Meditation has been practiced for millennia in many traditions around the world. According to the 2012 National Health Interview Survey, nearly 18 million adults and 927,000 children practice meditation ⁽²⁾. It is defined as “a wakeful hypo-metabolic physiologic state” ⁽¹⁾ in which the practitioner is relaxed but focused and alert. In addition to developing attention, most formats include regulated or conscious breathing, and increasing nonjudgmental awareness. Common goals include inner calmness, physical relaxation, psychological balance, and improved vitality and coping.

There may also be differences in the types of attention emphasized: Mindfulness based stress reduction (MBSR) involves present moment awareness and interoception. Loving kindness or metta (affect) meditation focuses on compassion and empathy for oneself and others. Observing-thoughts or perspective meditation allows for the nonjudgmental observation of thoughts or feelings without engaging with them. Data from randomized trials have shown that developing an orientation of acceptance toward present-moment experiences, the central mechanism of mindfulness interventions, helps promote positive emotions ⁽⁶⁵⁾. Further, attention-based training has also been reported to reduce burnout, stress and anxiety in emergency department staff ⁽⁶⁶⁾. MRI studies of these specific techniques suggest they correlate with training-induced behavioral improvements in attention, compassion, and cognitive perspective-taking, respectively ⁽⁴⁴⁾. Other approaches include mantra or mantram meditation, which involves the repetition of words or sounds with phonetic significance, and movement meditative practices such as tai chi (taiji) and qigong, which are components of traditional Chinese medicine (TCM), and yoga, which originated from ayurvedic medicine.

The most researched form of meditation is MBSR, typically offered as an 8-week program. Elements include sitting meditation, a technique known as body scan, which reorients the mind to sense the connection with body and breath, and walking meditation, which applies these practices in moving form. Current data show the value of MBSR in managing chronic pain ⁽³⁾, insomnia ^(4) (5), stress, depression, and anxiety associated with vascular disease ⁽⁶⁾, coronary heart disease ⁽⁷⁾, diabetes ⁽⁸⁾, and irritable bowel syndrome ⁽⁹⁾, and distress associated with hot flashes in perimenopausal women ⁽¹⁰⁾. In patients with AIDS, MBSR helped improve psychological functioning, coping with adverse effects, and stability of CD4 T-cell counts ⁽¹²⁾. Preliminary data also suggest an association between MBSR compliance and smoking cessation ⁽¹¹⁾ or reduced alcohol consumption ⁽⁴⁵⁾. Other analyses suggest that mindfulness-based interventions may be helpful for eating behavior changes and disorder-specific symptoms ^(61) (62).

Several randomized trials have employed MBSR in the oncology setting, with the majority involving breast cancer patients. These studies reported decreased anxiety, depression, fear of recurrence, and fatigue ^(15) (17), as well as improved sleep quality ^(15) (54), enhanced psychosocial adjustment and quality of life ⁽⁵⁹⁾, and reductions in long-term emotional and physical adverse effects associated with medical and endocrine treatments ⁽¹⁶⁾. MBSR was also reported to afford psychological benefit along with optimizing immune function in those newly diagnosed with breast cancer ⁽⁶⁷⁾; and to affect short-term reductions in salivary cortisol and interleukin-6 levels in breast cancer survivors ⁽⁶⁸⁾. In patients with mixed cancer diagnoses, MBSR improved distress, mood, stress, general well-being, and cancer-related cognitive impairment ^(13) (18); and in partners of cancer patients, it improved psychological functioning ⁽¹⁴⁾. A modification of MBSR known as Mindfulness Based Cancer Recovery (MBCR) that involves mindfulness meditation and gentle yoga also lowered stress symptoms and positively affected quality of life ^(20) (21). In one of the largest long-term studies of distressed breast cancer survivors, MBCR was superior to supportive expressive group therapy, with benefits lasting over one year ⁽⁴⁶⁾. Conclusions from systematic reviews and meta analyses indicate benefits of mindfulness-based interventions as adjuvants for managing cancer-related symptoms such as anxiety, depression and fatigue in both patients and survivors ^(70) (71). Although brief mindfulness interventions (BMBIs) have shown promise in relieving acute pain, a systematic review cited the need for large scale studies to recommend BMBIs for addressing acute or chronic pain ⁽⁶⁹⁾.

Other studies show that Tibetan Sound Meditation, which uses sound to promote healing, improves short-term memory, cognitive function and mental health in breast cancer patients with chemotherapy-induced cognitive impairment ⁽¹⁹⁾. Guided meditation during core-needle breast biopsy significantly lowered pain, without compromising radiologist-patient communications, and reduced post-procedure anxiety and fatigue ⁽⁴⁷⁾. It also reduced anxiety during stereotactic breast biopsy ⁽⁷²⁾. In head and neck cancer patients undergoing radiation therapy, both coached meditation or utilization of a more cost-effective meditation CD were equally effective in reducing distress ⁽⁴⁸⁾. Mindfulness practice during chemotherapy in colorectal cancer patients reduced cortisol blunting typically seen in these patients ⁽⁴⁹⁾. Preliminary data also suggest benefits of a combination of somatic yoga and meditation in improving balance and quality of life in cancer survivors with chemo-induced peripheral neuropathy ⁽⁷³⁾.

Meditation has shown utility in pediatric populations as well. Guided mantram meditation relieved acute pain in children with neuroblastoma undergoing anti-GD2 monoclonal antibody therapy ⁽²²⁾, and a review of mind-body therapy studies including MBSR in pediatric oncology revealed greater self-confidence and optimism in coping with illness ⁽²³⁾. In another systematic review, mindfulness-based interventions were found to confer psychological benefits in patients with advanced cancer ⁽⁵⁵⁾, but many of these studies are limited by the study design ^{(56) (57) (58)}. Future trials with stronger methodologies can help validate the use of mindfulness practices ⁽⁶⁰⁾.

Meditation is a safe practice and can be learned in classes offered in the community or at hospitals. Both the American Society of Clinical Oncology (ASCO) ⁽⁶³⁾ and Society of Integrative Oncology (SIO) ^(24) (50) recommend meditation for anxiety, stress reduction, depression, mood disturbance, and improved quality of life in cancer patients. In addition, the American Heart Association recently added meditation to intervention guidelines to reduce risk of heart disease ⁽⁵¹⁾. MSK offers meditation courses for our patients and caregivers, and as part of a new online program, Integrative Medicine at Home, to help support the recovery and well-being of cancer patients everywhere.