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