A Cost-Effective Mindfulness Stress Reduction Program: A Randomized Control Trial for Breast Cancer Survivors

By Lengacher, Cecile A.; Kip, Kevin E. et al. | Nursing Economics, July/August 2015 | Go to article overview

A Cost-Effective Mindfulness Stress Reduction Program: A Randomized Control Trial for Breast Cancer Survivors


Lengacher, Cecile A., Kip, Kevin E., Reich, Richard R., Craig, Benjamin M., Mogos, Mulubrhan, Ramesar, Sophia, Paterson, Carly L., Farias, Jerrica R., Pracht, Etienne, Nursing Economics


EXECUTIVE SUMMARY

* Many breast cancer survivors continue to experience residual symptoms including anxiety, cognitive impairment, depression, fatigue, and pain.

* In this study, the cost-effectiveness of a Mindfulness-Based Stress Reduction intervention for breast cancer survivors was examined.

* The cost of the program was assessed from the societal perspective, accounting for both direct medical and patient opportunity costs.

* The cost per quality-adjusted life year was relatively low compared to the cost-utility findings of other published breast cancer interventions.

* The program appears to provide for significantly improved health-related quality of life at a comparatively low cost.

IN THE UNITED STATES, it is estimated 288,130 new cases of breast cancer will be diagnosed among women each year (American Cancer Society [ACS], 2011). In 2008, approximately 2.6 million breast cancer survivors were living in the United States (Howlader et al., 2011). Current curative cancer treatments are increasingly successful in improving survival rates but may be associated with short-term as well as long-term psychological and physiological effects that significantly reduce health-related quality of life (HRQOL) (Mao et al., 2007). Mao and colleagues (2007) found rates of ongoing pain, psychological distress, and insomnia were significantly higher among cancer survivors than control subjects without cancer. Younger cancer survivors also had higher symptom burden compared to older survivors (Mao et al., 2007).

In 2010, the ACS estimated the 5-year survival rate for patients with breast cancer at 89%; however, many of these survivors continued to experience residual symptoms including anxiety, cognitive impairment, depression, fatigue, and pain (Brem & Kumar, 2011). Many breast cancer survivors reported severe physical and mental health disturbances after treatment including symptoms such as depression, anxiety, sleep disturbances, pain, and fatigue (Byar, Berger, Bakken, & Cetak, 2006; Kenefick, 2006).

A study of 139 breast cancer survivors found the most often reported symptom was fatigue and the most severe symptom reported was muscle ache (Fu et al., 2009). The results were complemented by those of other studies which found 15% of survivors suffered from depression and anxiety after 1 year (Burgess et al., 2005); 60%90% still had persistent fatigue up to 5 years after the completion of treatment (Cella, Davis, Breitbart, & Curt, 2001); 21% had residual cognitive impairment 9 months after treatment completion (Weis, Poppelreuter, & Bartsch, 2009); and 21% never recovered from postsurgical pain, numbness, and/ or loss of strength. The 15-year survival rate of breast cancer is 75% (ACS, 2010).

Symptoms that persist after treatment ends may result in increased utilization of health care services (more frequent visits to primary care practitioners or emergency department or higher use of medications to treat persistent psychological or physical symptoms) and loss of work productivity due to increased absenteeism, all of which may result in overall higher societal costs (Carlson & Bultz, 2004). Due to increased rates of survivorship and the subsequent increase in those suffering from treatment-related symptoms, more focus has been placed on psychosocial interventions aimed at improving psychological and physical symptoms (Brem & Kumar, 2011). Many of these interventions have been efficacious in reducing symptoms such as distress, depression, sleep disturbance, and diminished HRQOL (Brem & Kumar, 2011).

The success of these psychosocial interventions in improving both psychological and physical symptoms may indirectly lead to potential cost savings; however, only a few oncology studies of psychosocial interventions have conducted formal cost-effectiveness analyses (Gordon et al., 2005; Lemieux, Topp, Chappell, Ennis, & Goodwin, 2006; Mandelblatt et al. …

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