Mindfulness-Based Stress Reduction in Relation to Quality of Life, Mood, Symptoms of Stress, and Immune Parameters in Breast and Prostate Cancer Outpatients LINDA E. CARLSON,PHD, MICHAEL SPECA,PSYD, KAMALA D. PATEL,PHD, AND EILEEN GOODEY, MSW Objectives: This study investigated the relationships between a mindfulness-based stress reduction meditation program for early stage breast and prostate cancer patients and quality of life, mood states, stress symptoms, lymphocyte counts, and cytokine production. Methods: Forty-nine patients with breast cancer and 10 with prostate cancer participated in an 8-week MBSR program that incorporated relaxation, meditation, gentle yoga, and daily home practice. Demographic and health behavior variables, quality of life (EORTC QLQ C-30), mood (POMS), stress (SOSI), and counts of NK, NKT, B, T total, T helper, and T cytotoxic cells, as well as NK and T cell production of TNF, IFN-, IL-4, and IL-10 were assessed pre- and postintervention. Results: Fifty-nine and 42 patients were assessed pre- and postintervention, respectively. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality. Although there were no significant changes in the overall number of lymphocytes or cell subsets, T cell production of IL-4 increased and IFN- decreased, whereas NK cell production of IL-10 decreased. These results are consistent with a shift in immune profile from one associated with depressive symptoms to a more normal profile. Conclusions: MBSR participation was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients. This study is also the first to show changes in cancer-related cytokine production associated with program participation. Key words: psychoneuroimmunology (PNI), meditation, cancer, stress, quality of life, lymphocytes, cytokines. ANOVA = analysis of variance; EORTC-QLQ-C30 = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; FBS = fetal bovine serum; IFN- = interferon gamma; IL = interleukin; MBSR = mindfulness-based stress reduc- tion; NK = natural killer; PBS = phosphate-buffered saline; PI = principal investigator; PMA = phorbol 12-myristate 13-acetate; POMS = Profile of Mood States; PTSD = posttraumatic stress disorder; QL = quality of life; RA = research assistant; RBC = red blood cells; SOSI = Symptoms of Stress Inventory; TNF = tumor necrosis factor; WBC = white blood cells. INTRODUCTION R ecently, there has been a growth of clinical treatment and wellness programs based on mindfulness meditation and yoga modeled after the mindfulness-based stress reduction (MBSR) program of Jon Kabat-Zinn and colleagues (1) at the Stress Reduction Clinic of the University of Massachusetts Medical Center. Since their initial inception in 1979, there are now over 240 such programs across North America. MBSR is rooted in the contemplative spiritual traditions in which the experience of conscious awareness is actively cul- tivated. Within a framework of nonjudging, acceptance, and patience, meditative practice often focuses awareness on the breath leading to a state of relaxation and observant detach- ment. The body of research investigating MBSR’s efficacy for the treatment of health problems has also grown. Studies have shown its efficacy for problems as varied as chronic pain (2, 3) anxiety disorders (4, 5), fibromyalgia (6, 7), epilepsy (8), psoriasis (9), and hypertension (10). Enhancement of health- related quality of life with improved vitality, less bodily pain, fewer role limitations caused by physical health, greater social functioning, and decreased anxiety and depression have been shown recently in a group of mixed diagnosis medical patients (11). It seemed logical, therefore, to offer the MBSR program to patients diagnosed with cancer, as emotional distress after receipt of a cancer diagnosis is common (12–14). Within the population of cancer patients, there is a growing interest in mind-body medicine and complementary and alternative ther- apies as well as a desire to be proactive and take initiative in personal care (15, 16). When asked about the cause of their breast cancer, a Canadian sample of women cited “stress” above other possible causal factors such as genetics, diet, and environmental factors (17). Thus, the MBSR program pro- vides not only an efficacious treatment for distress, but fits with the patients’ own framework of positive health behavior. Our initial work with MBSR showed improvements in symp- toms of stress and mood disturbance in a mixed group of cancer patients (18, 19). In addition to the demonstrated psychological benefits of the MBSR program, the practice of meditation has been as- sociated with immunological effects. Solberg (20) found that meditation may modify the suppressive influence of strenuous physical stress on the immune system in male athletes. A randomized study of relaxation, meditation, and hypnosis training in asymptomatic HIV-positive men found improved T cell counts in the treatment group which were maintained at a 1-month follow-up (21). QiGong training, a Chinese energy system that combines meditative techniques with other prac- tices, was associated with elevation in CD4 T cells and a higher CD4/CD8 cell ratio in a group of healthy practitioners compared with healthy controls (22). Many studies have shown that cancer patients have com- promised immune function (23), and immune factors have been used to predict disease progression. Levy et al. (24) found that less distress on the Profile Of Mood States pre- dicted a longer disease-free interval in breast cancer patients, but lower natural killer (NK) cell activity predicted recur- rence. In a group of breast cancer patients who had recently From the Department Psychosocial Resources, Tom Baker Cancer Centre (L.E.C., M.S., E.G.), Calgary, Alberta, Canada; and the Departments of Oncology (L.E.C., M.S.) and Physiology and Biophysics (K.D.P.), Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. Address reprint requests to: Linda E. Carlson, PhD, Department of Psy- chosocial Resources, Tom Baker Cancer Centre, 1331 29th Street NW, Calgary, Alberta, Canada T2N 4N2. Email: lcarlso@ucalgary.ca Received for publication January 23, 2002; revision received August 5, 2002. DOI: 10.1097/01.PSY.0000074003.35911.41 571 Psychosomatic Medicine 65:571–581 (2003) 0033-3174/03/6504-0571 Copyright © 2003 by the American Psychosomatic Society