DISCUSSION

Our study was the first to explore the effects of MBSR on DTC patients receiving RIT. Important findings from this study include statistically significant improvements in emotional function, fatigue, global QoL, depression, and anxiety scales after MBSR intervention compared with those after UC.

Usually several weeks ahead of RIT, DTC patients come to our department for RIT consultation and seek guidance regarding thyroid hormone withdrawal, low iodine diet, and the time schedule. This leaves us plenty of time to communicate with them. Recognizing the inadequacy of psychological support for these patients, we begin to think over what we could do to reduce their suffering in this period.


Continue Reading

MBSR is now regarded as a well-established adjunctive treatment to assist well-being for medical patients in the USA. Since the introduction of this psychological intervention program to China, an increasing number of studies have been conducted to test its applicability in various patient groups such as breast cancer, chronic pain, and chronic insomnia. The results have been encouraging.13–15

In our study, most of the improvements in QoL, depression, and anxiety can be seen immediately after RIT hospitalization was concluded, when patients were experiencing the most negative impact of 4 weeks of thyroid hormone withdrawal, RIT-associated side effects, and isolation. Previous researchers have reported such changes in other types of cancers receiving MBSR program.9,16–19 However, we thought that the supportive interaction among the group members may also result in positive health effect. In this regard, future research might be needed to evaluate whether MBSR adds benefit over an active psychological treatment such as cognitive behavior therapy (CBT), which could provide coping skills of a different type. Nonetheless, our results indicate that an 8-week schedule ahead of RIT hospitalization is applicable and effective for patients to cope with worsened QoL, depression, and anxiety in this period.

Three months after RIT, DTC patients began to recover from the panic and fear of the disease, as well as the damage caused by necessary medical treatment. However, we still observed significant benefits in the MBSR intervention group compared to the UC group at this time point. Parameters such as emotional function, fatigue, global QoL, depression, and anxiety were significantly better in the MBSR group than the UC group. The effect of MBSR on psychological aspect is more evident in this observation time point.

Two subscales (dyspnea and diarrhea) in QLQ-C30 recovered significantly in both the UC and MBSR groups. This is due to the resumption of levothyroxine, which reverses the state of hypothyroidism and leads to less related symptoms. One subscale (appetite loss) continued to be high in the two observation time points in both the UC and MBSR groups. Appetite loss is a side effect from RIT. However, different from nausea and vomiting, which usually disappear 2 or 3 days after RIT, it lasts for a very long period of time.20 Our results demonstrate that MBSR has no significant impact on this subscale within 3 months after RIT hospitalization.

There are some limitations to this study. First, although the study design is an RCT, this clinical trial was limited by a modest sample size. Further studies with larger study population are required to confirm our results. Second, to understand the positive effect in patients receiving MBSR, 3-month point seems to be not enough and extended follow-up is needed. Third, because the study population was from one single hospital center, the results may not applicable to the general patients due to several DTC treatment strategies. Finally, we did not evaluate whether patients continuing practicing mindfulness after 3-month time point are benefitted. Because psychological intervention can improve the adherence of traditional treatment, we anticipate that DTC patients might benefit from long-term MBSR, even in recurrence and survival. However, future studies are needed to confirm this assumption.

CONCLUSION

An 8-week MBSR program significantly improved a wide range of scales in health-related QoL and mitigated depression and anxiety among DTC patients receiving RIT.

Acknowledgment

We thank all the participating patients and the research nurses and staff for their efforts in completing this study.

Disclosure

The authors report no conflicts of interest in this work.


Tianji Liu,1,* Wenqi Zhang,1,* Shuai Xiao,2 Lei Xu,3 Qiang Wen,1 Lin Bai,1 Qingjie Ma,1 Bin Ji1

1Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China; 2Department of Nursing, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China; 3Department of Psychology and Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China

*These authors contributed equally to this work 


References

1. La Vecchia C, Malvezzi M, Bosetti C, et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer. 2015;136(9):2187–2195.

2. Yang L, Zheng RS, Wang N, et al. Analysis of incidence and mortality of thyroid cancer in China, 2013. Zhonghua Zhong Liu Za Zhi. 2017;39(11):862–867.

3. Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.

4. Singer S, Lincke T, Gamper E, et al. Quality of life in patients with thyroid cancer compared with the general population. Thyroid. 2012;22(2):117–124.

5. Robbins RJ, Schlumberger MJ. The evolving role of (131)I for the treatment of differentiated thyroid carcinoma. J Nucl Med. 2005;46(Suppl 1):28S–37S.

6. Lu L, Shan F, Li W, Lu H. Short-term side effects after radioiodine treatment in patients with differentiated thyroid cancer. Biomed Res Int. 2016;2016(9):1–5.

7. Kabat-Zinn J. Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice. 2006;10(2):144–156.

8. Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982;4(1):33–47.

9. Zhang MF, Wen YS, Liu WY, Peng LF, Wu XD, Liu QW. Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: A Meta-analysis. Medicine. 2015;94(45):e0897–e0890.

10. Anheyer D, Haller H, Barth J, Lauche R, Dobos G, Cramer H. Mindfulness-based stress reduction for treating low back pain: a systematic review and meta-analysis. Ann Intern Med. 2017;166(11):799–807.

11. Lawrence M, Booth J, Mercer S, Crawford E. A systematic review of the benefits of mindfulness-based interventions following transient ischemic attack and stroke. Int J Stroke. 2013;8(6):465–474.

12. Kabat-Zinn J. Bringing mindfulness to medicine: an interview with Jon Kabat-Zinn, PhD. Interview by Karolyn Gazella. Adv Mind Body Med. 2005;21(2):22–27.

13. Zhang JY, Zhou YQ, Feng ZW, Fan YN, Zeng GC, Wei L. Randomized controlled trial of mindfulness-based stress reduction (MBSR) on posttraumatic growth of Chinese breast cancer survivors. Psychol Health Med. 2017;22(1):94–109.

14. Zhang JX, Liu XH, Xie XH, et al. Mindfulness-based stress reduction for chronic insomnia in adults older than 75 years: a randomized, controlled, single-blind clinical trial. Explore. 2015;11(3):180–185.

15. Wong SY. Effect of mindfulness-based stress reduction programme on pain and quality of life in chronic pain patients: a randomised controlled clinical trial. Hong Kong Med J. 2009;15(Suppl 6):13–14.

16. Hoffman CJ, Ersser SJ, Hopkinson JB, Nicholls PG, Harrington JE, Thomas PW. 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. J Clin Oncol. 2012;30(12):1335–1342.

17. Pollard A, Burchell JL, Castle D, et al. Individualised mindfulness-based stress reduction for head and neck cancer patients undergoing radiotherapy of curative intent: a descriptive pilot study. Eur J Cancer Care. 2017;26(2):e12474.

18. Johns SA, Brown LF, Beck-Coon K, et al. Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors. Support Care Cancer. 2016;24(10):4085–4096.

19. Schellekens MPJ, van den Hurk DGM, Prins JB, et al. Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial. Psychooncology. 2017;26(12):2118–2126.

20. Florenzano P, Guarda FJ, Jaimovich R, Droppelmann N, González H, Domínguez JM. Radioactive iodine administration is associated with persistent related symptoms in patients with differentiated thyroid cancer. Int J Endocrinol. 2016;2016:1–6.

Source: Cancer Management and Research.
Originally published January 4, 2019.