Mindfulness-Based Stress Reduction Enhances Quality of Life and Positive Psychological Traits Among Head and Neck Cancer Patients: Findings from a Randomized Controlled Trial

Abstract

Head and neck cancer (HNC) is a broad group of different types of cancer that affect regions such as the neck, oral cavity, thyroid, nasopharynx, larynx, salivary glands, tongue, cheek, and lips. As a result of the location of HNC and the adverse effects of its treatment, disruption of body image, interference with physical and social functioning, and impairment in quality of life (QOL) often occur. Hence, it is vital to investigate the effectiveness of psychotherapy such as mindfulness based stress reduction (MBSR) to improve positive psychological traits that may, in turn, enhance QOL among HNC patients, as such data remain scarce. This randomized controlled trial filled the research gap by: (1) comparing the changes in the degree of QOL, posttraumatic growth (PTG), hope and optimism across three time points (T 0 = baseline prior to intervention; T 1 = post-intervention, immediately after completion of intervention; and T 2 = follow-up, 12 weeks after completion of intervention) between MBSR and treatment-as-usual (TAU) control groups and (2) evaluating the mediation effects of PTG, hope and optimism on the relationship between MBSR and degree of QOL among HNC patients. Three time points of assessment allowed measurement of the sustainability of the MBSR effects at the third time point and greater statistical power as more data points were recorded per participant. A total of 110 HNC patients were recruited and randomized to MBSR ( n = 55) and TAU ( n = 55) groups using stratified permuted block randomization and the Functional Assessment for Cancer Therapy-Head and Neck module, Posttraumatic Growth Inventory-Short Form, Dispositional Hope Scale and Life Orientation Test-Revised were administered to all participants across the three time points. MBSR significantly increased the degrees of QOL (T 0 to T 1 : p < 0.001, d = 0.799; T 1 to T 2 : p = 0.030, d = 0.166), optimism (T 0 to T 1 : p < 0.001, d = 0.998; T 1 to T 2 : p < 0.001, d = 0.471) and hope (T 0 to T 1 : p < 0.001, d = 0.587; T 1 to T 2 : p < 0.001, d = 0.603) from T 0 to T 1 and from T 1 to T 2 . Although MBSR also significantly enhanced the degree of PTG from T 0 to T 1 ( p < 0.001, d = 0.743) it did not change the degree of PTG from T 1 to T 2 ( p = 0.273, d = 0.107). In essence, increasing hope played a crucial role in the mechanism underlying the effect of MBSR in enhancing QOL as hope acted as a full mediator on the relationship between MBSR and QOL among the HNC participants, while PTG and optimism were non-mediating factors. MBSR could be an ideal candidate psychotherapy for inclusion as part of the treatment regimen for HNC as it enhances positive psychological traits and QOL among patients. As hope is a full mediator between MBSR and QOL, future studies should evaluate the effects of psychological interventions which enhance hope (such as group meaning-centered hope therapy, dignity therapy, or art therapy for cancer patients) on QOL of HNC patients. ClinicalTrials.gov (identifier: NCT04800419).