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Objective: The aim of this study was to evaluate the efficacy of mindfulness-based stress reduction (MBSR) on health-related quality of life (QoL), depression, and anxiety in patients with differentiated thyroid cancer (DTC) receiving radioactive iodine therapy (RIT).
Patients and methods: A randomized controlled trial of MBSR with 120 DTC patients was performed. They were randomly assigned into the MBSR intervention group and usual care (UC) group. An 8-week MBSR program was administered to the MBSR group starting 8 weeks before RIT. Health-related QoL, depression, and anxiety were measured immediately before the start of MBSR (T1), immediately after RIT hospitalization was concluded (1 week after concluding the last MBSR session, T2), and 3 months after RIT hospitalization (T3), using the QoL Questionnaire Core 30 Items (QLQ-C30), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS).
Results: Fifty-three patients in the UC group and 49 patients in the MBSR group completed the study and were analyzed. Both the UC and MBSR groups reported low QoL and high SDS and SAS scores immediately after RIT hospitalization. Patients randomly assigned to the MBSR group showed significantly greater improvements in emotional function (P=0.012, d=–0.03 for T2 and d=1.17 for T3), fatigue (P=0.037, d=1.00 for T2 and d=–0.69 for T3), global QoL (P=0.015, d=1.61 for T2 and d=1.56 for T3), depression (P=0.027, d=–1.19 for T2 and d=–0.83 for T3), and anxiety (P=0.043, d=–1.00 for T2 and d=–0.86 for T3).
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.
Keywords: mindfulness-based stress reduction, differentiated thyroid cancer, radioactive iodine therapy, quality of life, anxiety, depression
INTRODUCTION
Thyroid cancer, the most frequently occurring endocrine malignancy, is becoming increasingly prevalent worldwide and accounts for more deaths than all other endocrine cancers combined.1 In China, the incidence of thyroid cancer has increased five times during the past 10 years and is now ranking as the seventh most prevalent malignancy among all cancers.2 Differentiated thyroid cancer (DTC), which includes papillary and follicular histologies, accounts for 70%–90% of all thyroid cancers. According to the American Thyroid Association (ATA) guidelines, standard management of DTC includes surgical removal of thyroid gland (thyroidectomy) followed by radioactive iodine therapy (RIT) and thyroid-stimulating hormone (TSH) suppression therapy.3
With an estimated overall 20-year relative survival rate of 95.4%, DTC is known to have a favorable prognosis upon effective treatment.4 However, in clinical practice, while patients were told they have the “good” cancer, this does not reflect their personal experience with this disease. For example, although RIT after thyroidectomy is associated with dramatic decreases in locoregional recurrences, distant metastasis, and disease-related mortality,5 patients receiving high-dose radioactive iodine still experience significant depression and anxiety associated with previous surgical complications (such as neck pain, dysphonia, and hypocalcemia), hormone withdrawal (causing a state of transient hypothyroidism symptoms such as fatigue, neurological deficiencies, and depression), fear of radiation, loneliness of isolation (being housed within radiation isolation wards), and side effect of radioactive iodine (such as swelling neck, sialadenitis, gastrointestinal symptoms, appetite loss, and insomnia).6
In modern medicine, psychological intervention has become an essential part of patient management. Mindfulness is a state of meditation that originated from Buddhist philosophy. It can be defined as the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.7 Mindfulness-based stress reduction (MBSR) was introduced to psychological treatment in 1979 by Kabat-Zinn8 to help patients cope with their stress, pain, and emotions. It is widely used in the field of clinical cancer on patients and has shown improvement in several psychosomatic problems, such as insomnia, stress, anxiety, and depression.9–11 However, to the best of our knowledge, no previous research has investigated the effects of MBSR on patients with thyroid cancer receiving RIT.
Therefore, the aim of this study was to explore whether MBSR intervention is effective in improving health-related quality of life (QoL) and reducing depression and anxiety in DTC patients receiving RIT.
