Mindfulness-Based Programs for Patients With Cancer via eHealth and Mobile Health: Systematic Review and Synthesis of Quantitative Research (Preprint)
Open accessAbstract
BACKGROUND: eHealth mindfulness-based programs (eMBPs) are on the rise in complex oncology and palliative care. However, we are still at the beginning of answering the questions of how effective eMBPs are and for whom, and what kinds of delivery modes are the most efficient. OBJECTIVE: This systematic review aims to examine the feasibility and efficacy of eMBPs in improving the mental health and well-being of patients with cancer, to describe intervention characteristics and delivery modes of these programs, and to summarize the results of the included studies in terms of moderators, mediators, and predictors of efficacy, adherence, and attrition. METHODS: In total, 4 databases (PubMed, PsycINFO, Scopus, and Web of Knowledge) were searched using relevant search terms (eg, mindfulness, program, eHealth, neoplasm) and their variations. No restrictions were imposed on language or publication type. The results of the efficacy of eMBPs were synthesized through the summarizing effect estimates method. RESULTS: A total of 29 published papers describing 24 original studies were included in this review. In general, the results indicate that eMBPs have the potential to reduce the levels of stress, anxiety, depression, fatigue, sleep problems, and pain, and improve the levels of mindfulness, posttraumatic growth, and some parameters of general health. The largest median of Cohen d effect sizes were observed in reducing anxiety and depression (within-subject: median −0.38, IQR −0.62 to −0.27; between-group: median −0.42, IQR −0.58 to −0.22) and facilitating posttraumatic growth (within-subject: median 0.42, IQR 0.35 to 0.48; between-group: median 0.32, IQR 0.22 to 0.39). The efficacy of eMBP may be comparable with that of parallel, face-to-face MBPs in some cases. All studies that evaluated the feasibility of eMBPs reported that they are feasible for patients with cancer. Potential moderators, mediators, and predictors of the efficacy, attrition, and adherence of eMBPs are discussed. CONCLUSIONS: Although the effects of the reviewed studies were highly heterogeneous, the review provides evidence that eMBPs are an appropriate way for mindfulness practice to be delivered to patients with cancer. Thus far, existing eMBPs have mostly attempted to convert proven face-to-face mindfulness programs to the eHealth mode. They have not yet fully exploited the potential of eHealth technology.
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The proportion of dropout was within the range of other self-guided eHealth/web-based interventions.
“Although dropout occurred, the proportion was within the range of other self-guided eHealth/web-based interventions [34].”
From Changes of Symptoms of Anxiety, Depression, and Fatigue in Cancer Patients 3 Months after a Video-Based Intervention (2023) · cites this paper as [34]
The Discussion (Attrition Rate; page unavailable) says dropout in the reviewed eHealth mindfulness programs was within the range reported by another review of such programs. It does not establish that the comparison range was specifically for self-guided eHealth or web-based interventions. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMindfulness-based eHealth interventions are feasible and effective in improving different outcomes in patients with cancer.
“Matis and colleagues conclude in their systematic literature review that mindfulness-based eHealth interventions are feasible and effective in improving different outcomes in patients with cancer.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [23]
The Discussion’s Conclusions state that these programs are feasible for patients with cancer and may improve various outcomes, especially anxiety, depression, and posttraumatic growth. The citing sentence drops the source’s uncertainty about effectiveness; the Principal Findings also caution that results vary across studies and may be overestimated. (LLM, conf=0.87)
Experimental — accuracy not yet measuredBeneficial effects of mindfulness extend to web-delivered MBSR.
“Moreover, research indicates that these beneficial effects of mindfulness extend to web-delivered MBSR (39).”
From Mindfulness and skills-based eHealth intervention to reduce distress in cancer-affected patients in the Reduct trial: Intervention protocol of the make it training optimized (2022) · cites this paper as [39]
The Discussion > Efficacy section reports beneficial effects of electronically delivered mindfulness-based programs in patients with cancer. The Results > Efficacy section identifies an online MBSR intervention, but the review’s overall efficacy finding covers a broader mix of programs rather than establishing those benefits specifically for web-delivered MBSR. No page numbers are available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredLittle is known about possible predictors of treatment response in iMBIs.
“Despite being shown efficacious, little is known about possible predictors of treatment response in iMBIs (Matis et al., 2020).”
From Internet-delivered Mindfulness-Based Cognitive Therapy for anxiety and depression in cancer survivors: Predictors of treatment response (2021) · cites this paper as Matis et al., 2020
The Discussion (Efficacy) says only nine reviewed studies analyzed predictors of adherence or efficacy, and Future Directions says questions about who benefits remain open. This supports limited knowledge of treatment-response predictors for eHealth mindfulness programs in patients with cancer, but the claim extends that conclusion to iMBIs generally. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOnline delivery of group interventions has shown good feasibility in previous studies.
“Online delivery of group interventions has shown good feasibility in previous studies (e.g., [43]).”
From A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. (2022) · cites this paper as [43]
The Results > Feasibility section reports that all 12 studies assessing feasibility as a primary outcome concluded that online mindfulness-based programs were feasible for patients with cancer. The Results > Intervention Characteristics section includes videoconference delivery, but the review does not establish feasibility specifically for online group interventions. No page numbers are available in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Simply converting proven face-to-face interventions to eHealth delivery does not exploit the full potential of technological options.
“However, it has been noted that simply converting proven face-to-face interventions to eHealth delivery does not exploit the full potential of technological options [12]”
There are existing systematic and metareviews on web-based interventions for cancer care/aftercare and on fear of cancer recurrence interventions more generally.
“There are a number of existing systematic and metareviews on web-based interventions for cancer care/aftercare [9–17] and on fear of cancer recurrence interventions more generally [18–21].”
Evidence on the effectiveness of reminders to improve engagement is lacking.
“The evidence on effectiveness of this approach is lacking and one review [12] has suggested a future study comparing the effectiveness of intervention with and without such reminders.”
A recent systematic review reported a median effect size of Cohen's d = 0.42 for symptoms of anxiety and depression for iMBIs compared with control conditions.
“with a recent systematic review reporting a median effect size of Cohen's d = 0.42 for symptoms of anxiety and depression, when compared with control conditions (Matis et al., 2020).”
From Internet-delivered Mindfulness-Based Cognitive Therapy for anxiety and depression in cancer survivors: Predictors of treatment response (2021) · cites this paper as Matis et al., 2020
There are promising studies regarding anxiety and depression using eHealth with different psychological interventions, but the results are heterogeneous.
“There are promising studies regarding anxiety and depression using eHealth with different psychological interventions.9,14-17 However, the results are heterogeneous.14,15”
From Effects of a Video Sequence Based Intervention on Anxiety, Fatigue and Depression in Cancer Patients: Results of a Randomized Controlled Trial. (2023) · cites this paper as [14]
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“Regarding psychological interventions based on mindfulness, only 1 RCT study compared MBCT and eMBCT with usual care and found that MBCT and eMBCT were equally efficacious compared with treatment as usual in reducing FCR [27,76,77].”
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“Despite being shown efficacious, little is known about possible predictors of treatment response in iMBIs (Matis et al., 2020).”
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Non-pharmacological integrative therapies for chronic cancer pain
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“Moreover, research indicates that these beneficial effects of mindfulness extend to web-delivered MBSR (39).”
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“Finally, further studies with active control conditions, extensive follow-up periods, and patients with higher symptom burdens are needed.”
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- Authors
- Matis, J., Svetlak, M., Slezackova, A., Svoboda, M., & Šumec, R.
- Affiliations
- Masaryk University (CZ)
- Masaryk Memorial Cancer Institute (CZ)
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-05-26
- Volume
- 22
- Issue
- 11
- Pages
- e20709-e20709
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7704284
- OpenAlex
- W3091096421
- Cited by
- 81
- References
- 139
- Citations by year
- 2026: 11 · 2025: 10 · 2024: 16 · 2023: 21 · 2022: 15 · 2021: 8
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- mindfulness program, e-health, mobile health, cancer patients, mental health, anxiety, depression, posttraumatic growth, fatigue, sleep disorders, pain, mode of delivery, palliative care, cancer care, feasibility, well-being, digital mental health interventions, patient-reported outcomes, quality of life
- MeSH terms
- Evaluation Studies as Topic, Humans, Neoplasms, Telemedicine, Mindfulness
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