Mindful Movement Program for Breast Cancer Survivors

Institution: WISE & Healthy Aging
Investigator(s): Holly Kiger, R.N., M.N. - Rebecca Crane-Okada, Ph.D., RN, CNS, AOCN -
Award Cycle: 2008 (Cycle 14) Grant #: 14AB-1201 Award: $93,750
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

This is a collaboration with: 14AB-1200 -

Initial Award Abstract (2008)

Research shows that many breast cancer survivors (BCS) continue to experience psychosocial and physical effects of cancer long after treatment is completed. Examples include anxiety, depression, altered feelings about their body, worry about cancer returning, and pain. Research on either mindfulness or movement-dance therapy for BCS is limited. Studies that combine these two approaches for BCS have not been reported. The purpose of this pilot study is to test a new and innovative 12-week Mindful Movement Program (MMP) intervention combining movement and mindfulness techniques on quality of life (QOL) and mindfulness outcomes in older BCS who are 12 months or more past completion of treatment.

We propose that BCS who participate in this 12-week MMP will show significantly more improvement in aspects of quality of life (QOL) and mindfulness than BCS who do not participate in the MMP. The areas we will study include physical, psychological, social, and spiritual well-being, and specific measures of upper body symptoms, fear about the cancer returning, anxiety, depression, and body image. The aspects of mindfulness we will study include attention, attitude, and intention.

This pilot study will develop and test a 12-week MMP intervention in 75 women who are BCS, age 50 and older (no upper age limit), at least one year past their initial diagnosis and completion of chemotherapy, biotherapy, or radiation therapy, and with no evidence of metastatic disease. BCS who consent to be in this study will be assigned by computer either to an experimental group (45 women who participate in the MMP), or to a control group (30 women who do not participate in the MMP). All participants will be asked to complete questionnaires three times: at the beginning of the study, and at 12 and 18 weeks. BCS in the experimental group will be invited to be in a focus group to give the research team feedback about their experience in the MMP. Control group participants who complete study requirements will be offered a complimentary 3-hour MMP class.

MMP is unique in that there is no formal sitting meditation, prescribed body movements or postures. Movement is self-directed and mindful. With mindful verbal cues from the MMP leader, often with music, participants are encouraged to move their bodies in ways that are comfortable, fun, creative and natural to them. Participants become aware of their thoughts, feelings and sensations in the “present moment”, and express them, non-judgmentally, in self-directed movement. MMP also incorporates partner activities that encourage awareness of ways to maintain “self” while in relationship with “another.”

This proposal is a result of multiple in-person meetings, conference calls, and email communications of the co-PIs; a Community Advisory Board (CAB); three consultants with expertise in mindfulness, dance therapy, and focus groups; and a mindful movement instructor with 25 years’ experience. The community co-PI, a clinical nurse specialist with community partner WISE & Healthy Aging, which serves a medically underserved multiethnic population, initiated the study idea based on six years’ experience with BCS and with mindful movement. Subsequently a partnership was developed with the academic co-PI, a nurse researcher and oncology clinical nurse specialist with academic partner (Beckman Research Institute at City of Hope), with 30 years’ experience working with BCS and with whom a successful collaborative research intervention with BCS was just completed. The CAB was established in 2006 with target community members (BCS in Los Angeles), and breast cancer advocates, and has strongly supported the type of mindful movement proposed in this study. Two CAB members will be hired and trained as integral research team members for recruitment and results dissemination. The CAB will continue to meet regularly with the co-PIs throughout the study, assisting in data interpretation, results dissemination, and future planning. With this BCS involvement we expect BCS to benefit from this project through strengthened ties with the community and academic partner organizations, gaining experience in developing, implementing, and evaluating research, and for those individual BCS who participate in the MMP intervention, improvements in their QOL and mindfulness.

Upon completion of this pilot study we will have sufficient preliminary data to be able to submit a proposal for a BCRP CRC full award to test this MMP in a randomized controlled trial. After completion of the full award study we hope to develop a training program for lay instructors of MMP, so that they can lead similar groups in their own communities. In this way, the MMP would eventually become widely disseminated with the potential of affecting the QOL of many more breast cancer survivors.

Final Report (2010)

We hypothesized that older breast cancer survivors (BCS) who participate in a 12-week Mindful Movement Program (MMP) combining mindfulness and movement would show significantly improved quality of life (QOL) and mindfulness than BCS who do not participate in the intervention. Once consented, participants were randomly assigned to experimental (EG) (mindful movement classes and focus group) or control group (CG) (no mindful movement classes). CG participants were offered a 3-hour complimentary mindful movement class at the end of the study. All participants completed questionnaires three times: QOL-Breast Cancer (QOL-BC), Body Image Scale, Fear of Recurrence (FOR), Hospital Anxiety and Depression Scale (HADS), Upper Body Symptoms, Experiences Questionnaire (EQ), Mindfulness Attention Awareness Scale (MAAS), Self Compassion Scale (SCS), and the Five Facet Mindfulness Questionnaire (FFMQ). Cronbach alpha reliabilities for all were above .70 with the exception of the physical subscale of the QOL-BC. EG participants recorded practice on a daily diary.

Aims: #1: Test the effects of MMP on QOL (physical, psychological, social, and spiritual well-being, and specific measures of upper body symptoms, fear about the cancer returning, anxiety, depression, and body image), and mindfulness (intention, attention and attitude) in older BCS who are 12 months or more after completion of primary treatment. #2: Compare mindfulness qualities in the EG vs CG. Three series of 12-week MMP sessions were held and data collection completed in November 2009. We enrolled 49 participants (30 assigned to EG, 19 to CG). One EG participant withdrew before study start. All questionnaires were completed by 84% of the CG; 91% of the EG (n=23) completed all questionnaires and 6-12 MMP sessions. Participants ranged in age from 50-90 (mean 65.6); were 9.8 years since diagnosis (range 1-32); non-Hispanic White (79%), unpartnered (58%), and retired (60%). Prior experience with mindfulness was reported by 42% and mindful types of movement by 52% (e.g., tai chi, yoga). Aims 1 and 2 were tested using an intention to treat analysis. A repeated measures Analysis of Variance (ANOVA) to determine if there was a significant immediate intervention effect on outcome variables at 12 weeks was followed by a repeated measures Analysis of Covariance (ANCOVA) to test whether intervention effects were maintained. EG participants showed significantly decreased fear of recurrence (p=.02) and improved mindfulness attitude (p=.026) at 12 weeks. At 18 weeks no significant differences were noted, suggesting that the significant effects seen at 12 weeks in the EG were retained. #3: Describe the experimental group’s perceptions of the MMP. Three focus groups were conducted jointly by the co-PIs with 17 EG participants, tape recorded, transcribed, and coded for common themes as a complement to the quantitative data. Common themes were rediscovery (e.g., “of parts of myself through movement that I thought I had lost”); reconnecting (e.g., with “the joy of moving”); freedom; and common experiences.

Barriers: These included delays in institutional approvals resulting in a compressed schedule for recruiting for Series 1, challenges recruiting in the African American (AA) community, and staffing changes due to budget cuts for the community partner. Our AA advisory committee members secured a site for Series 2 in an AA community which facilitated AA recruitment. Overall study enrollment barriers for 46 of 95 BCS screened as eligible were conflicts with the schedule for (25) or distance from (11) MMP sessions; or inquiry after the enrollment deadline (7). Only 3 expressed no interest after learning more about the study.

Accomplishments: The study remained on schedule, participant retention was good and the MMP was well received. A 16-member community advisory board was actively supportive throughout. The MMP demonstrated effects on QOL (fear of recurrence) and mindfulness attitude that were retained at 6 weeks after intervention completion. Research processes worked well. The community and academic partners gained expertise in research and community participation, respectively.

Future Plans: To obtain funding for a CRC full award to study the MMP in a larger sample, with a strengthened intervention and research processes, and inclusive of measures to address barriers encountered in the pilot study. We are actively preparing manuscripts and community meetings for dissemination of our findings.