PURPOSE: Cancers of the head and neck (H&N) are associated with a complex array of unique stressors for patients in the diagnostic, treatment, and even survivorship stages. These patients are at higher risk for psychosocial issues, including anxiety and depression. Mindfulness-based stress reduction interventions teach strategies to increase self-regulated attention to the present moment and cultivation of nonjudgmental attitudes. Such interventions have proven beneficial in reducing distress, and improving quality of life and disease outcomes among patients with cancer. In order to tailor behavioral interventions for this subset of cancer patients, it is important to evaluate their pre-existing, or “trait” levels of mindfulness. It is possible that trait mindfulness may serve a protective role in patients with cancer by attenuating psychological distress. In this pilot study, we hypothesized that patients who report higher levels of trait mindfulness would report lower levels of anxiety and depression, present at an earlier stage of disease, have less pain, and be less likely to use tobacco.
METHODS: Patients presenting to a Multidisciplinary H&N Cancer Clinic for treatment planning (N=33) completed psychometrics on innate mindfulness (CAMS-R) and symptoms of anxiety (GAD-7) and depression (PHQ-9). Preliminary bivariate correlations were performed to explore relationships between trait mindfulness and psychological and clinical characteristics.
RESULTS: Patients (61% male, mean age = 59) presented primarily with advanced stage (72% Stage III or higher) cancers of oral, oropharyngeal, laryngeal or other origin. The average patient reported mild levels of anxiety and depression, and relatively high levels of trait mindfulness (CAMS-R mean = 31; scores range from 10 - 40). Higher trait mindfulness was related to lower reports of anxiety (r = -.411, p = .033), but not depression. Trait mindfulness was not associated with stage of disease on presentation, age, pain rating, or pack-years of tobacco use. Interestingly, though prior research suggests the presence of gender differences in trait mindfulness, no differences between men (mean score = 30) and women (mean score = 31) were observed in this sample.
CONCLUSIONS: In a pilot sample of H&N cancer patients, those presenting with higher trait mindfulness endorsed fewer symptoms of anxiety near the time of diagnosis. We did not observe significant relationships between mindfulness and depressive symptoms, stage of disease, age, pain ratings, or pack-years. This suggests the potential for trait levels of mindfulness to assist in lessening experiences of psychological distress, particularly anxiety, after the diagnosis of H&N cancer. This preliminary study facilitates the development of future behavioral interventions for H&N cancer patients, which may include strategies that enhance existing mindfulness skills or other complementary coping methods. Ongoing research with a larger sample will further examine trait mindfulness to better understand its influence on psychological and treatment outcomes among H&N cancer patients. Funding support provided by a University of Louisville Multidisciplinary Research Grant.