Perioperative Mindfulness Proposal

Breast cancer affects 1 in 8 women in the United States and the majority are managed surgically as part of their primary treatment. Annually over 800 women at Hoag are treated surgically for breast cancer. Anxiety and fear are commonly associated with breast cancer diagnosis, with as many as 20% of breast cancer patients suffering from full blown depressive disorder and 10% from an anxiety disorder.(1) Mindfulness practices have demonstrated improvements in self reported well being, reductions in stress and fatigue, reduced reactivity to distressing thoughts and improvements in both sensory and affective pain components in a variety of chronic pain conditions including arthritis and chronic pain syndromes. (2) Adoption of Mindfulness Based Stress Reduction (MBSR) has shown improvements in psychological health for breast cancer survivors, (3) but significant reductions in pain levels have not been demonstrated. The limitations of MBSR (Mindfulness Based Stress Reduction) include significant time investment for patients as well as time and cost of care providers and health care systems. The effect of meditation and specific yogic breath work practices on pain has not been studied. Opioid addiction is a growing social problem. In 2016 over 2 million Americans over the age of 12 were estimated to suffer from addiction to prescription pain medications, leading to over 20,000 overdose related deaths. (4) The majority of these patients were women. Indicated use narcotic exposure has been reported as an initiation event for some patients in the development of opioid addiction, with over 5% of patients who initiated prescription pain medication at the time of surgery continuing to use the medications after the acute surgical process has resolved. (5) We propose to study the effect of meditation and breath work practice on the distress and perioperative pain of breast cancer patients undergoing primary surgical treatment for breast cancer. The benefit of meditation and breath work practice over standard MBSR practice includes lower burden on patients of time and therefore higher potential cost effectiveness and long term sustainability of patients adopting and committing to a regular practice. The breath work and specific meditation practices that will be taught could be a novel method to address perioperative pain, plus improve management of anxiety and stress during this period and beyond. If successful, this pre recorded meditation guidance that patients can utilize in home practice could be a cost effective addition to improve overall perioperative patient experience.