A Randomized Controlled Trial of a Buddhist-based Nursing Program for Women with Breast Cancer

Main Article Content

Samonnan Thasaneesuwan
Wongchan Petpichetchian
Tippamas Chinnawong


             Psychological symptoms are commonly experienced in women with breast cancer undergoing chemotherapy. This study examined the effect of a Buddhist-based Nursing Program on psychological symptom experiences of these women. Ninety-three breast cancer women were randomized to either the experimental group (n = 45) receiving both the BNP and routine care, or the control group (n = 48) receiving only routine care at the outpatient department of a chemotherapy infusion center of a university hospital. The intervention consisted of 1) raising self-awareness; 2) integrating the Buddhist principles of the Four Noble Truths in the care of self; and 3) self-reflection regarding psychological symptom experiences and the progress of the Buddhist practices. The psychological symptom subscale of the Memorial Symptom Assessment Scale was used to measure psychological symptom experiences. Data were collected three times: at the start of chemotherapy as a baseline (T1), chemotherapy cycle-3 (T2), and chemotherapy cycle-6 (T3). Statistical analysis included descriptive statistics, chi-square test, independent t-test, and one-way repeated measures ANOVA.
             There was a non-significant difference in the mean scores of psychological symptom experiences between the two groups, but there was a significant time difference and a significant interaction effect. These findings indicate that although the Buddhist-based Nursing Program might not have strong contribution to reducing psychological symptom experiences, its potential benefit might be stronger than that of routine care. Thus, this Program might be used as a complementary intervention in relieving psychological symptom experiences of women with breast cancer undergoing chemotherapy. However, it requires further testing with different groups in different locations.

Article Details

How to Cite
Thasaneesuwan S, Petpichetchian W, Chinnawong T. A Randomized Controlled Trial of a Buddhist-based Nursing Program for Women with Breast Cancer. PRIJNR [Internet]. 2018 Jan. 1 [cited 2022 Sep. 29];22(1):58-73. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/84210
Original paper


1. World Health Organization. Cancer [Internet]. 2016 [cited 2015 Nov 12]. Available from: https://www.who.int/ mediacentre/factsheets/fs297/en/

2. Suwisith N, Hanucharurnkul S, Dodd M, Vorapongsathorn T, Pongthavorakamol K, Asavametha N. Symptom clusters and functional status of women with breast cancer. Pac Rim Int J Nurs Res. 2008 12 (3):153-165.

3. Phligbua W, Pongthavornkamol K, Knobf TM, Junda T, Viwatwongkasem C, Srimuninnimit V. Symptom clusters and quality of life in women with breast cancer receiving adjuvant chemotherapy. Pac Rim Int J Nurs Res. 2013 17 (3):249-267.

4. Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, et. al. Advancing the science of symptom management. J Adv Nurs. 2001 33 (5):668 -676.

5. Ho SSM, So WKW, Leung DYP, Lai ETL, Chan CWH. Anxiety, depression and quality of life in Chinese women with breast cancer during and after treatment: A comparative evaluation. Eur J Oncol Nurs. 2013 17 (6):877-882.

6. Veit CT, Ware JE. The structure of psychological distress and well-being in general populations. J Consult Clin Psychol. 1983 51 (5):730-742.

7. Love RR, Leventhal H, Easterling DV, Nerenz DR. Side effects and emotional distress during cancer chemotherapy. Cancer. 1989 63 (3):604-612.

8. Browall M, Brandberg Y, Nasic S, Rydberg P, Bergh J, Rydén A, et.al. A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment. Support Care Cancer. 2017 25 (5):1423-1429.

9. Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E, et.al. The memorial symptom assessment scale: An instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994 30 (9):1326-1336.

10. Su F, Ouyang N, Zhu P, Ouyang N, Jia W, Gong, C, et.al. Psychological stress induces chemoresistance in breast cancer by upregulating. Biochem Biophys Res Commun. 2005 329 (3):888-897.

11. Andrykowski MA. The role of anxiety in the development of anticipatory nausea in cancer chemotherapy: A review and synthesis. Psychosom Med.1990 52 (4):458-475.

12. Fredrikson M, Furst C, Lekander M, Rotstein S, Blomgren H. Trait anxiety and anticipatory immune reactions in women receiving adjuvant chemotherapy for breast cancer. Brain Behav Immun. 1993 7 (1):79-90.

13. Colleoni M, Mandala M, Peruzzotti G, Robertson C, Bredart A, Goldhirsch A. Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet. 2000356 (9238):1326-1327.

14. Payutto PA. Buddhadhamma: Natural laws and values for life. New York: University of New York Press; 1995.

15. Viradhammo V. Suffering and no suffering. Bangkok: Pim Dee; 1996.

16. Chaanchamnong S. The Buddha’s core teaching. Bangkok: Rungrungsan Printing; 2003.

17. Tanphaichitr K. Essence of life: Mindfulness and selfawareness. Khon Kaen: Pen Printing; 2005.

18. Disayavanish C, Disayavanish P. The development of wisdom health. J Psychiatr Assoc Thai. 2005 50:113-125.

19. King SB. From is to ought: Natural law in Buddhadasa Bhikkhu and Phra Prayudh Payutto. J Relig Ethics. 2002 30 (2):275-293.

20. Bannaasan B, Pothiban L, Khampolsiri T, Saengthong S. Effects of Buddhist doctrine-based practice on fear of cancer recurrence and hopelessness: A randomized controlled trial. Pac Rim Int J Nurs Res. 2015 19 (4):295-310.

21. Rungreangkulkij S, Wongtakee W. The psychological impact of Buddhist counseling for patients suffering from symptoms of anxiety. Arch Psychiatr Nurs. 2008 22 (3):127-134.

22. Tubtimhin S, Rungreangkij S. Impact of Buddhism-oriented group therapy on anxiety and depression levels in breast cancer patients undergoing radiotherapy. Thai J Nurs Council. 2012 27 (1):109-123 [in Thai].

23. Wiriyasombat R, Pothiban L, Panuthai S, Sucamvang K, Saengthong S. Effectiveness of Buddhist doctrine practicebased programs in enhancing spiritual well-being, coping and sleep quality of Thai elders. Pac Rim Int J Nurs Res. 2011 15 (3):203-218.

24. Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on psychological science. 2011 6 (6):537-559.

25. Zeichner RL, Kibler JL, Zeichner SB. Relationship between mindfulness-based stress reduction and immune function in cancer and HIV/AIDS. Cancer Clin Oncol. 2013 2 (1): 62-72.

26. Harinth R, Rungreangkulkij S. Buddhist-oriented individual counseling for depressed chronic illness patient. J Mental Health Thai. 2008 16 (1):14-23 [in Thai].

27. Sungsing K, Hatthakit U, Aphichato A. Cancer patient’s experiences in in using meditation for self-healing. Songkla Med J. 2007 25 (1):39-48 [in Thai].

28. Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M. The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Support Care Cancer. 2001 9(2): 112-123.

29. Jim HS, Small B, Faul LA, Franzen J, Apte S, Jacobsen PB. Fatigue, depression, sleep, and activity during chemotherapy: Daily and intraday variation and relationships among symptom changes. Ann Behav Med. 2011 42 (3):321-333.

30. Yee MK, Sereika SM, Bender CM, Brufsky AM, Connolly MC, Rosenzweig MQ. Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer. Cancer. 2017 123 (11):2061-2069.

31. Hsu HT, Lin KC, Wu LM, Juan CH, Hou MF, Hwang SL, et.al. Symptom cluster trajectories during chemotherapy in breast cancer outpatients. J Pain Symptom Manage. 2017 53 (6):1017-1025.

32. Jafari N, Farajzadegan Z, Zamani A, Bahrami F, Emami H, Loghmani A, et.al. Spiritual therapy to improve the spiritual well-being of Iranian women with breast cancer: A randomized controlled trial. Evid Based Complement Alternat Med. 2013 2013:354-362.

33. Zeller DL. The program minimized randomization 2.01 [Internet]. 1997 [cited 2012 May 30]. Available from: https://mahmoodsaghaei.tripod.com/Softwares/randalloc.html

34. Hart W. The art of living: Vipassana by SN Goenka. San Francisco, CA: Harper and Row; 1987.

35. Lundberg PC, Trichorb K. Thai Buddhist patients with cancer undergoing radiation therapy: Feeling, coping, and satisfaction with nurse-provided education and support. Cancer Nurs. 2001 24 (6):469-475.

36. Liamputtong P, Suwankhong D. Living with breast cancer: the experiences and meaning making among women in Southern Thailand. Eur J Cancer Care. 2016 25 (3):371- 380.

37. Sirintharo V. Meditation instructor course. Vol 3. 15th ed. Bangkok: Prachachon; 2016 [in Thai].

38. Liao MN, Chen SC, Chen SC, Lin YC, Chen MF, Wang CH, et.al. Change and predictors of symptom distress in breast cancer patients following the first 4 months after diagnosis. J Formos Med Assoc. 2015 114 (3):246-253.

Most read articles by the same author(s)