Mindfulness for cancer support

What is mindfulness?

Mindfulness is the practice of bringing your awareness and attention to your present moment experience in a non-judgemental way (Kabat-Zinn 2013). When you are mindful, you bring your awareness to what you are experiencing moment to moment via your five senses – physical sensations, sights, sounds, smells and taste – as well as to your thoughts, emotions, urges and behaviours. This inner landscape is ever changing and impermanent. 

Mindfulness can help you to meet yourself and your experience with kindness and curiosity, lessening resistance, stress and struggle to the difficult and helping to calm your mind, body and emotions (Feldman, Kuyken and Segal 2019). Much of the time people which spend a lot of time in their heads, thinking about both the future and the past and are seldom living with a sense of embodied presence (Williams and Penman 2011, Feldman) .

Mindfulness can be practised formally via awareness of breathing and body, including movement, sitting, walking and lying down practices. Informally, mindfulness can be practised in everyday life to support yourself by meeting your life experience with awareness in a kind and non-judgemental way (Kabat-Zinn 2009). 

Mindfulness and a kindly attitude can also help you by bringing attention to and savouring the beauty, wonder and experiencing the moments of joy in life, rather than letting it slip by unnoticed. This aspect of practice is important to help build inner resilience and a sense of wellbeing (Germer 2009).

There are a number of structured courses to help learn mindfulness and self-compassion that are used to teach people affected by cancer including:

1. Mindfulness-based Stress Reduction (MBSR) programme (8-weeks + retreat day):

   This is the original course developed by Jon Kabat-Zinn in the USA (Kabat-Zinn 2009, 2013). This programme teaches the foundation of mindfulness practice and forms the basis from which the other programmes listed below were developed. This has been taught all over the world with people affected by cancer.

2. Mindfulness-based Cognitive Therapy for Cancer (MBCT-Ca) (8-week + retreat day):

   This is an programme specifically designed for people affected by cancer by Trish Bartley in the UK (Bartley 2011). It is an adaption of the MBSR programme and the MBCT programme by Zindal Segal, John Teasdale and Mark Williams (Segal, Teasdale and Williams 2014, 2018).

3. Mindfulness-based Cancer Recovery(MBCR) (9-weeks):

   This programme is designed for people to support people after cancer treatment. This is an adaptation of MBSR programme by Linda Carlson and Michael Speca in Canada (Carlson and Speca 2011).

4. Mindful Self-Compassion programme (MSC) (8-weeks + retreat day):

   This programme teaches some mindfulness but has its main emphasis on cultivating kindness to ourselves in the face of our difficulties, this is called self-compassion. It has been used with people affected by cancer around the world. MSC was developed in the USA by Christopher Germer and Kristin Neff (Germer 2009. Neff 2011, Neff and Germer 2018, Center for Mindful-Self-Compassion 2023).

How does it work?

There are several ways that mindfulness works:

1. Knowing our experience from moment to moment:

   You start to drop become aware of physical sensations, emotions, thoughts and behaviours as they are happening. This is the cultivation of a grounded, embodied presence.

2. Attention regulation:

   When you practise, you keep bringing our attention and awareness back to your present moment experience again and again, recognising that it is natural for the mind to wander, as this is part of staying safe and looking out for danger.

3. Reducing the chatter of the mind:

   Mindfulness gives you the opportunity to start calming the mind and the body from the tendency everyone has to be constantly lost in thoughts, whatever they might be about, worry, anxiety, depression, fear. These thoughts are often about the past or the future. It gives people a chance for their mind to rest more fully in the present moment.

4. Attitudinal foundations of mindfulness:

   To support the cultivation of mindfulness, you can bring the following: a beginner’s mind (allowing yourself to see things as they are), a non-judgemental attitude towards your experience), trust what is emerging in your experience, letting go (of trying to change your experience), non-striving (not trying to get anywhere else), acceptance (of your experience as it is as best you can), patience (Kabat-Zinn 2013).

5. The role of kindness and compassion:

   The opportunity to bring kindness and compassion to ourselves when you experience difficulties and suffering (self-compassion), plays a vital role in the practice of mindfulness. You notice your own experience of difficulty and recognise that this is the way most other people would be in the same situation. This enables you to recognise that you are not alone, even though you often feel you are. Bringing this recognition and then bringing kindness to yourself (through a warm gaze, soothing touch and kind words), this helps transform your experience in a beneficial way both physically and psychologically. It is important to mention that in addition to the ‘tender’ side of self-compassion, there is a so-called ‘fierce’ side can include protecting yourself (e.g. saying no), providing for yourself (e.g. I can give myself what I need), and motivating yourself (e.g. you can get through this, you can do it) (Neff 2011, Germer 2009, Germer and Neff 2018).

How can it help people affected by cancer through their care?

The impact of a diagnosis of cancer and its treatments has both physical and psychological impact on the person diagnosed and living with the illness and also the people close to them. 

There are many ways that mindfulness can be helpful to people affected by cancer and there are now hundreds of published randomised controlled trials and other research studies to show these benefits (Smith et al 2005, Shennan et al 2011, Piet et al 2012). These include support both psychological and physical benefits. This is not so surprising as mindfulness practice can help bring the mind and body more into balance.

Physical benefits of mindfulness include improvements in fatigue (Eyles et al 2014, , sleep (Shapiro 2003, Carlson and Garland 2005, Ong et al 2014), menopausal symptoms including hot flushes (van Driel et al, 2018, Hoffman et al 2012), chronic pain (Johannsen et al 2016), cognitive functioning (Cifu et al 2018), and improving the immune system (Witek-Janusek et al 2008). 

Psychological improvements include reductions in stress, anxiety, worry, depression, and fear (Hoffman and Baker 2022, Hoffmann et al 2010, Hoffman et al 2012, Piet et al 2012).  This impact is reported not only to help the person practising mindfulness, but also helps with their relationships with others, including family and friends.

Practising mindfulness, through its function of regulating attention (Hölzel et al 2011), can help to calm mind and body with a ‘side effect’ of helping people feel more relaxed. This can be very helpful going through a cancer experience, enabling people to function better and think more clearly. People also report feeling more energised at times from practising mindfulness, another useful effect of the practice.

Mindfulness can be very helpful when living with chronic pain (Hilton et al 2016) as it can support the mind and body to reduce the experience and impact of some non-acute pain.

Self-compassion can help us by meeting our experience with kindness and friendliness, just as you might treat a dear friend in the same circumstances. You can ask yourself the question ‘What do I need right now?’ which gives you a chance to bring a practice of kindness or to take good care of yourself in everyday life, rather than always putting other people first. This can be helpful when going through treatment or when feeling fatigued or in a difficult place emotionally and can give you the courage to ask for what you need. Mindful self-compassion has been shown to increase levels of mindfulness, self-compassion and satisfaction with life as well as reduce stress, anxiety, depression in people affected by breast cancer (Hoffman and Baker 2022).

What to expect from the process

Just getting started is often the hardest thing, or starting to make it a regular part of your routine can also be challenging, particularly if you are going through cancer treatment. Just doing any amount of mindfulness practice rather than none, is beneficial. However, the longer you practice mindfulness and self-compassion approaches, the more you experience their benefits.

It is helpful to plan your formal mindfulness practice time to do it regularly. If possible, find a time of day where you have some free time and can be uninterrupted. This might be early in the morning, perhaps in the evening or at another time of day. It is best not to practice immediately after eating a big meal, rather giving time for your food to digest.

There are various ways to practice mindfulness:  

1. To learn and practice via a mindfulness-based programme

   Many people start to practice mindfulness-based approaches by learning through a formal course either in person or online. These programmes that have weekly classes for around eight weeks are a great starting point and give a good introduction to mindfulness and how to practise it, learning from the teacher and others in the class as you move through this experience. They usually involve practising with audio recordings during the week between classes and other exercises engaging mindfulness in everyday life. Some cancer support services and organisations offer bespoke classes for people affected by cancer.

2. To do your own formal practice wherever you are

   The formal practice of mindfulness is often begun either with instruction from a teacher in person, online during a course or via audio recordings or mindfulness apps. There are various formal practices across different mindfulness and self-compassion modalities. These can include practices that can be done in any comfortable position including sitting, lying, walking or moving. 

   The length of time practising with instructions can vary from anything from a few minutes up to 30 or 45 minutes. We know that the benefits of practice are congruent with the amount of time practising but this can be broken up into short bursts of 5-10 minutes which all add up. 

   Through the use of audio recordings, you can practise mindfulness wherever you are. You can put time aside and practice for a period of time each day. People find this helpful both at home and also when in hospital or going through treatment such as scans or undergoing chemotherapy.

3. Informal practice of mindfulness 

   Once you have learned the basics of mindfulness practice, bringing a kind and curious embodied awareness into your moment-to-moment experience, you can then apply this to activities in daily life, such as brushing your teeth, getting dressed, eating or drinking, walking. Feeling our feet on the floor or our body on its support can be very grounding when we are feeling anxious and uncertain. Bringing attention to our breathing, particularly breathing out can be helpful in supporting us. When we are having moments of difficulty, we can recognise them as such, e.g. ‘I am feeling anxious now and can feel the tightness in my body’ (this is mindfulness) and then remembering that other people would feel the same as we do in the same situation can be very helpful, (this is common humanity) This helps us feel less alone. We can then bring kindness to ourselves e.g. ‘Let me give myself the care and kindness I need now’ (this is self-compassion).

How can I access the modality with a suitably qualified teacher?

There are many mindfulness and self-compassion teachers trained across the UK. The links below will help you find someone who is suitably qualified:

• Through a formal course or programme - there are a range of in person and online mindfulness and self-compassion courses available:

  • Free via UK based cancer charities support charities including: 

  • Penny Brohn

  • Paul’s Cancer Support

  • Maggie’s Centres

• Via mindfulness teacher directories (bursaries or free places may be available)

• Mindfulness Teachers

  Mindful Self-Compassion Teacherscom/find-a-teacher/ 

• Center for Mindful Self-Compassion, USA, also offer online courses and has a qualified teacher directory

• Live Online 10-week MSC courses

• International MSC Teacher Directory

Join free, live teacher-led practices, audio recordings via apps or websites:

Join a live teacher-led practice session:

• The Mindfulness Network UK - teachers lead mindfulness and self-compassion practices on Fridays 8.15am UK time :

• Mindful Self-Compassion UK offer monthly practice sessions at 7pm in the evenings 

• The Center for Mindful Self-Compassion, USA offer public daily taught mindful-self compassion practices 

Find free teacher-led audio recordings:

• Mindfulness  (You can apply for free access)

• Christopher Germer (co-founder of the Mindful Self-Compassion program). Free access 

• Kristin Neff (co-founder of the Mindful Self-Compassion program). Free access 

• Dr Caroline Hoffman (certified Mindful Self-Compassion teacher and retreat leader). Free access 

• Headspace  (Mindfulness practices- Not free, but some cancer support centres have free acc

Limitations on scope of practice, side effects, safety, contraindications

Mindfulness is generally a safe for people affected by cancer to learn and practice. For 8-week programmes of mindfulness-based approaches, a screening process is undertaken with potential participants to make sure that the timing of the programme is suitable for them and whatever they may be going through.

There are some contraindications for the learning and practising of mindfulness-based approaches which around serious mental health conditions. It is not advisable for people actively suffering from psychosis to join mindfulness programmes. The mindfulness teacher will ask you about your past and current physical and mental health history in the pre-course screening process. 

Also, for people who are suffering recent trauma or bereavement, this may not be suitable for them to join a programme. This should be assessed during the course screening process.

It is generally advised that people undergoing primary cancer treatment finish surgery and chemotherapy treatments before embarking on a mindfulness programme, this enables people to give the necessary time for attending and practising during the course. Some people find they can manage this during radiotherapy treatment but others it can be helpful to wait until primary cancer treatment is finished.

For people living with metastatic cancer or ongoing cancer treatments, they often find it helpful to attend a course, even if they cannot make the full programme and practise whatever they have learned.

Guidelines

Mindfulness is strongly recommended for anxiety and depression with adults with cancer both during and after treatment. The guidelines are as follows:

Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology–ASCO Guideline (Linda E. Carlson et al, 2023). The full document and any related tools and resources can be found at:

• ASCO website

• SIO website

• JCO publication

• JCO_OP companion piece
  

Expert content written and reviewed by:

Dr Caroline Hoffman OAM 

Mindfulness and Self-Compassion Teacher and Retreat Leader

CEO of Paul’s Cancer Support

drcarolinehoffman.com  

References:

Bartley, T. (2011). Mindfulness-Based Cognitive Therapy for Cancer. John Wiley & Sons.

Carlson, L. and Speca, M. (2011). Mindfulness-Based Cancer Recovery. New Harbinger Publications.

Carlson, L.E. and Garland, S.N. (2005). Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine, [online] 12(4), pp.278–285. doi:https://doi.org/10.1207/s15327558ijbm1204_9.

Center for Mindful Self-Compassion. (2023). Center for Mindful Self-Compassion -. [online] Available at: https://centerformsc.org [Accessed 11 Aug. 2023].

Cifu, G., Power, M.C., Shomstein, S. and Arem, H. (2018). Mindfulness-based interventions and cognitive function among breast cancer survivors: a systematic review. BMC Cancer, 18(1). doi:https://doi.org/10.1186/s12885-018-5065-3.

Eyles, C., Leydon, G.M., Hoffman, C.J., Copson, E.R., Prescott, P., Chorozoglou, M. and Lewith, G. (2014). Mindfulness for the Self-Management of Fatigue, Anxiety, and Depression in Women With Metastatic Breast Cancer. Integrative Cancer Therapies, 14(1), pp.42–56. doi:https://doi.org/10.1177/1534735414546567.

Feldman, C., Willem Kuyken and Segal, Z.V. (2019). Mindfulness : ancient wisdom meets modern psychology. New York, Ny ; London The Guilford Press.

Germer, C.K. (2009). The mindful path to self-compassion : freeing yourself from destructive thoughts and emotions. New York: Guilford Press.

Hilton, L., Hempel, S., Ewing, B.A., Apaydin, E., Xenakis, L., Newberry, S., Colaiaco, B., Maher, A.R., Shanman, R.M., Sorbero, M.E. and Maglione, M.A. (2016). Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Annals of Behavioral Medicine, [online] 51(2), pp.199–213. doi:https://doi.org/10.1007/s12160-016-9844-2.

Hoffman C, Baker B. Effects of Mindful Self-Compassion Program on Psychological Well-being and Levels of Compassion in People Affected by Breast Cancer. Alternative Therapies in Health and Medicine. 2022 May:AT7227. PMID: 35648691. 

Hoffman, C.J., Ersser, S.J., Hopkinson, J.B., Nicholls, P.G., Harrington, J.E. and Thomas, P.W. (2012). Effectiveness of Mindfulness-Based Stress Reduction in Mood, Breast- and Endocrine-Related Quality of Life, and Well-Being in Stage 0 to III Breast Cancer: A Randomized, Controlled Trial. Journal of Clinical Oncology, 30(12), pp.1335–1342. doi:https://doi.org/10.1200/jco.2010.34.0331.

Hofmann, S.G., Sawyer, A.T., Witt, A.A. and Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, [online] 78(2), pp.169–183. doi:https://doi.org/10.1037/a0018555.

Hölzel, B.K., Lazar, S.W., Gard, T., Schuman-Olivier, Z., Vago, D.R. and Ott, U. (2011). How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective. Perspectives on Psychological Science, 6(6), pp.537–559. doi:https://doi.org/10.1177/1745691611419671.

Johannsen, M., O’Connor, M., O’Toole, M.S., Jensen, A.B., Højris, I. and Zachariae, R. (2016). Efficacy of Mindfulness-Based Cognitive Therapy on Late Post-Treatment Pain in Women Treated for Primary Breast Cancer: A Randomized Controlled Trial. Journal of Clinical Oncology, 34(28), pp.3390–3399. doi:https://doi.org/10.1200/jco.2015.65.0770.

Kabat-Zinn, J. (2009). Wherever you go, there you are : mindfulness meditation in everyday life. New York: Hyperion E-Book.

Kabat-Zinn, J. (2013). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face stress, pain, and Illness. New York: Bantam Books.

Linda E. Carlson, Nofisat Ismaila, Elizabeth L. Addington, Gary N. Asher, Chloe Atreya, Lynda G. Balneaves, Joke Bradt, Nina Fuller-Shavel, Joseph Goodman, Caroline J. Hoffman, Alissa Huston, Ashwin Mehta, Channing J. Paller, Kimberly Richardson, Dugald Seely, Chelsea J. Siwik, Jennifer S. Temel, and Julia H. Rowland. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology–ASCO Guideline. Journal of Clinical Oncology. 23.00857 

Neff, K. (2011). Self compassion. London: Hodder & Stoughton.

Neff, K. and Germer, C.K. (2018). The mindful self-compassion workbook : a proven way to accept yourself, build inner strength, and thrive. New York, Ny: Guilford Press.

Ong, J.C., Manber, R., Segal, Z., Xia, Y., Shapiro, S. and Wyatt, J.K. (2014). A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep, [online] 37(9), pp.1553–63. doi:https://doi.org/10.5665/sleep.4010.

Piet, J., Würtzen, H. and Zachariae, R. (2012). The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 80(6), pp.1007–1020. doi:https://doi.org/10.1037/a0028329.

Segal, Z.V., G, M., Teasdale, J.D. and Kabat-Zinn, J. (2018). Mindfulness-based cognitive therapy for depression. 2nd ed. New York: The Guilford Press.

Shapiro, S.L., Bootzin, R.R., Figueredo, A.J., Lopez, A.M. and Schwartz, G.E. (2003). The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer. Journal of Psychosomatic Research, 54(1), pp.85–91. doi:https://doi.org/10.1016/s0022-3999(02)00546-9.

Shennan, C., Payne, S. and Fenlon, D. (2010). What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psycho-Oncology, 20(7), pp.681–697. doi:https://doi.org/10.1002/pon.1819.

Smith, J.E., Richardson, J., Hoffman, C. and Pilkington, K. (2005). Mindfulness-Based Stress Reduction as supportive therapy in cancer care: systematic review. Journal of Advanced Nursing, 52(3), pp.315–327. doi:https://doi.org/10.1111/j.1365-2648.2005.03592.x.

Teasdale, J.D., G, M. and Segal, Z.V. (2014). The mindful way workbook : an 8-week program to free yourself from depression and emotional distress. New York: The Guilford Press.

van Driel, C., de Bock, G., Schroevers, M. and Mourits, M. (2018). Mindfulness-based stress reduction for menopausal symptoms after risk-reducing salpingo-oophorectomy (PURSUE study): a randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 126(3), pp.402–411. doi:https://doi.org/10.1111/1471-0528.15471.

Williams, M. and Penman, D. (2011). Mindfulness : a practical guide to finding peace in a frantic world. London: Piatkus.

Witek-Janusek, L., Albuquerque, K., Chroniak, K.R., Chroniak, C., Durazo-Arvizu, R. and Mathews, H.L. (2008). Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, Behavior, and Immunity, 22(6), pp.969–981. doi:https://doi.org/10.1016/j.bbi.2008.01.012.