findings from a Randomized Controlled Trial
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Efficacy of mindfulness-based interventions for pain in patients with cancer: A systematic review and meta-analysis
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Non-pharmacological therapy options for chemotherapy-related cognitive impairment
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Sexual Functioning and Body Image in Younger Breast Cancer Survivors
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Research Status of Mindfulness Decompression Therapy for Fear of Recurrence in Cancer Survivors
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Authors: Lengacher, C. A., Shelton, M. M., Reich, R. R., Barta, M. K., Johnson-Mallard, V., Moscoso, M. S., Paterson, C., Ramesar, S., Budhrani, P., Carranza, I., Lucas, J., Jacobsen, P. B., Goodman, M. J., & Kip, K. E.
Affiliations: University of South Florida (US)
Moffitt Cancer Center (US)
University of Virginia (US)
Corresponding author: Lengacher, Cecile A.
ORCID: Lengacher, Cecile A.
Reich, Richard R.
Moscoso, Manolete S.
Jacobsen, Paul B.
Goodman, Matthew J.
Kip, Kevin E.
Venue: Journal of Behavioral Medicine
Publisher: Springer Science and Business Media LLC
Published: 2012-11-27
Volume: 37
Issue: 2
Pages: 185-195
ISSN: 0160-7715 (ISSN-L)
1573-3521
DOI: 10.1007/s10865-012-9473-6
PMC: PMC3627743
OpenAlex: W1968517896
Cited by: 117
References: 67
Citations by year: 2026: 7 · 2025: 7 · 2024: 8 · 2023: 3 · 2022: 15 · 2021: 5 · 2020: 11 · 2019: 11 · 2018: 12 · 2017: 10 · 2016: 11 · 2015: 10 · 2014: 4 · 2013: 1
FWCI: 2.37
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
Locations: Journal of Behavioral Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health
National Cancer Institute (R21CA109168)
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Stress, Anesthesia, and Immune Response
Keywords: mindfulness-based stress reduction, breast cancer survivors, fear of recurrence, perceived stress, state anxiety, trait anxiety, physical function, psychological symptoms, somatic symptoms, mediation
MeSH terms: Breast Neoplasms, Fear, Female, Humans, Middle Aged, Recurrence, Stress, Psychological, Treatment Outcome, Mindfulness

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Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT)

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