Artikel: 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
Purpose: Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate psychological distress in
patients with cancer. However, patients experience barriers to participating in face-to-face MBCT.
Individual Internet-based MBCT (eMBCT) could be an alternative. The study aim was to compare
MBCT and eMBCT with treatment as usual (TAU) for psychological distress in patients with cancer.
Patients and Methods
We obtained ethical and safety approval to include 245 patients with cancer with psychological
distress ($ 11 on the Hospital Anxiety and Depression Scale) in the study. They were randomly
allocated to MBCT (n = 77), eMBCT (n = 90), or TAU (n = 78). Patients completed baseline (T0) and
postintervention (T1) assessments. The primary outcome was psychological distress on the Hospital
Anxiety and Depression Scale. Secondary outcomes were psychiatric diagnosis, fear of cancer recurrence,
rumination, health-related quality of life, mindfulness skills, and positive mental health.
Continuous outcomes were analyzed using linear mixed modeling on the intention-to-treat sample.
Because both interventions were compared with TAU, the type I error rate was set at P , .025.
Results
Compared with TAU, patients reported significantly less psychological distress after both MBCT
(Cohen’s d, .45; P , .001) and eMBCT (Cohen’s d, .71; P , .001) . In addition, post-treatment
prevalence of psychiatric diagnosis was lower with both MBCT (33% improvement; P = .030) and
eMBCT (29% improvement; P = .076) in comparison with TAU (16%), but these changes were not
statistically significant. Both interventions reduced fear of cancer recurrence and rumination, and
increased mental health–related quality of life, mindfulness skills, and positive mental health
compared with TAU (all Ps , .025). Physical health–related quality of life did not improve (P = .343).
Conclusion
Compared with TAU, MBCT and eMBCT were similarly effective in reducing psychological distress
in a sample of distressed heterogeneous patients with cancer.
J Clin Oncol 36. © 2018 by American Society of Clinical Oncology