Living with graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (SCT) can be physically and emotionally challenging for patients (GVHD survivors) and their families. Physical changes, fatigue, sleep disturbances, and some drugs to treat GVHD can contribute to anxiety, anger, sadness, depression, mood swings, confusion, and other emotions. Cancer survivors may benefit from mindfulness meditation, but those dealing with GVHD have special needs related to coping with GVHD.
Mindfulness Basics
Mindfulness is learning to live in the present by paying full attention to personal emotions without interpretation or judgment. It isn’t just yoga, sitting on a cushion with legs crossed, or a retreat-only activity, but instead, a daily practice meant to redirect attention to the present to fully engage in the moment. Mindfulness is essential for people with GVHD and their caregivers as it can bring more joy and peace to their constantly changing and unpredictable journey—it can support them physically, mentally, and spiritually.
Although not specific to GVHD survivors, the CNT article, “Mindfulness Meditation for Lung Cancer Survivors,” by Ben Garcia, BSN, RN, oncology nurse, and certified mindfulness meditation facilitator is beneficial. His video presentation can help nurses learn more about how mindfulness benefits cancer survivors.
Benefits of Mindfulness in Transplant Survivors
As the BMTinfonet.org website suggests, “the goal [for GVHD survivors] is to learn to manage GVHD without being defined by it.” The practice of being in the present moment through mindfulness meditation, guided imagery, and relaxation techniques can help survivors manage the stress of living with GVHD. Research suggests that mindfulness interventions may be beneficial for SCT patients and caregivers.
Although data is limited for GVHD survivors, there is enough evidence with cancer survivors for the Oncology Nursing Society to list mindfulness meditation as an evidence-based practice likely to be effective for fatigue. Several studies continue to determine preferences for mindfulness-based stress management programs and the benefits of different mindfulness activities.
Pilot Home-Based Exercise and Mindfulness Program in Allogeneic SCT Patients
A recent pilot study of a 6-week, virtual, home-based, combined exercise and mindfulness training program for allogeneic SCT survivors more than 6 months post-transplant suggested this training program can potentially improve physical capacity and quality-of-life outcomes. Interventions included physical education training sessions and mindfulness-based stress management (MBSM) sessions. Each session consisted of a guided experiential mindfulness exercise with assigned homework exercises. Along with stress management, the MBSM sessions focused on psychoeducation about stress, anxiety, and low mood symptoms; individual, cognitive, and behavioral coping strategies; and skills to improve well-being.
Walking, sitting, and hand strength screening significantly improved at 3 months versus baseline. In addition, self-reported measures of functioning and quality-of-life and the FACT-BMT and FACT-G scores were significantly higher. More than 80% of participants gave the program a high rating, with no reports of adverse events.
Mindfulness Meditation Practices
Melanie Stachelski, MA, Colorado Cancer Counseling and AML allogeneic unrelated stem cell transplant survivor, offers a 30-minute presentation followed by a 30-minute question-and-answer session for SCT survivors in her video, “Managing Emotional Challenges After Transplant.” She comments that although the physical toll is enormous, the mental, emotional, and spiritual turmoil is more challenging. Her goal for the video is for survivors to learn mindfulness. She shares straightforward mindfulness tools and how to live in the present moment, including deep breathing, body scanning, square breathing, and mindful eating. She offers a few simple tools to provide extra support from a professional and personal perspective and encourages patients to share the video with their parents and guardians.
Although there are many mindfulness resources such as courses, drop-in groups, or apps, the Calm app is a favorite. My daily routine is:
- Morning: Daily Jay 7-minute wisdom podcast by Jay Shetty
- Mid-day: Daily Trip by Jeff Warren or the Daily Move by Mel Mah
- Evening: Daily Calm by Tamara Levitt
Starting and ending the day with this app can be beneficial, and when possible, using the mid-day routine can help round out daily practice to reduce stress and increase productivity. In addition to daily meditation practice, consider creating an action plan for resilience, including a gratitude diary to record positive experiences daily.
Since mindfulness meditation is a free or low-cost intervention to help patients and caregivers deal more effectively with their situation, oncology nurses must explore their willingness to try mindfulness. In addition, oncology nurses should consider incorporating mindfulness into their daily plan to more successfully care for patients receiving SCT and those with GVHD.
References
Coping With the Stress of Graft-Versus-Host Disease
Mindfulness Meditation for Lung Cancer Survivors
Mindfulness Meditation for Patients with Lung Cancer
Mindfulness, Experiential Avoidance, and Recovery From Hematopoietic Stem Cell Transplantation
ONS Symptom Interventions and Guidelines for Fatigue
