Mindfulness-Based Interventions for Fear of Recurrence in Patients with Breast Cancer: A Meta-Analysis

Abstract

Background: Fear of cancer recurrence (FCR) is a prevalent psychological distress among breast cancer survivors. Although mindfulness-based interventions (MBIs) are increasingly used in cancer care, their efficacy remains inconclusive, and the influence of cultural background on outcomes is unclear. This heterogeneity hinders the development of personalized clinical strategies.

Objective: We aimed to systematically evaluate the overall efficacy of MBIs in terms of FCR in people with breast cancer through meta-analysis, and to examine the moderate effects of factors, such as geographic area, length of intervention, and measurement instruments. This study intends to yield evidence supporting the creation of individualized intervention in clinical settings.

Methods: We searched relevant databases in Chinese and English, including PubMed, Web of Science, Scopus, Cochrane Library, the China National Knowledge Infrastructure (CNKI), WanFang Data, and VIP Journal (CQVIP) for articles that published from inception through Aug 30 2025, which compared MBIs with control groups to determine the effects of MBIs on FCR of breast cancer patients. We used the Cochrane Risk of Bias tool (RoB 2.0) to assess the methodological qualities. The combined analysis was based on a random-effects model using Hedges’s g to yield the effect size. Subgroup analysis was used to explore sources of heterogeneity. We used funnel plot and Egger’s test to analyze for publication bias.

Results: The initial search yielded 264 records. Following a stepwise screening process, 10 RCTs were included. Sensitivity analysis identified one outlier study. After its exclusion, the analysis was based on the remaining 9 studies (involving 896 patients). The results showed that MBIs significantly reduced FCR levels in breast cancer patients, with a pooled effect size of Hedges’s g = -0.56 (95% CI: -0.83 to -0.29, P < 0.001). However, substantial heterogeneity was observed among studies ( I² = 73.83%). Subgroup analysis indicated: 1) Region significantly moderated the efficacy, with MBIs showing a pronounced effect in Chinese patients (g = -0.71, 95% CI: -0.90 to -0.44, P < 0.001), while the effect was not statistically significant in patients from other countries (g = -0.26, 95% CI: -0.56 to 0.04, P = 0.08); 2) Intervention duration (<8 weeks vs. ≥8 weeks) had no significant effect on efficacy ( P = 0.99); 3) Different assessment tools (CARS, FCRI, FoP-Q-SF) all confirmed the effectiveness of MBIs (all P < 0.05), with no difference in efficacy between tools ( P = 0.88). Egger’s test ( P = 0.03) suggested potential publication bias.

Conclusion: Mindfulness-based interventions can effectively reduce fear of cancer recurrence in breast cancer patients, and their efficacy is moderated by cultural background, with more pronounced effects observed in Chinese populations. For clinical practice, we strongly recommend developing culturally adapted mindfulness programs, especially for Chinese patients, to maximize therapeutic benefits. Future research requires larger sample sizes and higher-quality studies to verify long-term efficacy and explore core mechanisms of action.