Mindful awareness practices (MAPs) and survivorship education significantly reduced depressive symptoms in younger breast cancer survivors, according to phase 3 trial results published in the Journal of Clinical Oncology.

The Pathways to Wellness trial (Clincaltrials.gov identifier: NCT03025139) included 247 women who were diagnosed with breast cancer before 50 years of age, had completed treatment, and had elevated depressive symptoms.

The participants were randomly assigned to a MAPs intervention (85 women), an educational intervention (81 women), and a concurrent wait-list control group (81 women).

Continue Reading

The primary outcome of the study was changes in symptoms of depression after the interventions, as measured by the Center for Epidemiologic Studies Depression (CES-D) scale.

At baseline, all 3 groups had depressive symptoms that were in the clinically significant range, with mean CES-D scores of 16 or greater. Scores were not significantly different between the groups.


Patients in the MAPs group met in person for 2-hour discussion sessions on mindfulness every week for 6 weeks. They received written materials summarizing the information covered in the sessions, and they were instructed to practice mindfulness exercises at home for 5-20 minutes each day.

At 4 weeks and 8 weeks after the 6-week program was over, patients in the MAPs group attended 1-hour in-person sessions, which included guided meditation and discussions. The sessions were led by experienced mindfulness instructors who had received specialized training.

The educational sessions were also 2-hour, in-person sessions conducted every week for 6 weeks. Patients in this group also received written materials as well as community resources.

The educational sessions covered topics such as quality of life after breast cancer, relationships and work-life balance, and energy balance, nutrition, and physical activity. The sessions were directed by trained nurses or physicians with expertise in breast cancer survivorship.

At 4 weeks and 8 weeks after the 6-week program was over, patients in the education group received newsletters containing health information tailored to younger breast cancer survivors.


The mean number of sessions attended was 4.5 for the MAPs group (range, 0-6) and 3.8 for the education group (range, 0-6).

Both interventions led to a significant reduction in CES-D scores from baseline to post-intervention, relative to the control group. The mean change was -4.7 for the MAPs group (P =.001) and -4.0 for the education group (P =.007).

In the MAPs group, the decline in CES-D scores was sustained at 3 months (-5.9, P <.001) and 6 months (-3.7, P =.013).

In the education group, the decline in CES-D scores was sustained at 3 months (-4.7; P =.003) but not at 6 months (-2.8; P =.063).

The MAPs group had improvements in fatigue post-intervention and at 6 months, improvements in vasomotor symptoms at 3 months and 6 months, and improvements in insomnia at all time points.

In the education group, patients had improvements in insomnia and vasomotor symptoms at 3 months.

There were no adverse events related to the interventions.

“These standardized programs have the potential for wide dissemination over virtual platforms, with significant potential benefit for quality of life and overall survivorship in this high-risk group,” the study authors wrote.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Bower JE, Partridge AH, Wolff AC, et al. Targeting depressive symptoms in younger breast cancer survivors: The Pathways to Wellness randomized controlled trial of mindfulness meditation and survivorship education. J Clin Oncol. Published online August 18, 2021. doi:10.1200/JCO.21.00279