A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship

Hulett, Jennifer M.; Armer, Jane M.

doi:10.1177/1534735416636222

Cited by 105Religion, Spirituality, and PsychologyCancer survivorship and careMindfulness and Compassion Interventions

A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship

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Hulett, Jennifer M., Armer, Jane M.·2016·Integrative Cancer Therapies

DOI 10.1177/1534735416636222PMC PMC5125023

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Abstract

Objective This is a review of spiritually based interventions (eg, mindfulness-based stress reduction) that utilized psychoneuroimmunological (PNI) outcome measures in breast cancer survivors. Specifically, this review sought to examine the evidence regarding relationships between spiritually based interventions, psychosocial-spiritual outcomes, and biomarker outcomes in breast cancer survivors. Methods A systematic search of 9 online databases was conducted for articles of original research, peer-reviewed, randomized and nonrandomized control trials from 2005-2015. Data were extracted in order to answer selected questions regarding relationships between psychosocial-spiritual and physiological measures utilized in spiritually based interventions. Implications for future spiritually based interventions in breast cancer survivorship are discussed. Results Twenty-two articles were reviewed. Cortisol was the most common PNI biomarker outcome studied. Compared with control groups, intervention groups demonstrated positive mental health outcomes and improved or stable neuroendocrine-immune profiles, although limitations exist. Design methods have improved with regard to increased use of comparison groups compared with previous reviews. There are few spiritually based interventions that specifically measure religious or spiritual constructs. Similarly, there are few existing studies that utilize standardized religious or spiritual measures with PNI outcome measures. Findings suggest that a body of knowledge now exists in support of interventions with mindfulness-breathing-stretching components; furthermore, these interventions appear to offer potential improvement or stabilization of neuroendocrine-immune activity in breast cancer survivors compared to control groups. Conclusion From a PNI perspective, future spiritually based interventions should include standardized measures of religiousness and spirituality in order to understand relationships between and among religiousness, spirituality, and neuroendocrine-immune outcomes. Future research should now focus on determining the minimum dose and duration needed to improve or stabilize neuroendocrine-immune function, as well as diverse setting needs, including home-based practice for survivors who are too ill to travel to group sessions or lack economic resources.

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A systematic review showed that mindfulness intervention can improve individual's mental health and lead to positive biomarker outcomes such as decreased interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α).
“A systematic review showed that mindfulness intervention can improve individual’s mental health and lead to positive biomarker outcomes such as decreased interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) (55).”
From Mindfulness-based online intervention on mental health among undergraduate nursing students during coronavirus disease 2019 pandemic in Beijing, China: A randomized controlled trial (2022) · cites this paper as [55]
The Results and Discussion tables report improved mental-health outcomes and decreased IL-6 with mindfulness-based stress reduction in breast cancer survivors. They attribute stable or decreased TNF-α to yoga, not mindfulness, so the TNF-α part of the claim is unsupported. The review does not establish these outcomes for individuals generally. (LLM, conf=0.90)
Experimental — accuracy not yet measured
The positive effect of mindfulness intervention on anxiety and stress has its biological basis.
“In this case, the positive effect of mindfulness intervention on anxiety and stress has its biological basis.”
From Mindfulness-based online intervention on mental health among undergraduate nursing students during coronavirus disease 2019 pandemic in Beijing, China: A randomized controlled trial (2022) · cites this paper as [55]
The Results and Discussion report lower stress and anxiety after mindfulness-based stress reduction, alongside a trend in awakening cortisol levels. But the cortisol finding and the association between stress and cortisol were not statistically significant, so the review does not establish a biological basis for the psychological effects. The evidence is also drawn from cancer patients rather than mindfulness interventions generally. (LLM, conf=0.85)
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A Randomized Trial of the Effect of Prayer on Depression and Anxiety
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Re-conceptualizing the Factor Structure of the Brief Multidimensional Measure of Religiousness/Spirituality
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Telomeres: Prognostic markers for solid tumors
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Relationships Among Spirituality, Religious Practices, Personality Factors, and Health for Five Different Faith Traditions
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Telomere length is an independent predictor of survival, treatment requirement and Richter's syndrome transformation in chronic lymphocytic leukemia
Rossi, D., Bodoni, C. L., Genuardi, E., Monitillo, L., Drandi, D., Cerri, M., Deambrogi, C., Ricca, I., Rocci, A., Ferrero, S., et al. (2009) · Leukemia · doi:10.1038/leu.2008.399 · Cited by 100 · see citing works
Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery
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Psychoneuroimmunology
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A Randomized Study of the Effects of Mindfulness Training on Psychological Well-being and Symptoms of Stress in Patients Treated for Cancer at 6-month Follow-up
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Effects of Mindfulness-Based Stress Reduction (MBSR) on Health Among Breast Cancer Survivors
Matchim, Y., Armer, J. M., & Stewart, B. R. (2010) · Western Journal of Nursing Research · doi:10.1177/0193945910385363 · Cited by 92 · see citing works
Effects of faith/assurance on cortisol levels are enhanced by a spiritual mantram intervention in adults with HIV: A randomized trial
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Exploratory Studies of Qigong Therapy for Cancer in China
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Spiritual health, clinical practice stress, depressive tendency and health‐promoting behaviours among nursing students
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The effects of spiritual interventions in patients with cancer: a meta-analysis.
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Is the Term 'Spirituality' a Word that Everyone Uses, But Nobody Knows What Anyone Means by it?
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Burden of Cardiovascular Risk Factors, Subclinical Atherosclerosis, and Incident Cardiovascular Events Across Dimensions of Religiosity: The Multi-Ethnic Study of Atherosclerosis
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Relaxation and guided imagery program in patients with breast cancer undergoing radiotherapy is not associated with neuroimmunomodulatory effects
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Complementary and Alternative Medicine Use, Spending, and Quality of Life in Early Stage Breast Cancer
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Immuno-modulatory effects of relaxation training and guided imagery in women with locally advanced breast cancer undergoing multimodality therapy: A randomised controlled trial
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A Critical Review of the Effects of Medical Qigong on Quality of Life, Immune Function, and Survival in Cancer Patients
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Lymphocyte Recovery After Breast Cancer Treatment and Mindfulness-Based Stress Reduction (MBSR) Therapy
Lengacher, C. A., Kip, K. E., Post‐White, J., Fitzgerald, S., Newton, C. A., Barta, M. K., Jacobsen, P. B., Shelton, M. M., Moscoso, M. S., Johnson‐Mallard, V., et al. (2011) · Biological Research For Nursing · doi:10.1177/1099800411419245 · Cited by 65 · see citing works
SUPPORT FOR A NEUROPSYCHOLOGICAL MODEL OF SPIRITUALITY IN PERSONS WITH TRAUMATIC BRAIN INJURY
Johnstone, B., & Glass, B. A. (2008) · Zygon® · doi:10.1111/j.1467-9744.2008.00964.x · Cited by 63 · see citing works
The Effects of Psychotherapy on Psychological Well-Being and Diurnal Cortisol Patterns in Breast Cancer Survivors
Hsiao, F.-H., Jow, G.-M., Kuo, W.-H., Chang, K.-J., Liu, Y.-F., Ho, R. T. H., Ng, S.-M., Chan, C. L. W., Lai, Y.-M., & Chen, Y.-T. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000329178 · Cited by 63 · see citing works
Differentiating the Impact of Spiritual Experiences, Religious Practices, and Congregational Support on the Mental Health of Individuals With Heterogeneous Medical Disorders
Cohen, D., Yoon, D. P., & Johnstone, B. (2009) · International Journal for the Psychology of Religion · doi:10.1080/10508610802711335 · Cited by 63 · see citing works
Older Breast Cancer Survivors: Factors Associated with Self-reported Symptoms of Persistent Lymphedema Over 7 years of Follow-up
Clough‐Gorr, K. M., Ganz, P. A., & Silliman, R. A. (2009) · The Breast Journal · doi:10.1111/j.1524-4741.2009.00878.x · Cited by 60 · see citing works
A systematic review of the effectiveness of qigong exercise in supportive cancer care
Chan, C., Wang, C., Ho, R., Ng, S., Chan, J. S. M., Ziea, E. T. C., & Wong, V. C. W. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-011-1378-3 · Cited by 57 · see citing works
Spirituality and Spiritual Self-Care
White, M. L., Peters, R. M., & Schim, S. M. (2011) · Nursing Science Quarterly · doi:10.1177/0894318410389059 · Cited by 54 · see citing works
Effects of Mindfulness Training on Levels of Cortisol in Cancer Patients
Bränström, R., Kvillemo, P., & Åkerstedt, T. (2012) · Psychosomatics · doi:10.1016/j.psym.2012.04.007 · Cited by 47 · see citing works
A Research-Based Use of Tai Chi/Movement Therapy as a Nursing Intervention
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Psychoneuroimmunology: an emerging framework for nursing research
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Audio recordings of mindfulness-based stress reduction training to improve cancer patients’ mood and quality of life—a pilot feasibility study
Altschuler, A., Rosenbaum, E., Gordon, P., Canales, S., & Avins, A. L. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-011-1216-7 · Cited by 42 · see citing works
Evaluation of intrapsychic factors, coping styles, and spirituality of patients affected by tumors
Vespa, A., Jacobsen, P. B., Spazzafumo, L., & Balducci, L. (2010) · Psycho-Oncology · doi:10.1002/pon.1719 · Cited by 39 · see citing works
Baseline Immune Biomarkers as Predictors of MBSR(BC) Treatment Success in Off-Treatment Breast Cancer Patients
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Psychoneuroimmunology-Based Stress Management during Adjuvant Chemotherapy for Early Breast Cancer
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Psychosocial Therapies for Patients With Cancer
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Immune Responses to Guided Imagery During Breast Cancer Treatment
Lengacher, C. A., Bennett, M. P., Gonzalez, L., Gilvary, D. L., Cox, C. E., Cantor, A. B., Jacobsen, P. B., Yang, C., & Djeu, J. Y. (2007) · Biological Research For Nursing · doi:10.1177/1099800407309374 · Cited by 26 · see citing works
A Program in Contemplative Self‐Healing
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The Brief Multidimensional Measure of Religiousness/Spirituality with an Irish sample: a factor analysis
Bodling, A. M., Heneghan, M., Walsh, J. C., Yoon, D. P., & Johnstone, B. (2013) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2013.20.2.72 · Cited by 24 · see citing works
Perspectives of the Breast Cancer Survivorship Continuum: Diagnosis through 30 Months Post-Treatment
Hulett, J. M., Armer, J. M., Stewart, B. R., & Wanchai, A. (2015) · Journal of Personalized Medicine · doi:10.3390/jpm5020174 · Cited by 21 · see citing works
External Qigong Therapy for Women With Breast Cancer Prior to Surgery
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Rehabilitation Concepts Among Aging Survivors Living With and At Risk for Lymphedema
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Flagged first, then by citations

2 of the 121 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

[1]Battaglini C Dennehy C Groff D Kirk D Anton P. Complementary therapies in the management of cancer treatment-related symptoms: the individualized prescriptive exercise intervention approach. Med Sportiva. 2006; 10(2): 49- 57.
[88]Altschuler A Rosenbaum E Gordon P Canales S Avins AL. Audio recordings of mindfulness-based stress reduction training to improve cancer patients’ mood and quality of life—a pilot feasibility study. Support Care Cancer. 2012; 20: 1291- 1297. 21688161

Sorted by citations

Handbook of Religion and Health
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Social Capital and Sleep Quality in Individuals Who Self-Isolated for 14 Days During the Coronavirus Disease 2019 (COVID-19) Outbreak in January 2020 in China
Xiao, H., Zhang, Y., Kong, D., Li, S., & Yang, N. (2020) · Medical Science Monitor · doi:10.12659/msm.923921 · Cited by 913 · see citing works
Complementary religious and spiritual interventions in physical health and quality of life: A systematic review of randomized controlled clinical trials
Gonçalves, J. P. D. B., Lucchetti, G., Menezes, P. R., & Vallada, H. (2017) · PLoS ONE · doi:10.1371/journal.pone.0186539 · Cited by 114 · see citing works
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Mindfulness meditation for workplace wellness: An evidence map
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Complementary therapies for symptom management in cancer patients
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Spirituality and Quality of Life in Black Patients With Cancer Pain
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Psychosocial interventions in breast cancer survivorship care
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Effectiveness of Stress-Reducing Interventions on the Response to Challenges to the Immune System: A Meta-Analytic Review
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Mindfulness-based online intervention on mental health among undergraduate nursing students during coronavirus disease 2019 pandemic in Beijing, China: A randomized controlled trial
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“A systematic review showed that mindfulness intervention can improve individual’s mental health and lead to positive biomarker outcomes such as decreased interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) (55).”
Background
The Role of Religion for Mindfulness-Based Interventions: Implications for Dissemination and Implementation
Palitsky, R., & Kaplan, D. M. (2021) · Mindfulness · doi:10.1007/s12671-019-01253-0 · Cited by 46 · see citing works
Mindful Eating: Connecting With the Wise Self, the Spiritual Self
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Psychosocial interventions reduce cortisol in breast cancer patients: systematic review and meta-analysis
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Complementary Therapies as a Strategy to Reduce Stress and Stimulate Immunity of Women With Breast Cancer
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Retracted
Spiritual well-being associated with personality traits and quality of life in family caregivers of cancer patients
Vespa, A., Spatuzzi, R., Merico, F., Ottaviani, M., Fabbietti, P., Meloni, A., Raucci, L., Ricciuti, M., Bilancia, D., Pelliccioni, G., et al. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4107-3 · Cited by 30 · see citing works
Religiousness, Spirituality, and Salivary Cortisol in Breast Cancer Survivorship
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Interconexão entre saúde, espiritualidade e religiosidade
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Preliminary study on the effects of treatment for breast cancer: immunological markers as they relate to quality of life and neuropsychological performance
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Spiritual interventions for cancer pain: a systematic review and narrative synthesis
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What Survivorship Means to Liver Transplant Recipients: Qualitative Groundwork for a Survivorship Conceptual Model
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The Effect of Religious–Spiritual Psychotherapy on Illness Perception and Inner Strength among Patients with Breast Cancer in Iran
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Sustained by the Sacred: Religious and Spiritual Factors for Resilience in Adulthood and Aging
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The association of mindfulness and psychological well-being among individuals who have recovered from COVID-19 in Jianghan District, Wuhan, China: A cross-sectional study
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Mindfulness is associated with improved psychological well-being but no change in stress biomarkers in breast cancer survivors with depression: a single group clinical pilot study
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The Relationship Between Spirituality and the Developing Brain: A Framework for Pediatric Oncology
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Spirituality and Transcendence
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Protocol and biomarker strategy for a multi-site randomized controlled trial examining biological mechanisms and dosing of active music engagement in children with acute lymphoblastic leukemia and lymphoma and parents
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Definitions
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0001 · Cited by 11 · see citing works
Long-term effects of an online mindfulness intervention on mental health in Chinese nursing students: a randomized controlled trial follow-up
Dai, Z., Jing, S., Wu, Y., Chen, X., Fu, J., Pan, C., Tang, Q., Wang, H., & Su, X. (2025) · BMC Public Health · doi:10.1186/s12889-025-21726-3 · Cited by 11 · see citing works
Does spiritual and religious orientation impact the clinical practice of healthcare providers?
Kelly, E. P., Hyer, M., Payne, N. G., & Pawlik, T. M. (2020) · Journal of Interprofessional Care · doi:10.1080/13561820.2019.1709426 · Cited by 13 · see citing works
A systematic review of interventional trials reporting relationships between silent mantram repetition and health in adults
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Effectiveness of Neurofeedback-Assisted and Conventional 6-Week Web-Based Mindfulness Interventions on Mental Health of Chinese Nursing Students: Randomized Controlled Trial
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Self-management Behaviors and Associated Factors in Adult Cancer Survivors
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Autonomic Rehabilitation
Gharbo, R. S. (2020) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2020.07.003 · Cited by 9 · see citing works
Associations between religious and spiritual variables and neuroimmune activity in survivors of breast cancer: a feasibility study
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Case Report: Dynamic Interdependencies Between Complementary and Alternative Medicine (CAM) Practice, Urinary Interleukin-6 Levels, and Fatigue in a Breast Cancer Survivor
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Psychoneuroimmunological approach to gastrointestinal related pain
Toljan, K., & Vrooman, B. (2017) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2017.10.010 · Cited by 7 · see citing works
Religious Coping for Covid-19 Patients: Islamic Approaches
Murtadho, A., Hidayanti, E., Fakhri, M., Masri, S., Purwanti, K. L., Algifahmy, A. F., & Hakim, L. (2022) · Journal of Al-Tamaddun · doi:10.22452/jat.vol17no1.3 · Cited by 6 · see citing works
Complementary Therapies as a Strategy to Reduce Stress and Stimulate the Immunity of Women With Breast Cancer
Abrahão, C. A., Bomfim, E., Lopes-Júnior, L. C., & Pereira-da-Silva, G. (2019) · Journal of Evidence-Based Integrative Medicine · doi:10.1177/2515690x19838897 · Cited by 30 · see citing works
Retracted
Spiritual and religious interventions as a complementary and supportive therapy in women with breast cancer: an integrative literature review
Soósová, M. S., Suchanová, R., Parová, V., & Hertelyová, Z. (2024) · Kontakt · doi:10.32725/kont.2024.011 · Cited by 4 · see citing works
Spirituality as a sociocultural determinant of health in the context of medical curriculum: A call for action
Seddigh, R., Azarnik, S., Memaryan, N., & Hadi, F. (2020) · Medical Journal of the Islamic Republic of Iran · doi:10.47176/mjiri.34.6 · Cited by 4 · see citing works
Measurement
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O REIKI E A SUA INFLUÊNCIA BENÉFICA PARA PACIENTES ONCOLÓGICOS
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Preface
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Health Policy Implications
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Foreword
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Physical Disability
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Authors: Hulett, J. M., & Armer, J. M.
Affiliations: University of Utah (US)
University of Missouri (US)
Corresponding author: Hulett, Jennifer M.
ORCID: Hulett, Jennifer M.
Armer, Jane M.
Venue: Integrative Cancer Therapies
Publisher: SAGE Publications
Published: 2016-07-26
Volume: 15
Issue: 4
Pages: 405-423
ISSN: 1534-7354 (ISSN-L)
1552-695X
DOI: 10.1177/1534735416636222
PMC: PMC5125023
OpenAlex: W2346863221
Cited by: 105
References: 121
Citations by year: 2026: 3 · 2025: 8 · 2024: 3 · 2023: 46 · 2022: 10 · 2021: 4 · 2020: 11 · 2019: 8 · 2018: 5 · 2017: 7
FWCI: 1.25
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Integrative Cancer Therapies (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Funders: University of Missouri
University of Utah
National Institutes of Health
National Institute of Nursing Research (T32NR013456)
Topics: Social Sciences › Health › Religion, Spirituality, and Psychology
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords: breast cancer survivorship, psychoneuroimmunology, mindfulness-based stress reduction, cortisol, home-based intervention
MeSH terms: Breast Neoplasms, Female, Humans, Psychoneuroimmunology, Quality of Life, Outcome Assessment, Health Care, Survivors, Mind-Body Therapies, Spirituality

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A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship

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