TABLE 1.
Design and main characteristics of the 40 studies
| First author year, country | Study design | Sample size (N); population | Intervention; N | Control, N | Time point/duration of intervention | Mean age | Women (%) | Follow‐up assessments (excluding baseline) | Funding sources | Comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Adair 2018, USA | Parallel pilot RCT | 40; head and neck cancer survivors | Hatha yoga; 20 | WL; 20 | >3 months post–cancer treatment/8 weeks | I: 65.0 (7.4); C: 61.8 (9.2) years | I: 26.7; C: 45.0 | 4 weeks | Private (non‐profit) institutions | VHNSS and BPI: see references |
| 8 weeks | ||||||||||
| Aguado 2012, USA | Parallel RCT | 221; newly diagnosed with cancer, scheduled to receive ≥4 cycles of intravenous CT | SSMT, including PMR and GIs; 109 | UCO; 111 | During chemotherapy; baseline visit (before chemotherapy cycle 1), then follow‐up visits 1, 2, and 3 | SSMT: Mean (SD) 57.5 (11.9); UCO 56.2 (12.0) | 73 in SSMT, 86 in UCO | Follow‐up visits: | Public | N = 220 after randomization |
| V1: before CT cycle 2 | ||||||||||
| V2: before CT cycle 3 | ||||||||||
| V3: before CT cycle 4 | ||||||||||
| Anderson 2006, USA | Parallel RCT | 57; patients with chronic cancer pain taking opioid medications | 1) relaxation; 16 | WL; 14 | Excluded if receiving pain‐modifying therapy (e.g., RT) or major surgery, or blood or BMT in past 30 days/2 weeks (practice at home) | 52 years (range 30–80) | 79 | T2: 2–3 weeks | Public | Only relaxation is really a mind–body intervention |
| 2) distraction; 13 | T3: 4–5 weeks | |||||||||
| 3) positive mood; 16 | T4: 8–9 weeks after baseline | |||||||||
| Bower 2015, USA | Parallel RCT | 71; early‐stage (0–III) BC, age ≤ 50 | Mindful awareness practices; 39 | WL; 32 | Cancer treatment completed/6 weeks | Mean: I: 46.1; C: 47.7 years | 100 | Post‐intervention | Public and private | Participants recruited from an earlier study (Ventura 2013) |
| 3‐month follow‐up (3 months after intervention) | ||||||||||
| Butler 2009, USA | Parallel RCT | 125; metastatic or locally recurrent BC | Group therapy with hypnosis plus education; 63 | Education‐only; 61 | 90‐min sessions for several times a day, duration 1 year | Mean (SD) I: 52.7 (10.5) years C: 53.1 (10.8) | 100 | Every 4 months for the first year and every 6 months thereafter | Public and private | Double intervention (supportive‐expressive therapy plus hypnosis) |
| Charalambous 2016, Cyprus | Parallel RCT | 236; (a) BC (T3N1M0) or prostate cancer (clinical stage T3a, Gleason score ≥ 8), (b) receiving chemotherapy, (c) experience of fatigue, pain, nausea and vomiting, anxiety, depression | GI and PMR; 120 | UC; 116 | 4 weekly supervised and daily unsupervised sessions of GI and PMR/4 weeks | Majority of participants: In 51–60 years age group (I: 41.3% and C: 36.5%). | 50 | Post‐intervention (4 weeks) | Public and private | No follow‐up after end of intervention; inability to blind patients (risk of placebo effect) |
| Chen 2015, Taiwan | Parallel RCT | 65; BC | Relaxation with GI; 32 after 1 exclusion | UC; 33 | 7 days after chemotherapy; inclusion criterion: received cyclophosphamide, epirubicin, and 5‐fluoro‐uracil chemotherapy for the first time. Each patient received 1 h of relaxation with GI before CT and 20 min daily at home for 7 days after CT (compact disk). Duration 7 days after CT | GI: 49.3 (9.6); C: 52.3 (11.6) years | 100 | Post‐intervention (7 days) | NR | |
| Cramer 2016, Germany | Parallel RCT, bicenter | 54; non‐metastatic colorectal cancer (stages I–III) | Traditional hatha yoga intervention (90 min once weekly); patients encouraged to practice yoga at home daily; 27 | UC; after week 22, offered the same yoga classes; 27 | Between 2 and 48 months post‐surgery prior to recruitment/10 weeks | Yoga: Mean 68.70 (9.13); control 67.81 (10.37) years | I: 37; C: 41 | Post‐intervention (10 weeks) | No external funding | Single item on pain in FACT |
| At 22 weeks | ||||||||||
| De Paolis, 2019; Italy | Multicenter parallel RCT | 104 hospice patients with terminal cancer | Single individual PMR–GI sessions of 20 min; 53 | UC; 51 | All patients admitted at least 48 h previously; otherwise NR/20 min | 71.83 (SD 11.57), range 41–99 | 51.92 | 24 h following the intervention | NR | Short intervention and follow‐up |
| Dikmen 2019, Turkey | Parallel RCT, 3 intervention groups | 80 participants with uterine, ovarian, and cervical cancers (grades I–III) | Reflexology (20), PMR (20), or both (20) | NR (probably UC); 20 | Patients treated with the second or third cycle of chemotherapy/8 weeks (16 home visits) | 56.36 (10.61) | 100 | 3rd, 8th, and 12th week | NR | 740 patients randomized, but 140 allocated to 1 of 4 groups |
| Ebell 2008, Germany | RCT, crossover | 32 (61 signed informed consent); routine cancer patients in a multidisciplinary pain unit | Treatment with instructions for self‐hypnosis in addition to pharmacological treatment; 15 | Pharmacological treatment alone; 17 | 4 weeks period 1, 4 weeks period 2 | NR | NR | Post‐intervention (4 weeks) | German cancer Society | Washout impossible with hypnosis |
| (8 weeks) | ||||||||||
| Eyigor 2018, Turkey | Parallel RCT | 42; BC | Hatha yoga 2 × 1 h/week; 22 | UC; 20 | Being free of any recurrent or progressive disease, having completed surgical treatment, RT, and/or CT/10 weeks | I: 52.3 (9.5); | 100 | Post‐intervention (10 weeks) | No external funds | |
| C: 51.5 (7.3) years | After 20 weeks | |||||||||
| Huberty 2019, USA | Parallel RCT | 62 enrolled; 48 completed; myeloproliferative neoplasm patients | Online yoga; 27 | WL; 21 | NR/12 weeks | I: 58.3 (9.3); C: 55.0 (11.4) | 93.8 | Week 7, 12, and 16 | Private | Yoga participation assessed (Clicky) |
| Johannsen 2016, Denmark | Parallel RCT | 129; BC with post‐treatment pain (≥3/10 intensity or burden) | MBCT; 67 | WL; 62 | ≥3 months after surgery, completed CT and/or RT/8 weeks | I: 56.8 (10.0); C: 56.7 (8.1) years | 100 | Post‐intervention | Private | Metastatic BC excluded |
| 3 months, | ||||||||||
| 6 months | ||||||||||
| Johns 2016, USA | Parallel RCT, pilot | 71; breast (n = 60) and colorectal (n = 11) cancer survivors (stages 0–III) with persistent CRF after completing CT and/or RT | MBSR; 35 | PES groups on CRF self‐management; 36 | Excluded if received any cancer treatment (i.e. CT, RT, or surgery) < 3 months or >5 years prior to enrollment/8 weeks | I: 56.9 (9.9); C: 56.4 (12.7) | 90.1 | Post‐intervention | Public and private | |
| 6 months | ||||||||||
| Kenne Sarenmalm 2017, Sweden | Parallel 3‐arm RCT | 177; BC | 1) MBSR (8 weeks self‐instructing MBSR + instructor and weekly group sessions); 62 | Non‐MBSR; 52 | After completion of adjuvant CT and/or RT, with or without endocrine therapy/8 weeks | 57.2 (SD 10.2) | 100 | 1 or 3 months after the intervention | Public + Swedish cancer Society | 11 dropouts after randomization Follow‐ups for MBSR and active controls: 1 month after intervention; similar time points of 3 months for non‐MBSR group |
| 2) active controls (8 weeks self‐instructing MBSR program); 52 | ||||||||||
| Kubo 2019, USA | Parallel RCT | 97 patients with a diagnosis of cancer and 31 caregivers | Mobile/online‐based mindfulness; 54 patients and 17 caregivers | WL; 43 patients and 14 caregivers | Currently receiving or had received chemotherapy, targeted therapies, or immunotherapy in the prior 6 months/8 weeks | I: 59.3 (14.1); C: 56.7 (14.7) patients | I: 62.3; C: 76.7 patients | Post‐intervention | Private | Feasibility study |
| Kumar 2013, India | Parallel RCT | 147, advanced‐stage (IIb–IV) BC | Standard along with Sudarshan Kriyas and Pranayam intervention; 78 | UC; 69 | Completed RT, CT, and surgery, and now in the follow‐up period for pain management/NR | I: 46.8 (9.4); C: 48.2 (9.4) | 100 | 3 months | Public | One 18‐h workshop spread over 3 days |
| 6 months | ||||||||||
| Kwekkeboom 2018, USA | RCT | 164; patients with metastatic or recurrent solid tumor cancer | Brief cognitive‐behavioral strategies intervention: Imagery, relaxation, and distraction exercises; 85 | Attention‐control: listened to cancer education recordings; 79 | Participants receiving outpatient chemotherapy/9 weeks | I: 58.44 (9.89); C: 58.61 (9.03) | I: 72; C: 75 | 3 weeks | Public | Pain, fatigue, and sleep disturbance symptom cluster |
| 6 weeks | ||||||||||
| 9 weeks | ||||||||||
| Kwekkeboom 2012, USA | Parallel RCT, pilot | 86; advanced lung, prostate, colorectal, or gynecological cancer | 12 relaxation, imagery, or distraction exercises delivered via an MP3 player; 43 | WL; 43 | During cancer treatment/2 weeks | I: 60.44 (10.76); C: 60.14 (11.54) | 59 | Post‐intervention | Public | Pain, fatigue, and sleep disturbance symptom cluster in cancer |
| Kwekkeboom 2008, USA | Parallel RCT, pilot crossover | 40; hospitalized patients with cancer‐related pain | Received 2 trials of PMR, 2 trials of analgesic imagery, Order 1 (PMR‐Imagery), n = 24; | Two trials of a control condition; the first trial of each day was always the control trial to prevent any potential carryover effect | Excluded postoperative pain/2‐day period, with subjects receiving 1 control trial and 2 trials of PMR or imagery each day | I (completers, n = 33): M = 46.45, (16.44); C (non‐completers, n = 7): 60.57, (9.61) | 55 | Post‐intervention (2 days) | Public | Not really a control group; design; randomized to the order of interventions |
| Order 2 (Imagery‐PMR), n = 16 | ||||||||||
| Lengacher 2009, USA | Parallel RCT | 84; BC (stages 0–III) | MBSR; 41 | UC; 43 | Within 18 months of treatment completion with surgery and adjuvant RT and/or CT/6 weeks (weekly 2‐h sessions) | 57.5 (SD 9.4) years | 100 | Post‐intervention | Public | |
| Lengacher 2016 a , USA | Parallel RCT | 322; BC (stages 0–III) | MBSR; 167 | UC; 155 | Post‐treatment/2‐h sessions once per week for 6 weeks | 56.6 (SD 9.7) | 100 | Post‐intervention | Public/state funds | Patients completed treatment (2 weeks to 2 years); BC stage IV excluded |
| 12 weeks | ||||||||||
| Lotzke 2016, Germany | Parallel RCT | 92; BC (stages I–III) | Yoga; 45 | Physical exercise; 47 | During (neo)adjuvant therapy/60‐min session over 12 weeks | 51.2 (SD 11.05) | 100 | 6 weeks, | No external funds | Patients undergoing cytotoxic (neo)adjuvant or endocrine adjuvant therapy |
| 25 weeks | ||||||||||
| Mendoza 2017, USA | Crossover RCT | 44; patients diagnosed with cancer (undergoing treatment or after treatment for cancer) | Valencia model of waking hypnosis with CBT; 22 | Education control; 22 | Patients under treatment or cancer survivors/4 sessions of 1 h each | 60.95 (range 29−85) | 89 | Post‐intervention and up to 3 months | Government | |
| Morishima 2019, Japan | Crossover | 56; cancer patients (breast, gastrointestinal, lung, urological, gynecological, and others) aged 40 –64 years | Laughter yoga; 26 | Routine care; 30 | During treatment/1 h every 2 weeks over 7 weeks | Median (interquartile range): 55 (48–61) versus 56 (52–62) | I: 77; C: 73 | Week 7 | Public | |
| Mozafari‐Motlagh 2019, Iran | Parallel RCT | 24; BC patients, > 6 months of diagnosis, stages II‐III | CBT integrated with mindfulness; 12 | Routine care; 12 | During treatment/8 weeks | Unspecific | 100 | Post‐intervention | None | |
| Nooner 2016, USA | Parallel RCT | 12; patients with hematologic malignancies or solid tumors | Relaxation, guided imagery, combined relaxation and guided imagery; 3 (for each group) | UC; 3 | During cancer treatment/60 days | 41 years (range = 27–63) | ≈45 | 1 month | Not reported | |
| 2 months | ||||||||||
| Oh 2008, Australia | Parallel RCT | 30; heterogeneous cancer patients | MQ; 15 | Control (UC); 15 | Unspecific/8 weeks (each session lasted 90 min) | 54 (SD 9, range 35‐75) years | 75 | NR (post‐intervention we assume) | Public university | |
| Peppone 2015, USA | Parallel RCT | 167; BC survivors receiving tamoxifen or aromatase inhibitors | Yoga; 75 | Control; 92 | BC survivors/4 weeks | Mean (standard error) 53.2 (0.86) in the control versus 55.1 (1.24) in the yoga group | 100 | During 1‐week post‐intervention | Public/state funds | No participation in yoga during the previous 3 months |
| Porter 2019, USA | Parallel RCT | 63; women with MBC | Mindful yoga; 43 | Support group; 20 | During treatment for MBC/8 weeks | 56.3 (SD 11.6) in yoga group; 59.4 (SD 11.3) in support group | 100 | Post‐intervention, and 3 and 6 months post‐intervention | Public and private | Pain is a secondary outcome; therefore, study under‐powered. The study was for feasibility and acceptability purposes |
| Rahmani 2014, Iran | Parallel RCT | 24; BC patients | Mindfulness; 12 | Control; 12 | Unspecific/8 sessions of 2 h length, thus 8‐week duration | 43.25 (SD 3.07 in the experimental group vs. 44.08 (SD 3.28) in the control group | 100 | 8 weeks (post‐intervention we assume) | Not reported | |
| Reinhardt 1999, Germany | Pilot parallel RCT | 28; patients with incurable, metastatic tumors of the pancreas, prostate, breast, and stomach with chronic pain | Relaxation therapy; 14 | No training; 14 | Incurable tumors/14 days | NR (range 36‐74 years) | 46 | Post‐intervention (14 days) | NR | |
| Song 2013, China | Parallel RCT | 100; postoperative BC patients | Relaxation techniques; 50 | Control (routine nursing care); 50 | Postoperative/respiratory frequency of 6 times/min or about 15 s each breath/duration NR | 43.6 (SD 12.7, range: 25‐70) years | 100 | NR | NR | |
| Spiegel 1983, USA | Parallel RCT | 54, primary carcinoma of the breast and documented metastases | Self‐hypnosis training; 30 | Control; 24 | 5–10 min of each self‐hypnosis exercise/duration NR | 54 (I); 55 (C) | 100 | Each 4 months for 1 year | Public/state funds | |
| Steindorf 2014, Germany | Parallel RCT | 160; BC (stages 0–III) | Relaxation; 80 | Resistance training; 80 | During adjuvant radiotherapy/60 min twice weekly for 12 weeks | 55.8 (SD 9.1) | 100 | 7 weeks (post‐RT, T1) and at week 13 (T2) | Public/state funds | The control intervention in this study is our intervention of interest |
| Teo 2020, Singapore and USA | Parallel RCT | 34 and 38; BC stage IV | CBT; 19 and 19 | WL group; 15 and 19 | During treatment/8 weeks | 60 or 55 | 100 | Post‐intervention | Public/private | Study in 2 countries |
| Vadiraja 2009; India | Parallel RCT | 88; stages I–III BC patients | Yoga; 44 | Supportive counseling; 44 | During adjuvant RT/at least 1 h 3 times/weekly for 6 weeks | Range 30–70 years | 100 | NR (post‐intervention we assume) | Public/state funds | |
| Vanderbyl 2017, Canada | Crossover RCT | 36; patients with advanced lung and gastrointestinal cancer | MQ; 11 | SET; 13 | Undergoing or eligible for chemotherapy/45‐min group sessions and 1 h every day at home/6 weeks | Mean (SD) MQ 66.1 (11.7), SET 63.7 (7.7) | ≈41.6 | NR, mean follow‐up time 27 months | Public/private Institutions | |
| Yagli 2015, Turkey | Parallel RCT | 20; elderly BC patients | Yoga group; 10 | Exercise group; 10 | During treatment/1 h weekly for 8 weeks | 65–70 years | 100 | NR (post‐intervention we assume) | NR |
Abbreviations: BC, breast cancer; BMT, bone marrow transplantation; BPI, Brief Pain Inventory; C, control group; CBT, cognitive–behavioral therapy; CRF, cancer‐related fatigue; CT, chemotherapy; FACT, Functional Assessment of Cancer Therapy; GI, guided imagery; I, intervention group; MBC, metastatic breast cancer; MBCT, mindfulness‐based cognitive therapy; MBSR, mindfulness‐based stress reduction program; MQ, medical qigong; NR, not reported; PES, psychoeducation/support; PMR, progressive muscle relaxation; RCT, randomized controlled trial; RT, radiotherapy; SD, standard deviation; SET, standard endurance and strength training; SSMT, self‐administered stress management training; UC, usual care; UCO, usual psychosocial care only; VHNSS, The Vanderbilt Head and Neck Symptom Survey; WL, waitlist.
a
Same study: Reich 2017.