Enhancing recovery in non-small cell lung cancer patients through mindfulness training and Jinshui Liujun decoction supplementation

Abstract

This article delves into the research conducted by Liu DW et al on the integration of mindfulness-based stress reduction training (MSRT) and flavored Jinshui Liujun decoction (FJLD) with conventional chemotherapy (CC) in the treatment of non-small cell lung cancer. The study investigates the impact of this combined approach on immune function and emotional well-being of non-small cell lung cancer patients. Patients were divided into a control group (CG) receiving CC alone and a treatment group (TG) receiving MSRT + FJLD alongside CC. The primary outcomes were progression-free survival and overall survival, with secondary outcomes including Karnofsky performance status scores, clinical efficacy, immune function markers, and emotional state assessments. The findings underscore significant improvements in median progression-free survival (20.50 months in TG vs 13.10 months in CG, P < 0.05), Karnofsky performance status scores (60 in TG vs 50 in CG, P < 0.05), and immune cell ratios, along with reductions in negative emotions (self-rating anxiety scale and self-rating depression scale scores significantly lower in TG, P < 0.05) among patients receiving MSRT + FJLD in conjunction with CC. This article highlights the potential of combining traditional Chinese medicine and modern psychological interventions to enhance the efficacy of conventional cancer treatments and improve patient outcomes.

Key Words: Non-small cell lung cancer; Mindfulness-based stress reduction training; Flavored Jinshui Liujun decoction; Curative effect; Immune function; Negative emotion

Core Tip: This article accentuates the pivotal role of integrating mindfulness-based stress reduction training with flavored Jinshui Liujun decoction alongside conventional chemotherapy in treating non-small cell lung cancer. The study by Liu DW et al demonstrates that this combined treatment significantly enhances immune function, alleviates negative emotions, and improves overall patient outcomes, suggesting a promising adjunctive therapy for non-small cell lung cancer management.

TO THE EDITOR

Non-small cell lung cancer (NSCLC) constitutes approximately 85% of lung cancer cases and remains a leading cause of cancer-related mortality globally[1,2]. Despite advances in treatment, conventional chemotherapy (CC) for NSCLC often leads to adverse effects such as cardiopulmonary dysfunction and immune system imbalance[2]. Moreover, the perioperative period is frequently marked by heightened anxiety and depression among patients due to treatment-related stressors, further compromising their quality of life[3]. Therefore, there is a critical need to explore integrative therapies that can alleviate these side effects and enhance overall treatment efficacy.

Recent studies have shown that while chemotherapy can extend the median survival time of patients with inoperable NSCLC from 20 weeks to 32 weeks, the adverse effects associated with such treatments highlight the need for complementary approaches to improve patient outcomes[4]. Mindfulness-based stress reduction training (MSRT) and flavored Jinshui Liujun decoction (FJLD) were selected for their potential synergistic benefits in enhancing treatment efficacy. MSRT is designed to reduce stress and improve emotional well-being, thereby potentially boosting immune function. FJLD, a traditional Chinese medicinal formula, is known for its immunomodulatory and anti-inflammatory properties, offering additional physiological support[5-8]. This combination aims to provide a comprehensive treatment approach by addressing both psychological and physiological health aspects, ultimately improving patient outcomes.

TREATMENT APPROACHES

The integration of MSRT and traditional Chinese medicine (TCM), specifically the flavored FJLD, into the regimen for gynecological cancer patients signifies a significant advancement in adjunctive treatments. These approaches offer a compelling alternative to conventional methodologies by addressing both the psychological and physical domains of health, consequently enhancing the overall quality of life for cancer patients. The efficacy of MSRT, which incorporates mindfulness breathing, body scanning, and other mindfulness exercises, in mitigating psychological symptoms such as anxiety and depression in cancer patients, has been well-documented. Forte et al[5] in 2023 highlighted the potential of MSRT to significantly reduce cancer-related fatigue and stress and improve quality of life and immune function in cancer patients. This underscores the critical role that psychological and emotional well-being plays in the overall recovery and quality of life in oncology patients[5]. Additionally, studies by Bränström et al[6] in 2010 have shown that mindfulness training significantly reduces perceived stress and enhances psychological well-being in cancer patients, mediated by increased mindfulness levels, further substantiating the benefits of MSRT.

On the complementary medicines front, FJLD, a compound made of herbs such as Rehmannia root and Pinellia ternata rhizome, is traditionally employed in treating lung diseases and boasts immunomodulatory properties. While the literature directly correlating FJLD with improvements in cancer patient outcomes is inchoate, its inclusion in treatment protocols for lung cancer presents an intriguing area for further research. TCM’s holistic view, emphasizing the equilibrium between physical health and psychological wellness, mirrors the principles of MSRT, thus providing a multidimensional approach to patient care. Given these perspectives, the call for developing specific recommendations for integrating such interventions into standard cancer care is warranted. The potential of MSRT and FJLD to minimize adverse effects associated with CC - such as cardiopulmonary dysfunction and immune system imbalance - while enhancing psychological resilience and overall well-being, represents a paradigm shift in cancer treatment. Future research, as indicated, should focus on refining these protocols and further exploring the long-term outcomes of such integrated treatments. Emphasis on diverse patient populations and varying clinical settings would yield a comprehensive understanding of the dynamics at play, ultimately guiding evidence-based practices in oncology care.

METHODS OF THE STUDY

In the study by Liu DW et al[7] in 2024, 92 patients with stage IIIb-IV NSCLC were divided into a control group (CG) receiving CC alone and a treatment group (TG) receiving MSRT + FJLD in addition to CC. The CG was selected to represent the standard care approach, allowing for a direct comparison to evaluate the additional benefits provided by the integrative therapy of MSRT and FJLD. This design ensures that the effects observed in the TG can be attributed to the added interventions, rather than variations in baseline care. By maintaining the standard chemotherapy regimen in the CG, the study effectively isolates and highlights the potential enhancements in treatment outcomes offered by the integrative approach. The primary evaluation indices included progression-free survival (PFS) and overall survival (OS), while secondary indices encompassed Karnofsky performance status (KPS) scores, clinical efficacy, TCM syndrome scores, immune function markers (CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺), and emotional state assessments using the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). The study was conducted in accordance with the Declaration of Helsinki and was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of Hebei North University, approval No. K2020227[7].

QUALITY CONTROL

Ensuring strict quality control in the implementation of MSRT and FJLD is crucial to avoid discrepancies in treatment efficacy. To achieve this, it is essential to establish comprehensive documentation procedures for monitoring adherence to protocols. Any deviations from the established protocol should be meticulously recorded, detailing the nature and reason for such variations. This documentation will not only support consistency across different clinical settings but also enhance the transparency and reproducibility of the study outcomes. Furthermore, regular audits and feedback mechanisms should be instituted to maintain high standards of treatment delivery. By systematically tracking the implementation process, healthcare providers can identify areas for improvement and ensure that the therapeutic interventions are delivered as intended. This approach will contribute to the reliability and validity of the study findings, ultimately supporting the broader integration of MSRT and FJLD into clinical practice for NSCLC patients.

RESULTS OF THE STUDY

The median PFS was significantly longer in the TG (20.50 months) compared to the CG (13.10 months) (P < 0.05). Although the median OS did not differ significantly between the groups, the TG showed improved KPS scores (60 in TG vs 50 in CG, P < 0.05) and higher disease control rates (71.94% vs 51.43%, P < 0.05; Figure 1A). Additionally, following two treatment courses, the TG exhibited a reduced incidence of adverse reactions, including breathing difficulties, diarrhea, vomiting, and proteinuria, compared to the CG. The overall response rates were similar, with no statistically significant difference observed between the TG (10.52%) and the CG (11.44%; Figure 1B). Symptoms such as cough, weakness, and chest pain were significantly reduced in the TG, as evidenced by lower TCM syndrome scores after treatment. Furthermore, the TG exhibited enhanced immune function, with increased CD3⁺ and CD4⁺ cells, reduced CD8⁺ cells, and an improved CD4⁺/CD8⁺ ratio. Notably, the TG also reported significantly lower SAS and SDS scores, indicating reduced anxiety and depression levels (P < 0.05). Importantly, the study monitored and recorded potential adverse effects related to FJLD supplementation. Patient-reported side effects were minimal, with no severe adverse events attributed to FJLD observed during the study period. This suggests a favorable tolerability profile for FJLD when used in conjunction with CC.

Figure 1 Therapeutic efficacy and adverse reactions. A: Therapeutic efficacy in the treatment group and control group, n (%); B: Adverse reactions in the treatment group (TG) and control group (CG), n (%). CR: Complete remission; PR: Partial remission; SD: Stable disease; PD: Progressive disease; TG: Treatment group; CG: Control group.

MSRT AND FJLD WITH CC IMPROVING BOTH THE PHYSICAL AND EMOTIONAL HEALTH OF NSCLC PATIENTS

The integration of MSRT and FJLD with CC shows considerable promise in improving both the physical and emotional health of NSCLC patients. The study’s findings suggest that MSRT + FJLD not only enhances immune function but also mitigates the psychological burden associated with cancer treatment. The potential mechanisms through which MSRT and FJLD exert their beneficial effects involve several biochemical and immunological pathways. MSRT is believed to modulate the hypothalamic-pituitary-adrenal axis, thereby reducing stress-induced immunosuppression and altering cytokine production, which enhances T-cell function. FJLD likely influences the phosphatidylinositol 3-kinase-protein kinase B signaling pathway, which plays a crucial role in cell survival, proliferation, and immune response regulation. The components of FJLD, such as Rehmannia root and Pinellia ternata, may help restore the balance of T-cell subsets, thereby improving the body’s immune response to cancer cells[7-13]. This combined approach aligns with the holistic principles of TCM and underscores the importance of addressing both the mind and body in cancer care.

First, this study retrospectively assessed the clinical effectiveness of combining MSRT with FJLD in treating NSCLC patients[7]. The findings demonstrated that MSRT + FJLD notably extended median PFS (P < 0.05) and enhanced KPS scores, suggesting potential long-term benefits for these patients[7]. Given that NSCLC typically leads to rapid tumor progression and shorter survival periods[2], the improved median OS observed in the TG compared to the CG is promising. However, larger-scale studies are necessary to confirm these results[2]. Additionally, the study revealed that incorporating MSRT + FJLD with CC in NSCLC patients significantly reduced TCM syndrome scores and improved immune function markers (CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺)[9].

Second, MSRT involves mindfulness practices such as body scanning, mindfulness breathing, and compassion meditation, typically guided by trained professionals. This technique, rooted in Eastern Zen and Western science, is used to address psychological issues like depression and anxiety, and it positively impacts cognitive, physical, and social health[10]. The reduction of stress and anxiety through MSRT can lead to improved emotional stability, which is crucial for cancer patients undergoing rigorous treatments like chemotherapy. By fostering a mindful state, patients can better manage the psychological challenges posed by their illness and treatment regimen, thus enhancing their overall quality of life[11].

Third, FJLD, a TCM, offers benefits such as reduced toxicity, enhanced efficacy, and lower recurrence rates[12]. It balances immune cells, delays tumor progression, and boosts the immune system. Components like Pinellia, orange peel, and licorice contribute to its anti-inflammatory and anti-tumor properties through mechanisms like the phosphatidylinositol 3-kinase-protein kinase B signaling pathway[13]. Ingredients like Poria polysaccharide and Astragaloside further enhance immune function by increasing CD3⁺ and CD4⁺ cells and decreasing CD8+ cells[14].

Fourth, CD3⁺, CD4⁺, and CD8⁺ are T cell surface markers crucial for immune responses. CD3 aids in cell-mediated immunity and antibody production, CD4⁺ cells activate other immune cells, and CD8⁺ cells regulate immune responses. Emotional stress can negatively impact these immune markers, reducing CD3⁺ and CD4⁺ cells and increasing CD8⁺ cells, thereby weakening immune function[15].

Fifth, long-term stress correlates with decreased immune cell activity. Chen et al[16] found that long-term TCM treatment can extend survival in advanced NSCLC, while Chen et al[16] reported that increased CD3⁺ and CD4⁺ levels and decreased CD8⁺ levels restore immune function, aligning with our findings.

Sixth, chemotherapy impacts both healthy and cancerous cells, causing adverse effects and psychological distress[17]. This study observed higher SAS and SDS scores in patients treated only with CC, indicating mild anxiety and depression. Conversely, MSRT + FJLD treatment improved these scores, suggesting a positive effect on emotional well-being. McDonnell et al[18] also found that MSRT intervention improved SAS and SDS scores in lung cancer patients, supporting our results. MSRT + FJLD enhances immune function and treatment efficacy through psychological and physiological benefits.

LIMITATIONS

Despite the promising results, the study by Liu DW et al[7] in 2024 is not without limitations. Firstly, the study design is retrospective, which may introduce inherent biases related to patient selection and data collection. Retrospective studies often rely on existing medical records, which might lack comprehensive data, thus affecting the accuracy of findings. The sample size of 92 patients, while adequate for statistical analysis within the study’s scope, may limit the generalizability of the findings to broader populations. This sample size was determined based on prior literature and statistical power calculations to detect significant differences between the treatment and CGs. However, larger-scale studies with more diverse cohorts are needed to confirm the generalizability of these results across different demographic and clinical settings. Additionally, the study did not account for potential confounding factors such as variations in the severity of NSCLC, genetic predispositions, and lifestyle differences among patients, which could influence treatment outcomes. The absence of a standardized protocol for MSRT implementation and FJLD preparation may lead to variations in treatment efficacy. Furthermore, the follow-up period, limited to two years, may not sufficiently capture long-term outcomes and late-onset adverse effects of the combined treatment regimen.

FUTURE DIRECTIONS AND CLINICAL RECOMMENDATIONS

The study by Liu DW et al[7] in 2024 provides a foundation for further exploration into the integration of MSRT and FJLD with CC. To enhance the understanding and application of these therapies, several future directions and clinical recommendations are proposed. Firstly, future research should focus on conducting large-scale, multicenter randomized controlled trials to validate the findings and establish robust evidence for the efficacy and safety of MSRT and FJLD in diverse patient populations. Such studies would contribute to the generalizability of the results and support their integration into standard care protocols[14,15]. Secondly, it is recommended to explore the molecular mechanisms underlying the synergistic effects of MSRT and FJLD. Investigating these pathways will provide deeper insights into how these interventions modulate immune function and psychological well-being, thereby optimizing treatment strategies[16]. Thirdly, the development of standardized protocols for MSRT and FJLD administration will ensure consistency in treatment delivery. This includes training programs for healthcare providers to enhance their understanding and skills in implementing these therapies[17]. Lastly, incorporating patient-reported outcomes and quality of life assessments in future studies will offer valuable information on the holistic benefits of this integrative approach, facilitating a more patient-centered care model[18]. By pursuing these directions, the integration of MSRT and FJLD into mainstream oncology care can be effectively achieved, leveraging their synergistic effects to enhance overall treatment outcomes for NSCLC patients.

CONCLUSION

The study by Liu DW et al[7] in 2024 offers robust evidence for the efficacy of integrating MSRT and FJLD with CC in the treatment of NSCLC. This integrative approach has been shown to significantly enhance immune function, alleviate negative emotions, and improve the overall quality of life for patients. To effectively integrate MSRT and FJLD into standard clinical practice, several strategic initiatives are recommended. First, the development of standardized protocols for the administration of these therapies is essential. Such protocols will ensure consistency and reproducibility across diverse clinical environments. It is imperative to train healthcare providers in MSRT techniques and establish precise guidelines for the preparation and dosage of FJLD. Second, it is advisable to organize workshops and training sessions for oncologists and healthcare professionals. These educational initiatives will enhance their understanding of the benefits and applications of MSRT and FJLD as adjunctive therapies in cancer treatment, thereby fostering broader acceptance and implementation within the medical community. Third, integrating MSRT sessions into the routine care schedules of NSCLC patients could prove beneficial. These sessions, ideally conducted by trained mindfulness practitioners, would systematically address psychological stressors and bolster emotional well-being throughout the treatment process. Fourth, regular monitoring and documentation of patient outcomes and feedback are crucial. This practice will facilitate a comprehensive assessment of the therapy’s effectiveness and safety, allowing for continuous refinement and adaptation of treatment protocols. Finally, fostering interdisciplinary collaboration among oncologists, traditional medicine practitioners, and mental health professionals is of paramount importance. Such collaboration would enable a holistic approach to cancer care, addressing both the physical and psychological dimensions of patient health. By implementing these strategies, the integration of MSRT and FJLD into mainstream oncology care can be effectively achieved, leveraging their synergistic effects to enhance overall treatment outcomes for NSCLC patients.