Efficacy of an online mindfulness program (MindOnLine) to reduce fear of recurrence in people living with-and beyond-breast, prostate or colorectal cancer: a randomized controlled trial.
Patricia M Livingston, Natalie Winter, Lahiru Russell, O Eric, Allan Ben Smith, Helena Romaniuk, Michael Jefford, Anna Ugalde, Afaf Girgis, David W Austin, Cathrine Mihalopoulos, Richard Chambers, Jo Phipps-Nelson, Dishan Herath, Bodil Rasmussen, Kathryn Whitfield, Maria Ftanou, Kirsten Pilatti, Sally Sara, Annie Wootten, Mari Botti, Kate Gillan, Madhu Singh, David Campbell, Brindha Pillay, Philip Dundee, Michael O'Callaghan, Sue M Evans, Liliana Orellana, Victoria M White
EClinicalMedicine August 1, 2025 DOI: 10.1016/j.eclinm.2025.103373 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 434 |
| Population | Adults in Australia who completed treatment for stage 1-3 breast, prostate, or colorectal cancer within the last 5 years and had a Fear of Cancer Recurrence Inventory severity score ≥13 |
| Duration | 9-week intervention, with follow-up at 9 months post-randomization |
| Topics | Anxiety Depression Meditation |
| Keywords | Cancer Supportive care Web-based platforms |
| Key findings | MindOnLine reduced fear of cancer recurrence, anxiety, and depression scores at 9 weeks and 9 months compared to a waitlist group. |
Abstract
Fear of cancer recurrence (FCR) is a prevalent and debilitating condition that effects around 60% of people living with cancer. It is severe, persistent, and imposes a significant financial burden on the healthcare system. Given FCR's profound impact on mental health and quality of life, adopting targeted interventions to mitigate its effects is essential. This study reports on the efficacy of MindOnLine, an online mindfulness program, for people living with-and beyond-breast, prostate or colorectal cancer, in reducing FCR, anxiety and depression. Randomized controlled trial (1:1) comparing MindOnline with a waitlist group (ANZCTR: 12620000645954). Eligibility criteria: ≥18 years, living in Australia, completed active treatment/surveillance for stages 1-3 breast, prostate or CRC, within the last 5 years, had internet access, and a Fear of Cancer Recurrence Inventory (FCRI) severity score ≥13. MindOnLine was a self-directed, brief, online 9-week program, with a new module unlocked each week. The intervention incorporated education, mindfulness practices, and meditation, to promote awareness and emotion regulation. Data were captured at baseline, 9-weeks and 9-months post-randomization. Linear mixed models assessed MindOnLine's impact on the primary (FCRI total score) and secondary (anxiety (GAD-7), depression (PHQ-9)) outcomes. Between October 2020 and June 2023, 434 participants randomized, of which 58% had breast, 26% prostate and 16% colorectal cancer; 70% were female; 50% were aged ≥60 years; and 67.5% resided in metropolitan areas. At 9-weeks, MindOnLine decreased the FCRI total score (-5.61, 95% CI [-8.61, -2.61], p < 0.001); anxiety (-1.29 [-2.15, -0.43], p = 0.003) and depression (-1.47 [-2.34, -0.61], p < 0.001) scores, compared to the waitlist group. Intervention effects were sustained at 9-months (FCRI: -5.06 [-8.61, -1.52]; p = 0.005; anxiety: -1.22 [-2.21, -0.24], p = 0.015; depression: -1.09 [-2.03, -0.16], p = 0.022). Our findings demonstrate that a self-directed, brief, online mindfulness-based program mitigates moderate or severe fear of cancer recurrence. Further research is necessary to guide the development of future services, policies and practices by identifying how online mindfulness programs can be customized to effectively support diverse population groups, ensuring the programs are effective and accessible and impactful, regardless of their personal circumstances or geographical location. This study was funded by the National Health and Medical Research Council (NHMRC) Partnership Grant ID APP1179317, with partner cash contributions from the Department of Health, Victoria, Epworth HealthCare and Western Health.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cites 3
- Effectiveness of Web-Based Mindfulness-Based Interventions for Patients With Cancer: Systematic Review and Meta-Analyses. Journal of Medical Internet Research June 25, 2024
- Engagement Strategies to Improve Adherence and Retention in Web-Based Mindfulness Programs: Systematic Review Journal of Medical Internet Research August 28, 2023
- Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared With Treatment as Usual in Reducing Psychological Distress in Patients With Cancer: A Multicenter Randomized Controlled Trial. Journal of Clinical Oncology June 28, 2018