Mindfulness-based interventions and cognitive function among breast cancer survivors: a systematic review.

BACKGROUND: Breast cancer survivors have an elevated risk of cognitive impairment compared to age-matched women without cancer. Causes of this impairment are complex, including both treatment and psychological factors. Mindfulness-based interventions, which have been shown to improve cognitive function in the general population, may be one approach to mitigate cognitive impairment in this survivor population. Our objective was to conduct a systematic literature review of studies on the effect of mindfulness-based interventions on cognition among breast cancer survivors. METHODS: We conducted searches of three electronic databases (Scopus, PubMed and Cochrane Database of Systematic Reviews) in September 2017 for studies pertaining mindfulness and cognitive function among breast cancer survivors. Abstracts were manually searched by two reviewers and additional articles were identified through reference lists. RESULTS: A total of 226 articles were identified through our systematic search and six met inclusion criteria for this review. The reviewed studies lacked consistency in terms of the cognition domains studied (e.g. executive function, recent memory, etc) and in the measures used to assess cognition. Of the included studies, two found no association between mindfulness interventions and cognitive function, two found improvement that was not sustained at the follow-up, and another two found sustained improvement at 2- or 6-months. CONCLUSIONS: Mindfulness-based interventions have shown some evidence for improving cognition among breast cancer survivors, but further research using validated and comprehensive cognitive assessments is needed. More research is also needed related to the timing, duration and content of mindfulness interventions.

A Feasibility Study of Group-Delivered Behavioral Interventions for Insomnia Among Breast Cancer Survivors: Comparing Cognitive Behavioral Therapy for Insomnia and a Mind-Body Intervention.

Objectives: An estimated 30%-50% of breast cancer survivors (BCSs) report persistent insomnia, which may affect daytime functioning and quality of life, and lead to longer term health complications. Although the gold standard insomnia intervention, cognitive behavioral therapy for insomnia (CBT-I), has demonstrated efficacy, accessibility is limited due to a scarcity of trained providers, and adherence to therapy is variable. Group-delivered alternative therapies may offer an opportunity to reach and treat BCSs with insomnia. This pilot study was designed to assess feasibility of a group-delivered mind-body intervention compared with group-delivered CBT-I among BCSs. Design: The authors recruited n = 25 stages I - IV BCSs to a 9-week trial of group therapy for insomnia. Eligible women were assigned to the next upcoming group until it was full. Primary outcomes were to assess intervention feasibility measured by (1) qualitative focus group feedback and (2) attendance. The feasibility of using the Insomnia Severity Index (ISI) was also assessed in this population and ISI change scores were gathered to allow for power calculations in a future trial. Means and frequencies were used to describe participant demographics and attendance. Results: The authors found higher attendance (86% vs. 67% of sessions) and greater satisfaction with the intervention (84.6% vs. 57.1%) reported among mind-body participants than among CBT-I participants. Qualitative feedback suggested more group cohesion among the mind-body group and lower incentive to attend in-person among the CBT-I group. Conclusions: The results suggest that delivering a mind-body intervention for BCSs is feasible and acceptable, based on attendance and qualitative feedback.

Adherence to lifestyle-related cancer prevention guidelines and breast cancer incidence and mortality.

PURPOSE: Breast cancer is the most common cancer in women. Many lifestyle factors have been associated with an increased risk of breast cancer incidence and mortality. An index-based approach to analyzing adherence to American Cancer Society (ACS) guidelines as a whole may better explain associations between lifestyle variables and breast cancer incidence and mortality. METHODS: We created an index based on American Cancer Society-specific guidelines, including body mass index (BMI), physical activity, alcohol intake, tobacco use, daily time spent watching television, and certain dietary habits. Cox proportional hazards regression was used to model the association between the lifestyle index and primary breast cancer and breast cancer-specific mortality in the National Institutes of Health-American Association of Retired Persons (NIH-AARP) cohort. RESULTS: We identified 7088 women with incident breast cancer, 1162 deaths overall, and 462 deaths due to breast cancer. Compared with the lowest quintile of lifestyle index score (meeting fewest guidelines), women in the highest quintile had a 24% lower risk of breast cancer (hazard ratio [HR] = 0.76, 95% CI: 0.70, 0.82) and 37% lower risk of all-cause mortality (HR = 0.63, 95% CI: 0.53, 0.76), while the association with breast cancer-specific mortality was nonsignificant. CONCLUSIONS: Healthier prediagnosis lifestyle is associated with a decreased risk of breast cancer and all-cause mortality in the NIH-AARP cohort.

Separation from supported employment: a retrospective chart review study.

PURPOSE: The objective of this study was to examine job separations from supported employment (SE). The aim was to identify the types and nature of separations and precipitating events leading to the separation. METHODS: A retrospective chart review methodology was utilized. The study was conducted in a metropolitan area in the Southeast United States by a university-based SE program. Participants were 47 SE clients who had been placed into and separated from 67 jobs. Using a coding form, information regarding the type of separation and issues that preceded the separation were recorded. Data were aggregated using descriptive statistics. RESULTS: The largest number of separations was due to termination, followed by resignation and mutual consent of the employer and employee. The mean number of issues leading to the separation was 2.2, ranging from one to five. Only eight positive issues were found (compared to 116 negative and 20 neutral), the most prevalent being entry into an educational or training program. Common negative issues included poor work performance, attendance and punctuality problems, conflicts with the supervisor, and social and behavioral issues. CONCLUSIONS: The findings of this study illustrate the need to address job retention issues during the job development process, finding the most appropriate person-job fit and workplace culture for each client. The findings also support the need for vigilant and regular communication between the SE program and employers to intervene quickly when problems arise. IMPLICATIONS FOR REHABILITATION: Separation from Supported Employment (SE) SE is an evidence-based employment practice that has been shown effective across multiple disability groups. Studying job separations can provide valuable information for improving service. Locating the best person-job fit, as well as frequent contract with employers, can help prevent unnecessary job loss.

Transition planning for youth with traumatic brain injury: findings from the National Longitudinal Transition Survey-2.

BACKGROUND: Despite of a growing body of research on vocational and educational difficulties for students with traumatic brain injury (TBI), only limited empirical studies specifically examined how school transition services facilitate later employment outcomes. OBJECTIVE: This exploratory, prospective longitudinal study examined the prevalence of employment and characteristics of transition planning practices that promoted positive school-to-work transition for students with TBI. METHOD: The participants (n = 200) was drawn from the National Longitudinal Transition Study-2 (NLTS-2), a ten-year study which followed a large nationally representative sample of youth with disabilities through secondary education in into young adulthood. Logistic regression was used to investigate the associations between student, school, and collaborative engagement in the planning process and employment outcomes up to 8 years after high school. RESULTS: Among youth with TBI, 51% held current employment at the time of interview and 73% had been employed at any time after high school. Findings showed that students with TBI who had transition goals for postsecondary education were more likely to be employed at some point since leaving high school. The findings also support active student engagement and leadership in the transition planning process, and the inclusion of outside organizations and individuals. CONCLUSIONS: Findings indicate the impact of student, school and adult service agency engagement in transition planning processes. Implications for educational practices and future research are discussed.