MINDFULNESS BASED STRESS REDUCTION FOR BREAST CANCER SURVIVORS (MBSR (BC)): EVALUATING MEDIATORS OF PSYCHOLOGICAL AND PHYSICAL OUTCOMES

Raeed Khaled H.
Hamoush

ABSTRACT

Background:
Breast cancer survivors (BCS) often face persistent psychological and physical challenges post
treatment. Mindfulness Based Stress Reduction (MBSR) has shown promise in alleviating these symptoms, but the
me chanisms underlying its effectiveness remain unclear. This study examined whether mindfulness and fear of
cancer recurrence (FOR) mediate the effects of MBSR for BCS (MBSR [BC]) on psychological and physical
outcomes. Methods: A randomized controlled trial (RCT) was conducted with 160 BCS (stage 0 III, within 18
months post treatment). Participants were assigned to an 8 week MBSR (BC) program (n=80) or usual care (UC;
n=80). Outcomes included perceived stress (PSS), FOR (FCRI), anxiety/depression (HADS), fa tigue (FSI), and
sleep disturbance (PSQI), measured at baseline (T1), post intervention (T2), and 12 week follow up (T3).
Mediation analysis tested mindfulness (FFMQ) and FOR as mediators. Results: The MBSR (BC) group showed
significant improvements in all outcomes compared to UC (p<0.01), with sustained effects at T3. Mediation
analysis revealed that both mindfulness (indirect effect=0.35, 95% CI: 0.25 0.45) and FOR (indirect effect=0.20,
95% CI: 0.15 0.25) partially mediated improvements in psychological outcomes. FOR also mediated reductions in
fatigue, while mindfulness effects emerged later (T3). Conclusion: MBSR(BC) enhances well being in BCS by
reducing FOR and fostering mindfulness, with distinct temporal pathways for psychological and physical benef its.
These findings highlight the importance of targeting cognitive emotional mechanisms in supportive care
interventions for cancer survivors.

Keywords: Mindfulness, Fear of recurrence, Breast cancer survivors, Stress reduction, Mediation analysis.