Purpose: Young adult cancer survivors (YACS; 18-39 years old) face ongoing physical and psychosocial sequelae. The REDEFINE study tested the feasibility of mindfulness-based stress reduction (MBSR) using a randomized design. This secondary mixed-methods analysis examined whether qualitative mindfulness reflections were associated with meaningful changes in Patient Reported Outcomes Measurement Information System (PROMIS) depression, anxiety, fatigue, and pain interference scores.
Methods: Participants were randomized to either an 8-week MBSR course or a waitlist control group. Waitlist participants began MBSR after 16 weeks. PROMIS measures were collected at baseline and at 8, 16, 24, and 32 weeks. For these analyses, data from both groups were combined. Participants submitted written mid-course and weekly homework reflections on their mindfulness experiences. Change scores were calculated between PROMIS T-scores at the start and end of MBSR and were assessed for meaningful change. Reflections were coded using grounded theory, and a concurrent triangulation mixed-methods design integrated qualitative and quantitative data.
Results: Among 31 participants (mean age, 32.6 ± 5.8 years; 83.9% female, White, and non-Hispanic), nearly half reported meaningful improvement in pain interference (48.3%) and fatigue (48.3%), while more than half improved in depression (51.7%) and anxiety (58.6%). Mixed-methods analysis linked improvements in pain, depression, and anxiety with reflections describing increased bodily awareness, a more positive relationship with the body, and learning mindfulness skills.
Conclusions: MBSR-related mind-body reflections align with meaningful improvements in psychosocial and physical symptoms among YACS. Reports of bodily relaxation and emotional regulation suggest the value of combining structured and unstructured patient-reported outcomes to capture the benefits of mindfulness interventions.
Keywords: PROMIS; bodily awareness; meaningful change; mindfulness.