A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship
Identifieur interne : 004688 ( Pmc/Curation ); précédent : 004687; suivant : 004689A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship
Auteurs : Jennifer M. Hulett [États-Unis] ; Jane M. Armer [États-Unis]Source :
- Integrative cancer therapies [ 1534-7354 ] ; 2016.
Abstract
This is a review of spiritually based interventions (eg, mindfulness-based stress reduction) that utilized psychoneuroimmunological (PNI) outcome measures in breast cancer survivors. Specifically, this review sought to examine the evidence regarding relationships between spiritually based interventions, psychosocial-spiritual outcomes, and biomarker outcomes in breast cancer survivors.
A systematic search of 9 online databases was conducted for articles of original research, peer-reviewed, randomized and nonrandomized control trials from 2005–2015. Data were extracted in order to answer selected questions regarding relationships between psychosocial-spiritual and physiological measures utilized in spiritually based interventions. Implications for future spiritually based interventions in breast cancer survivorship are discussed.
Twenty-two articles were reviewed. Cortisol was the most common PNI biomarker outcome studied. Compared with control groups, intervention groups demonstrated positive mental health outcomes and improved or stable neuroendocrine-immune profiles, although limitations exist. Design methods have improved with regard to increased use of comparison groups compared with previous reviews. There are few spiritually based interventions that specifically measure religious or spiritual constructs. Similarly, there are few existing studies that utilize standardized religious or spiritual measures with PNI outcome measures. Findings suggest that a body of knowledge now exists in support of interventions with mindfulness-breathing-stretching components; furthermore, these interventions appear to offer potential improvement or stabilization of neuroendocrine-immune activity in breast cancer survivors compared to control groups.
From a PNI perspective, future spiritually based interventions should include standardized measures of religiousness and spirituality in order to understand relationships between and among religiousness, spirituality, and neuroendocrine-immune outcomes. Future research should now focus on determining the minimum dose and duration needed to improve or stabilize neuroendocrine-immune function, as well as diverse setting needs, including home-based practice for survivors who are too ill to travel to group sessions or lack economic resources.
Url:
DOI: 10.1177/1534735416636222
PubMed: 27151592
PubMed Central: 5125023
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship</title><author><name sortKey="Hulett, Jennifer M" sort="Hulett, Jennifer M" uniqKey="Hulett J" first="Jennifer M." last="Hulett">Jennifer M. Hulett</name><affiliation wicri:level="1"><nlm:aff id="A1">University of Utah, Salt Lake City, UT, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Utah, Salt Lake City, UT</wicri:regionArea></affiliation></author><author><name sortKey="Armer, Jane M" sort="Armer, Jane M" uniqKey="Armer J" first="Jane M." last="Armer">Jane M. Armer</name><affiliation wicri:level="1"><nlm:aff id="A2">University of Missouri, Columbia, MO, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Missouri, Columbia, MO</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27151592</idno><idno type="pmc">5125023</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125023</idno><idno type="RBID">PMC:5125023</idno><idno type="doi">10.1177/1534735416636222</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">004689</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004689</idno><idno type="wicri:Area/Pmc/Curation">004688</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004688</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship</title><author><name sortKey="Hulett, Jennifer M" sort="Hulett, Jennifer M" uniqKey="Hulett J" first="Jennifer M." last="Hulett">Jennifer M. Hulett</name><affiliation wicri:level="1"><nlm:aff id="A1">University of Utah, Salt Lake City, UT, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Utah, Salt Lake City, UT</wicri:regionArea></affiliation></author><author><name sortKey="Armer, Jane M" sort="Armer, Jane M" uniqKey="Armer J" first="Jane M." last="Armer">Jane M. Armer</name><affiliation wicri:level="1"><nlm:aff id="A2">University of Missouri, Columbia, MO, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Missouri, Columbia, MO</wicri:regionArea></affiliation></author></analytic><series><title level="j">Integrative cancer therapies</title><idno type="ISSN">1534-7354</idno><idno type="eISSN">1552-695X</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">This is a review of spiritually based interventions (eg, mindfulness-based stress reduction) that utilized psychoneuroimmunological (PNI) outcome measures in breast cancer survivors. Specifically, this review sought to examine the evidence regarding relationships between spiritually based interventions, psychosocial-spiritual outcomes, and biomarker outcomes in breast cancer survivors.</p></sec><sec id="S2"><title>Methods</title><p id="P2">A systematic search of 9 online databases was conducted for articles of original research, peer-reviewed, randomized and nonrandomized control trials from 2005–2015. Data were extracted in order to answer selected questions regarding relationships between psychosocial-spiritual and physiological measures utilized in spiritually based interventions. Implications for future spiritually based interventions in breast cancer survivorship are discussed.</p></sec><sec id="S3"><title>Results</title><p id="P3">Twenty-two articles were reviewed. Cortisol was the most common PNI biomarker outcome studied. Compared with control groups, intervention groups demonstrated positive mental health outcomes and improved or stable neuroendocrine-immune profiles, although limitations exist. Design methods have improved with regard to increased use of comparison groups compared with previous reviews. There are few spiritually based interventions that specifically measure religious or spiritual constructs. Similarly, there are few existing studies that utilize standardized religious or spiritual measures with PNI outcome measures. Findings suggest that a body of knowledge now exists in support of interventions with mindfulness-breathing-stretching components; furthermore, these interventions appear to offer potential improvement or stabilization of neuroendocrine-immune activity in breast cancer survivors compared to control groups.</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">From a PNI perspective, future spiritually based interventions should include standardized measures of religiousness and spirituality in order to understand relationships between and among religiousness, spirituality, and neuroendocrine-immune outcomes. Future research should now focus on determining the minimum dose and duration needed to improve or stabilize neuroendocrine-immune function, as well as diverse setting needs, including home-based practice for survivors who are too ill to travel to group sessions or lack economic resources.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Battaglini, C" uniqKey="Battaglini C">C Battaglini</name></author><author><name sortKey="Dennehy, C" uniqKey="Dennehy C">C Dennehy</name></author><author><name sortKey="Groff, D" uniqKey="Groff D">D Groff</name></author><author><name sortKey="Kirk, D" uniqKey="Kirk D">D Kirk</name></author><author><name sortKey="Anton, P" uniqKey="Anton P">P Anton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Armer, Jm" uniqKey="Armer J">JM Armer</name></author><author><name sortKey="Stewart, Br" uniqKey="Stewart B">BR 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<front><journal-meta><journal-id journal-id-type="nlm-journal-id">101128834</journal-id><journal-id journal-id-type="pubmed-jr-id">31537</journal-id><journal-id journal-id-type="nlm-ta">Integr Cancer Ther</journal-id><journal-id journal-id-type="iso-abbrev">Integr Cancer Ther</journal-id><journal-title-group><journal-title>Integrative cancer therapies</journal-title></journal-title-group><issn pub-type="ppub">1534-7354</issn><issn pub-type="epub">1552-695X</issn></journal-meta><article-meta><article-id pub-id-type="pmid">27151592</article-id><article-id pub-id-type="pmc">5125023</article-id><article-id pub-id-type="doi">10.1177/1534735416636222</article-id><article-id pub-id-type="manuscript">NIHMS828457</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Hulett</surname><given-names>Jennifer M.</given-names></name><degrees>PhD, APRN, FNP-BC, PPCNP-BC</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Armer</surname><given-names>Jane M.</given-names></name><degrees>PhD, RN, FAAN</degrees><xref ref-type="aff" rid="A2">2</xref></contrib></contrib-group><aff id="A1"><label>1</label>University of Utah, Salt Lake City, UT, USA</aff><aff id="A2"><label>2</label>University of Missouri, Columbia, MO, USA</aff><author-notes><corresp id="FN1">Corresponding Author: Jennifer M. Hulett, College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA. <email>jennifer.hulett@nurs.utah.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>9</day><month>11</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>4</day><month>5</month><year>2016</year></pub-date><pub-date pub-type="ppub"><month>12</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>12</month><year>2016</year></pub-date><volume>15</volume><issue>4</issue><fpage>405</fpage><lpage>423</lpage><pmc-comment>elocation-id from pubmed: 10.1177/1534735416636222</pmc-comment>
<permissions><license license-type="permissions-link"><license-p>Reprints and permissions: <ext-link ext-link-type="uri" xlink:href="sagepub.com/journalsPermissions.nav">sagepub.com/journalsPermissions.nav</ext-link></license-p></license><license license-type="open-access" xlink:href="http://www.creativecommons.org/licenses/by-nc/3.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>Creative Commons CC-BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (<ext-link ext-link-type="uri" xlink:href="http://www.creativecommons.org/licenses/by-nc/3.0/">http://www.creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (<ext-link ext-link-type="uri" xlink:href="https://us.sagepub.com/en-us/nam/open-access-at-sage">https://us.sagepub.com/en-us/nam/open-access-at-sage</ext-link>).</license-p></license></permissions><abstract><sec id="S1"><title>Objective</title><p id="P1">This is a review of spiritually based interventions (eg, mindfulness-based stress reduction) that utilized psychoneuroimmunological (PNI) outcome measures in breast cancer survivors. Specifically, this review sought to examine the evidence regarding relationships between spiritually based interventions, psychosocial-spiritual outcomes, and biomarker outcomes in breast cancer survivors.</p></sec><sec id="S2"><title>Methods</title><p id="P2">A systematic search of 9 online databases was conducted for articles of original research, peer-reviewed, randomized and nonrandomized control trials from 2005–2015. Data were extracted in order to answer selected questions regarding relationships between psychosocial-spiritual and physiological measures utilized in spiritually based interventions. Implications for future spiritually based interventions in breast cancer survivorship are discussed.</p></sec><sec id="S3"><title>Results</title><p id="P3">Twenty-two articles were reviewed. Cortisol was the most common PNI biomarker outcome studied. Compared with control groups, intervention groups demonstrated positive mental health outcomes and improved or stable neuroendocrine-immune profiles, although limitations exist. Design methods have improved with regard to increased use of comparison groups compared with previous reviews. There are few spiritually based interventions that specifically measure religious or spiritual constructs. Similarly, there are few existing studies that utilize standardized religious or spiritual measures with PNI outcome measures. Findings suggest that a body of knowledge now exists in support of interventions with mindfulness-breathing-stretching components; furthermore, these interventions appear to offer potential improvement or stabilization of neuroendocrine-immune activity in breast cancer survivors compared to control groups.</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">From a PNI perspective, future spiritually based interventions should include standardized measures of religiousness and spirituality in order to understand relationships between and among religiousness, spirituality, and neuroendocrine-immune outcomes. Future research should now focus on determining the minimum dose and duration needed to improve or stabilize neuroendocrine-immune function, as well as diverse setting needs, including home-based practice for survivors who are too ill to travel to group sessions or lack economic resources.</p></sec></abstract><kwd-group><kwd>breast cancer</kwd><kwd>interventions</kwd><kwd>oncology</kwd><kwd>psychoneuroimmunology</kwd><kwd>religious</kwd><kwd>review</kwd><kwd>spirituality</kwd></kwd-group></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Flowchart of article identification, screening, and selection process.</p></caption><graphic xlink:href="nihms828457f1"></graphic></fig><table-wrap id="T1" position="float" orientation="portrait"><label>Table 1</label><caption><p>Spiritually Based Interventions and Psychosocial-Spiritual Outcomes in Breast Cancer Survivors.</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="middle" align="left" rowspan="1" colspan="1">Study Number (See <xref rid="T3" ref-type="table">Table 3</xref>)</th><th valign="middle" align="left" rowspan="1" colspan="1">Spiritually Based Interventions</th><th valign="middle" align="left" rowspan="1" colspan="1">Psychosocial-Spiritual Outcomes (↓ or ↑)<xref rid="TFN2" ref-type="table-fn">a</xref></th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">1,4, 6, 8, 15, 18</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM, MBSR, Qigong, RVT, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Depression</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">1, 4, 6, 8, 12</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM, MBSR, RVT, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Anxiety</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2, 4, 14, 15, 18, 19, 20</td><td align="left" valign="top" rowspan="1" colspan="1">MBCR, MBSR, Qigong, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Quality of life/vitality/vigor</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">4</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Distress</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">4, 17</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Symptoms</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Coping</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">5, 7</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Relaxation</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">1, 6, 8, 12, 14, 18</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM, MBCR, MBSR, RVT, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Stress</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">16</td><td align="left" valign="top" rowspan="1" colspan="1">Tai Chi</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Stress</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">9, 12, 13</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Mindfulness</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">11</td><td align="left" valign="top" rowspan="1" colspan="1">BMS</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Spiritual growth/spiritual well-being</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">13</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Rumination</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">14</td><td align="left" valign="top" rowspan="1" colspan="1">MBCR</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Social support</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">15, 17, 18, 19, 20</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR, Qigong, Stretching, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Fatigue</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">9, 14</td><td align="left" valign="top" rowspan="1" colspan="1">MBCR, MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Mood</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">17</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Cognitive function (postchemotherapy)</td></tr></tbody></table><table-wrap-foot><fn id="TFN1"><p>Abbreviations: CBSM, cognitive-based stress management; MBCR, mindfulness-based cancer recovery; MBSR, mindfulness-based stress reduction; RVT, relaxation visualization therapy; BMS, body-mind-spirit.</p></fn><fn id="TFN2"><label>a</label><p>↓ indicates decreased and ↑ indicates increased.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" position="float" orientation="portrait"><label>Table 2</label><caption><p>RS Interventions and Biomarker Outcomes in Breast Cancer Survivors.</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="middle" align="left" rowspan="1" colspan="1">Study Number (See <xref rid="T3" ref-type="table">Table 3</xref>)</th><th valign="middle" align="left" rowspan="1" colspan="1">RS Intervention</th><th valign="middle" align="left" rowspan="1" colspan="1">Biomarker Outcomes (↓, ↑, or Stable)<xref rid="TFN4" ref-type="table-fn">a</xref></th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">18</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Interleukin (IL)-1</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">7, 20</td><td align="left" valign="top" rowspan="1" colspan="1">GI, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ IL-1β</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">3, 6</td><td align="left" valign="top" rowspan="1" colspan="1">GI, CBSM</td><td align="left" valign="top" rowspan="1" colspan="1">↑ (IL)-2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2, 17</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↓ IL-4</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">6</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM</td><td align="left" valign="top" rowspan="1" colspan="1">↑ IL-4</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2, 20</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ IL-6</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↓ IL-10</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2, 3, 7</td><td align="left" valign="top" rowspan="1" colspan="1">GI, MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↑Natural killer (NK) cell activity</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">4</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Immunoglobulin A (IgA)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">4</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↑ CD56 %</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2, 5, 6, 8, 9<xref rid="TFN5" ref-type="table-fn">b</xref>, 11, 14, 19</td><td align="left" valign="top" rowspan="1" colspan="1">BMS, CBSM, MBCR, MBSR, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Cortisol</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">1, 12, 15, 18</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR, Qigong, RVT, Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">Stable or no change in cortisol</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">18, 20</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga</td><td align="left" valign="top" rowspan="1" colspan="1">Stable or ↓ tumor necrosis factor–α (TNF-α)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">9, 13</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Blood pressure</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">9</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Pulse</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">9</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↓ Respirations</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2, 6, 10, 17</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM, MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Lymphocyte subsets; T cells, Th1/Th2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">7, 17</td><td align="left" valign="top" rowspan="1" colspan="1">GI, MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↑ CD4+/CD8+</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2, 6, 17</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM, MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">↑ Interferon-γ (IFN-γ)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">21, 22</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">Stable (preserved) telomere length</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">17</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">Stable/no change in CD4+ T lymphocytes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">17</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR</td><td align="left" valign="top" rowspan="1" colspan="1">Stable/no change CD3+ subsets (T1/T2)</td></tr></tbody></table><table-wrap-foot><fn id="TFN3"><p>Abbreviations: RS, religious and spiritual; GI, guided imagery; CBSM, cognitive-based stress management; MBSR, mindfulness-based stress reduction; BMS, body-mind-spirit; RVT, relaxation/visualization therapy; MBCR, mindfulness-based cancer recovery.</p></fn><fn id="TFN4"><label>a</label><p>↓ indicates decreased and ↑ indicates increased.</p></fn><fn id="TFN5"><label>b</label><p>Decreased cortisol not sustained at 1 month follow-up.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T3" position="float" orientation="landscape"><label>Table 3</label><caption><p>RS Interventions With PNI Measures in Breast Cancer Survivors.</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="bottom" align="left" rowspan="1" colspan="1">No.</th><th valign="bottom" align="left" rowspan="1" colspan="1">Study (First Author, Year)</th><th valign="bottom" align="center" rowspan="1" colspan="1">Design</th><th valign="bottom" align="center" rowspan="1" colspan="1">Cancer Stage</th><th valign="bottom" align="left" rowspan="1" colspan="1">Intervention Group (IG) (n) vs Control Group (CG) (n)</th><th valign="bottom" align="left" rowspan="1" colspan="1">Intervention Duration</th><th valign="bottom" align="left" rowspan="1" colspan="1">Psychosocial and RS Measures</th><th valign="bottom" align="left" rowspan="1" colspan="1">Objective (PNI) Measures</th><th valign="bottom" align="left" rowspan="1" colspan="1">Key Health Outcomes</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">1</td><td align="left" valign="top" rowspan="1" colspan="1">Nunes (2007)<sup><xref rid="R71" ref-type="bibr">71</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">I–II</td><td align="left" valign="top" rowspan="1" colspan="1">Relaxation/visualization (IG) (RVT)* (n = 20)<break></break>vs<break></break>CG: Assessment only* (n = 14)<break></break>*All participants undergoing concurrent radiotherapy</td><td align="left" valign="top" rowspan="1" colspan="1">24 consecutive days, 30-min sessions</td><td align="left" valign="top" rowspan="1" colspan="1">Stress, Anxiety, Depression (ISSL, STAI, BAI, BDI)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol</td><td align="left" valign="top" rowspan="1" colspan="1">RVT improved depression and anxiety scores (<italic>P</italic> < .05). Change in anxiety negatively correlated with cortisol (<italic>r</italic> = −0.38). RVT had no effect on cortisol levels</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2</td><td align="left" valign="top" rowspan="1" colspan="1">Witek-Janusek (2008)<sup><xref rid="R105" ref-type="bibr">105</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">Non-RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–II</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR (IG) (n = 38)<break></break>vs<break></break>CG: Assessment only (n = 28)</td><td align="left" valign="top" rowspan="1" colspan="1">8 weeks; 150 min/wk</td><td align="left" valign="top" rowspan="1" colspan="1">Quality of Life, Coping, Mindfulness (QOLI-cv3, JCS, MAAS)</td><td align="left" valign="top" rowspan="1" colspan="1">Lymphocytes, NKCA, Cytokines (Interleukin [IL])-2, IL-4, IL-6, IL-10, and interferon-gamma (IFN-γ), cortisol</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR group had lower levels of NKCA, IL-4, IL-6, IFN-γ (all <italic>P</italic> < .04) compared with CG. cortisol was lower in MBSR group (<italic>P</italic> = .002) than CG. No effect on mindfulness (<italic>P</italic> > .05). Treatment group reestablished positive immune function while control group had continued immune dysregulation</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">3</td><td align="left" valign="top" rowspan="1" colspan="1">Lengacher (2008)<sup><xref rid="R74" ref-type="bibr">74</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–II</td><td align="left" valign="top" rowspan="1" colspan="1">Guided imagery (IG) (n = 15)<break></break>vs<break></break>Usual care CG (n = 13)</td><td align="left" valign="top" rowspan="1" colspan="1">6–7 weeks (2–3 weeks preop through 4 weeks postop)</td><td align="left" valign="top" rowspan="1" colspan="1">None</td><td align="left" valign="top" rowspan="1" colspan="1">Natural killer (NK) cells, cytokine (IL-2)</td><td align="left" valign="top" rowspan="1" colspan="1">Guided imagery positively influenced NK cell cytotoxicity after IL-2 activation at 4 weeks postoperative compared with CG (<italic>P</italic> < .05)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">4</td><td align="left" valign="top" rowspan="1" colspan="1">Rao (2008)<sup><xref rid="R79" ref-type="bibr">79</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">II–III</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga (IG) (n = 33)<break></break>vs<break></break>Supportive therapy and exercise CG (n = 36)</td><td align="left" valign="top" rowspan="1" colspan="1">4 weeks</td><td align="left" valign="top" rowspan="1" colspan="1">(Anxiety, Depression, Function) (STAI, BDI, FLIC)</td><td align="left" valign="top" rowspan="1" colspan="1">T-lymphocyte subsets, CD4%, CD8%, NK cells, and immunoglobulin (IgA, IgG, IgM)</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga group demonstrated decreased anxiety (<italic>P</italic> = .04), depression (<italic>P</italic> = .01), decreased symptom severity (<italic>P</italic> = .01), decreased distress (<italic>P</italic> < .01) and improved QOL (<italic>P</italic> = .01) compared with CG. Less immune dysfunction was observed in yoga group (decreased CD56%, <italic>P</italic> = .02) and (decreased IgA, <italic>P</italic> = .001) compared with CG</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">5</td><td align="left" valign="top" rowspan="1" colspan="1">Phillips (2008)<sup><xref rid="R106" ref-type="bibr">106</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–III</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM (IG) (n = 65)<break></break>vs<break></break>1-day education CG (n = 63)</td><td align="left" valign="top" rowspan="1" colspan="1">10 weeks; repeat measures over 12 months</td><td align="left" valign="top" rowspan="1" colspan="1">Current Status (MOCS-Relaxation)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol</td><td align="left" valign="top" rowspan="1" colspan="1">Greater reductions in cortisol levels across 12 months in CBSM compared with CG, although effect was small (<italic>d</italic> = 0.20).</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">6</td><td align="left" valign="top" rowspan="1" colspan="1">Antoni (2009)<sup><xref rid="R107" ref-type="bibr">107</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–III</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM (IG) (n = 65)<break></break>vs<break></break>Usual care CG: 1-day education (n = 63)</td><td align="left" valign="top" rowspan="1" colspan="1">10 weeks</td><td align="left" valign="top" rowspan="1" colspan="1">Stress, Anxiety & Depression, & Negative Mood (IES, HADS, ABS)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol, lymphocyte subsets, cytokines (IL-2, IFN-γ, IL-4)</td><td align="left" valign="top" rowspan="1" colspan="1">CBSM had improved cortisol patterns (<italic>P</italic> < .01), improved IL-2 (<italic>P</italic> < .05), and improved IFN-γ (<italic>P</italic> < .01) function compared with CG during the first 6 months. Results suggest CBSM group may have experienced a buffering effect of adjuvant therapy compared with the CG. Improved trends observed in psychosocial measures; however, no significant effects observed between changes in psychosocial measures and biomarker measures</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">7</td><td align="left" valign="top" rowspan="1" colspan="1">Eremin (2009)<sup><xref rid="R72" ref-type="bibr">72</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">II–IV</td><td align="left" valign="top" rowspan="1" colspan="1">Relaxation and guided imagery (IG) (n = 40)<break></break>vs<break></break>Standard care CG (n = 40)</td><td align="left" valign="top" rowspan="1" colspan="1">37 weeks</td><td align="left" valign="top" rowspan="1" colspan="1">None</td><td align="left" valign="top" rowspan="1" colspan="1">T-cell subsets and lymphokine activated killer cells, B lymphocytes and monocytes; cytokines IL-1beta (1β), IL-2, IL-4 and IL-6 and TNF-α</td><td align="left" valign="top" rowspan="1" colspan="1">At 8 weeks, significant correlations observed between imaging ratings and natural killer cell activity (<italic>r</italic> = 0.319, <italic>P</italic> = .02). Relaxation frequency (<italic>r</italic> = 0.308, <italic>P</italic> = .018) and imagery ratings (<italic>r</italic> = 0.308, <italic>P</italic> = .019) correlated significantly with blood IL-1β, CD4+, and CD8+ levels.</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">8</td><td align="left" valign="top" rowspan="1" colspan="1">Vadiraja (2009)<sup><xref rid="R108" ref-type="bibr">108</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">I–III</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga (IG) (n = 44)*<break></break>vs<break></break>Supportive therapy CG* (n = 44)<break></break>*All participants undergoing concurrent radiotherapy</td><td align="left" valign="top" rowspan="1" colspan="1">6 weeks<break></break>(3) 1-hour sessions per week</td><td align="left" valign="top" rowspan="1" colspan="1">Anxiety & Depression, Stress (HADS, PSS)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol</td><td align="left" valign="top" rowspan="1" colspan="1">Positive correlations between decreased AM cortisol levels and decreased anxiety (Cohen’s <italic>f</italic> = 0.31), depression (<italic>f</italic> = 0.31), and stress (<italic>f</italic> = 0.36) in yoga group compared with CG</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">9</td><td align="left" valign="top" rowspan="1" colspan="1">Matchim (2010)<sup><xref rid="R109" ref-type="bibr">109</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">Non-RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–II</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR (IG) (n = 15)<break></break>vs<break></break>Wait list CG (n = 17)</td><td align="left" valign="top" rowspan="1" colspan="1">8 weeks<break></break>90 min/wk<break></break>Repeat measures at 1 month</td><td align="left" valign="top" rowspan="1" colspan="1">Mood, Stress, Mindfulness (POMS, C-SOSI, FFMQ)</td><td align="left" valign="top" rowspan="1" colspan="1">Salivary cortisol, blood pressure (BP), pulse, and respirations</td><td align="left" valign="top" rowspan="1" colspan="1">Increased mindfulness decreased BP, pulse, and respirations observed in MBSR compared with CG (<italic>P</italic> = .05 to <italic>P</italic> = .001). Initial decrease in AM cortisol within MBSR group was statistically significant (<italic>P</italic> < .05), but was not sustained at 1-month follow-up</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">10</td><td align="left" valign="top" rowspan="1" colspan="1">Lengacher (2013)<sup><xref rid="R50" ref-type="bibr">50</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–III</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR (IG) (n = 42)<break></break>vs<break></break>Usual care CG (n = 40)</td><td align="left" valign="top" rowspan="1" colspan="1">6 weeks<break></break>2 h/wk<break></break>Repeat measures at 12 weeks</td><td align="left" valign="top" rowspan="1" colspan="1">None</td><td align="left" valign="top" rowspan="1" colspan="1">Lymphocyte subsets, T helper 1 and 2 cells (Th1/Th2), NK cells, IFN-γ, IL-4</td><td align="left" valign="top" rowspan="1" colspan="1">Positive associations between all immune subset recoveries in MBSR group compared with CG. Women who received MBSR had T cells more readily activated by the mitogen phytohemagglutinin and an increase in the Th1/Th2 ratio (<italic>P</italic> = .002). MBSR associated with a more rapid return to normal immune function compared with CG, particularly in early posttreatment recovery periods</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">11</td><td align="left" valign="top" rowspan="1" colspan="1">Hsiao (2012)<sup><xref rid="R104" ref-type="bibr">104</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–III</td><td align="left" valign="top" rowspan="1" colspan="1">Body-mind-spirit (BMS) (IG) (n = 26)<break></break>vs<break></break>Education CG (n = 22)</td><td align="left" valign="top" rowspan="1" colspan="1">8 weeks<break></break>2 h/wk<break></break>Repeat measures at 5 and 8 months</td><td align="left" valign="top" rowspan="1" colspan="1">Depression Meaning in Life (Purpose, Search) (BDI, MLQ-P, MLQ-S)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol</td><td align="left" valign="top" rowspan="1" colspan="1">At 5 months, BMS was related to greater spiritual growth (search for meaning in life) (<italic>P</italic> < .01). At 8 months, the BMS group demonstrated healthier cortisol patterns compared with CG (<italic>P</italic> < .05).</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">12</td><td align="left" valign="top" rowspan="1" colspan="1">Branstrom (2012; 2013)<sup><xref rid="R110" ref-type="bibr">110</xref>,<xref rid="R111" ref-type="bibr">111</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">Data not provided</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR (IG) (n = 32)<break></break>vs<break></break>Wait list CG (n = 39)</td><td align="left" valign="top" rowspan="1" colspan="1">8 weeks<break></break>2 h/wk<break></break>Repeat measures at 3 and 6 months</td><td align="left" valign="top" rowspan="1" colspan="1">Stress, Anxiety & Depression, Mood, Coping; Mindfulness (PSS, HADS, IES-R, PSOM, CSES, FFMQ)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR associated with lower stress (<italic>P</italic> = .06), lower anxiety (<italic>P</italic> = .09), and increased mindfulness (<italic>P</italic> < .01). Although not quite significant (<italic>r</italic> = −0.38, <italic>P</italic> = .06) a trend was observed that MBSR demonstrated a moderate effect on awakening cortisol levels and was sustained at 6-month follow-up. Nonsignificant effects between stress and cortisol (<italic>P</italic> = .06) were observed</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">13</td><td align="left" valign="top" rowspan="1" colspan="1">Campbell (2012)<sup><xref rid="R92" ref-type="bibr">92</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">NonRCT</td><td align="center" valign="top" rowspan="1" colspan="1">Data not provided</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR (IG) (n = 19)<break></break>vs<break></break>Wait list CG (n = 16)</td><td align="left" valign="top" rowspan="1" colspan="1">8 weeks<break></break>90 min/wk</td><td align="left" valign="top" rowspan="1" colspan="1">Mindfulness, Rumination (MAAS, RRQ-rs)</td><td align="left" valign="top" rowspan="1" colspan="1">Blood pressure (BP)</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR may improve mindfulness, moderate effect between decreased rumination and decrease systolic BP (<italic>r</italic> = 0.35), no main effects observed</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">14</td><td align="left" valign="top" rowspan="1" colspan="1">Carlson (2013)<sup><xref rid="R68" ref-type="bibr">68</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–IV</td><td align="left" valign="top" rowspan="1" colspan="1">MBCR (IG) (n = 113)<break></break>vs<break></break>Supportive emotional therapy (SET) (IG) (n = 104)<break></break>vs<break></break>Usual care CG: 1-day stress management seminar (n = 54)</td><td align="left" valign="top" rowspan="1" colspan="1">8 weeks<break></break>90 min/wk</td><td align="left" valign="top" rowspan="1" colspan="1">Mood, Stress, Quality of Life, Social Support (POMS-TMD, C-SOSI, FACT-B, FACT-G, MOS-SSS)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol patterns were stable over time in both SET (<italic>P</italic> = .003) and MBCR (<italic>P</italic> = .014) groups relative to the CG, who had more flattened cortisol slopes. Women in MBCR improved more over time on stress symptoms compared with both SET (<italic>P</italic> = .009) and control (<italic>P</italic> = .023) groups. Greater improvements in MBCR group in quality of life compared with SET (<italic>P</italic> = .006) and CG (<italic>P</italic> = .005); and in social support compared with the SET (<italic>P</italic> = .012)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">15</td><td align="left" valign="top" rowspan="1" colspan="1">Chen (2013)<sup><xref rid="R112" ref-type="bibr">112</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–III</td><td align="left" valign="top" rowspan="1" colspan="1">Qigong (IG) (n = 49)*<break></break>vs<break></break>Wait list CG (n = 47)*<break></break>*Participants currently undergoing radiotherapy</td><td align="left" valign="top" rowspan="1" colspan="1">5 weeks<break></break>40 min/wk<break></break>with 1- and 3-month repeat measures</td><td align="left" valign="top" rowspan="1" colspan="1">Depression, Fatigue, Quality of Life, Sleep Disturbance (CES-D, BFI, FACT-G, PSQI)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol</td><td align="left" valign="top" rowspan="1" colspan="1">Qigong group reported less depression over time than women in CG (<italic>P</italic> = .05). Women who had elevated depressive symptoms at the start of radiotherapy reported less fatigue (<italic>P</italic> < .01) and better overall quality of life (<italic>P</italic> < .05) in the Qigong group compared with the CG. No significant changes observed in cortisol slopes</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">16</td><td align="left" valign="top" rowspan="1" colspan="1">Robins (2013)<sup><xref rid="R77" ref-type="bibr">77</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">I–IIIa</td><td align="left" valign="top" rowspan="1" colspan="1">(n = 109)* (no further data)<break></break>Tai Chi (IG)<break></break>vs<break></break>Spiritual growth group (IG)<break></break>vs<break></break>Usual care CG<break></break>*Concurrent chemotherapy</td><td align="left" valign="top" rowspan="1" colspan="1">10 weeks<break></break>90 min/wk<break></break>Repeat measures at 1 week, 4.5 months, 6 months</td><td align="left" valign="top" rowspan="1" colspan="1">Stress, Quality of Life, Depression (IES, FACT-B, CES-D)</td><td align="left" valign="top" rowspan="1" colspan="1">Cytokine panel (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17, TNF-α)</td><td align="left" valign="top" rowspan="1" colspan="1">Interesting patterns in biomarkers observed; however, no statistically significant effects observed between intervention and control groups while <italic>currently</italic> receiving chemotherapy</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">17</td><td align="left" valign="top" rowspan="1" colspan="1">Reich (2014)<sup><xref rid="R113" ref-type="bibr">113</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–III</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR (IG) (n = 17)<break></break>vs<break></break>Usual care/wait list CG (n = 24)</td><td align="left" valign="top" rowspan="1" colspan="1">6 weeks<break></break>2 hs/wk<break></break>Measures at baseline and 6 weeks</td><td align="left" valign="top" rowspan="1" colspan="1">Symptoms (MDASI)</td><td align="left" valign="top" rowspan="1" colspan="1">Lymphocyte subsets, mitogen-stimulated subsets, cytokines</td><td align="left" valign="top" rowspan="1" colspan="1">After 6 weeks, multiple baseline biomarkers were significantly positively improvement in GI symptoms (<italic>P</italic> = .035) and fatigue (<italic>P</italic> = .035) in MBSR group. Regression modeling identified B-lymphocytes and IFN-γ as the strongest predictors of gastrointestinal symptom improvement (<italic>P</italic> < .01). CD4+, CD8+ were predictive of strongest predictor of cognitive/psychological improvement (<italic>P</italic> = .02). Lymphocytes and IL-4 were strongest predictors of fatigue improvement (<italic>P</italic> < .01)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">18</td><td align="left" valign="top" rowspan="1" colspan="1">Bower (2012; 2014)<sup><xref rid="R78" ref-type="bibr">78</xref>,<xref rid="R114" ref-type="bibr">114</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–II</td><td align="left" valign="top" rowspan="1" colspan="1">Iyengar yoga (IG) (n = 14)<break></break>vs<break></break>Usual care CG (n = 15)</td><td align="left" valign="top" rowspan="1" colspan="1">12 weeks<break></break>90 min, twice weekly<break></break>Repeat measures at baseline, 12 weeks, and 24 weeks</td><td align="left" valign="top" rowspan="1" colspan="1">Fatigue, Depression, Sleep, Stress, Vigor (FSI, BDI-II, PSQI, PSS, MSFI)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol, tumor necrosis factor-alpha (TNF-α), IL-1, IL-6, CRP</td><td align="left" valign="top" rowspan="1" colspan="1">Decreased fatigue in yoga group from baseline to posttreatment and sustained at 3-month follow-up compared to CG (<italic>P</italic> = .032). Yoga group had significant increases in vigor compared with CG (<italic>P</italic> = .011). Both groups had positive changes in depressive symptoms and perceived stress (<italic>P</italic> < .05). Yoga group showed improved immune biomarker functioning compared with controls (<italic>P</italic> < .05). Tumor necrosis factor patterns remained stable in yoga group, while CG levels increased (<italic>P</italic> = 0.28). Similar trend observed with IL-1, but nonsignificant (<italic>P</italic> = .16). No significant changes in CRP, IL-6 or diurnal cortisol patterns</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">19</td><td align="left" valign="top" rowspan="1" colspan="1">Chandwani (2014)<sup><xref rid="R115" ref-type="bibr">115</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–III</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga (IG) (n = 53)*<break></break>vs<break></break>Stretching (IG) (n = 56)*<break></break>vs<break></break>Wait list CG (n = 54)*<break></break>*Concurrently undergoing radiotherapy</td><td align="left" valign="top" rowspan="1" colspan="1">6 weeks<break></break>Up to 180 min/wk<break></break>Repeat measures at 1, 3, and 6 months postintervention</td><td align="left" valign="top" rowspan="1" colspan="1">Quality of Life, Fatigue, Depression, Sleep (MO-SF 36, BFI, CES-D, PSQI)</td><td align="left" valign="top" rowspan="1" colspan="1">Cortisol</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga group demonstrated greater increases in physical component scale scores compared with CG at 1 and 3 months after radiotherapy (<italic>P</italic> = .01 and <italic>P</italic> = .01, respectively). At 1, 3, and 6 months, the yoga group had greater increases in physical functioning compared with both stretching and CG (<italic>P</italic> < .05), with stretching and CG differences at only 3 months (<italic>P</italic> < .02). Yoga and stretching groups had reduced fatigue (<italic>P</italic> < .05) at radiotherapy completion. No group differences for mental health and sleep quality. Cortisol slope was steepest for the yoga group compared with the stretching and CG at the end (<italic>P</italic> = .023 and <italic>P</italic> = .008, respectively) and 1 month after radiotherapy completed (<italic>P</italic> = .05 and <italic>P</italic> = .04, respectively)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">20</td><td align="left" valign="top" rowspan="1" colspan="1">Kiecolt-Glaser (2014)<sup><xref rid="R116" ref-type="bibr">116</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–IIIa</td><td align="left" valign="top" rowspan="1" colspan="1">Yoga (IG) (n = 100)<break></break>vs<break></break>Wait list CG (n = 100)</td><td align="left" valign="top" rowspan="1" colspan="1">12 weeks<break></break>90 min/twice weekly<break></break>Repeat measures at 3 months postintervention</td><td align="left" valign="top" rowspan="1" colspan="1">Fatigue, Quality of Life, Depression, Sleep, Activity, Diet (MFSI-SF, MO SF-36, CES-D, PQSI, CHAMPS, FFQ)</td><td align="left" valign="top" rowspan="1" colspan="1">Cytokines (IL-1β, IL-6, TNF-α)</td><td align="left" valign="top" rowspan="1" colspan="1">At posttreatment, fatigue was not lower in yoga compared with CG (<italic>P</italic> > .05) but vitality was higher (<italic>P</italic> = .01). At 3 months posttreatment, fatigue was lower in the yoga group (<italic>P</italic> = .002), vitality was higher (<italic>P</italic> = .01), and IL-6 (<italic>P</italic> = .027), TNF-α (<italic>P</italic> = .027), and IL-1 (<italic>P</italic> = .037) were lower for yoga group compared with CG. No group differences in depression at either time points (<italic>P</italic> > .20). Frequency of yoga practice showed a stronger association with fatigue and vitality, but not depression; greater changes associated with more frequent practice. At 3 months posttreatment, increased yoga practice was associated with decreased IL-6 (<italic>P</italic> = .01) and IL-1 (<italic>P</italic> = .03), but not TNF-α production (<italic>P</italic> > .05)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">21</td><td align="left" valign="top" rowspan="1" colspan="1">Lengacher (2014)<sup><xref rid="R117" ref-type="bibr">117</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">0–III</td><td align="left" valign="top" rowspan="1" colspan="1">MBSR (IG) (n = 74)<break></break>vs<break></break>Usual care (n = 68)</td><td align="left" valign="top" rowspan="1" colspan="1">6 weeks intervention<break></break>Repeat measures at 12 weeks</td><td align="left" valign="top" rowspan="1" colspan="1">Recurrence Concerns, Mindfulness, Stress, Anxiety, Depression (CARS, CAMS, PSS, STAI, CES-D)</td><td align="left" valign="top" rowspan="1" colspan="1">Telomere length, telomere activity</td><td align="left" valign="top" rowspan="1" colspan="1">Telomere activity (TA) increased steadily over 12 weeks in MBSR group (17%) compared with minimal increase in CG (approximately 3%, <italic>P</italic> < .01). No effects observed on Telomere length (<italic>P</italic> = .92). MBSR appears to increase TA in peripheral blood mononuclear cells. TA was not associated with change in mindfulness, stress, anxiety, or fear of recurrence</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">22</td><td align="left" valign="top" rowspan="1" colspan="1">Carlson (2015)<sup><xref rid="R118" ref-type="bibr">118</xref></sup></td><td align="center" valign="top" rowspan="1" colspan="1">RCT</td><td align="center" valign="top" rowspan="1" colspan="1">I–III</td><td align="left" valign="top" rowspan="1" colspan="1">MBCR (IG) (n = 53)<break></break>vs<break></break>Supportive emotional therapy group (SET) (IG) (n = 49)<break></break>vs<break></break>Usual care (n = 26) (1-day seminar)</td><td align="left" valign="top" rowspan="1" colspan="1">8 weeks<break></break>90 min/wk plus 6-hour, 1-day retreat<break></break>12 weeks<break></break>90 min/wk<break></break>1-day, 6-hour, stress management seminar</td><td align="left" valign="top" rowspan="1" colspan="1">Mood, Stress (POMS, C-SOSI)</td><td align="left" valign="top" rowspan="1" colspan="1">Telomere length</td><td align="left" valign="top" rowspan="1" colspan="1">No correlations between measures of mood (<italic>P</italic> = .80) and stress (<italic>P</italic> = .24) and changes in telomere length between MBCR and SET groups and the CG (<italic>P</italic> = .28), or across the 2 intervention conditions (<italic>P</italic> = .31) and (<italic>P</italic> = .55). Telomere length in the MBCR and SET groups remained preserved (positive outcome) while a decrease among the CG was significant (<italic>P</italic> = .04)</td></tr></tbody></table><table-wrap-foot><fn id="TFN6"><p>Abbreviations: RS, religious and spiritual; PNI, psychoneuroimmunological; RCT, randomized control trial group; IG, intervention group; CRP, C-reactive protein; CG, control group; RVT, relaxation and visualization therapy; ISSL, Inventory of Stress Symptoms Lipp; STAI, State-Trait Anxiety Inventory; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; non-RCT, nonrandomized control trial group; MBSR, mindfulness-based stress reduction; QOLI-v3, Quality of Life Index Cancer Version 3, JCS, Jaloweic Coping Scale; MAAS, Mindfulness Attention Awareness Scale; FLIC, Functional Living Index of Cancer; MOCS-R, Measure of Current Status–Relaxation; IES, Impact of Events Scale; HADS, Hospital Anxiety and Depression Scale; ABS, Affects Balance Scale; PSS, Perceived Stress Scale; POMS, Profile of Mood States; C-SOSI, Calgary Symptoms of Stress Inventory; FFMQ, Five Facet Mindfulness Questionnaire; MDASI, MD Anderson Symptom Inventory; MLQ-P, Meaning in Life Questionnaire, Presence; MLQ-S, Meaning in Life Questionnaire; IES-R, Impact of Events Scale–Revised; PSOM, Positive State of Mind; CSES, Coping Self-Efficacy Scale; RRQ-rs, Rumination Reflection Questionnaire—revised; MBCR, mindfulness-based cancer recovery; POMS-TMD, Profile of Mood States–Total Mood Disturbance; FACT-B, Functional Assessment of Cancer Therapy–Breast; FACT-G, Functional Assessment of Cancer Therapy–General; MOS-SSS, Medical Outcomes Study–Social Support Survey; SOSI, Symptoms of Stress Inventory; NK, natural killer; IFN-γ, interferon-gamma; IL, interleukin; DHEA, dehydroepiandrosterone sulfate; FACIT-G, Functional Assessment of Cancer Illness Therapy–General; CES-D, Center for Epidemiological Studies–Depression Scale; BFI, Brief Fatigue Inventory; PSQI, Pittsburg Sleep Quality Index; FSI, Fatigue Symptom Inventory; BDI-II, Beck Depression Inventory–II; MFSI, Multidimensional Fatigue Symptom Inventory; MO SF-36, Medical Outcomes Short-Form 36; CHAMPS, Community Healthy Activities Model Program for Seniors; FFQ, Food Frequency Questionnaire; CARS, Concerns About Recurrence Scale; CAMS, Cognitive and Affective Mindfulness Scale–Revised.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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