Improving cancer patients’ prognosis by incorporating mindfulness intervention into the treatment strategy

Abstract

This letter discusses the study by Liu et al recently published in World Journal of Psychiatry, which examines the benefits of combining epirubicin (EPI) with mindfulness interventions for patients with urinary system tumors and depression. The study included 110 patients and compared an experimental group receiving EPI and a mindfulness intervention strategy with a control group treated with mitomycin and standard care. Results showed that the experimental group had significant improvements in immune function, tumor markers, depression severity, quality of life, cancer-related fatigue, and nursing satisfaction. Despite acknowledging the study limitations such as a relatively small sample size and a short duration, the study highlights the efficacy of integrating mindfulness interventions into cancer treatment strategies to enhance patient outcomes and address psychological distress.

Key Words: Mindfulness intervention; Urinary system tumor; Cancer patient; Psychiatric distress; Suicide

Core Tip: The study by Liu et al highlights the clinical benefits of combining epirubicin with mindfulness interventions for patients with urinary system tumors and depression. Results showed that combined therapy significant improved immune function, tumor marker levels, depression severity, quality of life, and nursing satisfaction. Despite the study limitations including a small sample size and a short intervention period, the findings underscore the potential benefits of integrating mindfulness interventions into cancer treatment strategies. Given the rising incidence of urinary system tumors and associated psychological distress, further research is essential to explore similar approaches across patients with various cancer types.

TO THE EDITOR

We read with great interest the recent paper by Liu et al[1] in World Journal of Psychiatry. This study evaluates the clinical value of a treatment strategy for patients with urinary system tumors and depression. The experimental group received combined epirubicin (EPI) with mindfulness interventions (n = 55), while the comparison group (n = 55) received mitomycin and routine nursing care. The authors assessed a wide range of outcome measures related to this combination therapy, including immune function indices, tumor marker levels, depressive mood improvement, health-related quality of life, severity of depression, cancer-related fatigue, adverse reaction rates, and patient nursing satisfaction.

Results indicated that patients in the experimental group exhibited significantly better clinical outcomes, including improved immune function, reduced tumor marker levels, lower depression severity, enhanced quality of life, decreased cancer fatigue, lower adverse reaction rates, and higher nursing satisfaction. Liu et al’s study[1] provides valuable insights into the efficacy of integrating mindfulness interventions into cancer treatment strategies.

Urinary system tumors, such as prostate and bladder cancer, are among the most prevalent malignancies and are steadily increasing. Between 2014 and 2019, the incidence of prostate cancer rose by 3% annually after two decades of decline[2]. In 2022, prostate cancer emerged as the most commonly diagnosed cancer in the urinary system and the leading cause of cancer-related death, closely followed by bladder cancer[3].

EPI, a second-generation anthracycline antibiotic and a semisynthetic stereoisomer of doxorubicin, is an effective anticancer agent for various malignancies, including breast, ovarian, gastric, lung, prostate, and bladder cancers. Its therapeutic efficacy is notable for reducing recurrences of malignancies, although concerns regarding cardiotoxic side effects remain. Nevertheless, EPI is often preferred over doxorubicin due to its comparatively lower cardiotoxicity and fewer side effects[4-6].

Despite EPI's effectiveness, its long-term clinical use is limited by cardiotoxic side effects and the psychological distress experienced by patients during treatment. Pain and discomfort during cancer therapy can lead to medication nonadherence, which is a growing concern among healthcare providers[7]. Poor adherence can result in disease relapse and increased treatment costs, as research indicates relationships between medication non-adherence, adverse clinical outcomes, and higher medical expenses[8-13].

Depression, a significant contributor to suicidal behavior, may arise from biological, psychological, and social factors[14-20]. It can occur across the lifespan, often leading to negative self-perceptions, suicidal ideation, and even suicide death, thereby necessitating effective interventions. Suicide remains a pressing public health issue, with increasing rates in various populations[21]. Individuals with depression face a notably elevated risk of suicide compared to the general population[22-24]. Furthermore, it has been well documented that a cancer diagnosis results in significant psychiatric distress and a high suicide risk rate[25-27]. Therefore, innovative treatment approaches, such as incorporating mindfulness interventions, are essential for improving outcomes and reducing suicide risk in cancer patients experiencing psychological distress.

Mindfulness is a psychological construct rooted in ancient traditions, and empirical studies have demonstrated its effectiveness in enhancing self-regulation and reducing anxiety, pain, stress, and depression[28-31]. Additionally, mindfulness meditation may strengthen the immune system and improve overall health[32-35]. Since the 1990s, mindfulness meditation has been integrated into treatments for various physical and mental health conditions, garnering significant attention in psychological and psychiatric research focused on cancer patients[36-40].

In this vein, the study by Liu et al[1] is promising, demonstrating positive healthcare outcomes from combining EPI with mindfulness interventions in patients with urinary system tumors and depression. The authors appropriately acknowledged several study limitations, including a relatively small sample size (n = 110), a single-center trial design, a moderately short intervention period, and the absence of long-term follow-up evaluations.

Given that cancer is the second leading cause of death worldwide with elevated suicide rates following cancer diagnoses[41-43], we commend Liu et al[1] for their contributions to the literature. Further research into similar combination treatment strategies is needed for other cancer types, especially since certain malignancies, such as pancreatic cancer, can also trigger depression, and specific cancer treatments, including chemotherapy, are associated with higher rates of depressive symptoms[44].