Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Efficacy of an online mindfulness program (MindOnLine) to reduce fear of recurrence in people living with and beyond, breast, prostate or colorectal cancer: a randomized controlled trial (#27)

Patricia M Livingston 1 2 , Natalie Winter 2 , Liliana Orellana 1 , Lahiru Russell 1 , Eric O 1 3 , Michael Jefford 4 5 , Anna Ugalde 2 , Helena Romaniuk 1 , Afaf Girgis AM 6 , David Austin 7 , Cathy Mihalopoulos 8 , Richard Chambers 8 , Jo Phipps-Nelson 4 , Dishan Herath 9 , Bodil Rasmussen 2 , Kathryn Whitfield 10 , Maria Ftanou 4 , Ben Smith 11 , Kirsten Pilatti 12 , Sally Sara 13 , Addie Wootten 14 , Mari Botti 2 , Kate Gillan 15 , Madhu Singh 16 , David Campbell 16 , Brindha Pillay 17 , Sue Evans 18 , Michael O'Callaghan 19 , Elles Stijinen 20 , Fisaha Tesfay 2 , Victoria White 7
  1. Faculty of Health, Deakin University, Melbourne, VIC, Australia
  2. Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
  3. DS Digital Equipment, Deakin University, Melbourne, VIC, Australia
  4. Peter Maccallum Cancer Centre, Melbourne , VIC, Australia
  5. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
  6. Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
  7. School of Psychology, Deakin University, Melbourne, Vic, Australia
  8. Monash University, Melbourne, VIC, Australia
  9. Oncology Department, Western Health, Melbourne , VIC, Australia
  10. Community Based Health Services, Policy and Improvement , Department of Health, Melbourne, VIC, Australia
  11. The Daffodil Centre: a Joint Venture with Cancer Council NSW, University of Sydney, Sydney, NSW, Australia
  12. Breast Cancer Network Australia, Melbourne , VIC, Australia
  13. Prostate Cancer Foundation Australia, Melbourne, VIC, Australia
  14. Smiling Mind, Melbourne, VIC, Australia
  15. Epworth Healthcare, Melbourne, VIC, Australia
  16. Barwon Health, Geelong, VIC, Australia
  17. Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  18. Victorian Cancer Registry, Cancer Council Victoria, Melbourne , VIC, Australia
  19. South Australian Cancer Clinical Outcomes Collaborative, Adelaide, South Australia, Australia
  20. Australian Prostate Centre, Melbourne , VIC, Australia

Aims

Online mindfulness programs may provide a mechanism to support between 30% and 54% of the cancer population who experience sub-clinical or clinical fear of cancer recurrence (FCR). This study determined the efficacy of MindOnLine, a 9-session mindfulness-based online program for people living with, and beyond, breast, prostate or colorectal cancer, in reducing FCR.

Methods

Randomised controlled trial comparing MindOnline with a wait-list control.  Adults, ≥18 years, living in Australia, who had completed active treatment/surveillance for stages 1–3 breast, prostate or colorectal cancer, within the past 5 years, had internet access, and FCR Inventory (FCRI) severity scores ≥13 were eligible. MindOnLine incorporated education, mindfulness practices, and meditation. Outcomes were assessed at baseline, 9-weeks and 9-months post-recruitment. Linear mixed models assessed MindOnLine’s impact on primary (FCRI total score) and secondary (depression (PHQ-9) and anxiety (GAD-7)) outcomes.

Results

Overall, 358 participants were randomly assigned to MindOnLine (n=183) or wait-list control (n=175); 58% had breast, 26% prostate and 16% colorectal cancer; 52% were ≥60 years old; 69% were female. At 9-weeks, MindOnLine participants demonstrated a significantly larger reduction in FCRI total score (-5.5 points, 95% CI [-8.5, -2.4], p=0.0004); anxiety score (-1.3, [-2.2, -0.5], p=0.0024); and depression score (-1.4 points, [-2.3, -0.5], p=0.0019) compared to participants in the control group. Significant intervention effects were sustained at 9-months (FCRI: -4.8 points, [ 8.4, -1.2]; p=0.0095; anxiety: -1.2, [-2.2, -0.16], p=0.023; depression: -0.97, [-1.9, -0.02], p=0.044). When stratified by cancer type, MindOnLine reduced FCR in people living with breast (9-weeks and 9-months) and colorectal (71% female; 9-weeks) cancer, but not males with prostate cancer.

Conclusions

This trial fills a significant gap in the role of self-directed online support programs to address moderate-severe FCR. Further research is required to understand how mindfulness programs can be effective for all population groups.