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Effectiveness and Cost-Effectiveness of an App-Based Mindfulness Breast Care Program for Reducing Body Image Distress and Stigma Among Survivors of Breast Cancer: Randomized Controlled Trial.

Huicong Lin, Yujing Zhong, Shuang Zheng, Xiaoying Jiang, Yun Xu, Sally Chan, Shengjie Liu, Ka Ming Chow, Qingmo Yang, Wenhe Huang, Jiemin Zhu

Journal of Medical Internet Research April 24, 2026 DOI: 10.2196/85913 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Randomized controlled trial Peer reviewed
Sample size 192
Population Survivors of breast cancer in China who had completed primary treatments and had mobile phone internet access
Interventions App-based mindfulness breast care (MBC) program routine care
Duration 3-month intervention with assessments at baseline, 3 months (T1), and 6 months (T2)
Topics Meditation
Keywords App-based mindfulness intervention Body image distress Breast cancer Cost-effectiveness Quality of life Randomized controlled trial Stigma
Key findings The app-based mindfulness breast care program reduced body image distress at six months and stigma at three and six months, and improved mental well-being at three months, compared with routine care alone; sleep quality, social support, and physical well-being did not differ significantly. The intervention group gained more quality-adjusted life years, with an incremental cost of US $19,431.25 per QALY and a 57% probability of being cost-effective at the US $37,530 threshold.

Abstract

Breast cancer surgery and corresponding treatments have significant residual effects on survivors of breast cancer in China. Body image distress and stigma are persistent challenges that negatively affect their quality of life. Accessible, sustainable, and cost-effective support remains scarce. This study aimed to evaluate the effectiveness and cost-effectiveness of an app-based mindfulness breast care (MBC) program in addressing body image distress and stigma for survivors of breast cancer. We carried out a randomized controlled trial in 2 university-affiliated hospitals in China. Survivors of breast cancer who had completed primary treatments and had mobile phone internet access were recruited and randomly assigned at a 1:1 ratio to the intervention (3-month MBC program plus routine care) or the control group (routine care alone). Under the conceptualization of mindfulness-based cognitive therapy, the MBC program was developed, including three modules: (1) Library, (2) Mindfulness Yoga, and (3) Mindfulness Practices. The primary outcomes measured were body image distress and stigma, and secondary outcomes included sleep quality, social support, and quality of life (physical and mental well-being). Assessments were conducted at baseline, 3 months (T1), and 6 months (T2). Multiple imputation was used to handle missing data and generalized estimating equations were fitted to evaluate the effectiveness. The incremental cost per quality-adjusted life year (QALY) gained was used to measure cost-effectiveness. A total of 192 survivors of breast cancer participated in the baseline assessment, with 155 completing the 2 follow-up surveys. The median total usage duration was 199.60 (IQR 70.90-451.31; mean 360.59, SD 511.72) minutes, and total login frequency was 39.50 (IQR 19.00-86.50; mean 57.02, SD 50.26) times. The reduction in body image distress at T2 (adjusted mean difference -1.91; 95% CI -3.40 to -0.42; P=.01; d=-0.31), the reduction in stigma at T1 (adjusted mean difference -5.83; 95% CI -8.46 to -3.20; P<.001; d=-0.61) and T2 (adjusted mean difference -7.79; 95% CI -10.62 to -4.97; P<.001; d=-0.82), and the improvement in mental well-being at T1 (adjusted mean difference 4.44; 95% CI 1.70 to 7.18; P=.002; d=0.43) were statistically significantly greater in the intervention group compared with the control group. No statistically significant group differences were observed regarding sleep quality, social support, and physical well-being. The cost-effectiveness analysis showed that the intervention group gained more QALYs than the control group at T2 (adjusted mean difference 0.008; 95% CI 0.004 to 0.016; P=.01). The incremental cost per QALY gained at T2 was US $19,431.25, indicating a 57% probability that the MBC program is a cost-effective intervention at a threshold of US $37,530, three times the 2023 gross domestic product per capita of China. An app-based MBC program was effective and potentially cost-effective and had the promise to be scalable for clinical practice. Chinese Clinical Trial Registry ChiCTR2200059952; https://www.chictr.org.cn/showproj.html?proj=167247.

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

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