Mindfulness-based interventions in oncology: A scoping review of outcomes and applications

Abstract

Cancer significantly impacts patients' physical and mental health, leading to a wide range of effects from physical pain to psychological issues such as anxiety and depression, severely diminishing their quality of life. As an emerging psychosomatic intervention, mindfulness interventions have gained increasing attention. This scoping review systematically searches and filters relevant literature, covering databases from their inception to January 2025, aiming to comprehensively outline the application, research characteristics, and main outcomes of mindfulness interventions in cancer recovery. We employed the Arksey and O'Malley framework, utilizing electronic databases and manual searches to rigorously select studies and extract key data. Results indicate that mindfulness interventions show broad potential in improving cancer patients' mental health, physical symptoms, and quality of life, despite the heterogeneity of the evidence. Future research should focus on higher-quality randomized controlled trials to explore different intervention modalities and long-term effects and to analyze their underlying mechanisms. This paper particularly highlights the advancements in Mindfulness-Based Cancer Recovery, providing valuable references for clinical practice.

Key Words: Mindfulness; Cancer; Psychosomatic intervention; Scoping review; Mental health; Quality of life

Core Tip: This scoping review synthesizes evidence on Mindfulness-Based Interventions (MBIs) in oncology, demonstrating their potential to improve mental health, physical symptoms, and quality of life for cancer patients. Utilizing the Arksey and O'Malley framework, the review highlights the broad application of MBIs, particularly Mindfulness-Based Cancer Recovery. Despite variability among previous studies, findings suggest that MBIs are promising psychosomatic interventions. Future research should prioritize high-quality randomized controlled trials to elucidate long-term effects and mechanisms, providing robust clinical guidance for integrating mindfulness into cancer care.

INTRODUCTION

Cancer remains one of the major global public health challenges, with millions of new diagnoses and deaths annually, imposing significant burdens on individuals, families, and societies[1-3]. The diagnosis and treatment of cancer bring substantial physical and mental burdens to patients, including the physical pain of surgery and chemotherapy, as well as potentially triggering anxiety, depression, fear, insomnia, fatigue, and other psychological and social issues, severely affecting patients' daily lives, social interactions, and work capabilities, and possibly shortening their lifespan[4,5]. In response to these challenges, an increasing number of studies have focused on non-pharmacological psychosomatic interventions, among which mindfulness interventions are noted for their simplicity and minimal side effects[6-8]. Mindfulness interventions emphasize conscious awareness of present bodily and mental experiences, fostering acceptance and a non-judgmental attitude towards oneself and one's environment, which helps patients better cope with the challenges brought by the disease[9,10]. Although many studies have explored the application of mindfulness interventions in cancer recovery[11-15], they tend to be dispersed across different fields and patient groups, lacking a comprehensive overview. This study employs a scoping review methodology to systematically compile existing literature, outlining the scope of application of mindfulness in cancer patient interventions and identifying the main features and knowledge gaps in research, thereby providing direction for future studies. This paper focuses on the application and progress of Mindfulness-Based Cancer Recovery (MBCR), aiming to provide a reference for clinical practice and future research.

SCOPING REVIEW METHODOLOGY

This scoping review was conducted using the framework proposed by Arksey and O'Malley[16], comprising the following steps:

Research question definition

The primary question of this study is: What are the scope, research characteristics, and main findings of mindfulness interventions in psychosomatic interventions for cancer patients? This study specifically focuses on the application of MBCR in cancer patients, aiming to gain a deeper understanding of its potential in clinical practice.

Identification of relevant studies

Multiple electronic databases were systematically searched including PubMed, Embase, PsycINFO, and Web of Science, with search timeframes extending from the inception of each database to January 2025. The search strategy employed combinations of keywords along with Boolean operators, such as ("mindfulness" OR "mindfulness-based" OR "meditation") AND ("cancer" OR "oncology" OR "neoplasm") AND ("psychological" OR "mental health" OR "quality of life" OR "pain" OR "fatigue" OR "sleep"). The reference lists of relevant articles were also manually searched to ensure the inclusion of as many pertinent studies as possible.

Study selection

The literature was filtered using predefined inclusion and exclusion criteria. Inclusion criteria included: (1) Studies involving cancer patients; (2) Interventions involving mindfulness [including Mindfulness-Based Stress Reduction (MBSR), mindfulness-based cognitive therapy (MBCT), or other mindfulness-based interventions (MBIs), with a particular focus on MBCR]; (3) Outcomes involving patients' mental health, physical symptoms, or quality of life (QOL); and (4) Articles in peer-reviewed journals or book chapters. Exclusion criteria included: (1) Studies on non-cancer patients; (2) Non-mindfulness interventions; and (3) Conference abstracts, review articles, etc. To ensure research quality, peer-reviewed articles only in English or Chinese were included, and grey literature was excluded.

Data extraction

Key information was extracted from each included study, including research design (e.g., randomized controlled trials, observational studies), sample characteristics (cancer type, patient age, gender, treatment stage), intervention measures (form, duration, frequency, content), main outcome indicators (e.g., psychological assessment scales, physical symptom assessment scales, QOL assessment scales), and main research findings and conclusions. Two independent researchers performed data extraction, resolving any discrepancies through discussion to ensure accuracy. Similarly, the screening process was independently conducted by two reviewers, and the inter-rater reliability was confirmed with a Cohen's kappa coefficient of 0.85.

Data summarization and reporting

Using descriptive statistics and narrative summaries, the extracted data were summarized and r the main themes, patterns, and knowledge gaps in the research were identified. Results were presented in forms of tables, graphics, or text for easy comprehension by readers.

Study selection and screening process

A systematic search was conducted across databases and registers, identifying a total of 1275 records (1263 from databases and 12 from registers). After removing 256 records due to duplication, automation screening, and other reasons, 1019 records remained. Of these, 633 were excluded, and 356 reports were sought for retrieval, with 150 not retrieved. Figure 1 illustrates the screening process. A total of 206 reports were assessed for eligibility, of which 169 were excluded based on specific criteria. Ultimately, 37 new studies were included in the review, along with six additional reports, resulting in a total of 43 included reports. Additionally, nine records were identified through other sources, with six assessed for eligibility and included in the final review.

Figure 1  Study selection and screening process.

SCOPE OF MBCR

According to the retrieved literature, mindfulness interventions have a broad scope of application in psychosomatic interventions for cancer patients:

Cancer types

Current research covers various cancer types, including breast cancer, prostate cancer, lung cancer, colorectal cancer, ovarian cancer, lymphoma, leukemia, etc. Notably, MBCR has been primarily applied to studies of breast and lung cancer, but its application is gradually expanding to other types of cancer such as stomach and pancreatic cancer. However, research on certain rare cancer types, such as sarcoma and brain tumors, is less common.

Patient groups

Mindfulness interventions involve cancer patients at different treatment stages, such as diagnosis, surgery, chemotherapy, recovery, and advanced stages. Research also focuses on diverse age groups, genders, and cultural backgrounds, including elderly patients, female patients, and patients from various ethnic backgrounds. Some studies specifically target intervention for certain groups, such as cancer survivors and end-of-life care for advanced cancer patients.

Intervention forms

The most widely used forms of mindfulness interventions are MBSR and MBCT, in addition to online mindfulness courses based on mobile apps and specific patient group interventions. This study focuses on MBCR, a form developed based on MBSR principles tailored to the specific needs of cancer patients, typically including practices like meditation, yoga, body scanning, and integrating cancer-related psychoeducation and cognitive coping strategies.

Intervention goals

Mindfulness interventions primarily address psychological health issues (such as anxiety, depression, stress, fear, cognitive decline), physical symptoms (such as pain, fatigue, insomnia, nausea, vomiting), and QOL. MBCR particularly focuses on psychological distress, sleep disorders, cancer-related fatigue, and post-traumatic growth, adjusting its goals according to different cancer types and treatment stages. For example, during chemotherapy, MBCR may focus more on alleviating fatigue and nausea; in the recovery phase, it may emphasize psychological adjustment and post-traumatic growth.

RESEARCH CHARACTERISTICS

Through the analysis of included literature, we have summarized some of the main characteristics of current research:

Research design

Most studies employ a randomized controlled trial design, aiming to compare the effects of mindfulness interventions with control groups to verify the efficacy of the interventions. However, there are also some observational studies and single-arm studies, which may not eliminate confounding factors, and therefore, the reliability of the results is relatively lower. Some literature also includes review articles.

Sample size

There is significant variation in sample sizes among the studies, ranging from dozens to hundreds of participants. Some studies with smaller sample sizes may impact the reliability of the results and reduce the statistical power, making it difficult to generalize the conclusions.

Intervention duration and frequency

The duration and frequency of mindfulness interventions vary, ranging from several weeks to several months. Most interventions last for 8 weeks, with sessions once or multiple times per week, but there are also studies with 4-week or 12-week interventions, with frequencies ranging from once a week to daily, depending on the study's objectives and the specific conditions of the patients.

Outcome indicators

Outcome indicators used in the studies include psychological assessment scales (e.g., Hamilton Anxiety Scale, Self-Rating Depression Scale, Cancer Fear Scale), physical symptom assessment scales (e.g., pain visual analogue scale, fatigue scale, sleep quality index), and QOL assessment scales (e.g., Quality of Life Scale for Cancer Patients, European Five-Dimension Health Scale).

Intervention implementation

Most mindfulness interventions are conducted by professionally trained psychotherapists or medical personnel, who typically require professional training in mindfulness interventions and have some clinical experience. Some studies also involve trained peer supporters for interventions. The content of MBCR interventions usually includes meditation, yoga, and body scanning, and combines cancer-related psychoeducation and cognitive coping strategies. The interveners need to be familiar with these contents and able to adjust them according to the specific situations of the patients.

KEY FINDINGS

Existing research indicates that mindfulness interventions have a positive impact on improving the psychosomatic health of cancer patients:

Effects on psychological distress and emotional well-being

Multiple randomized controlled trials have shown that MBIs reduce anxiety, depression, and stress across diverse cancer types and stages, including breast cancer, head and neck cancer, and gynecologic cancers[17-20]. In one study of patients with breast cancer (n = 74), an eight-week MBCT program decreased psychological distress (Cohen’s d = 1.17) and fatigue, alongside improvements in spiritual well-being and QOL[19]. Moreover, these benefits often persisted beyond the end of active treatment. A separate trial among breast cancer survivors demonstrated that mindfulness resulted in maintained gains at 4-week or even 3-month follow-ups, reinforcing the notion of durable symptom relief[21]. In another investigation involving MBSR for women with breast cancer (n = 166), patients had reduced depression scores post-intervention and significantly improved overall mood states and symptom experience[22]. These results collectively underscore the broad effectiveness of mindfulness practices for alleviating psychological distress and promoting emotional regulation.

Influence on fatigue and physical symptoms

Cancer-related fatigue is a pervasive issue that undermines patients’ daily functioning. Several trials have demonstrated the moderate efficacy of mindfulness interventions in mitigating fatigue, with some participants reporting better energy levels, pain control, and coping skills than those receiving standard care[21]. In a study of early-stage breast cancer patients undergoing chemotherapy (n = 136), 8 weeks of mindfulness yoga led to significant reductions in both anxiety and depression, as well as improvements in health-related QOL, although the direct impact on fatigue and pain varied over time[19]. Analogous positive outcomes have been documented in gynecologic cancers where progressive muscle relaxation and mindfulness meditation helped diminish physical stressors like insomnia and pain. Although some interventions integrating brief yoga sessions did not consistently reach statistical significance for pain relief, they often resulted in clinically meaningful gains in overall symptom management[21].

QOL and overall well-being

Improvements in QOL metrics are a recurring theme in mindfulness research, reflected in better emotional, social, and physical functioning across cancers[22,23]. For instance, one randomized controlled study examining younger breast cancer survivors (ages ≤ 50) noted that mindfulness meditation significantly elevated QOL indices and eased depression, insomnia, and vasomotor symptoms, suggesting that mindfulness can be tailored to specific demographic subgroups experiencing unique post-treatment challenges. In another trial, participants undergoing MBSR showed gains in psychological, physical, and spiritual well-being, suggesting that the intervention’s scope extends beyond symptom relief into areas like personal growth and overall life satisfaction[23]. These findings point to mindfulness as a patient-centered approach that enhances not only coping abilities but also long-term survivorship outcomes.

Effects on fear of cancer recurrence and spiritual well-being

Fear of cancer recurrence (FCR) ranks among the most distressing concerns for patients in remission or ongoing treatment. Several mindfulness- and acceptance-based approaches have targeted FCR by teaching individuals to reframe anxious thoughts and develop a more accepting stance toward uncertainty[24,25]. In one Japanese cohort, MBCT effectively alleviated FCR when measured at both 8 and 12 weeks, with participants reporting moderate improvements in spiritual well-being[25]. Similarly, web-based mindfulness interventions tailored to address FCR have demonstrated patient satisfaction and feasibility, especially in early breast cancer survivors, reinforcing the potential of mindfulness to foster acceptance, hope, and spiritual coping during and after treatment[26].

Biological and immunological markers

While fewer studies focus on biological outcomes compared to psychological endpoints, MBIs have been increasingly explored for their effects on physiological and immunological markers in cancer patients. Research indicates that MBIs may influence stress-related hormones, regulate inflammation, and enhance immune responses[27,28]. For instance, a randomized trial on MBSR in women with breast cancer reported improvements in natural killer (NK) cell activity and cytokine profiles, alongside reductions in depression[29]. Other studies have observed potential benefits such as decreased cortisol fluctuations, reduced levels of pro-inflammatory cytokines (e.g., IL-6), and improved immune cell activity, including T-cell and NK-cell function[30]. Mindfulness may reduce cortisol levels by regulating the hypothalamic-pituitary-adrenal axis while enhancing the regulation of the amygdala by the prefrontal cortex, improving stress response in cancer patients[31]. Preliminary findings also suggest that mindfulness may slow cellular aging processes by increasing telomerase activity and stabilizing telomere length[32]. Additionally, gene expression studies suggest that mindfulness could downregulate pro-inflammatory gene transcription, highlighting its potential to modulate stress physiology and immune recovery pathways[33].

Boyle et al[34] studied 22 young breast cancer survivors in a 6-week MBI trial, finding a significant decrease in pro-inflammatory gene expression in PBMCs. While eudaimonic well-being was linked to lower CTRA scores, the association was not significant. The study hints at a link between MBI, immune regulation, and well-being in survivors. However, the variability in sample sizes, intervention designs, and biomarker measurement methods across studies limits the generalizability of these findings.

DISCUSSION

This scoping review systematically evaluates the application and outcomes of mindfulness interventions in psychosomatic rehabilitation for cancer patients. The findings suggest that mindfulness interventions, particularly MBCR, show significant potential in improving patients' mental health, alleviating physical symptoms, and enhancing QOL. However, there are several limitations in the existing research that affect the interpretation and generalization of the results. The following discussion provides an in-depth analysis of the main findings, the limitations of the research, and their implications, along with suggestions for future research directions and hypotheses.

Interpretation of key findings

The key findings of this review show that mindfulness interventions, especially MBCR, have demonstrated positive effects across various cancer types and treatment stages. Specifically, mindfulness interventions significantly reduce anxiety, depression, and stress levels, and improve emotional regulation. Furthermore, mindfulness interventions have shown beneficial effects in alleviating cancer-related fatigue, pain, and sleep disturbances, thereby improving overall QOL. Although there is limited research on biological and immunological indicators, preliminary evidence suggests that mindfulness interventions may help regulate stress hormone levels and enhance immune function, further supporting their application in cancer rehabilitation.

Limitations of the research and their impact

Despite the promising findings, several limitations in the existing research warrant consideration. Many studies have small sample sizes, leading to insufficient statistical power and limiting generalizability. Furthermore, the heterogeneity of study designs, including randomized controlled trials, observational studies, and single-arm studies, complicates the comparison and synthesis of results.

Significant variability exists in the types, durations, and implementation details of mindfulness interventions across studies, hindering the identification of optimal intervention models. Moreover, most studies lack long-term follow-up data, limiting our understanding of sustained effects.

The majority of research has been conducted in Western contexts, raising concerns about the generalizability of findings across diverse cultural settings. Finally, while some studies have explored biological mechanisms, research in this area remains limited, hindering our understanding of how mindfulness interventions exert their effects.

This review has methodological limitations, including a large proportion of single-arm trials, which may overestimate effects, and limited reporting on intervention compliance, affecting reliability. Future research should explore the application of mindfulness interventions in cancer rehabilitation in greater depth, particularly through large-scale, multicenter randomized controlled trials to validate their efficacy across different cancer types and treatment stages. Studies should assess the differences between intervention models such as MBSR, MBCT, and MBCR in improving psychological and physical symptoms and explore the long-term effects of mindfulness interventions, especially regarding their applicability and effectiveness in diverse cultural settings. Furthermore, a deeper investigation into the biological mechanisms of mindfulness interventions - such as how they regulate hormone levels, inflammation responses, and immune function - will be crucial.

CONCLUSION

This scoping review summarizes the scope of application and key findings of MBCR in psychosomatic interventions for cancer patients. The results indicate that mindfulness interventions have broad application potential and positive therapeutic effects for cancer patients, although the evidence remains heterogeneous and limited. Future research should focus on high-quality randomized controlled trials to explore the efficacy of different intervention models, specific cancer types, and long-term effects, while also gaining deeper insights into the underlying mechanisms. This review demonstrates that MBCR, a specialized psychosomatic intervention developed for cancer patients, holds significant value in cancer rehabilitation management. Future studies should expand intervention research to cover diverse cancer populations and explore how to integrate MBCR into existing cancer rehabilitation treatment systems. This review provides direction for future research and suggests that clinicians consider mindfulness interventions as a beneficial adjunctive therapy in cancer rehabilitation. At the same time, clinicians should be aware of the limitations of mindfulness interventions and choose appropriate intervention plans based on the specific needs of individual patients.

ACKNOWLEDGEMENTS

We thank all who contributed to this work from all institutions.