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Efeito da meditação no nível de estresse psicológico de mulheres com neoplasia mamária: revisão sistemática

Efecto de la meditación en el nivel de estrés psicológico de mujeres con neoplasia mamaria: revisión sistemática

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

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

INTRODUÇÃO

O câncer de mama constitui doença heterogênea, em relação à clínica e morfologia, além de multifatorial, envolve fatores biológicos-endócrinos, vida reprodutiva, comportamento e estilo de vida, com maior incidência e mortalidade na população feminina no mundo e no Brasil(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...
). As taxas são maiores nos países desenvolvidos e variam nas diferentes regiões nacionais e mundiais(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...
).

É considerada doença devastadora, interpretada como castigo, punição(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...
), envolvendo sentimentos difíceis de serem administrados, como estigma social, medo da morte, revolta, irritação, angústia, desespero e não aceitação(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...
). As alterações na vida da mulher com câncer de mama são decorrentes do tratamento, que ocasiona inúmeras repercussões(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...
), incluindo mudanças na imagem corporal, decorrentes da alopecia, ganho de peso, cicatriz e perda da mama, que repercutem na sexualidade e autoestima(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...
).

Reações como astenia, fadiga, náusea, vômito, insônia, perda de apetite, alterações no peso corporal, queda do cabelo e dispneia, em geral, são decorrentes do tratamento quimioterápico(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...
) e ocasionam tristeza, ansiedade e vergonha(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...
). As reações dermatológicas são frequentes naquelas mulheres submetidas ao tratamento radioterápico, levando ao desconforto, dor e vermelhidão na região da mama e axila(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...
).

Neste contexto do adoecimento por doença estigmatizante, o estresse psicológico configura evento frequente na vida de muitas mulheres com câncer de mama, com taxa de prevalência de 35% a 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...
). Na maioria dos casos, é decorrente das preocupações relacionadas à autoimagem, sexualidade, perda da fertilidade, feminilidade, mudanças na autonomia e independência entre outros fatores(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...
). Ademais, ocasiona sentimentos de vulnerabilidade, tristeza e medo, que podem despertar nas mulheres situações debilitantes, como depressão, ansiedade, pânico, isolamento social, crise existencial e espiritual(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...
).

Mediante as dificuldades em lidar com o estresse psicológico e os sentimentos decorrentes do diagnóstico e tratamento do câncer de mama, é imprescindível a atuação dos profissionais de saúde no rastreamento e controle(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...
), a fim de prevenir complicações debilitantes. Neste cenário, é fundamental o planejamento e o desenvolvimento de ações que auxiliem a mulher no processo de enfrentamento, de modo a proporcionar vivência menos traumática e dolorosa. Neste sentido é que as Práticas Integrativas e Complementares em Saúde podem ser utilizadas como mecanismo natural de prevenção de agravos, recuperação da saúde(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...
) e gerenciamento dos sintomas relacionados ao diagnóstico e tratamento da doença(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...
).

A meditação, prática de harmonização dos estados mentais e da consciência, presente em inúmeras culturas e tradições, traz benefícios para o sistema cognitivo, promove a concentração, auxilia na percepção sobre as sensações físicas e emocionais, amplia a autodisciplina no cuidado à saúde, estimula o bem-estar, relaxamento, reduz o estresse, a hiperatividade e os sintomas depressivos(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...
), diminui o pensamento repetitivo, promove alterações favoráveis no humor e proporciona maior integração entre mente, corpo e mundo exterior(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...
). Ainda, essa prática contribui para a redução dos níveis de adrenalina e cortisol, hormônios relacionados ao estresse e à ansiedade, consequentemente, intensifica a produção de endorfina e serotonina, responsáveis pela sensação de bem-estar e felicidade(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...
).

Tem-se observado, em estudos, o efeito da meditação na melhora dos quadros de ansiedade e transtornos do humor, nível “A” de evidência na redução do estresse, da depressão, da fadiga; e nível “B” de evidência na melhora da qualidade de vida(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...
). No entanto, no Brasil, ainda não há estudos clínicos que comprovem o efeito deste ato nos sintomas relacionados ao diagnóstico e tratamento do câncer de mama e nem revisão da literatura para verificar o efeito no nível de estresse psicológico de mulheres com câncer de mama, motivo pelo qual o estudo foi conduzido. Deste modo, objetivou-se avaliar o efeito da meditação no nível de estresse psicológico de mulheres com câncer de mama.

MÉTODO

Tipo de estudo

Revisão sistemática da literatura, conforme recomendações da Diretriz 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...
), que orienta a aplicação de checklist com 27 itens e fluxograma de quatro etapas, com foco nos ensaios clínicos. O protocolo da revisão sistemática foi registrado na PROSPERO: International prospective register of systematic reviews: CRD42018088863.

Para formular a questão de pesquisa, foi utilizada a estratégia PICO, na qual o P se refere à população ou grupo de pacientes (mulheres com neoplasia mamária), I à Intervenção (meditação), C à comparação (não foi utilizada a comparação com outras intervenções), O, desfecho/outcomes (efeitos da meditação no nível de estresse psicológico de mulheres com neoplasia mamária). A pergunta da revisão sistemática foi: qual o efeito da meditação no nível de estresse psicológico de mulheres com neoplasia mamária?

Coleta de dados

O levantamento dos dados foi realizado em janeiro e fevereiro de 2018, nas bases eletrônicas: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS); Cochrane Collaboration; PMC (PubMEd Central); SciVerse Scopus (Scopus); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Science Citation Indexes (Web of Science), acessados pelo Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, e os descritores foram selecionados após consulta aos vocabulários Medical Subject Headings (MeSH), produzido pelo National Library of Medicine dos Estados Unidos, Descritores em Ciências da Saúde (DeCS) e Títulos da CINAHL.

Depois da combinação entre os termos de buscas, foram geradas as seguintes expressões: 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).

Critérios de seleção

Os estudos foram exportados para o formato BibTex e importados para ferramenta StArt(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...
), que auxiliou no processo de seleção e coleta de dados, realizado a partir de formulário semiestruturado contendo as seguintes informações: Título, ano de publicação, objetivo, tipo de meditação, prática em grupo e em domicílio, follow-up, profissionais que conduziram a intervenção e significância dos estudos. Esta ferramenta possui como vantagens a assistência direta do investigador aos arquivos e garantia da uniformidade na interpretação dos dados e critérios pelos quais são fornecidos. A seleção dos estudos foi realizada após leitura minuciosa de títulos e resumos, seguida da análise e interpretação dos resultados.

Foram incluídos na revisão sistemática ensaios clínicos que descrevessem o efeito da meditação no nível de estresse e ansiedade de mulheres com neoplasia mamária, e excluídos estudos que não respondiam à pergunta da pesquisa, estudos de revisão, protocolos de ensaios clínicos, ensaios clínicos em andamento, teses, dissertações e monografias.

Análise e tratamento dos dados

A extração e análise de dados foram realizadas por dois revisores, de forma independente. Para a avaliação da qualidade dos estudos, utilizou-se do 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...
), que os classifica em quatro níveis: alto, moderado, baixo e muito baixo. Na Figura 1, encontra-se a descrição do processo de seleção dos estudos.

Figura 1
Seleção dos estudos incluídos na revisão – Brasil, 2018.

Aspectos éticos

A revisão sistemática da literatura constitui estudo secundário, portanto, não foi necessária a avaliação do Comitê de Ética em pesquisa e nem assinatura de Termo de Consentimento Livre e Esclarecido.

RESULTADOS

Foram recuperados 366 estudos. Depois da aplicação dos critérios de inclusão e exclusão, foram considerados elegíveis para a leitura de título e resumo 85 artigos, destes, 22 foram selecionados para leitura na íntegra, análise e discussão. Foram identificadas publicações nos anos de 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.). A maioria dos estudos foi desenvolvida nos Estados Unidos da América(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.), Dinamarca(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....
) e Canadá(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...
). Em relação ao nível de evidência, três foram classificados como muito baixo(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...
), oito, alto(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...
), sete, moderado(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.), e quatro, baixo(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....
).

Nos estudos analisados, observou-se que para a inclusão ou exclusão de mulheres foram ponderados idade, estadiamento do câncer de mama, tratamento, diagnóstico de outras doenças, incluindo os transtornos mentais graves e uso de algumas medicações. A média de idade das mulheres que participaram dos estudos foi de 46,1 anos(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...
).

O estadiamento se comportou da seguinte maneira: câncer de mama em Estágio 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...
), Estágio 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...
), Estágio 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...
), Estágio 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....
), Estágios 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...
). Em relação às mulheres: submetidas à cirurgia, quimioterapia ou radioterapia(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....
), em terapia hormonal(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...
) ou concluída(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....
), sem distúrbios endócrinos relacionados ao cortisol(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...
) e que não estivessem em quimioterapia sistêmica(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...
).

Entre os outros diagnósticos usados para a exclusão, foram identificados pensamento suicida(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...
), sintomas depressivos graves(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...
), transtorno mental grave ou neurológico(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...
), doença imunológica(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....
) e doença inflamatória ativa descontrolada(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...
), e por último os medicamentos ansiolíticos, antidepressivo, psicotrópicos(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....
), substâncias crônicas(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...
), corticosteroides(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-hipertensivo(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...
), com outro tipo de câncer (exceto câncer de pele não melanoma)(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...
), assim como câncer de mama avançado(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...
), recidiva(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...
), metástase(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...
), incapacidade de se comprometer com o programa de meditação(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...
) e participação prévia em Programa de Meditação(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...
). A descrição referente aos autores, ano de publicação e objetivos encontra-se no Quadro 1.

Quadro 1
Descrição dos estudos analisados, segundo autores, anos de publicação e objetivos.

A descrição em relação ao tipo de programa de meditação, prática em grupo e em domicílio, tempo de seguimento (follow-up) e aos profissionais que conduziram a intervenção encontram-se no Quadro 2.

Quadro 2
Detalhes do programa de meditação.

No Quadro 3 é apresentada a significância do efeito da meditação no nível de estresse psicológico de mulheres com câncer de mama que participaram dos estudos incluídos na revisão, sendo categorizada em: alta significância (+++), moderada significância(++) e baixa significância(+). A meditação teve efeito significativo alto na redução do estresse psicológico(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...
), na redução do 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.), depressão(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...
), ansiedade(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...
), na melhoria da qualidade de vida(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...
), entre outros fatores.

Quadro 3
Descrição da significância do efeito da meditação no nível de estresse psicológico de mulheres com câncer de mama que participaram dos estudos incluídos na revisão.

Dos instrumentos utilizados para avaliar o efeito da meditação no nível de estresse, foram identificados: Inventário de Estresse (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.), Escala de Estresse Percebido (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...
), Escala de resiliência para estresse e adversidade(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...
), Escala de sintomas de estresse pós-traumático (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...
), Inventário de Desenvolvimento Pós-traumático (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...
), assim com a avaliação do nível de cortisol salivar(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...
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...
) e 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...
).

Outros aspectos foram avaliados, como humor, enfrentamento, suporte social, medo de recorrência, depressão, ansiedade, qualidade de vida, sintomas (náusea, vômito, fadiga, mal-estar), otimismo, atenção plena e qualidade do sono, com auxílio da Escala do estado de humor (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.), Escala de Coping (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...
), Escala de enfrentamento (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.), Escala de suporte social (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....
), Escala do medo de recorrência (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...
), Questionário da Saúde do Doente ou 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...
), Inventário de Beck Depressão(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...
), Inventário de Beck Anxiety(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...
), 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....
), Escala global de qualidade de vida (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.), Escala de vitalidade (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...
), Escala de Sintomas Médicos (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...
), Inventário de Sintomas de Fadiga (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...
), Inventário de Sintomas (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...
), Escala de Otimismo (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...
), 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...
), 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...
), Índice de gravidade de insônia (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...
), Questionário de avaliação do Índice de Qualidade do Sono de Pittsburgh (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...
).

DISCUSSÃO

No estudo foi identificada predominância dos Programas de Meditação Mindfulness na redução do estresse (MBSR), a maioria baseada e adaptada a partir do Programa original de Kabbat-Zinn, fundador do método(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...
), que é largamente utilizado e difundido há muito tempo em instituições de saúde nos Estados Unidos(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...
). No Brasil, as Práticas Integrativas e Complementares só foram institucionalizadas no Sistema Único de Saúde em maio de 2006, com ampliação de 14 outras práticas, como o yoga e meditação, em 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.).

A meditação mindfulness ou “atenção plena” também é conhecida pela consciência, atenção, foco, presença ou vigilância e diferencia-se das demais por apoiar-se na respiração e no corpo e ser desvinculada de qualquer aspecto religioso(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.), ao contrário da meditação raja yoga, ciência que ensina como alcançar o poder de concentração, analisar a mente, construir o mundo espiritual, e que conduz o indivíduo à obtenção de percepções sutis. Em raja-yoga a respiração entra no plano psíquico e leva ao espiritual, a prática é iniciada partindo-se do mundo interno, da natureza interna, para que através dela seja possível controlar tudo, tanto aspectos internos como externos(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...
). O grande objetivo da meditação raja-yoga é controlar e dirigir o prana, energia vital, que ocorre quando o homem concentra suas energias e domina o prana que está em seu corpo(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...
).

A prática da meditação nos estudos analisados foi em grupo, e com atividades desenvolvidos de modo similar na maioria dos estudos. Na meditação em grupo houve momento para o acolhimento das participantes, apresentação de material teórico, orientações para prática em domicílio, entrega de material informativo, de disco CD ou fitas cassete para guiar a prática em domicílio e um diário para registro(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.), com o incentivo à prática formal e informal.

Em outros estudos identificou-se o uso de imagens curativas(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...
), retiro de 6 horas(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...
) e atividades de psicoeducação(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...
). Observou-se que, apesar da adaptação no formato dos programas de meditação nos estudos analisados, eles mantiveram-se similares ao programa tradicional de Kabbat-Zinn de oito encontros(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.). Outras adaptações foram com a realização de Programa Intensivo de 2 dias, retiros para vivência na Natureza, Workshops de Mindfulness e palestras(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...
).

Nos estudos analisados, o tempo de seguimento (follow-up) foi de 4, 12 e 24 meses(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 e 12 meses(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 e 5 meses(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 meses(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 semanas(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...
) e 18 horas(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...
). Alguns pesquisadores trouxeram discussões acerca da relação entre o tempo de prática da meditação e a manutenção do efeito desejado(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.). O tempo de duração das sessões de meditação foi de 20 minutos a uma hora; e a prática em domicílio inicial, de 5 a 20 minutos(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...
).

Pesquisadores trazem considerações relevantes quanto ao tempo de seguimento e o efeito da intervenção. Em estudo realizado com o tempo de seguimento reduzido, os pesquisadores não tiveram convicção de afirmar o efeito da intervenção(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...
). Em outro, não foi identificado efeito significativo da meditação nos sintomas depressivos de mulheres com câncer de mama, os autores acreditam que o tempo de avaliação precoce pode ter comprometido o resultado esperado(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...
).

Quanto à randomização, foi realizada algumas de maneira informatizada e com sorteio aleatório em blocos de nove, 12 e 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...
), estratificada, não bloqueada, com taxa de alocação de 1:1 aleatória com cegamento(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...
), e sorteio aleatório em blocos de quatro a seis com cegamento(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...
), alocação de 4:3(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...
), randomização, informatizada, com alocação de 1:1(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...
,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....
), por estágio da doença (0, I, II, III, IV), idade das participantes, tipo de tratamento e instituição de saúde(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...
), por meio de seleção das participantes potencialmente elegíveis por contato telefônico(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...
) ou autosseleção para o MBSR ou o grupo não MBSR(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...
) e recrutadas em hospitais, organizações comunitárias, com distribuição de cartazes, panfletos e 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.).

Houve variedade em relação aos métodos utilizados pelos pesquisadores para realizar a randomização. Destaca-se a importância de seguir com rigor metodológico a pesquisa, a fim de evitar limitações no estudo e interferência de vieses nos resultados da pesquisa, o que pode implicar incertezas quanto ao desenlace da pesquisa. Observou-se que, em um dos grupos, as participantes tiveram interesse em participar do grupo experimental, o que impediu a formação do grupo-controle(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...
), aspecto que compromete a força do estudo e a significância dos resultados.

A condução da meditação foi realizada por médico e psicólogo(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...
) e psiquiatra(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...
), todos com experiência e formação no programa de MBSR, bem como por instrutores certificados(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....
) e por pesquisador qualificado como instrutor de Programa de Atenção Plena pela Universidade de 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...
). Cabe destacar que tal desvelo tem a finalidade de esquivar-se de qualquer esfacelo ou prejuízo que possa advir da prática conduzida de modo inadequado ou mesmo por profissionais inexperientes. Diante disto, reforça-se a necessidade e a importância da formação de enfermeiros nos programas de meditação para a redução de estresse, já que podem melhorar o estado psicológico e a qualidade de vida de indivíduos(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...
).

Sabe-se que qualquer intervenção conduzida por profissionais inexperientes ou sem a adequada formação pode ocasionar implicações na vida do indivíduo. Em estudo realizado com programa de yoga combinado com meditação, as mulheres queixaram-se de dor no quadril, no entanto, ao serem avaliadas, foram observadas queixas em mulheres do grupo de cuidados habituais, isto é, que não participaram da intervenção, como dor ciática, no portocath, cotovelo, joelho e ataque de pânico, queixas que podem ter sido associadas à doença ou ao tratamento, e não à intervenção(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...
). Deste modo, reforça-se a importância de profissionais experientes e com habilidade de reconhecer sintomas ou queixas que possam provir ou não da intervenção realizada(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...
).

Nos estudos analisados, a meditação foi empregada com a finalidade de avaliar o efeito na melhora do nível de estresse(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.) e em outros aspectos da vida da mulher(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...
). Foi identificado efeito significativo na redução do nível de estresse(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...
), dos sintomas depressivos(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...
), ansiedade(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...
), qualidade de vida(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...
), fadiga(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....
), qualidade do sono(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...
), capacidade de enfrentamento(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...
) e medo de recorrência(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...
). Os resultados encontrados são condizentes com o que vários estudiosos têm defendido em relação aos inúmeros benefícios da meditação na vida do indivíduo(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...
).

De fato, foram constatados vastos benefícios da meditação em estudos realizados, como na melhora da dor, insônia e constipação(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...
), no bem-estar emocional, na saúde em geral, no medo de recorrência e angústia(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...
), melhora na vitalidade e capacidade funcional, atenção plena, espiritualidade, religiosidade, satisfação com a vida e saúde(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...
), na interpretação da doença como algo de valor e não como castigo e na maior confiança da ajuda médica(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.). Em outros estudos, a meditação auxiliou as mulheres a desenvolverem mecanismos naturais para enfrentar o processo de adoecimento, com menos trauma e sofrimento(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...
). Percebe-se na rotina da oncologia que os indivíduos que conseguem manter pensamentos e sentimentos positivos parecem ter mais êxito no tratamento, ainda mais quando aceitam o processo do adoecimento, tornando-o menos doloroso.

O aumento da autobondade, autoestima, atenção plena, diminuição da ruminação, fadiga, sintomas depressivos e estresse foi percebido entre mulheres jovens sobreviventes do câncer de mama que participaram de um programa de meditação(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...
), as que fizeram técnicas de relaxamento com música e meditação apresentaram melhora da espiritualidade, felicidade e otimismo(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...
), aquelas que praticaram o yoga e meditação apresentaram redução da fadiga persistente e sintomas depressivos(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...
). Deste modo, é possível afirmar que as terapias complementares ajudaram na melhora dos recursos de adaptação psicológica e controle do estresse de mulheres com câncer de mama(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...
).

Sabe-se que são muitas as inquietações emocionais decorrentes de preocupações relativas à realização de exames necessários para o diagnóstico da doença, assim, estudo realizado com mulheres durante a biópsia de mama, utilizando-se da meditação guiada e de imagens, constatou redução da ansiedade, dor e fadiga(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...
). Estudiosos destacam também os efeitos benéficos da meditação na melhora da sobrevivência de pacientes com câncer(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...
), assim como da qualidade de vida das mulheres(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...
), nos sintomas da menopausa, fadiga e estresse(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...
). A meditação também ajudou na autobondade, que desempenhou papel fundamental na redução do sofrimento entre os sobreviventes mais jovens que participaram do estudo(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 redução do nível de estresse foi comprovada mediante a redução do cortisol na saliva ou no sangue, em três momentos distintos do dia(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...
), no entanto, em estudo, não foi identificada associação com o cortisol como nível de estresse(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...
). Na oncologia, a palavra estresse vem sendo substituída pelo termo “distress”, termo específico para indivíduos que vivenciam o diagnóstico de câncer(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...
). O distress é definido como experiência emocional multifatorial desagradável, de natureza psicológica (cognitiva, comportamental, emocional, social e/ou espiritual) e que pode interferir na capacidade de lidar com a doença(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.), envolvendo sentimentos de vulnerabilidade, como tristeza e medo, consequentemente, depressão, ansiedade, síndrome do pânico, isolamento social e crise existencial(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...
).

Apesar dos benefícios da meditação, vale ressaltar que as estratégias de regulação de emoções ainda são pouco estudadas e devem ser avaliadas em outras populações(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...
). Do mesmo modo, destaca-se a necessidade de estudos mais consistentes que comprovem o efeito, a eficácia, a efetividade e o custo dos programas de meditação(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...
) e de estudos longitudinais para investigar se os resultados positivos permanecem constantes, aumentam ou diminuem com o tempo(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...
), bem como de estudos controlados na área(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...
).

Pesquisadores defendem que a meditação é uma intervenção viável, segura, eficaz, de baixo custo e fácil incorporação na prática clínica(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...
) e deve ser implementada por enfermeiros durante o momento estressante de formalização do tratamento oncológico, assim como na retomada das atividades e estilo de vida, a fim de melhorar o estado psicológico e a qualidade de vida(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 limitações dos estudos analisados foram relacionadas ao recrutamento r, com base no diagnóstico do câncer de mama, viés que pode ter comprometido os resultados(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...
), ausência de distribuição aleatória(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...
), taxas de abandono relativamente altas, carência de acompanhamento em longo prazo dos grupos(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...
), escassez de avaliação da relação custo-eficácia, delimitação de mulheres com câncer de mama estágios 0 a III e inexistência de um grupo de controle(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...
). O uso de grupo-controle de lista de espera(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...
) e a necessidade de randomização comprometeram os resultados dos estudos(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...
).

No estudo realizado buscou-se descrever o efeito da meditação no nível de estresse de mulheres com câncer de mama, no entanto, apesar da amostra razoável, não é possível generalizar os resultados, pois estes trazem apenas a realidade internacional, além da variedade dos tipos de meditação, de variáveis avaliadas em um mesmo estudo e dos diversos instrumentos de avaliação. A delimitação do status da doença ou idade da mulher também compromete a generalização dos resultados.

CONCLUSÃO

Com base nos estudos analisados, foi identificado efeito positivo da meditação na redução do estresse psicológico de mulheres com neoplasia mamária, assim como na depressão, ansiedade, fadiga, insônia, medo de recorrência e ruminação, representando uma estratégia para o enfrentamento da doença e para a melhoria da qualidade de vida.

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Datas de Publicação

  • Publicação nesta coleção
    2 Dez 2019
  • Data do Fascículo
    2019

Histórico

  • Recebido
    23 Jul 2018
  • Aceito
    30 Abr 2019
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