Education/Behavioral Interventions Reduced Depressive Symptoms in Younger Breast Cancer Survivors


Compared with a wait-list control group, mindful awareness practices and survivorship education significantly reduced depressive symptoms from preintervention to postintervention in younger survivors of breast cancer.

Both mindful awareness practices and survivorship education reduced depressive symptoms among younger survivors of breast cancer, according to results from the randomized, controlled phase 3 Pathways to Wellness trial (NCT03025139) published in the Journal of Clinical Oncology.

A total of 247 patients were randomized to distinct group interventions including mindful awareness practices (n = 85), survivorship education (n = 81), or wait-list control (WLC; n = 81). From preintervention to postintervention, mindful awareness practices (mean change relative to WLC, –4.7; 95% CI, –7.5 to –1.9) and survivorship education (mean change relative to WLC, –4.0; 95% CI, –6.9 to –1.1) significantly decreased depressive symptoms relative to the WLC group and persisted to the 6-month follow up for mindful awareness practices (mean change relative to WLC, –3.7; 95% CI, –6.6 to –0.8).

“Women diagnosed with breast cancer before 50 years of age are at increased risk for psychologic and behavioral problems that may not be adequately addressed even in highly resourced cancer centers,” the investigators wrote. “Here, we show that 2 interventions specifically designed for younger survivors are effective in reducing depressive symptoms and, in the case of mindfulness, also improve related symptoms that pose serious threats to women’s health and well-being after cancer.”

Eligible women had a breast cancer diagnosis of stage 0, I, II, or III at or before the age of 50 years. Eligibility also required that patients be within 5 years of diagnosis; have completed surgery, radiation, and/or chemotherapy at least 6 months prior; be able to complete questionnaires in English; be able to participate in the intervention; and have at least mild depressive symptoms.

The primary end point for the study was depressive symptoms as assessed by the Center for Epidemiologic Studies-Depression scale. Key secondary end points focused on common symptoms in young survivors of breast cancer including fatigue, insomnia, and vasomotor symptoms.

Median age for the study population was 46 years and median years since breast cancer diagnosis was 2.4 years. Most survivors were White (82%), married (65%), and working full-time (68%). Additionally, 44% of patients had a college education. Most patients also had chemotherapy (62%), radiation (66%), and current endocrine therapy (66%).

Relative to WLC, mindful awareness practices led to significant reductions in fatigue and insomnia from preintervention to postintervention. Marginal reductions were also noted in vasomotor symptoms at post-treatment, although were significant at 3- and 6-month follow ups. Survivorship education did not have a significant effect on fatigue with a significant insomnia decrease relative to WLC only at 3-month follow up.

The unblinded nature of the study’s randomized assignment allocation was a limiting factor of the data. Moreover, the investigators explained the conduct at comprehensive cancer centers instead of community centers and lack of diversity among study participants might limit the generalizability of the results.

“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 investigators concluded.


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. 2021;39(31):3473-3484. doi:10.1200/JCO.21.00279

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