For women who undergo risk-reducing salpingo-oophorectomy (RRSO), participating in an 8-week mindfulness-based stress reduction (MBSR) program post-surgery can help reduce postmenopausal symptoms and improve quality of life (QoL).That is the conclusion of a small randomized clinical trial that compared MBSR to standard care in women after RRSO.
Called PURSUE (Psychosexual conseqUences of Risk-reducing Salpingo-oopherectomy in BRCA1/2 mUtation carriErs), the open-label trial specifically looked at the benefit of MBSR after RRSO in a cohort of BRCA1 or BRCA2 mutation carriers. For many of these patients, hormone replacement therapy is contraindicated and nonhormonal options are needed for postmenopausal symptoms.
“A possible non-hormonal alternative could be a psychological intervention that targets perception and acceptance, such as mindfulness-based training,” said lead author CMG van Driel, Department of Obstetrics and Gynecology, University of Groningen, University of Medical Center Groningen, Groningen, the Netherlands. “The goal of such training is to help the patient pay full attention to the present moment in a non-judgmental, accepting way.”
Sixty-six women who had undergone RRSO at the Family Cancer Clinic at the University Medical Center Groningen were enrolled in the study. All were BRCA1 or BRCA2 carriers, had undergone RRSO before age 52, and reported at least two moderate-to-severe postmenopausal symptoms in the 2 weeks prior to study entry. Women were not included if they had undergone cancer treatment at study entry (except for those receiving adjuvant hormonal or immune therapy) or received psychiatric care.
The women were randomized after RRSO to MBSR (n=34) or standard care (CAU) (n=32) for 8 weeks.
Women randomized to an 8-week MBSR course underwent 2.5 hours/week of mindfulness training that included meditation, gentle yoga poses, and body awareness exercises; a silent 4-hour retreat; and a commitment to doing mindfulness exercises for 30 to 45 minutes at home for 6 days a week. Women randomized to CAU received information on lifestyle advice to help reduce symptoms such as hot flashes, night sweats, vaginal dryness, improve sexual functioning, and address cardiovascular and bone health.
Assessment of the primary outcome with the Change in the Menopause-Specific Quality of Life Questionnaire (MENQOL) score showed significant improvements in QoL in the MBSR group compared to the CAU group at 3 months from baseline (mean score of 3.5 vs 3.8, respectively; P= 0.04) and 12 months (3.6 vs 3.9; P= 0.04).
According to the authors, the main symptoms shown to be improved, based on the MENQOL score, were hot flashes, night sweats, general sweating, stamina reduction, aches, and frequent urination.
No statistically significant difference was found between the two groups in sexual functioning or sexual distress based on information obtained from the Female Sexual Function Index and the Female Sexual Distress Scale.
Based on these findings, the authors “recommend that healthcare providers advocate MBSR in conjunction with HRT; however, MBSR may be especially relevant for breast cancer survivors or in other settings when HRT is contraindicated.