Systematischer Review und Metaanalyse zur Wirksamkeit und Sicherheit von achtsamkeitsbasierten Interventionen bei Frauen mit Brustkrebs
Objective: The aim of this meta-analysis was to systematically update the evidence for Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) in women with breast cancer. Materials and Methods: In October 2016, PubMed, Scopus and Central were searched for randomized controlled trials on MBSR/MBCT in women with breast cancer. The primary outcome was health-related quality of life, secondary outcomes were fatigue, sleep, stress, anxiety, depressiveness and safety. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. The risk for bias was assessed using the Cochrane Risk of Bias Tool. Results: The Literature search identified 14 articles on 10 studies that included 1709 participants. The overall risk of bias was unclear, except for risk of low attrition bias and low other bias. Compared to usual care, significant post-intervention effects of MBSR/MBCT were found for health-related quality of life (SMD = 0.21; 95% KI = [0.04 | 0.39]), fatigue (SMD = -0.28; 95% KI = [-0.43 | -0.14]), sleep (SMD = -0.23), and quality of life (SMD = 0.21; 95% KI = [0.04 | 0.39]); 95% CI = [-0.40 | -0.05]), stress (SMD = -0.33; 95% CI = [-0.61 | -0.05]), anxiety (SMD = -0.28; 95% CI = [-0.39 | -0.16]), and depression (SMD = -0.34; 95% CI = [-0.46 | -0.21]). Significant medium-term effects were found for anxiety (SMD = -0.28; 95% KI = [-0.47 | -0.09]) and depression (SMD = -0.26; 95% KI = [-0.47 | -0.04]); long-term effects for anxiety (SMD = -0.21; 95% CI = [-0.40 | -0.03]). Other active interventions were significantly superior to MBSR/MBCT only in the short term with respect to anxiety (SMD = -0.45; 95% CI = [-0.71 | -0.18]) and depression (SMD = -0.39; 95% CI = [-0.65 | -0.14]). Subgroup analysis showed no differences between MBSR and MBCT, different disease stages or women during versus after adjuvant therapy. The effects were robust against possible methodological bias. Adverse events were insufficiently reported. Conclusions: This meta-analysis revealed evidence for the short-term effectiveness and safety of mindfulness-based interventions in women with breast cancer. However, their clinical relevance remains unclear. Further research is needed.