Mindfulness-Based Cognitive Therapy in Advanced Prostate Cancer: A Randomized Controlled Trial

J Clin Oncol. 2017 Jan 20;35(3):291-297. doi: 10.1200/JCO.2016.68.8788. Epub 2016 Nov 21.

Abstract

Purpose Advanced prostate cancer (PC) is associated with substantial psychosocial morbidity. We sought to determine whether mindfulness-based cognitive therapy (MBCT) reduces distress in men with advanced PC. Methods Men with advanced PC (proven metastatic and/or castration-resistant biochemical progression) were randomly assigned to an 8-week, group-based MBCT intervention delivered by telephone (n = 94) or to minimally enhanced usual care (n = 95). Primary intervention outcomes were psychological distress, cancer-specific distress, and prostate-specific antigen anxiety. Mindfulness skills were assessed as potential mediators of effect. Participants were assessed at baseline and were followed up at 3, 6, and 9 months. Main statistical analyses were conducted on the basis of intention to treat. Results Fourteen MBCT groups were conducted in the intervention arm. Facilitator adherence ratings were high (> 93%). Using random-effects mixed-regression models, intention-to-treat analyses indicated no significant changes in intervention outcomes or in engagement with mindfulness for men in MBCT compared with those receiving minimally enhanced usual care. Per-protocol analyses also found no differences between arms in outcomes or engagement, with the exception of the mindfulness skill of observing, which increased over time for men in MBCT compared with usual care ( P = .032). Conclusion MBCT in this format was not more effective than minimally enhanced usual care in reducing distress in men with advanced PC. Future intervention research for these men should consider approaches that map more closely to masculinity.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adaptation, Psychological
  • Aged
  • Australia
  • Cognitive Behavioral Therapy / methods*
  • Cost of Illness
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Intention to Treat Analysis
  • Male
  • Middle Aged
  • Mindfulness*
  • Patient Education as Topic
  • Prostatic Neoplasms, Castration-Resistant / pathology
  • Prostatic Neoplasms, Castration-Resistant / psychology
  • Prostatic Neoplasms, Castration-Resistant / therapy*
  • Psychotherapy, Group
  • Quality of Life
  • Remote Consultation
  • Stress, Psychological / diagnosis
  • Stress, Psychological / psychology
  • Stress, Psychological / therapy*
  • Time Factors
  • Treatment Outcome