An iPod-based adaptation of MBSR for lung cancer: Associations of usage with depression and behavioral and endocrine circadian markers

Abstract

Depressive symptoms are common in lung cancer. In turn, depression and disrupted circadian rhythms predict early mortality in several cancer types, including lung cancer. Mindfulness-based Stress-Reduction (MBSR) shows promise for depression treatment but lacks feasibility for those with socioeconomic disadvantage or functional disability precluding group attendance. We piloted an iPod-based adaptation of MBSR for cancer patients. We explored patient factors related to intervention use; and associations of usage with depressive symptoms, rest activity rhythms, and cortisol rhythms. Participants reported distress and depressive symptoms. They wore actigraphs and collected waking and bedtime saliva for cortisol assessment over 10 days. A subsequent interview oriented them to mindfulness. They were given iPods with MBSR didactic and meditation practice tracks. Follow-up data were collected at three months. Alpha = 0.10 was adopted for this pilot. The sample (n = 65, 67% female, 78% non–Hispanic white) averaged 23 months post-diagnosis, mostly with advanced or metastatic disease. Thirty-eight participants provided follow-up data, and 24 returned iPods. Usage was not linked with baseline demographic, medical, or psychological factors. Stronger baseline rest-activity and cortisol rhythms emerged as predictors of subsequent intervention use. Usage (total minutes, tracks played) was linked with reduction of depression and bedtime cortisol. It’s interesting that rhythms, not clinical factors/symptoms, predicted iPod use. Future research should continue to explore the potential of simple media-based interventions to alleviate psychological symptoms in patients with advancing cancer.