Papers by Linda E Carlson
Mindfulness, 2020
Objectives Mindfulness-based cancer recovery (MBCR) is a mindfulness-based intervention (MBI) evi... more Objectives Mindfulness-based cancer recovery (MBCR) is a mindfulness-based intervention (MBI) evidenced to improve the psychosocial well-being of cancer survivors. Like many MBI group programs, there is typically attrition of 20-30% of participants who initially register for the program. Understanding the barriers to participation in and completion of MBCR may highlight potential avenues to improve uptake and adherence to MBIs, which would help more survivors benefit from MBCR. Methods The present study included: (1) quantitative analysis of barriers to practice; (2) qualitative analysis of survivors' perceived barriers to participation, and; (3) qualitative analysis of MBCR instructors' perceptions of barriers to participation. Results Most survivors reported relatively low levels of barriers and tended to report similar types of barriers, but those who dropped out were twice as likely to report experiencing barriers "daily" than those who did not drop out. In interviews, survivors' reported barriers fell into four themes that were practical, person-related, cancer-related, and program-related. Instructors identified themes of practical barriers, there being a "right time", participant attitudes, and the group setting as factors that influenced participation. Conclusions Barriers are ubiquitous and those who eventually dropped out did not appear to experience distinct barriers, just more of them. In light of this, broad strategies that might help facilitate the participation of all survivors in MBCR and other MBIs are discussed.
Reducing Mind-Wandering Through the Development of Mindfulness and Meta-Awareness
This was a poster presentation made at the Mind and Life Institute Summer Research Conference in ... more This was a poster presentation made at the Mind and Life Institute Summer Research Conference in 2008. The research question explored was whether eight weeks of Mindfulness-Based Stress Reduction Training impacted mind-wandering while reading.
Mindfulness-Based Stress Reduction for Medical Conditions
Biopsychosocial Factors of Stress, and Mindfulness for Stress Reduction
Health and Quality of Life Outcomes, Apr 17, 2003
The burden of cancer in the worldwide context continues to grow, with an increasing number of new... more The burden of cancer in the worldwide context continues to grow, with an increasing number of new cases and deaths each year. A significant proportion of cancer patients at all stages of the disease trajectory will suffer social, emotional and psychological distress as a result of cancer diagnosis and treatment. Psychosocial interventions have proven efficacious for helping patients and families confront the many issues that arise during this difficult time. This paper reviews the literature detailing the extent of distress in patients, the staffing needed to treat such levels of distress, and the efficacy of psychosocial treatments for cancer patients. This is followed by a summary of the literature on medical cost offset in mental health, other medical populations, and in cancer patients, which supports the notion that psychosocial interventions are not only effective, but also economical. Conclusions support taking a whole-person approach, as advocated by a growing number of heal...
eCALM Trial-eTherapy for cancer appLying mindfulness: online mindfulness-based cancer Method/desi... more eCALM Trial-eTherapy for cancer appLying mindfulness: online mindfulness-based cancer Method/design: The study includes cancer patients in Alberta, exhibiting moderate distress, who do not have access to F2F MBCR. Participants will be randomized to either online MBCR, or waiting for the next available group. Zernicke et al. BMC Complementary and Alternative Medicine 2013, 13:34
Distress
Handbook of Cancer Survivorship
Health and Quality of Life Outcomes
Background An increasing number of gastrointestinal cancer (GI) patients suffer from side effects... more Background An increasing number of gastrointestinal cancer (GI) patients suffer from side effects of cancer treatment that can affect their mood states and quality of life. Despite its demonstrated effectiveness in female cancer patients, Supportive Expressive Group Therapy (SEGT) has not been tested in male cancer patients. The current study sought to examine the longitudinal effects of a professionally-led, men-only SEGT on mood states, coping, and quality of life (QoL) in male GI cancer patients. Methods A sample of male GI cancer patients (n = 31), at different stages of cancer treatment, was recruited from an ongoing, men-only biweekly GI cancer SEGT. Data were collected at baseline (before or near the beginning of group attendance) and at three months and six months follow-up. All study outcomes were patient-reported and included socio-demographic data as well as validated questionnaires: Profile of Mood States (POMS) for mood states, Functional Assessment of Cancer Therapy-Ge...
Supportive Care in Cancer
Goal To determine patient-reported financial and family burden associated with treatment of cance... more Goal To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. Methods A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and “other” costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. Results Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772),...
BMC Research Notes
Objective To examine the factors associated with loss to follow-up (LTFU) in an ongoing preferenc... more Objective To examine the factors associated with loss to follow-up (LTFU) in an ongoing preference-based randomized waitlist controlled trial of mindfulness-based cancer recovery (MBCR) and Taichi/Qigong (TCQ) for cancer survivors (the MATCH Study). Hierarchical logistic regression was used to determine the factors associated with LTFU. Predictors included adherence to treatment, preference vs. randomized, type of intervention (MBCR vs. TCQ) and program timing (immediate {IM} vs. waitlist control {WLC} group). Results Data indicated that randomization to the WLC group and, once in the intervention, low adherence were the main predictors of LTFU. Participants in the WLC group were 4 times more likely to be LTFU post-randomization [OR 3.96, 95% CI 2.08–7.56, p
Current Oncology
A growing number of cancer patients use complementary and alternative therapies during and after ... more A growing number of cancer patients use complementary and alternative therapies during and after conventional cancer treatment. Patients are often reluctant to discuss these therapies with their oncologist, and oncologists may have limited knowledge and confidence on how to advise patients on the appropriate use. Integrative oncology is a patient-centered, evidence-informed field that utilizes mind–body practices, lifestyle modifications and/or natural products interwoven with conventional cancer treatment. It prioritizes safety and best available evidence to offer appropriate interventions alongside conventional care. There are few opportunities for oncologists to learn about integrative oncology. In this commentary, we highlight the Integrative Oncology Scholars (IOS) program as a means to increase competency in this growing field. We provide an overview of several integrative oncology modalities that are taught through this program, including lifestyle modifications, physical act...
Journal of Clinical Medicine
Lower-extremity lymphedema (LEL) is a progressive, lifelong complication of cancer that places a ... more Lower-extremity lymphedema (LEL) is a progressive, lifelong complication of cancer that places a substantial burden upon cancer survivors’ quality of life (QOL) and psychosocial well-being. Despite its prevalence, cancer-related LEL is inconsistently diagnosed, treated, and poorly recognized by health care professionals. The purpose of this systematic review was to summarize and appraise the quantitative literature evaluating the impact of cancer-related LEL on patients’ psychosocial well-being and QOL. Three databases (PubMed, PROQuest, and Scopus) were searched for observational research articles published before May 1st, 2020. Twenty-one articles were eligible (cross-sectional (n = 16), prospective cohort designs (n = 3), and retrospective cohort designs (n = 2)). The majority of studies reported a negative relationship between cancer-related LEL and global QOL and/or one or more psychosocial domains including (1) physical and functional; (2) psycho-emotional; (3) social, relatio...
Current Oncology
Background Limited research has been conducted about the perspectives of oncology health care pro... more Background Limited research has been conducted about the perspectives of oncology health care providers (hcps) concerning the use of cannabis in cancer care and their potential role in advising patients. We sought to determine the barriers encountered by hcps with respect to medical cannabis and their preferred practices in this area. Methods An anonymous survey about cannabis was distributed to oncology hcps at the Tom Baker Cancer Centre in Calgary, Alberta. The 45-question survey measured the opinions of hcps about cannabis use and authorization in oncology. Results Of 103 oncology hcps who participated in the study, 75% were women. By hcp type, the most commonly reported professional groups were oncology nurse (40%), radiation therapist (9%), and pharmacist 6%); and 75% reported providing direct care to cancer patients. More than half (69%) had spoken to a patient about cannabis in the preceding month, and 84% believed that they lacked sufficient knowledge about cannabis to make...
Uptake of mindfulness-based interventions: A phenomenon of wealthy white western women?
Clinical Psychology: Science and Practice
The article in this issue entitled “Dissemination before Evidence” by Michalek and Heidenreich (2... more The article in this issue entitled “Dissemination before Evidence” by Michalek and Heidenreich (2018) muses about the driving forces behind the wide dissemination of mindfulness‐based interventions in society, beyond the influence of the scientific evidence base of efficacy and effectiveness. The authors consider supporting factors including the development of a solid neuroscience of meditation, growing acceptance of Buddhism in Western culture, our fast‐ paced technology‐driven society which contributes to high levels of stress and mental health problems, the fit of mindfulness within both traditional spiritual traditions and atheistic viewpoints, and the novelty factor of mindfulness within a well‐established psychotherapeutic culture of cognitive‐behavioral therapy. Although I agree with these assessments (some more than others), I am pleased to be invited to add additional points to the conversation that may help to deepen our understanding of the societal factors supporting this interest in mindfulness, and point to useful directions for future research. I believe I am qualified to provide this commentary on several fronts. First, I am a clinical psychologist trained in MBI delivery and have been leading MBI groups for over 20 years; I am also an active research scientist in this area, within my academic specialty of behavioral medicine and specifically psychosocial oncology; finally, I also personally practice mindfulness meditation and have done so for over 25 years. Hence, I have both taught mindfulness programs to thousands of people with cancer and their support persons, and rigorously studied the effects of these programs on a wide range of patient‐reported outcomes and well as biomarkers of health. Although some may contend that this makes me favorably biased toward MBIs and their dissemination, I would suggest it has given me a vast array of lived experience in this realm (both positive and negative) that may be worth sharing. Within these roles, I have seen the development of the field from the perspectives of the clinician, the patient, the research community, and as a meditation practitioner. I would agree that many of the features described by Michalek and Heidenreich (2018) likely play a part, but would also like to introduce a few other factors to the conversation they did not emphasize. First, we need to further address the issue of dissemination, versus what I might call “uptake,” which has implications for the role of media and lay people as primary drivers, rather than clinical scientists. I would also contend that this is largely a movement of wealthy, white, western women, both as participants in MBIs, but also through their role in the media. It may not seem this way at first glance, as many of the pivotal and charismatic leaders of the movement are men (as are many of the researchers), but the bulk of the study participants, the mindfulness instructors, and the people in society taking up mindfulness practices are largely female, and this also has implications for understanding uptake. At last, the issue of terminology and the role of the media are important, as
Integrative Approaches to Stress Management
The Cancer Journal
This narrative review provides an overview of the scope of psychosocial distress and stress in ca... more This narrative review provides an overview of the scope of psychosocial distress and stress in cancer patients and survivors and the potential negative consequences of untreated symptoms. Evidence-based interventions to treat these symptoms are reviewed, beginning with a summary of published clinical practice guidelines, followed by more detailed reviews of the specific integrative interventions with the largest empirical support: cognitive-behavioral stress management, yoga, mindfulness-based interventions, and massage. We also comment on use of natural health products because of their popularity. Finally, we conclude with recommendations to improve the quality of research in integrative interventions for stress management.
The ONE‐MIND Study: Rationale and protocol for assessing the effects of ONlinE MINDfulness‐based cancer recovery for the prevention of fatigue and other common side effects during chemotherapy
European Journal of Cancer Care
Cancer patients often experience poor quality of life (QoL) during chemotherapy (CT) treatments d... more Cancer patients often experience poor quality of life (QoL) during chemotherapy (CT) treatments due to side effects including fatigue, insomnia, pain and nausea/vomiting. Mindfulness-based cancer recovery (MBCR) is an evidence-based intervention for treating such symptoms, but has not been investigated as an adjunctive treatment during CT. This study aims to determine the efficacy of an online group MBCR programme delivered during CT in 12 real-time interactive weekly sessions for managing fatigue (primary outcome). Secondary outcomes include sleep disturbance, pain, nausea/vomiting, mood, stress and QoL. Exploratory outcomes include cognitive function, white blood cell counts and return to work. The study is a two-armed randomised controlled waitlist trial with 2:1 allocation to treatment (online group MBCR during CT) or control (waitlist usual care; online MBCR following CT completion) with a target sample size of N = 178. Participants are breast or colorectal cancer patients undergoing common CT regimens in Calgary, Canada. Online assessments using validated self-reported instruments will take place at baseline, post-MBCR, post-CT and 12 months' post-baseline. If online MBCR delivered during CT significantly reduces fatigue in cancer patients' post-CT and also impacts secondary symptoms, this would provide evidence for including mindfulness training as an adjunctive symptom management therapy during CT.
Integrative Oncology Trials in the Real World: Assessing the Pragmatism of an Ongoing Integrative Oncology Trial of Mindfulness and T'ai Chi/Qigong
Journal of alternative and complementary medicine (New York, N.Y.)
The aim of this study was to highlight features of pragmatic real-world integrative oncology rese... more The aim of this study was to highlight features of pragmatic real-world integrative oncology research by applying the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) criteria to an ongoing integrative oncology clinical trial. The ongoing trial is a preference-based randomized comparative effectiveness trial of mindfulness-based cancer recovery (MBCR) versus t'ai chi/qigong (TCQ) for cancer survivors (the Mindfulness and T'ai Chi for Cancer Health [MATCH] study). The primary outcome of the MATCH study is distress, and secondary outcomes are quality of life, sleep disturbance, and physical functioning. The clinical trial is being undertaken at tertiary care cancer centers across two sites in Canada: Calgary (AB) and Toronto (ON), with a sample of 600 cancer survivors who have finished all cancer treatments and are distressed. The MATCH trial was scored on the explanatory-pragmatic continuum for each of the nine domains of the PRECIS-2 criteria on a scale of 1-5, a...
The Role of Hypnosis in Cancer Care
Current Oncology Reports
This paper reviews the current evidence-base for the use of hypnosis as an adjunct treatment for ... more This paper reviews the current evidence-base for the use of hypnosis as an adjunct treatment for common cancer-related symptoms and side effects, including those experienced during treatment, as well as long-term and late effects. First, a general description and history of medical hypnosis in cancer care is provided, followed by a review of the latest evidence across a range of common symptoms. The evidence suggests that hypnosis may help treat symptoms of nausea and vomiting in breast cancer patients, manage pain in a variety of contexts, and also reduce levels of anxiety and overall distress around surgical and medical procedures, both in children and adults. Emerging research shows promise for treating hot flashes in women with breast cancer. The research in this area would benefit from assessing populations beyond women with breast cancer, including late-stage disease, using more rigorous study designs, following published reporting guidelines and better describing and standardizing interventions.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 10, 2018
Purpose Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate psychological dist... more Purpose Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate psychological distress in patients with cancer. However, patients experience barriers to participating in face-to-face MBCT. Individual Internet-based MBCT (eMBCT) could be an alternative. The study aim was to compare MBCT and eMBCT with treatment as usual (TAU) for psychological distress in patients with cancer. Patients and Methods We obtained ethical and safety approval to include 245 patients with cancer with psychological distress (≥ 11 on the Hospital Anxiety and Depression Scale) in the study. They were randomly allocated to MBCT (n = 77), eMBCT (n = 90), or TAU (n = 78). Patients completed baseline (T0) and postintervention (T1) assessments. The primary outcome was psychological distress on the Hospital Anxiety and Depression Scale. Secondary outcomes were psychiatric diagnosis, fear of cancer recurrence, rumination, health-related quality of life, mindfulness skills, and positive mental health. C...
Integrative cancer therapies, 2018
Many cancer survivors seek complementary therapies (CTs) to improve their quality of life. While ... more Many cancer survivors seek complementary therapies (CTs) to improve their quality of life. While it is well-known that women who are younger, more highly educated, and have higher incomes are more likely to use CTs, individual differences such as personality factors have been largely unexplored as predictors of CT use. In a secondary analysis of a larger study, 270 women with stage I to III breast cancer completed self-report measures of demographic and illness-related information, personality variables, and use of several different types of CTs. A series of logistic regression models were used to explore whether demographic, illness-related, and personality variables predicted different types of CT use. Prior relationships between education and CT use were replicated. There were no significant relationships between illness-related variables and different types of CT use. Of the 5 personality factors, only openness to experience was a significant predictor of multiple types of CT us...
Integrative cancer therapies, Sep 1, 2018
Cancer survivors use complementary therapies (CTs) for a variety of reasons; however, with intere... more Cancer survivors use complementary therapies (CTs) for a variety of reasons; however, with interest and use reportedly on the rise and a widening range of products and practices available, there is a need to establish trends in and drivers of interest. We aimed to determine (1) frequencies of use, level of interest, and barriers for 30 specific CTs and (2) whether physical symptoms, perceived stress (PS), or spiritual well-being were related to interest levels. A total of 212 cancer outpatients were surveyed at the Tom Baker Cancer Centre in Calgary, Canada. Overall, up to 75% of survivors already used some form of CTs since their diagnosis. The most highly used were the following: vitamins B12 and D, multivitamins, calcium, and breathing and relaxation exercises. Those who had not used CTs indicated highest interest in massage, vitamin B12, breathing and relaxation, mindfulness-based stress reduction, and antioxidants. The most frequently reported barriers for all CTs were not know...
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Papers by Linda E Carlson