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Meditation effect on psychological stress level in women with breast cancer: a systematic review

ABSTRACT

Objective:

To evaluate the effect of meditation on the psychological stress level of women with breast cancer.

Method:

A systematic literature review performed in the LILACS, PubMed, Scopus, CINAHL and Web of Science databases.

Results:

The sample consisted of 22 studies using Mindfulness, Transcendental Meditation, and Contemplative Self-Healing Meditation techniques. There was a significant effect of meditation on stress reduction, post-traumatic stress symptoms, self-reported stress, and chronic stress verified. In some studies, the effect was associated with decreased cortisol and increased telomerase.

Conclusion:

Meditation has shown positive effects in reducing physical and emotional symptoms such as psychological stress, depression, anxiety, fatigue, fear of recurrence and rumination, representing an efficient strategy for coping with the disease and improving quality of life.

DESCRIPTORS
Breast Neoplasms; Stress, Psychological; Complementary Therapies; Meditation; Oncology Nursing; Review

RESUMO

Objetivo:

Avaliar o efeito da meditação no nível de estresse psicológico de mulheres com neoplasia mamária.

Método:

Revisão sistemática da literatura, realizada nas bases de dados LILACS, PubMed, Scopus, CINAHL e Web of Science.

Resultados:

A amostra foi composta de 22 estudos que empregaram as técnicas Mindfulness, Meditação Transcendental, Meditação Contemplativa de autocura. Verificou-se efeito significativo da meditação na redução do nível de estresse, nos sintomas de estresse pós-traumático, autorrelato de estresse e estresse crônico. Em alguns estudos, o efeito esteve associado à redução do cortisol e ao aumento da telomerase.

Conclusão:

A meditação apresentou efeitos positivos na redução de sintomas físicos e emocionais, como o estresse psicológico, depressão, ansiedade, fadiga, medo de recorrência e ruminação, representando estratégia eficiente para enfrentamento da doença e melhoria da qualidade de vida.

DESCRITORES
Neoplasias da Mama; Estresse Psicológicos; Terapias Complementares; Meditação; Enfermagem Oncológica; Revisão

RESUMEN

Objetivo:

Evaluar el efecto de la meditación en el nivel de estrés psicológico de mujeres con neoplasia mamaria.

Método:

Revisión sistemática de la literatura, realizada en las bases de datos LILACS, PubMed, Scopus, CINAHL y Web of Science.

Resultados:

La muestra estuvo compuesta de 22 estudios que emplearon las técnicas Mindfulness, Meditación Transcendental, Meditación Contemplativa de autocuración. Se verificó efecto significativo de la medicación en la reducción del nivel de estrés, los síntomas de estrés postraumático, autorrelato de estrés y estrés crónico. En algunos estudios, el efecto estuvo asociado con la reducción del cortisol y el aumento de la telomerasa.

Conclusión:

La meditación presentó efectos positivos en la reducción de síntomas físicos y emotivos, como el estrés psicológico, depresión, ansiedad, fatiga, miedo de recidiva y rumiación, representando estrategia eficiente para enfrentamiento de la enfermedad y mejoría de la calidad de vida.

DESCRIPTORES
Neoplasias de la Mama; Estrés Psicológico; Terapias Complementarias; Meditación; Enfermería Oncológica; Revisión

INTRODUCTION

Breast cancer is a heterogeneous disease in relation to clinical, morphological and multifactorial aspects, involving biological-endocrine, reproductive life, behavior and lifestyle factors, with higher incidence and mortality in the female population in the world and in Brazil(11. Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes para a detecção precoce do câncer de mama no Brasil [Internet]. Rio de Janeiro: INCA; 2015 [citado 2018 jun. 23]. Disponível em: https://www.inca.gov.br/publicacoes/livros/diretrizes-para-deteccao-precoce-do-cancer-de-mama-no-brasil
https://www.inca.gov.br/publicacoes/livr...
). Rates are higher in developed countries and vary across different national and global regions(22. Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2018: incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2017 [citado 2018 jul. 15]. Disponível em: http://www.inca.gov.br/estimativa/2018/estimativa-2018.pdf
http://www.inca.gov.br/estimativa/2018/e...
).

It is considered a devastating disease, interpreted as a punishment(33. Pisoni AC, Kolankiewicz ABC, Scarton J, Loro MM, Souza MM, Rosanelli CLSP. Difficulties experienced by women undergoing treatment for breast cancer. Rev Online Pesq Cuid Fundam. 2013;5(3):194-201. DOI: http://dx.doi.org/10.9789/2175-5361.2013v5n3p194
http://dx.doi.org/10.9789/2175-5361.2013...
), involving feelings that are difficult to manage such as social stigma, fear of death, anger, irritation, anguish, despair and non-acceptance(44. Lôbo SA, Fernandes AFC, Almeida PC, Carvalho CML, Sawada NO. Quality of life in women with breast cancer undergoing chemotherapy. Acta Paul Enferm. 2014;27(6):554-9. DOI: http://dx.doi.org/10.1590/1982-0194201400090
http://dx.doi.org/10.1590/1982-019420140...
55. Alvares RB, Santos IDL, Lima NM, Mattias SR, Cestari MEW, Gomes NCRC, et al. Sentimentos despertados nas mulheres frente ao diagnóstico de câncer de mama. J Nurs Health. 2017;7(3):1-10. DOI: HTTP://DX.DOI.ORG/10.15210/JONAH.V7I3.12639
HTTP://DX.DOI.ORG/10.15210/JONAH.V7I3.12...
). Changes in the lives of women with breast cancer are due to treatment which causes numerous repercussions(66. Geraldini MCCS, Moura L. Sentimentos relatados por mulheres mastectomizadas: uma revisão sistematizada. Rev Uningá [Internet]. 2018 [citado 2018 jul. 01];38(1):175-88. Disponível em: http://revista.uninga.br/index.php/uninga/article/view/1128
http://revista.uninga.br/index.php/uning...
), including changes in body image resulting from alopecia/hair loss, weight gain, scarring and breast loss, which affect sexuality and self-esteem(77. Silveira CF, Regino PA, Soares MBO, Mendes LC, Elias TC, Silva SR. Quality of life and radiation toxicity in patients with gynecological and breast cancer. Esc Anna Nery. 2016;20(4):e20160089. DOI: http://dx.doi.org/10.5935/1414-8145.20160089
http://dx.doi.org/10.5935/1414-8145.2016...
).

Reactions such as asthenia, fatigue, nausea, vomiting, insomnia, loss of appetite, changes in body weight, hair loss and dyspnea are usually due to chemotherapy(33. Pisoni AC, Kolankiewicz ABC, Scarton J, Loro MM, Souza MM, Rosanelli CLSP. Difficulties experienced by women undergoing treatment for breast cancer. Rev Online Pesq Cuid Fundam. 2013;5(3):194-201. DOI: http://dx.doi.org/10.9789/2175-5361.2013v5n3p194
http://dx.doi.org/10.9789/2175-5361.2013...
) and cause sadness, anxiety and shame(44. Lôbo SA, Fernandes AFC, Almeida PC, Carvalho CML, Sawada NO. Quality of life in women with breast cancer undergoing chemotherapy. Acta Paul Enferm. 2014;27(6):554-9. DOI: http://dx.doi.org/10.1590/1982-0194201400090
http://dx.doi.org/10.1590/1982-019420140...
). Dermatological reactions are frequent in women undergoing radiotherapy, leading to discomfort, pain and redness in the breast and armpit region(88. Oliveira MA, Sousa C, Ferreira A, Cruz A. Rastreio do distress, o sexto sinal vital em oncologia: dados preliminares de doentes recém-diagnosticados no hospital CUF Porto. Gazeta Méd [Internet]. 2017 [citado 2018 jul. 02];3(4):130-6. Disponível em: http://www.gazetamedica.pt/index.php/gazeta/article/view/54
http://www.gazetamedica.pt/index.php/gaz...
).

Psychological stress in this context of illness due to a stigmatizing disease is a frequent event in the lives of many women with breast cancer, with a prevalence rate of 35% to 60%(99. Oliveira FBM, Silva FSS, Prazeres ASB. Impacto do câncer de mama e da mastectomia na sexualidade feminina. Rev Enferm UFPE On line [Internet]. 2017 [citado 2018 maio 22]; 11 Supl.6:2533-40. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/23421/19103
https://periodicos.ufpe.br/revistas/revi...
). In most cases it is due to concerns related to self-image, sexuality, loss of fertility, femininity, changes in autonomy and independence, among other factors(99. Oliveira FBM, Silva FSS, Prazeres ASB. Impacto do câncer de mama e da mastectomia na sexualidade feminina. Rev Enferm UFPE On line [Internet]. 2017 [citado 2018 maio 22]; 11 Supl.6:2533-40. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/23421/19103
https://periodicos.ufpe.br/revistas/revi...
1010. Araújo RV, Nery IS, Fernandes AFC, Campelo RCV, Freitas FRNN, Batista MMSL, et al. Repercussions of therapy for breast cancer on woman's quality of life. Int Arc Med. 2016;9(100):1-7. DOI: http://dx.doi.org/10.3823/1971
http://dx.doi.org/10.3823/1971...
). In addition, it causes feelings of vulnerability, sadness and fear which can arouse debilitating situations in women, such as depression, anxiety, panic, social isolation, existential and spiritual crisis(99. Oliveira FBM, Silva FSS, Prazeres ASB. Impacto do câncer de mama e da mastectomia na sexualidade feminina. Rev Enferm UFPE On line [Internet]. 2017 [citado 2018 maio 22]; 11 Supl.6:2533-40. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/23421/19103
https://periodicos.ufpe.br/revistas/revi...
).

Due to the difficulties in dealing with psychological stress and the feelings arising from the diagnosis and treatment of breast cancer, it is essential that health professionals perform screening and control(99. Oliveira FBM, Silva FSS, Prazeres ASB. Impacto do câncer de mama e da mastectomia na sexualidade feminina. Rev Enferm UFPE On line [Internet]. 2017 [citado 2018 maio 22]; 11 Supl.6:2533-40. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/23421/19103
https://periodicos.ufpe.br/revistas/revi...
) in order to prevent debilitating complications. In this scenario, it is critical to plan and develop actions which help women in the coping process in order to provide a less traumatic and painful experience. In this sense, Integrative and Complementary Health Practices can be used as a natural mechanism for disease prevention, health recovery(1111. Brasil. Ministério da Saúde. Política nacional de práticas integrativas e complementares no SUS: atitude de ampliação de acesso [Internet]. 2015 [citado 2018 abr. 13]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_praticas_integrativas_complementares_2ed.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
) and for managing symptoms related to the disease diagnosis and treatment(1212. Honnegha AM, Harrison T. Complementary and alternative medicine therapies as symptom management strategies for the late effects of breast cancer treatment. J Holist Nurs. 2015;33(1):84-97. DOI: http://dx.doi.org/10.1177/0898010114539191
http://dx.doi.org/10.1177/08980101145391...
).

Meditation is a practice of harmonizing mental states and consciousness. It is present in countless cultures and traditions, brings benefits to the cognitive system, promotes concentration, aids in perception of physical and emotional sensations, increases self-discipline in healthcare, stimulates well-being, relaxation, reduces stress, hyperactivity and depressive symptoms(1313. Brasil. Ministério da Saúde. Portaria n. 849, de 27 de março de 2017. Inclui a Arteterapia, Ayurveda, Biodança, Dança Circular, Meditação, Musicoterapia, Naturopatia, Osteopatia, Quiropraxia, Reflexoterapia, Reiki, Shantala, Terapia Comunitária Integrativa e Yoga à Política Nacional de Práticas Integrativas e Complementares [Internet] Brasília; 2017 [citado 2018 jun. 16]. Disponível em: http://189.28.128.100/dab/docs/portaldab/documentos/prt_849_27_3_2017.pdf
http://189.28.128.100/dab/docs/portaldab...
), decreases repetitive thinking, promotes favorable mood changes and provides greater integration between mind, body and the outside world(1414. Brasil. Ministério da Saúde. Glossário temático: práticas integrativas e complementares em saúde [Internet]. Brasília; 2018 [citado 2019 abr. 23]. Disponível em: http://portalarquivos2.saude.gov.br/images/pdf/2018/marco/12/glossario-tematico.pdf
http://portalarquivos2.saude.gov.br/imag...
). Furthermore, this practice contributes to reducing levels of adrenaline and cortisol, stress and anxiety related hormones, and consequently intensifies the production of endorphin and serotonin, which are responsible for feelings of well-being and happiness(1515. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-93. DOI: http://dx.doi.org/10.1002/pon.3648
http://dx.doi.org/10.1002/pon.3648...
).

The effect of meditation on improving anxiety and mood disorders has been observed in studies, with evidence level “A” in reducing stress, depression, fatigue; and evidence level “B” in improving quality of life(1616. Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014;(50):346-58. DOI: http://dx.doi.org/10.1093/jncimonographs/lgu041
http://dx.doi.org/10.1093/jncimonographs...
). However, there are no clinical studies in Brazil to prove the effect of this act on symptoms related to the diagnosis and treatment of breast cancer, and no literature review to verify the effect on the psychological stress level of women with breast cancer, thus constituting the reason for which this study was conducted. Thus, the objective of this study was to evaluate the effect of meditation on the psychological stress level of women with breast cancer.

METHOD

Study design

A systematic literature review as recommended by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)(1717. Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar revisões sistemáticas e meta-análises: a recomendação PRISMA. Epidemiol Serv Saúde. 2015;24(2):335-42. DOI: http://dx.doi.org/10.5123/S1679-49742015000200017
http://dx.doi.org/10.5123/S1679-49742015...
) guideline, which guides the application of a 27-item checklist and four-step flowchart focusing on clinical trials. The systematic review protocol was registered in PROSPERO: International prospective register of systematic reviews: CRD42018088863.

The PICO strategy was used to formulate the research question, in which P refers to the population or group of patients (women with breast cancer), I to Intervention (meditation), C to comparison (no comparison with other interventions), O to outcome (effects of meditation on the psychological stress level in women with breast cancer). The question of the systematic review was: what is the effect of meditation on the psychological stress level of women with breast cancer?

Data collection

Data were collected in January and February 2018 from the following electronic databases: Latin American and Caribbean Health Sciences Literature. (LILACS); Cochrane Collaboration; PMC (PubMEd Central); SciVerse Scopus (Scopus); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Science Citation Indexes (Web of Science), accessed by the Higher Level Personnel Improvement Coordination (CAPES – Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) Journals Portal, and the descriptors were selected after consulting the vocabularies Medical Subject Headings (MeSH), produced by the National Library of Medicine of the United States, Health Sciences Descriptors (DeCS – Descritores em Ciências da Saúde) and Titles of the CINAHL.

After combining the search terms, the following expressions were generated: LILACS: neoplasias da mama AND meditação AND estresse psicológico; PUBMED: breast neoplasms AND meditation AND stress, psychological; SCOPUS: TITLE-ABS-KEY (breast AND neoplasms ) AND TITLE-ABS-KEY (meditation) AND TITLE-ABS-KEY (stress, AND psychological); CINAHL: breast neoplasms AND meditation AND stress, psychological, WEB OF SCIENCE: TS=(breast neoplasms) AND TS=(meditation) AND TS=(Stress, Psychological).

Selection criteria

The studies were exported to BibTex format and imported to the StArt tool(1818. Hernandes E, Zamboni A, Fabbri S, Di Thommazo A. Using GQM and TAM to evaluate StArt: a tool that supports systematic review. CLEI Eletr J [Internet]. 2012 [cited 2018 Apr 13];15(1). Available from: http://www.scielo.edu.uy/pdf/cleiej/v15n1/v15n1a03.pdf
http://www.scielo.edu.uy/pdf/cleiej/v15n...
), which assisted in the selection and data collection process, performed from a semi-structured form containing the following information: Title, publication year, objective, type of meditation, group and home practice, follow-up, professionals who conducted the intervention and significance of the studies. The advantages of this tool are the direct assistance of the investigator to the archives and a guarantee of uniformity in interpreting the data and criteria by which they are provided. Study selection was performed after thorough reading of titles and abstracts, followed by analysis and interpretation of the results.

Clinical trials describing the effect of meditation on the stress and anxiety level of women with breast cancer were included in the systematic review, while studies which did not answer the research question, review studies, clinical trial protocols, ongoing clinical trials, theses, dissertations and monographs were excluded.

Data analysis and processing

Data extraction and analysis were performed by two reviewers independently. Grading of Recommendations Assessment, Development and Evaluation (GRADE)(1919. Brasil. Ministério da Saúde. Diretrizes metodológicas: Sistema GRADE: manual de graduação da qualidade da evidência e força de recomendação para tomada de decisão em saúde [Internet]. Brasília; 2014 [citado 2018 jun. 13]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_sistema_grade.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
) was used to evaluate the quality of the studies, which classifies them into four levels: high, moderate, low and very low. Figure 1 provides the description of the study selection process.

Figure 1
Selection of studies included in the review – Brazil, 2018.

Ethical aspects

A systematic review of the literature is a secondary study, therefore an evaluation by the Ethics Committee in research or signing of an informed consent form were not necessary.

RESULTS

First, 366 studies were retrieved. After applying the inclusion and exclusion criteria, 85 articles were considered eligible for title and abstract reading, of which 22 were selected for full reading, analysis and discussion. Publications were identified in the years of 2017(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
), 2016(2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
), 2015(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
), 2014(2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
), 2013(2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
), 2012(3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
), 2011(3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
), 2010(3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
), 2009(3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
), 2008(3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
), 2007(4040. Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients, Brain Behav Immun. 2007;21(8): 1038-49. DOI: https://doi.org/10.1016/j.bbi.2007.04.002
https://doi.org/10.1016/j.bbi.2007.04.00...
), 2003(4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.). Most studies were conducted in the United States(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
,4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), Denmark(3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
) and Canada(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,4040. Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients, Brain Behav Immun. 2007;21(8): 1038-49. DOI: https://doi.org/10.1016/j.bbi.2007.04.002
https://doi.org/10.1016/j.bbi.2007.04.00...
). Regarding the level of evidence, three were classified as very low(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
), eight as high(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
,3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
), seven as moderate(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
,4040. Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients, Brain Behav Immun. 2007;21(8): 1038-49. DOI: https://doi.org/10.1016/j.bbi.2007.04.002
https://doi.org/10.1016/j.bbi.2007.04.00...
4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), and four as low(2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
,2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
).

In the analyzed studies, it was observed that age, breast cancer stage, treatment, diagnosis of other diseases, including severe mental disorders and the use of some medications were considered for the inclusion or exclusion of women. The average age of the women who participated in the studies was 46.1 years(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
), 49(3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
), 50(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
), 53.9(3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
), 54.2(4040. Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients, Brain Behav Immun. 2007;21(8): 1038-49. DOI: https://doi.org/10.1016/j.bbi.2007.04.002
https://doi.org/10.1016/j.bbi.2007.04.00...
), 54.6(3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
), 55(2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
), 55.1(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
), 55.3(2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
), 55.9(2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
), 56.8(3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
), 56.9(2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
), 57.2(2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
), 57.5(3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), 58(3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
), 60(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
), 63.1(2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
), 63.8(3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
).

The staging behaved as follows: breast cancer in Stage 0 – II(3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
), Stage 0 – III(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
), Stage I – II(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
), Stage I – III(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
,3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
), Stage II – IV(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
). Regarding the women: undergoing surgery, chemotherapy or radiotherapy(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
), on hormone therapy(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
) or completed(3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
), no cortisol-related endocrine disorders(3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
) and not on systemic chemotherapy(2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
).

Among the other diagnoses used for exclusion were suicidal thinking(3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
), severe depressive symptoms(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
), severe or neurological mental disorder(2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
,3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), immune disease(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
) and uncontrolled active inflammatory disease(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
), and lastly anxiolytic, antidepressant, psychotropic medications(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
), chronic substances(2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
), corticosteroids(2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
), anti-hypertensive medication(3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
), Herceptin(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
), diagnosed with another cancer (except non-melanoma skin cancer)(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
), as well as advanced breast cancer(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), relapse(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), metastasis(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
), inability to commit to the meditation program(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
) and previous participation in the Meditation Program(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
). The description of the authors, publication year and objectives are shown in Chart 1.

Chart 1
Description of the analyzed studies according to authors, years of publication and objectives.

A description of the type of meditation program, group and home practice, follow-up time, and the professionals who conducted the intervention can be found in Chart 2.

Chart 2
Meditation program details.

Chart 3 shows the significance of the effect of meditation on the psychological stress level of women with breast cancer who participated in the studies included in the review, categorized as: high significance(+++), moderate significance(++) and low significance(+). Meditation had a significant effect on reducing psychological stress(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
,2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), reducing cortisol(3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), depression(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), anxiety(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), improving the quality of life(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), among other factors.

Chart 3
Significance description of the effect of meditation on the psychological stress level of women with breast cancer who participated in the studies included in the review.

The following instruments were used to evaluate the effect of meditation on stress level: Stress Inventory (SOSI)(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
,3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
,4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), Perceived Stress Scale (PSS)(2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
), Stress and adversity resilience scale(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
), Post-traumatic stress disorder symptom scale (PTSD)(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
), Post-traumatic Development Inventory (PTGI)(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
), as well as salivary cortisol level assessment(32.36–4040. Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients, Brain Behav Immun. 2007;21(8): 1038-49. DOI: https://doi.org/10.1016/j.bbi.2007.04.002
https://doi.org/10.1016/j.bbi.2007.04.00...
) and telomerase(2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
).

Other aspects were evaluated such as mood, coping, social support, fear of recurrence, depression, anxiety, quality of life, symptoms (nausea, vomiting, fatigue, malaise), optimism, mindfulness and sleep quality with the aid of: the Mood State Scale (POMS)(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
,3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
,4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), the Jalowiec Coping Scale (JCS)(3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), the Sense of Coherence scale (SOC)(2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
,4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), the Social Support Scale (MOS-SSS)(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
), the Fear of Recurrence Scale (QLACS)(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
), the Patient Health Questionnaire or PHQ-9(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
), the Beck Depression Inventory(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
), the Beck Anxiety Inventory(2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
), the Functional Assessment of Cancer Therapy-Breast (FACT-B)(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
,2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
), the Global Quality of Life Scale (EORTC QLQ-C30)(3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
,4040. Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients, Brain Behav Immun. 2007;21(8): 1038-49. DOI: https://doi.org/10.1016/j.bbi.2007.04.002
https://doi.org/10.1016/j.bbi.2007.04.00...
4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), the Vitality Scale (SF-36)(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
), the Medical Symptom Checklist (MSCL)(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
), the Fatigue Symptom Inventory (FSI)(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
), the MD Anderson Symptom Inventory (MDASI)(3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
), the Optimism Scale (LOT-R)(3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
), the Five Facet Mindfulness Questionnaire (FFMQ)(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
), the Mindful Attention Awareness Scale (MAAS)(2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
), the Insomnia Severity Index (ISI)(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
), and the Pittsburgh Sleep Quality Index (PSQI)(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
).

DISCUSSION

The study identified a predominance of Mindfulness-Based Stress Reduction Meditation Programs (MBSR), mostly based on and adapted from the original Kabbat-Zinn Program, the founder of the method(2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
), and which has been widely used and disseminated in healthcare facilities in the United States(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
). Integrative and Complementary Practices in Brazil were only institutionalized in the Unified Health System in May 2006, with the expansion of 14 other practices such as yoga and meditation in 2017(4242. Brasil. Ministério da Saúde; Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Manual de implantação de serviços de práticas integrativas e complementares no SUS. Brasília: MS; 2018.).

Mindfulness meditation is also known for awareness, attention, focus, presence, or vigilance, and differs from others by relying on breath and body and being detached from any religious aspect(4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), unlike raja yoga meditation, a science which teaches you how to attain the power of concentration, analyze the mind, build the spiritual world, and guides the individual to subtle perceptions. In raja yoga, breathing enters the individual into the psychic plane which leads to the spiritual world, and the practice is started from the inner world, the inner nature, so that it is possible to control everything, both internal and external aspects(4343. Vivekananda S. Raja Yoga: o caminho real [internet]. 2009 [citado 2019 abr 23]. Disponivel em: https://www.scriptaetveritas.com.br/livrospdf/raja-yoga-o-caminho-real.pdf
https://www.scriptaetveritas.com.br/livr...
). The ultimate goal of raja yoga meditation is to control and direct the prana, the vital energy that occurs when man concentrates his energies and masters the prana in his body(4343. Vivekananda S. Raja Yoga: o caminho real [internet]. 2009 [citado 2019 abr 23]. Disponivel em: https://www.scriptaetveritas.com.br/livrospdf/raja-yoga-o-caminho-real.pdf
https://www.scriptaetveritas.com.br/livr...
).

The practice of meditation in the analyzed studies was in groups, and developed activities were similar in most studies. There was time for welcoming participants in the group meditation, presentation of theoretical material, guidelines for home practice, delivery of informative material, CD disc or cassette tapes to guide home practice and a diary for recording(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), thus encouraging formal and informal practice.

Other studies have identified the use of healing images(4444. Medeiros AM. Práticas integrativas e complementares no SUS: os benefícios do Yoga e da Meditação para a saúde do corpo e da alma. Rev Eletr Correlation [Internet]. 2017 [citado 2018 jul. 19];16(2):283-301. Disponível em: https://www.metodista.br/revistas/revistas-ims/index.php/COR/article/view/8369/6145
https://www.metodista.br/revistas/revist...
), 6-hour retreats(1414. Brasil. Ministério da Saúde. Glossário temático: práticas integrativas e complementares em saúde [Internet]. Brasília; 2018 [citado 2019 abr. 23]. Disponível em: http://portalarquivos2.saude.gov.br/images/pdf/2018/marco/12/glossario-tematico.pdf
http://portalarquivos2.saude.gov.br/imag...
1616. Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014;(50):346-58. DOI: http://dx.doi.org/10.1093/jncimonographs/lgu041
http://dx.doi.org/10.1093/jncimonographs...
) and psychoeducation activities(3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
,4444. Medeiros AM. Práticas integrativas e complementares no SUS: os benefícios do Yoga e da Meditação para a saúde do corpo e da alma. Rev Eletr Correlation [Internet]. 2017 [citado 2018 jul. 19];16(2):283-301. Disponível em: https://www.metodista.br/revistas/revistas-ims/index.php/COR/article/view/8369/6145
https://www.metodista.br/revistas/revist...
4545. Soo MS, Jarosz JA, Wren AA, Soo AE, Mowery YM, Johnson KS, et al. Imaging-guided core-needle breast biopsy: impact of meditation and music interventions on patient anxiety, pain, and fatigue. J Am Coll Radiol. 2016;13(5):526 DOI: http://dx.doi.org/10.1016/j.jacr.2015.12.004
http://dx.doi.org/10.1016/j.jacr.2015.12...
). Despite adaptation in the format of the meditation programs in the analyzed studies, they remained similar to the traditional eight-meeting Kabbat-Zinn program(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.). Other adaptations included the 2-day Intensive Program, Nature retreats, Mindfulness Workshops and lectures(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
).

The follow-up time in the analyzed studies was 4, 12 and 24 months(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
), 6 and 12 months(3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
), 2 and 5 months(1919. Brasil. Ministério da Saúde. Diretrizes metodológicas: Sistema GRADE: manual de graduação da qualidade da evidência e força de recomendação para tomada de decisão em saúde [Internet]. Brasília; 2014 [citado 2018 jun. 13]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_sistema_grade.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
), 2 months(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
,3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
), 6 weeks(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
) and 18 hours(3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
). Some researchers have brought discussions about the relationship between meditation practice time and maintaining the desired effect(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
,2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
,2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
,4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.). The duration of the meditation sessions was 20 minutes to an hour, while the practice at home was from 5 to 20 minutes(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
).

Researchers have introduced relevant considerations regarding the follow-up time and the effect of the intervention. In a study conducted with a short follow-up, researchers were not convinced to state the effect of the intervention(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
). In another, no significant effect of meditation on depressive symptoms of women with breast cancer was identified, and the authors believed that the early assessment time may have compromised the expected outcome(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
).

For randomization, some were computerized and randomly drawn into blocks of nine, 12 and 15(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
), stratified and unblocked with a randomized 1:1 allocation ratio with blinding(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
), and random draw into blocks of four to six with blinding(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
), 4:3 allocation(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
), computerized randomization, 1:1 allocation(2727. Lengacher CA, Reich RR, Kip KE, Barta M, Ramesar S, Paterson CL, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. 2014;16(4):438-47. DOI: http://dx.doi.org/10.1177/1099800413519495
http://dx.doi.org/10.1177/10998004135194...
,3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
), 2:2:1(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
,3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
), by disease stage (0, I, II, III, IV), age of participants, type of treatment and health institution(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
), by selecting potentially eligible participants by telephone contact(2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
) or self-selection for MBSR or non-MBSR group(2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
) and recruited from hospitals, community organizations using distribution of posters, pamphlets and e-mail(3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,4040. Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients, Brain Behav Immun. 2007;21(8): 1038-49. DOI: https://doi.org/10.1016/j.bbi.2007.04.002
https://doi.org/10.1016/j.bbi.2007.04.00...
4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.).

There was a variety regarding the methods used by researchers to perform randomization. The importance of implementing the research with methodological rigor is emphasized in order to avoid limitations in the study and the interference of biases in the research results, which may imply uncertainties regarding the research outcome. It was observed that the participants in one of the groups were interested in participating in the experimental group, which prevented the formation of the control group(2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
); an aspect that compromises the strength of the study and the significance of the results.

Meditation was conducted by a physician and psychologist(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
,2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
,2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), and a psychiatrist(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
), all with experience and training in the MBSR program, as well as certified instructors(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
3939. Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008;22(6):969-81. DOI: http://dx.doi.org/10.1016/j.bbi.2008.01.012
http://dx.doi.org/10.1016/j.bbi.2008.01....
) and a researcher qualified as a Full Mindfulness Program instructor at the University of Massachusetts(3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
). It is noteworthy that such care has the purpose of evading any disruption or damage that may arise from the practice conducted improperly or even by inexperienced professionals. Given this, the need and importance of training nurses in meditation programs for stress reduction is emphasized, as they can improve the psychological state and quality of life of individuals(1515. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-93. DOI: http://dx.doi.org/10.1002/pon.3648
http://dx.doi.org/10.1002/pon.3648...
1616. Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014;(50):346-58. DOI: http://dx.doi.org/10.1093/jncimonographs/lgu041
http://dx.doi.org/10.1093/jncimonographs...
).

It is known that any intervention conducted by inexperienced professionals or those without proper training can have implications on an individual's life. In a study conducted with a yoga program combined with meditation, women complained of hip pain; however, when evaluated, the complaints were observed in women in the usual care group, i.e. those who did not participate in the intervention, such as sciatica, portocath, elbow, and knee pain, as well as panic attacks; complaints which may have been associated with the disease or treatment rather than intervention(4444. Medeiros AM. Práticas integrativas e complementares no SUS: os benefícios do Yoga e da Meditação para a saúde do corpo e da alma. Rev Eletr Correlation [Internet]. 2017 [citado 2018 jul. 19];16(2):283-301. Disponível em: https://www.metodista.br/revistas/revistas-ims/index.php/COR/article/view/8369/6145
https://www.metodista.br/revistas/revist...
4545. Soo MS, Jarosz JA, Wren AA, Soo AE, Mowery YM, Johnson KS, et al. Imaging-guided core-needle breast biopsy: impact of meditation and music interventions on patient anxiety, pain, and fatigue. J Am Coll Radiol. 2016;13(5):526 DOI: http://dx.doi.org/10.1016/j.jacr.2015.12.004
http://dx.doi.org/10.1016/j.jacr.2015.12...
). Thus, the importance of experienced professionals with the ability to recognize symptoms or complaints that may or may not come from the intervention is emphasized(4343. Vivekananda S. Raja Yoga: o caminho real [internet]. 2009 [citado 2019 abr 23]. Disponivel em: https://www.scriptaetveritas.com.br/livrospdf/raja-yoga-o-caminho-real.pdf
https://www.scriptaetveritas.com.br/livr...
4545. Soo MS, Jarosz JA, Wren AA, Soo AE, Mowery YM, Johnson KS, et al. Imaging-guided core-needle breast biopsy: impact of meditation and music interventions on patient anxiety, pain, and fatigue. J Am Coll Radiol. 2016;13(5):526 DOI: http://dx.doi.org/10.1016/j.jacr.2015.12.004
http://dx.doi.org/10.1016/j.jacr.2015.12...
).

Meditation was used in the analyzed studies to evaluate the effect on the improvement of stress level(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3636. Matchim Y, Armer JM, Stewart BR. Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. West J Nurs Res. 2011;33(8):996-1016. DOI: http://dx.doi.org/10.1177/0193945910385363
http://dx.doi.org/10.1177/01939459103853...
,4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.) and other aspects of women's lives(2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
,2828. Lengacher CA, Shelton MM, Reich RR, Barta MK, Johnson-Mallard V, Moscoso MS, et al. Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT). J Behav Med. 2014;37(2):185-95. DOI: http://dx.doi.org/10.1007/s10865-012-9473-6
http://dx.doi.org/10.1007/s10865-012-947...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
,4040. Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients, Brain Behav Immun. 2007;21(8): 1038-49. DOI: https://doi.org/10.1016/j.bbi.2007.04.002
https://doi.org/10.1016/j.bbi.2007.04.00...
). A significant effect was identified in reducing the stress level(2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), depressive symptoms(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
,2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), anxiety(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
,3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
), quality of life(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2626. Charlson ME, Loizzo J, Moadel A, Neale M, Newman C, Olivo E, et al. Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress. BMC Complement Altern Med. 2014;14:349. DOI: http://dx.doi.org/10.1186/1472-6882-14-349
http://dx.doi.org/10.1186/1472-6882-14-3...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
), fatigue(2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
2222. Offidani E, Peterson JC, Loizzo J, Moore A, Charlson ME. Stress and response to treatment: insights from a pilot study using a 4-week contemplative self-healing meditation intervention for posttraumatic stress in breast cancer. J Evid Based Complementary Altern Med. 2017;22(4):715-20. DOI: http://dx.doi.org/10.1177/2156587217708522
http://dx.doi.org/10.1177/21565872177085...
,3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
), sleep quality(2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
,2525. Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, et al. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015;121(8):1231-40. DOI: http://dx.doi.org/10.1002/cncr.29194
http://dx.doi.org/10.1002/cncr.29194...
,3131. Andersen SR, Würtzen H, Steding-Jessen M, Christensen J, Andersen KK, Flyger H, et al. Effect of mindfulness-based stress reduction on sleep quality: results of a randomized trial among Danish breast cancer patients. Acta Oncol. 2013;52(2):336-44. DOI: http://dx.doi.org/10.3109/0284186X.2012.745948
http://dx.doi.org/10.3109/0284186X.2012....
,3333. Lengacher CA, Reich RR, Post-White J, Moscoso M, Shelton MM, Barta M, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. 2012;35(1):86-94. DOI: http://dx.doi.org/1007/s10865-011-9346-4
http://dx.doi.org/1007/s10865-011-9346-4...
), coping ability(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
2121. Boyle CC, Stanton AL, Ganz PA, Crespi CM, Bower JE. Improvements in emotion regulation following mindfulness meditation: effects on depressive symptoms and perceived stress in younger breast cancer survivors. J Consult Clin Psychol. 2017;85(4):397-402. DOI: http://dx.doi.org/10.1037/ccp0000186
http://dx.doi.org/10.1037/ccp0000186...
,2929. Henderson VP, Massion AO, Clemow L, Hurley TG, Druker S, Hébert JR. A randomized controlled trial of mindfulness-based stress reduction for women with early-stage breast cancer receiving radiotherapy. Integr Cancer Ther. 2013;12(5):404-13. DOI: http://dx.doi.org/10.1177/1534735412473640
http://dx.doi.org/10.1177/15347354124736...
) and fear of recurrence(3030. Carlson LE, Doll R, Stephen J, Faris P, Tamagawa R, Drysdale E, et al. Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013;31(25):3119-26. DOI: http://ascopubs.org/doi/10.1200/JCO.2012.47.5210
http://ascopubs.org/doi/10.1200/JCO.2012...
,3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
,3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
). The findings are consistent with what many scholars have argued regarding the numerous benefits of meditation in one's life(4040. Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients, Brain Behav Immun. 2007;21(8): 1038-49. DOI: https://doi.org/10.1016/j.bbi.2007.04.002
https://doi.org/10.1016/j.bbi.2007.04.00...
4343. Vivekananda S. Raja Yoga: o caminho real [internet]. 2009 [citado 2019 abr 23]. Disponivel em: https://www.scriptaetveritas.com.br/livrospdf/raja-yoga-o-caminho-real.pdf
https://www.scriptaetveritas.com.br/livr...
).

The vast benefits of meditation have been found in studies such as improving pain, insomnia and constipation(3434. Matousek RH, Pruessner JC, Dobkin PL. Changes in the cortisol awakening response (CAR) following participation in Mindfulness-Based Stress Reduction in women who completed treatment for breast cancer. Complement Ther Clin Pract. 2011;17(2):65-70. DOI: http://dx.doi.org/10.1016/j.ctcp.2010.10.005
http://dx.doi.org/10.1016/j.ctcp.2010.10...
), emotional well-being, overall health, fear of recurrence and distress(3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
), improved vitality. and functional capacity, mindfulness, spirituality, religiosity, satisfaction with life and health(3737. Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-72. DOI: http://dx.doi.org/10.1002/pon.1529
http://dx.doi.org/10.1002/pon.1529...
3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
), in interpreting the disease as something of value and not as punishment, and in the greater confidence of medical help(3535. Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J, et al. Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs. 2011;29(2):107-17. DOI: http://dx.doi.org/10.1177/089801011038593
http://dx.doi.org/10.1177/08980101103859...
,3838. Nidich SI, Fields JZ, Rainforth MV, Pomerantz R, Cella D, Kristeller J, et al. A randomized controlled trial of the effects of transcendental meditation on quality of life in older breast cancer patients. Integr Cancer Ther. 2009;8(3):228-34. DOI: http://dx.doi.org/10.1177/153473540934300
http://dx.doi.org/10.1177/15347354093430...
,4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.). In other studies, meditation has helped women develop natural mechanisms to cope with the disease process, with less trauma and suffering(1212. Honnegha AM, Harrison T. Complementary and alternative medicine therapies as symptom management strategies for the late effects of breast cancer treatment. J Holist Nurs. 2015;33(1):84-97. DOI: http://dx.doi.org/10.1177/0898010114539191
http://dx.doi.org/10.1177/08980101145391...
). It is noticed that individuals in the oncology routine who can keep positive thoughts and feelings seem to be more successful in treatment, especially when they accept the disease process, making it less painful.

Increased self-worth, self-esteem, and mindfulness, decreased rumination, fatigue, depressive symptoms, and stress were noted among young breast cancer survivors who participated in a meditation program(1515. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-93. DOI: http://dx.doi.org/10.1002/pon.3648
http://dx.doi.org/10.1002/pon.3648...
,2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
), and those who performed relaxation techniques with music and meditation showed improvement in spirituality, happiness and optimism(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
); those who practiced yoga and meditation showed persistent fatigue reduction and depressive symptoms(4545. Soo MS, Jarosz JA, Wren AA, Soo AE, Mowery YM, Johnson KS, et al. Imaging-guided core-needle breast biopsy: impact of meditation and music interventions on patient anxiety, pain, and fatigue. J Am Coll Radiol. 2016;13(5):526 DOI: http://dx.doi.org/10.1016/j.jacr.2015.12.004
http://dx.doi.org/10.1016/j.jacr.2015.12...
). Thus, it can be stated that complementary therapies have helped to improve the psychological adaptation and stress control resources of women with breast cancer(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
).

It is known that there are many emotional issues due to concerns regarding the necessary tests to diagnose the disease. Thus, a study conducted with women during breast biopsy using guided meditation and images found a reduction in anxiety, pain and fatigue(4343. Vivekananda S. Raja Yoga: o caminho real [internet]. 2009 [citado 2019 abr 23]. Disponivel em: https://www.scriptaetveritas.com.br/livrospdf/raja-yoga-o-caminho-real.pdf
https://www.scriptaetveritas.com.br/livr...
4444. Medeiros AM. Práticas integrativas e complementares no SUS: os benefícios do Yoga e da Meditação para a saúde do corpo e da alma. Rev Eletr Correlation [Internet]. 2017 [citado 2018 jul. 19];16(2):283-301. Disponível em: https://www.metodista.br/revistas/revistas-ims/index.php/COR/article/view/8369/6145
https://www.metodista.br/revistas/revist...
). Scholars also highlight the beneficial effects of meditation on improving cancer patient survival(11. Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes para a detecção precoce do câncer de mama no Brasil [Internet]. Rio de Janeiro: INCA; 2015 [citado 2018 jun. 23]. Disponível em: https://www.inca.gov.br/publicacoes/livros/diretrizes-para-deteccao-precoce-do-cancer-de-mama-no-brasil
https://www.inca.gov.br/publicacoes/livr...
,33. Pisoni AC, Kolankiewicz ABC, Scarton J, Loro MM, Souza MM, Rosanelli CLSP. Difficulties experienced by women undergoing treatment for breast cancer. Rev Online Pesq Cuid Fundam. 2013;5(3):194-201. DOI: http://dx.doi.org/10.9789/2175-5361.2013v5n3p194
http://dx.doi.org/10.9789/2175-5361.2013...
,1010. Araújo RV, Nery IS, Fernandes AFC, Campelo RCV, Freitas FRNN, Batista MMSL, et al. Repercussions of therapy for breast cancer on woman's quality of life. Int Arc Med. 2016;9(100):1-7. DOI: http://dx.doi.org/10.3823/1971
http://dx.doi.org/10.3823/1971...
), on women's quality of life(99. Oliveira FBM, Silva FSS, Prazeres ASB. Impacto do câncer de mama e da mastectomia na sexualidade feminina. Rev Enferm UFPE On line [Internet]. 2017 [citado 2018 maio 22]; 11 Supl.6:2533-40. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/23421/19103
https://periodicos.ufpe.br/revistas/revi...
,1212. Honnegha AM, Harrison T. Complementary and alternative medicine therapies as symptom management strategies for the late effects of breast cancer treatment. J Holist Nurs. 2015;33(1):84-97. DOI: http://dx.doi.org/10.1177/0898010114539191
http://dx.doi.org/10.1177/08980101145391...
,1515. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-93. DOI: http://dx.doi.org/10.1002/pon.3648
http://dx.doi.org/10.1002/pon.3648...
), as well as on menopausal symptoms, fatigue and stress(4444. Medeiros AM. Práticas integrativas e complementares no SUS: os benefícios do Yoga e da Meditação para a saúde do corpo e da alma. Rev Eletr Correlation [Internet]. 2017 [citado 2018 jul. 19];16(2):283-301. Disponível em: https://www.metodista.br/revistas/revistas-ims/index.php/COR/article/view/8369/6145
https://www.metodista.br/revistas/revist...
). Meditation also helped in self-worth, which played a key role in reducing suffering among younger survivors who participated in the study(4545. Soo MS, Jarosz JA, Wren AA, Soo AE, Mowery YM, Johnson KS, et al. Imaging-guided core-needle breast biopsy: impact of meditation and music interventions on patient anxiety, pain, and fatigue. J Am Coll Radiol. 2016;13(5):526 DOI: http://dx.doi.org/10.1016/j.jacr.2015.12.004
http://dx.doi.org/10.1016/j.jacr.2015.12...
).

A reduction in stress level was confirmed by reducing cortisol in saliva or blood at three different times of the day(66. Geraldini MCCS, Moura L. Sentimentos relatados por mulheres mastectomizadas: uma revisão sistematizada. Rev Uningá [Internet]. 2018 [citado 2018 jul. 01];38(1):175-88. Disponível em: http://revista.uninga.br/index.php/uninga/article/view/1128
http://revista.uninga.br/index.php/uning...
,88. Oliveira MA, Sousa C, Ferreira A, Cruz A. Rastreio do distress, o sexto sinal vital em oncologia: dados preliminares de doentes recém-diagnosticados no hospital CUF Porto. Gazeta Méd [Internet]. 2017 [citado 2018 jul. 02];3(4):130-6. Disponível em: http://www.gazetamedica.pt/index.php/gazeta/article/view/54
http://www.gazetamedica.pt/index.php/gaz...
,1313. Brasil. Ministério da Saúde. Portaria n. 849, de 27 de março de 2017. Inclui a Arteterapia, Ayurveda, Biodança, Dança Circular, Meditação, Musicoterapia, Naturopatia, Osteopatia, Quiropraxia, Reflexoterapia, Reiki, Shantala, Terapia Comunitária Integrativa e Yoga à Política Nacional de Práticas Integrativas e Complementares [Internet] Brasília; 2017 [citado 2018 jun. 16]. Disponível em: http://189.28.128.100/dab/docs/portaldab/documentos/prt_849_27_3_2017.pdf
http://189.28.128.100/dab/docs/portaldab...
1414. Brasil. Ministério da Saúde. Glossário temático: práticas integrativas e complementares em saúde [Internet]. Brasília; 2018 [citado 2019 abr. 23]. Disponível em: http://portalarquivos2.saude.gov.br/images/pdf/2018/marco/12/glossario-tematico.pdf
http://portalarquivos2.saude.gov.br/imag...
). However, in one study, no association of cortisol was identified with stress(55. Alvares RB, Santos IDL, Lima NM, Mattias SR, Cestari MEW, Gomes NCRC, et al. Sentimentos despertados nas mulheres frente ao diagnóstico de câncer de mama. J Nurs Health. 2017;7(3):1-10. DOI: HTTP://DX.DOI.ORG/10.15210/JONAH.V7I3.12639
HTTP://DX.DOI.ORG/10.15210/JONAH.V7I3.12...
). The word stress in oncology has been replaced by the term “distress”, a specific term for individuals who are diagnosed with cancer(99. Oliveira FBM, Silva FSS, Prazeres ASB. Impacto do câncer de mama e da mastectomia na sexualidade feminina. Rev Enferm UFPE On line [Internet]. 2017 [citado 2018 maio 22]; 11 Supl.6:2533-40. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/23421/19103
https://periodicos.ufpe.br/revistas/revi...
). Distress is defined as an unpleasant psychological multifactorial emotional experience (cognitive, behavioral, emotional, social and/or spiritual) which can interfere with the ability to cope with the disease(4141. Carlson LE, Speca Michael PSYD, Patel, Kamala D. PHD; Goodey, Eileen MSW. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65(4):571-81.), involving feelings of vulnerability such as sadness and fear, and consequently depression, anxiety, panic syndrome, social isolation and existential crisis(99. Oliveira FBM, Silva FSS, Prazeres ASB. Impacto do câncer de mama e da mastectomia na sexualidade feminina. Rev Enferm UFPE On line [Internet]. 2017 [citado 2018 maio 22]; 11 Supl.6:2533-40. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/23421/19103
https://periodicos.ufpe.br/revistas/revi...
,4343. Vivekananda S. Raja Yoga: o caminho real [internet]. 2009 [citado 2019 abr 23]. Disponivel em: https://www.scriptaetveritas.com.br/livrospdf/raja-yoga-o-caminho-real.pdf
https://www.scriptaetveritas.com.br/livr...
).

Despite the benefits of meditation, it is noteworthy that emotion regulation strategies are still poorly studied and should be evaluated in other populations(1515. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-93. DOI: http://dx.doi.org/10.1002/pon.3648
http://dx.doi.org/10.1002/pon.3648...
). Likewise, there is a need for more consistent studies that prove the effect, efficacy, effectiveness and cost of meditation programs(3232. 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):1335-42. DOI: http://dx.doi.org/10.1200/JCO.2010.34.0331
http://dx.doi.org/10.1200/JCO.2010.34.03...
,4444. Medeiros AM. Práticas integrativas e complementares no SUS: os benefícios do Yoga e da Meditação para a saúde do corpo e da alma. Rev Eletr Correlation [Internet]. 2017 [citado 2018 jul. 19];16(2):283-301. Disponível em: https://www.metodista.br/revistas/revistas-ims/index.php/COR/article/view/8369/6145
https://www.metodista.br/revistas/revist...
4545. Soo MS, Jarosz JA, Wren AA, Soo AE, Mowery YM, Johnson KS, et al. Imaging-guided core-needle breast biopsy: impact of meditation and music interventions on patient anxiety, pain, and fatigue. J Am Coll Radiol. 2016;13(5):526 DOI: http://dx.doi.org/10.1016/j.jacr.2015.12.004
http://dx.doi.org/10.1016/j.jacr.2015.12...
), and longitudinal studies to investigate whether positive results remain constant, increase or decrease over time(11. Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes para a detecção precoce do câncer de mama no Brasil [Internet]. Rio de Janeiro: INCA; 2015 [citado 2018 jun. 23]. Disponível em: https://www.inca.gov.br/publicacoes/livros/diretrizes-para-deteccao-precoce-do-cancer-de-mama-no-brasil
https://www.inca.gov.br/publicacoes/livr...
,33. Pisoni AC, Kolankiewicz ABC, Scarton J, Loro MM, Souza MM, Rosanelli CLSP. Difficulties experienced by women undergoing treatment for breast cancer. Rev Online Pesq Cuid Fundam. 2013;5(3):194-201. DOI: http://dx.doi.org/10.9789/2175-5361.2013v5n3p194
http://dx.doi.org/10.9789/2175-5361.2013...
,55. Alvares RB, Santos IDL, Lima NM, Mattias SR, Cestari MEW, Gomes NCRC, et al. Sentimentos despertados nas mulheres frente ao diagnóstico de câncer de mama. J Nurs Health. 2017;7(3):1-10. DOI: HTTP://DX.DOI.ORG/10.15210/JONAH.V7I3.12639
HTTP://DX.DOI.ORG/10.15210/JONAH.V7I3.12...
,77. Silveira CF, Regino PA, Soares MBO, Mendes LC, Elias TC, Silva SR. Quality of life and radiation toxicity in patients with gynecological and breast cancer. Esc Anna Nery. 2016;20(4):e20160089. DOI: http://dx.doi.org/10.5935/1414-8145.20160089
http://dx.doi.org/10.5935/1414-8145.2016...
), as well as controlled studies in the field(2020. Sarenmalm Ek, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017;6(5):1108-22. DOI: http://dx.doi.org/10.1002/cam4.1052
http://dx.doi.org/10.1002/cam4.1052...
,2323. Johns SA, Brown LF, Beck-Coon K, Talib TL, Monahan PO, Giesler RB, 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):4085-96. DOI: http://dx.doi.org/10.1007/s00520-016-3220-
http://dx.doi.org/10.1007/s00520-016-322...
).

Researchers argue that meditation is a viable, safe, effective, low-cost intervention that is easily incorporated into clinical practice(2424. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncology. 2016;25(7):750-9. DOI: http://dx.doi.org/10.1002/pon.4150
http://dx.doi.org/10.1002/pon.4150...
,4343. Vivekananda S. Raja Yoga: o caminho real [internet]. 2009 [citado 2019 abr 23]. Disponivel em: https://www.scriptaetveritas.com.br/livrospdf/raja-yoga-o-caminho-real.pdf
https://www.scriptaetveritas.com.br/livr...
4545. Soo MS, Jarosz JA, Wren AA, Soo AE, Mowery YM, Johnson KS, et al. Imaging-guided core-needle breast biopsy: impact of meditation and music interventions on patient anxiety, pain, and fatigue. J Am Coll Radiol. 2016;13(5):526 DOI: http://dx.doi.org/10.1016/j.jacr.2015.12.004
http://dx.doi.org/10.1016/j.jacr.2015.12...
) and should be implemented by nurses during the stressful time when cancer treatment is formalized, as well as in resuming activities and lifestyle in order to improve psychological status and quality of life(1515. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-93. DOI: http://dx.doi.org/10.1002/pon.3648
http://dx.doi.org/10.1002/pon.3648...
).

Limitations of the analyzed studies were related to recruitment r, based on breast cancer diagnosis, bias which may have compromised results(1919. Brasil. Ministério da Saúde. Diretrizes metodológicas: Sistema GRADE: manual de graduação da qualidade da evidência e força de recomendação para tomada de decisão em saúde [Internet]. Brasília; 2014 [citado 2018 jun. 13]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_sistema_grade.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
), absence of randomized distribution(66. Geraldini MCCS, Moura L. Sentimentos relatados por mulheres mastectomizadas: uma revisão sistematizada. Rev Uningá [Internet]. 2018 [citado 2018 jul. 01];38(1):175-88. Disponível em: http://revista.uninga.br/index.php/uninga/article/view/1128
http://revista.uninga.br/index.php/uning...
77. Silveira CF, Regino PA, Soares MBO, Mendes LC, Elias TC, Silva SR. Quality of life and radiation toxicity in patients with gynecological and breast cancer. Esc Anna Nery. 2016;20(4):e20160089. DOI: http://dx.doi.org/10.5935/1414-8145.20160089
http://dx.doi.org/10.5935/1414-8145.2016...
), relatively high dropout rates, lack of follow-up in the long term of the groups(88. Oliveira MA, Sousa C, Ferreira A, Cruz A. Rastreio do distress, o sexto sinal vital em oncologia: dados preliminares de doentes recém-diagnosticados no hospital CUF Porto. Gazeta Méd [Internet]. 2017 [citado 2018 jul. 02];3(4):130-6. Disponível em: http://www.gazetamedica.pt/index.php/gazeta/article/view/54
http://www.gazetamedica.pt/index.php/gaz...
,1515. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-93. DOI: http://dx.doi.org/10.1002/pon.3648
http://dx.doi.org/10.1002/pon.3648...
), lack of cost-effectiveness evaluation, delimitation of women with stage 0 to III breast cancer, and lack of a control group(1515. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-93. DOI: http://dx.doi.org/10.1002/pon.3648
http://dx.doi.org/10.1002/pon.3648...
). The use of a waiting list control group(33. Pisoni AC, Kolankiewicz ABC, Scarton J, Loro MM, Souza MM, Rosanelli CLSP. Difficulties experienced by women undergoing treatment for breast cancer. Rev Online Pesq Cuid Fundam. 2013;5(3):194-201. DOI: http://dx.doi.org/10.9789/2175-5361.2013v5n3p194
http://dx.doi.org/10.9789/2175-5361.2013...
) and the need for randomization compromised study results(66. Geraldini MCCS, Moura L. Sentimentos relatados por mulheres mastectomizadas: uma revisão sistematizada. Rev Uningá [Internet]. 2018 [citado 2018 jul. 01];38(1):175-88. Disponível em: http://revista.uninga.br/index.php/uninga/article/view/1128
http://revista.uninga.br/index.php/uning...
77. Silveira CF, Regino PA, Soares MBO, Mendes LC, Elias TC, Silva SR. Quality of life and radiation toxicity in patients with gynecological and breast cancer. Esc Anna Nery. 2016;20(4):e20160089. DOI: http://dx.doi.org/10.5935/1414-8145.20160089
http://dx.doi.org/10.5935/1414-8145.2016...
).

This study aimed to describe the effect of meditation on the stress level of women with breast cancer, however despite the reasonable sample, it is not possible to generalize the results, as they only show the international reality, in addition to the variety of meditation types, different variables evaluated in the same study, and the various assessment instruments. Defining the disease status or age of the women also compromises generalizing the results.

CONCLUSION

A positive effect of meditation was identified based on the analyzed studies in reducing the psychological stress of women with breast cancer, as well as depression, anxiety, fatigue, insomnia, fear of recurrence and rumination, representing a strategy for coping with the disease and for improving the quality of life.

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Publication Dates

  • Publication in this collection
    2 Dec 2019
  • Date of issue
    2019

History

  • Received
    23 July 2018
  • Accepted
    30 Apr 2019
Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br