The study determined the efficacy of MBSR in improving female sexual function, anxiety, stress, everyday activity, and vasomotor function among women with breast cancer. However, MBSR yielded no improvement with respect to depression.
Approximately 50%-75% of women diagnosed with breast cancer experience sexual difficulties; of those treated with aromatase inhibitors, as many as 79% develop new sexual problems, and nearly 25% stop sexual activity [21–23]. In addition, patients with breast cancer can experience a reduced quality of life because of side effects or psychological problems after treatment. Therefore, we hypothesized an immediate increase in the level of female sexual function from pre- to post-MBSR intervention. Our finding indicated that MBSR intervention improves female sexual function, especially in their relationship with their partner and in their overall sexual satisfaction. Previous study analyzed data from three databases (EBSCO, PubMed, and ResearchGate) and the findings of 15 original research articles; the results demonstrated that MBSR can be effectively used to treat female sexual dysfunction, especially with regard to sexual arousal and satisfaction, and to reduce sexual dysfunction related to anxiety and negative cognitive patterns . Studies have determined that MBSR can improve anxiety and stress, self-esteem, sexual relationships, and sexual satisfaction in women , which is consistent with the present study’s findings.
Because no significant improvement in depression was noted, a long-term intervention for depression is likely warranted. Nonetheless the MBSR intervention was unlikely to be effective in all aspects over the short duration of 6 weeks. Würtzen conducted a study with 336 women (stages I–III) who had undergone breast cancer surgery, randomly assigning them to a routine care or mindfulness intervention group and using intention-to-treat analysis. Patients participated in 6 consecutive weeks of mindfulness intervention; depression did not significantly improve during the posttest (p = .07) but did at the 6 months (p = .01) and 12 months (p = .03) of follow-up . Following MBSR intervention, improvement was noted only in everyday activity and not in the other four items of the EQ-5D. Kanter et al. (2016) determined no difference in the quality of life between an MBSR group and a control group , which may be attributable to the short follow-up period of the study or to the small sample size. The EQ-5D questionnaire must be administered to patients with serious diseases and who face restrictions in their activity to ensure more meaningful results.
Traditional MBSR courses last for 8 weeks and can effectively improve quality of life [27–29] and anxiety . However, some studies have indicated that 6 weeks of intervention can also improve quality of life and reduce depression . Demarzo et al. (2017) compared an 8-week mindfulness-based intervention with its 4-week counterpart. The intervention was demonstrated to be effective relative to the control, and the effect sizes of the 4- and 8-week courses were similar findings . Braden et al. (2016) analyzed the effectiveness of a 4-weeks MBSR intervention (n = 12) against a control that involved only reading as a means to reduce stress (n = 11). Studies have shown that 4-week MBSR treatment can alleviate symptoms of low back pain and improve emotional awareness in the frontal lobe and that its 8-week counterpart can yield improvements in depression, anxiety, and cognition. Therefore, improvements in perceived pain are achievable with short-term MBSR intervention, but depression and anxiety may require long-term MBSR . Our study limited the intervention to 6 weeks to better ensure that the study did not inconvenience the participants and to thus encourage their continued participation. Nonetheless, 6 weeks may have been overly short for the intervention to yield improvements in all aspects. Future studies should investigate the effects of course duration or adopt an intervention with a longer duration.
MBSR can improve the mental health of patients with breast cancer, as indicated by the GCS. Climacteric syndrome in patients with breast cancer is usually caused by chemotherapy and hormone therapy . Up to 85% of women with climacteric syndrome have vasomotor symptoms (i.e., hot flashes and night sweats), 60% report vaginal discomfort (i.e., vaginal dryness and dyspareunia), and 86.5% report sexual dysfunction (such as a lack of libido and difficulty in reaching orgasm) [33, 34]. Among the patients in this study, 13 (21.7%) received chemotherapy and 26 received hormonal therapy (43.3%). An improvement in overall climacteric symptoms in the vasomotor domain was noted following MBSR intervention. This finding is consistent with those of a study involving a randomized trial of 110 postmenopausal and early postmenopausal women who experienced an average of ≥ 5 moderate or severe hot flashes (including night sweats) per day. Additionally, in the vasomotor domain of the GCS scale, the total scores were lower for the MBSR group than the routine care group; this may be because the postmenopausal stage and transition to menopause can induce vasomotor symptoms in younger women .
The quantitative results were consistent with the findings of the qualitative interviews. For example, one patient who participated in this course narrated their experience as follows: “I have symptoms such as hot flashes, night sweats, and frequent urination after taking hormonal drugs. I also feel particularly tired the next day. After doing an MBSR session, I felt an unprecedented peace of mind. When I do mindful breathing and body scanning, I can fall asleep quickly, and I can even sleep until dawn.” As indicated in the statistical analysis and the qualitative responses in the questionnaires, patients with breast cancer were prone to having trouble sleeping and experiencing pain after receiving treatment; sleep and pain can thus be measured independently in future studies. Data from both subjective (e.g., self-reports) and objective (e.g., wearable devices, functional magnetic resonance imaging) sources can be used to establish more specific patterns of how patients sleep and experience pain.
In general, MBSR alleviated the serious problems this study’s participants faced with their physical and mental health. Thus, MBSR can be incorporated into alternative therapies.
Studies have rarely discussed the improvement of female sexual function in breast cancer patients through MBSR intervention and have predominantly considered sexual function to be an unimportant aspect of an individual’s quality of life. The main strengths of our study were that female sexual function was regarded as a vital part of quality of life, and that MBSR intervention was demonstrated to improve sexual function and mental health. MBSR is a nonpharmacologic therapy, and it is safe, accessible, and simple to practice for patients with breast cancer. In the future, MBSR intervention can be used in clinical care and established as part of standard care procedures. However, the limitations of our study must also be acknowledged. Further studies should use random assignment for more robust findings. Mindfulness can be implemented anytime and anywhere and becomes more beneficial with practice; therefore, research tools can incorporate a mobile app to build courses, record information, and provide mindfulness videos to encourage participants to keep up their mindfulness practice. This study was conducted during the COVID-19 pandemic, and patients wore protective facemasks during every session. Should other public health crises occur in the future, research interventions can employ distance learning methods. Because of the ease and convenience of course participation, a larger sample can be used in future studies to ensure greater representativeness.