Mindfulness-Based Therapy for Brain Tumour Survivors
Condition: Brain Tumour; Depressive Symptoms; Survivors
MeSH terms: Brain Neoplasms; Depression
Study type: Interventional

Summary: 
      Brain Tumour (BT) survivors struggle with disabling physical, emotional, cognitive and
      psychosocial sequelae. Unfortunately, to-date there has been very limited research into
      rehabilitative interventions for this population. With 55,000 BT survivors in Canada alone1,
      access to effective, evidence-based rehabilitative treatment that would improve BT survivors'
      quality of life (QOL) and capacity to cope is a necessity. Mindfulness-Based Therapy's (MBTs)
      are emerging as a potential treatment to address this need. MBTs are group-based
      psychological treatments for coping with illness or disability, with the goal of improving
      psychological wellbeing. Recent studies have begun to suggest a role for MBTs in addressing
      symptom burden and QOL in the acquired brain injury (ABI) population, a heterogeneous
      population that includes survivors of stroke and traumatic brain injury, as well as BT
      survivors. High quality research including within-subject controlled trials, are needed to
      demonstrate whether MBTs can provide efficacious, accessible and cost-effective treatment to
      improve the lives of BT survivors.
    

Detailed description: 
      Increased survival rates and life expectancy of primary BT survivors today have resulted in a
      need to expand the focus from acute treatment to reducing disability and long-term symptom
      burden in survivorship. Many BT survivors are left with reduced autonomy in their lives, with
      a lower likelihood of independent living and increased risk of functional and symptom
      adversity (pain and physical disability), unemployment, and family difficulties.
      Unsurprisingly, these factors are associated with increased stress, psychological suffering,
      and reduced QOL. Research has noted the prevalence of psychological distress and cognitive
      impairment, experienced as late effects, with up to 90% of survivors experiencing some form
      of cognitive impairment and depressive symptoms, as well as many as 80% experiencing mental
      fatigue and up to 60% experiencing anxiety.

      80% of all central nervous system tumour survivors exhibit rehabilitation needs, and
      survivors report an interest in learning coping techniques for stress, yet the majority of
      symptoms remain underestimated and untreated. BT survivors are left with limited treatment
      options to promote long-term wellbeing, with 71% of resources containing minimal to no
      information on coping with outcomes. Despite considerable research demonstrating BT survivors
      increased risk of symptom burden and reduced QOL, there has been little research on treatment
      or effective interventions.

      Some outpatient rehabilitation therapies have been made available to other neurologically
      impaired populations (e.g. Traumatic Brain Injury, Stroke) but evidence in support of
      specific approaches has been equivocal, with limited rehabilitative research in BT survivors
      specifically. Such treatments for the broader ABI population to-date have included Cognitive
      Behavioural Therapy (CBT) and Applied Behavioural Analysis (ABA), with debatable
      effectiveness. Positive studies have suggested that treatment may only prove effective for a
      handful of ABI sequelae. Studies to date are marred by limited methodological rigour and
      applicability to the BT population because of the broader, heterogeneous ABI focus. As a
      result, healthcare professionals and national organizations, such as National Coalition for
      Cancer Survivorship, have called for higher quality research to inform novel treatments to
      improve outcomes for specific groups, such as the BT population.

      In response to these calls, Mindfulness-Based Therapy's (MBTs) have been proposed as a
      plausible treatment for long term care of ABI survivors, in general. MBTs use a
      non-stigmatizing approach, combining secularized eastern meditative practices with western
      psychological advances. MBTs have good evidence that they improve a wide range of sequelae,
      including, stress, depression, anxiety and cognitive impairment. MBT efficacy has been
      repeatedly demonstrated across multiple psychiatric, neurological, and cancer populations.
      MBTs focus on acceptance-based and adaptive approaches, which might theoretically be better
      suited to the realities of the lives of BT survivors, than would change-based approaches such
      as CBT or ABA. MBT participants learn to generate less distress, engage more positively in
      their lives, and respond to difficult situations more adaptively; they often describe it as
      transformative.

      MBTs have begun to be studied in the broader ABI survivor population, and this emerging
      literature suggests efficacy in reducing symptom burden. However, there are no known studies
      considering the effectiveness of an MBT for BT survivors specifically; the present study aims
      to fill this important knowledge gap. The goal of this study is to test the effectiveness of
      a five session MBT course in reducing depressive symptoms and perceived stress, as well as
      improving overall QOL and wellbeing for BT survivors.
    

Intervention name(s): Mindfulness-based Therapy
Intervention type(s): Behavioral
Intervention description(s): MBT will be delivered in group format, 135 minutes per week, for 5 consecutive weeks with 10-20 participants per group.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Mindfulness-based Therapy; Brain Tumour Survivors; Depressive Symptoms; Quality of Life; Perceived Stress; Wellbeing; Treatment