The Experience of Mindfulness-Based Stress Reduction on Menopausal Symptoms, Sleep Disturbance, and Body Image among Patients with Breast Cancer—A Qualitative Study
Abstract
:1. Introduction
Mindfulness Mechanisms
2. Materials and Methods
2.1. Study Design
2.2. Sampling and Eligibility Criteria
2.3. Procedure
- During the MBSR intervention, what have been the most notable changes that you have experienced with respect to aspects such as menopausal symptoms and body image?
- What difficulties did you encounter during the program and how did you solve them? When the interviewers determined that an interview could not generate new themes (i.e., saturation had been achieved), data collection was stopped.
2.3.1. Participation in Focus Groups
2.3.2. MBSR Intervention
2.4. Data Analysis
2.5. Rigor
3. Results
3.1. Symptoms Caused by Treatment
3.1.1. Sleep Disturbance following Diagnosis or Treatment
“My arms are often swollen like an elephant’s legs (the patient rolls up her sleeves to show us her arms), and my limbs feel different depending on the weather.”(Adelina)
“I have experienced sleep disturbance, and I can’t fall asleep even after taking sleeping pills. I wake up early in the morning and feel considerable pain [the patient frowns and clenches her fists.”(Jessica)
“The side effect of taking Tamoxifen (Nolvadex) is that I’m always going to the bathroom at midnight and sometimes three or four times a night. This affects my sleep quality substantially.”(Hellen)
“Taking Tamoxifen (Nolvadex) causes me to wake up two or three times around midnight because of hot flushes and frequent urination; thus, I feel exhausted the next day.”(Emma)
3.1.2. Negative Body Image and Sexual Problem among Patients with Breast Cancer
“The scar on my body is like a centipede, I was afraid of seeing the mirror, so I removed all the mirrors in the house…I don’t let my husband touch my body because I’m worried he doesn’t love me anymore.”(Jane)
3.2. Initial Behavioral Pattern of Mindfulness
3.2.1. Self-Aware of the Stress of Life but Still Trying to Practice
“I forgot to do mindful breathing at the beginning…I thought a lot at the beginning and would zone out during the process, but I was being able to absorb the lessons later. Mindful breathing helps to gradually slow my respiratory rate.”(Lucy)
“I currently have to work and undergo regular targeted therapy, so I don’t have much time to practice, but I will try mindful breathing and body scanning when I have the time. In the beginning, I couldn’t sense my body, but through rehabilitation…”(Fiona)
“I don’t practice often because I’m too busy…I either have work to do or just want to sleep when I have time to spare. It is quite difficult for me to practice mindfulness in my daily life, but I can take time to practice it for a few minutes each day.”(Aileen)
3.2.2. The Support of a Patient Peer Group
“Because of cancer, it is difficult for me to find a job…Some people have experienced severe side effects after chemotherapy and radiotherapy, including dizziness, soaring blood pressure, and insomnia. I have to help myself by setting goals while confronting the hardships in life…The goals I set are to live for more than 5 years and to train my son to take care of himself and live independently after I’m gone.”(Cherry)
“If you don’t control your temper well after you get sick, the people around you will be affected. I hope that this group can continue in the future so that everyone can share their experiences at any time.”(Kelly)
“We can all help ourselves. Mindfulness courses help us to gradually understand that we must rely on ourselves to solve problems and must focus on the present. All difficulties can be overcome over time. Health is the most important thing.”(Rebecca)
“Actually, I was quite happy when I heard that I was sick. This was because I was so overwhelmed by life that becoming sick allowed me to take a rest. I deal with my difficulties and anxiety by accepting them, focusing on the present, and getting support by interacting with other patients. There are always trials to overcome in our lives for various reasons. They force us to grow and bring fulfillment in our lives.”(Danielle)
3.3. The Experience of MBSR among Patients with Breast Cancer
3.3.1. Discovery of the Benefits of Implementing Mindfulness in Daily Life
“I am impressed by mindful eating, meditation, stretching, and walking because all these activities remind me that I need to slow down; in particular, when I’m tasting raisins, I find that the practice of mindfulness is very good but difficult to implement because I’m always in a rush to finish my meal.”(Chloe)
“When I touched the wound of my mastectomy, I was very low self-esteem. I wanted to cry every night (eyes were red), but through breathing adjustment and body scans, it seemed that the sadness gradually diminished.”(Abby)
“I used to hate having sex with my husband, but through “mindfulness” sex, I felt involved in the whole sex process…”(Una)
“In mindfulness practice, I can relax…Everything happens at a slow pace. I set goals for myself, keep records, and write in a diary every day. Doing only one thing at a time is less distracting for me.”(Wendy)
“I’m very impressed with the mindfulness program because I initially thought that this course was just a yoga course; however, I gained a lot by learning various mindfulness skills after joining the course.”(Zera)
3.3.2. Additional Benefits of the Mindfulness Intervention
“Sometimes I wake up halfway through my sleep at night because I always have so many thoughts that I can’t let go of. Through mindfulness, I can relax more…Thus, I want to tell everyone to let go of their obsessions. This is more beneficial for us.”(Vicky)
“During my hospitalization, I often felt very irritable, but after I performed mindfulness body scans and adjusted my breathing before going to bed, I found that the distracting thoughts in my mind slowly subsided.”(Tracy)
4. Discussion
4.1. Limitations
4.2. Implications for Nursing Practice
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Dahl, C.A.F.; Reinertsen, K.V.; Nesvold, I.L.; Fosså, S.D.; Dahl, A.A. A study of body image in long-term breast cancer survivors. Cancer 2010, 116, 3549–3557. [Google Scholar] [CrossRef] [PubMed]
- Thompson, J.K.; Heinberg, L.J.; Altabe, M.; Tantleff-Dunn, S. Exacting Beauty: Theory, Assessment, and Treatment of Body Image Disturbance; American Psychological Association: Washington, DC, USA, 1999; pp. xii, 396. [Google Scholar] [CrossRef]
- Lewis-Smith, H.; Diedrichs, P.C.; Harcourt, D. A pilot study of a body image intervention for breast cancer survivors. Body Image 2018, 27, 21–31. [Google Scholar] [CrossRef] [PubMed]
- Rezaei, M.; Elyasi, F.; Janbabai, G.; Moosazadeh, M.; Hamzehgardeshi, Z. Factors Influencing Body Image in Women with Breast Cancer: A Comprehensive Literature Review. Iran. Red Crescent Med. J. 2016, 18, e39465. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sebri, V.; Triberti, S.; Pravettoni, G. Injured Self: Autobiographical Memory, Self-Concept, and Mental Health Risk in Breast Cancer Survivors. Front Psychol. 2020, 11, 607514. [Google Scholar] [CrossRef]
- Chang, Y.C.; Hu, W.Y.; Chang, Y.M.; Chiu, S.C. Changes in sexual life experienced by women in Taiwan after receiving treatment for breast cancer. Int. J. Qual. Stud. Health Well-Being 2019, 14, 1654343. [Google Scholar] [CrossRef]
- Leite, F.M.C.; Oliveira, A.G.; Barbosa, B.L.F.d.A.; Ambrosim, M.Z.; Vasconcellos, N.A.V.; Maciel, P.M.A.; Amorim, M.H.C.; Furieri, L.B.; Lopes-Júnior, L.C. Intimate Partner Violence against Mastectomized Women: Victims’ Experiences. Current Oncol. 2022, 29, 8556–8564. [Google Scholar]
- Mazor, M.; Lee, K.; Dhruva, A.; Cataldo, J.K.; Paul, S.M.; Melisko, M.; Smoot, B.J.; Levine, J.D.; Elboim, C.; Conley, Y.P.; et al. Menopausal-Related Symptoms in Women One Year after Breast Cancer Surgery. J. Pain Symptom Manag. 2018, 55, 1138–1151.e1. [Google Scholar] [CrossRef] [Green Version]
- Cao, J.; Eshak, E.S.; Liu, K.; Muraki, I.; Cui, R.; Iso, H.; Tamakoshi, A. Sleep duration and risk of breast cancer: The JACC Study. Breast Cancer Res. Treat. 2019, 174, 219–225. [Google Scholar] [CrossRef]
- Zhang, X.; Sun, D.; Wang, Z.; Qin, N. Triggers and Coping Strategies for Fear of Cancer Recurrence in Cancer Survivors: A Qualitative Study. Curr. Oncol. 2022, 29, 9501–9510. [Google Scholar] [CrossRef]
- Lehrer, S.; Green, S.; Ramanathan, L.; Rosenzweig, K.E. Insufficient sleep associated with increased breast cancer mortality. Sleep Med. 2013, 14, 469. [Google Scholar] [CrossRef]
- Riemann, D.; Krone, L.B.; Wulff, K.; Nissen, C. Sleep, insomnia, and depression. Neuropsychopharmacology 2020, 45, 74–89. [Google Scholar] [CrossRef] [PubMed]
- Breyer, J.Z.; Wendland, E.M.; Kops, N.L.; Caleffi, M.; Hammes, L.S. Assessment of potential risk factors for breast cancer in a population in Southern Brazil. Breast Cancer Res. Treat. 2018, 169, 125–131. [Google Scholar] [CrossRef]
- Rada, G.; Capurro, D.; Pantoja, T.; Corbalán, J.; Moreno, G.; Letelier, L.M.; Vera, C. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst. Rev. 2010, 9, CD004923. [Google Scholar] [CrossRef] [PubMed]
- Kabat-Zinn, J. Full Catastrophe Living: The Program of the Stress Reduction Clinic at the University of Massachusetts Medical Center; Delta: New York, NY, USA, 1990. [Google Scholar]
- Schellekens, M.P.; Jansen, E.T.; Willemse, H.H.; van Laarhoven, H.W.; Prins, J.B.; Speckens, A.E. A qualitative study on mindfulness-based stress reduction for breast cancer patients: How women experience participating with fellow patients. Support Care Cancer 2016, 24, 1813–1820. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Accoto, A.; Chiarella, S.G.; Raffone, A.; Montano, A.; de Marco, A.; Mainiero, F.; Rubbino, R.; Valzania, A.; Conversi, D. Beneficial Effects of Mindfulness-Based Stress Reduction Training on the Well-Being of a Female Sample during the First Total Lockdown Due to COVID-19 Pandemic in Italy. Int. J. Environ. Res. Public Health 2021, 18, 5512. [Google Scholar] [CrossRef]
- Albert, J.G.; Lo, C.; Rosberger, Z.; Frenkiel, S.; Hier, M.; Zeitouni, A.; Kost, K.; Mlynarek, A.; Black, M.; MacDonald, C.; et al. Biopsychosocial Markers of Body Image Concerns in Patients with Head and Neck Cancer: A Prospective Longitudinal Study. Curr. Oncol. 2022, 29, 4438–4454. [Google Scholar] [CrossRef]
- Thornton, M.; Lewis-Smith, H. “I listen to my body now”: A qualitative exploration of positive body image in breast cancer survivors. Psychol. Health 2021, 1–20. [Google Scholar] [CrossRef]
- Guedes, T.S.R.; Dantas de Oliveira, N.P.; Holanda, A.M.; Reis, M.A.; Silva, C.P.; Rocha e Silva, B.L.; Cancela, M.C.; de Souza, D.L.B. Body Image of Women Submitted to Breast Cancer Treatment. Asian Pac J. Cancer Prev. 2018, 19, 1487–1493. [Google Scholar] [CrossRef]
- Baer, R.A. Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review. Clin. Psychol. Sci. Pract. 2003, 10, 125–143. [Google Scholar] [CrossRef]
- Shapiro, S.L.; Carlson, L.E.; Astin, J.A.; Freedman, B. Mechanisms of mindfulness. J. Clin. Psychol. 2006, 62, 373–386. [Google Scholar] [CrossRef]
- Charmaz, K. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis; Sage: Thousand Oaks, CA, USA, 2006. [Google Scholar]
- Glaser, B.G.; Strauss, A.L.; Strutzel, E. The discovery of grounded theory; strategies for qualitative research. Nurs. Res. 1968, 17, 364. [Google Scholar] [CrossRef] [Green Version]
- Glaser, B.G. Basics of Grounded Theory Analysis: Emergence vs Forcing; Sociology Press: Mill Valley, CA, USA, 1992. [Google Scholar]
- Speziale, H.S.; Streubert, H.J.; Carpenter, D.R. Qualitative Research in Nursing: Advancing the Humanistic Imperative; Wolters Kluwer: Philadelphia, PA, USA, 2011. [Google Scholar]
- Vignes, S. Lymphedema: From diagnosis to treatment. Rev. Med. Interne 2017, 38, 97–105. [Google Scholar] [CrossRef] [PubMed]
- Chang, Y.C.; Chang, S.-R.; Chiu, S.-C. Sexual Problems of Patients With Breast Cancer After Treatment: A Systematic Review. Cancer Nurs. 2019, 42, 418–425. [Google Scholar] [CrossRef] [PubMed]
- Brédart, A.; Dolbeault, S.; Savignoni, A.; Besancenet, C.; This, P.; Giami, A.; Michaels, S.; Flahault, C.; Falcou, M.C.; Asselain, B.; et al. Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: Results of a French exploratory survey. Psychooncology 2011, 20, 841–850. [Google Scholar] [CrossRef]
- Nomaguchi, K.M.; Milkie, M.A. Costs and rewards of children: The effects of becoming a parent on adults’ lives. J. Marriage Fam. 2003, 65, 356–374. [Google Scholar] [CrossRef]
- Czepczor-Bernat, K.; Brytek-Matera, A.; Staniszewska, A. The effect of a web-based psychoeducation on emotional functioning, eating behaviors, and body image among premenopausal women with excess body weight. Arch. Womens Ment. Health 2021, 24, 423–435. [Google Scholar] [CrossRef]
- Chang, Y.C.; Lin, G.M.; Yeh, T.L.; Chang, Y.M.; Yang, C.H.; Lo, C.; Yeh, C.Y.; Hu, W.Y. Impact of mindfulness-based stress reduction on female sexual function and mental health in patients with breast cancer. Support. Care Cancer 2022, 30, 4315–4325. [Google Scholar] [CrossRef]
- Banth, S.; Ardebil, M.D. Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain. Int. J. Yoga 2015, 8, 128–133. [Google Scholar] [CrossRef]
- Jensen, M.R.; Simonsen, L.; Karlsmark, T.; Bülow, J. Microvascular filtration is increased in the forearms of patients with breast cancer-related lymphedema. J. Appl. Physiol. 2013, 114, 19–27. [Google Scholar] [CrossRef] [Green Version]
- Kwak, A.; Jacobs, J.; Haggett, D.; Jimenez, R.; Peppercorn, J. Evaluation and management of insomnia in women with breast cancer. Breast Cancer Res. Treat. 2020, 181, 269–277. [Google Scholar] [CrossRef]
- Rusch, H.L.; Rosario, M.; Levison, L.M.; Olivera, A.; Livingston, W.S.; Wu, T.; Gill, J.M. The effect of mindfulness meditation on sleep quality: A systematic review and meta-analysis of randomized controlled trials. Ann. N. Y. Acad. Sci. 2019, 1445, 5–16. [Google Scholar] [CrossRef] [PubMed]
- Holzel, B.K.; Carmody, J.; Vangel, M.; Congleton, C.; Yerramsetti, S.M.; Gard, T.; Lazar, S.W. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011, 191, 36–43. [Google Scholar] [CrossRef] [Green Version]
- Holzel, B.K.; Hoge, E.A.; Greve, D.N.; Gard, T.; Creswell, J.D.; Brown, K.W.; Barrett, L.F.; Schwartz, C.; Vaitl, D.; Lazar, S.W. Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. Neuroimage Clin. 2013, 2, 448–458. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Madson, L.; Klug, B.; Madson, L.; Stimatze, T.; Eness-Potter, K.; MacDonald, J. Effectiveness of mindfulness-based stress reduction in a community sample over 2 years. Ann. Clin. Psychiatry 2018, 30, 52–60. [Google Scholar] [PubMed]
- Chattu, V.K.; Manzar, M.D.; Kumary, S.; Burman, D.; Spence, D.W.; Pandi-Perumal, S.R. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare 2018, 7, 1. [Google Scholar] [CrossRef] [Green Version]
- Campbell-Enns, H.; Woodgate, R. The psychosocial experiences of women with breast cancer across the lifespan: A systematic review protocol. JBI Database Syst. Rev. Implement Rep. 2015, 13, 112–121. [Google Scholar] [CrossRef] [Green Version]
- Koopman, C.; Nouriani, B.; Erickson, V.; Anupindi, R.; Butler, L.D.; Bachmann, M.H.; Sephton, S.E.; Spiegel, D. Sleep disturbances in women with metastatic breast cancer. Breast J. 2002, 8, 362–370. [Google Scholar] [CrossRef] [Green Version]
- Touitou, Y.; Reinberg, A.; Touitou, D. Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption. Life Sci. 2017, 173, 94–106. [Google Scholar] [CrossRef]
Characteristic | N = 26 |
---|---|
Age (years), mean (SD) | 45.65 (8.09) |
Time since diagnosis (months), mean (SD) | 26.35 (19.62) |
Educational level, n (%) | |
Senior high school | 3 (11.5) |
Junior college | 5 (19.2) |
College | 17 (65.4) |
Graduate institute | 1 (3.8) |
Cancer staging, n (%) | |
Stage 0 | 1 (3.8) |
Stage I | 3 (11.5) |
Stage II | 16 (61.5) |
Stage III | 1 (3.8) |
Stage IV | 5 (19.2) |
Treatment, n (%) | |
Chemotherapy | 9 (34.6) |
Radiotherapy | 1 (3.8) |
Targeted therapy | 2 (7.7) |
Hormone therapy | 13 (50) |
Other | 1 (3.8) |
Use of sleeping pills, n (%) | |
No | 14 (53.8) |
Yes | 12 (46.2) |
Themes | Subthemes |
---|---|
Symptoms caused by treatment | Sleep disturbance following diagnosis or treatment |
Negative body image and sexual problems among patients with breast cancer | |
Initial behavioral pattern of mindfulness | Self-awareness of the stress of life but still trying to practice |
The support of a patient peer group | |
The experience of MBSR among patients with breast cancer | Discovery of the benefits of implementing mindfulness in daily life |
Additional benefits of the mindfulness intervention |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Chang, Y.-C.; Lin, G.-M.; Tseng, T.A.; Vitale, E.; Yang, C.-H.; Yang, Y.-L. The Experience of Mindfulness-Based Stress Reduction on Menopausal Symptoms, Sleep Disturbance, and Body Image among Patients with Breast Cancer—A Qualitative Study. Curr. Oncol. 2023, 30, 1255-1266. https://doi.org/10.3390/curroncol30010097
Chang Y-C, Lin G-M, Tseng TA, Vitale E, Yang C-H, Yang Y-L. The Experience of Mindfulness-Based Stress Reduction on Menopausal Symptoms, Sleep Disturbance, and Body Image among Patients with Breast Cancer—A Qualitative Study. Current Oncology. 2023; 30(1):1255-1266. https://doi.org/10.3390/curroncol30010097
Chicago/Turabian StyleChang, Yun-Chen, Gen-Min Lin, Tzuhui Angie Tseng, Elsa Vitale, Ching-Hsu Yang, and Ya-Ling Yang. 2023. "The Experience of Mindfulness-Based Stress Reduction on Menopausal Symptoms, Sleep Disturbance, and Body Image among Patients with Breast Cancer—A Qualitative Study" Current Oncology 30, no. 1: 1255-1266. https://doi.org/10.3390/curroncol30010097
APA StyleChang, Y. -C., Lin, G. -M., Tseng, T. A., Vitale, E., Yang, C. -H., & Yang, Y. -L. (2023). The Experience of Mindfulness-Based Stress Reduction on Menopausal Symptoms, Sleep Disturbance, and Body Image among Patients with Breast Cancer—A Qualitative Study. Current Oncology, 30(1), 1255-1266. https://doi.org/10.3390/curroncol30010097