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  • Clinical implementations with interventional protocols are s

    2018-11-09

    Clinical implementations with interventional protocols are starting using this assay permitting distinction between patients without any over-risk of toxicity (considered as resistant to late effects) and patients clearly at risk of developing more late effects defined as very sensitive (). In terms of altered management, hyperfractionation can reduce toxicity with no risk of loss of local control or to allow for dose escalation in very sensitive patients. For more resistant patients, an increase in dose should be possible and hypofractionation regimen should be largely proposed leading to a medicoeconomical improvement of our treatments. This might be in favor of adding novel targeted or existing systemic therapies ().
    In this issue of , make a significant and interesting contribution to a growing literature of changes seen in participants who receive formal programmatic instruction in mindfulness meditation. Since paper reporting on what would become the mindfulness-based stress reduction (MBSR) program, the literature and application of mindfulness meditation instruction within the Western biomedical approach has expanded greatly. The initial MBSR program was developed for patients at an academic medical center who had on-going chronic pain despite maximized allopathic treatment. These participants reported significant reductions in pain, improvements in mood, and fewer medical symptoms (). Since that time, mindfulness meditation instruction has been applied and, especially MBSR, studied in broadening clinical scenarios, as well as for general health and wellness. Mindfulness meditation programming is aimed at enhancing participants\' innate capacity for mindfulness, described as “the present moment, held in awareness, non-judgmentally…” (). (In bosentan to mindfulness meditation, concentration meditation is aimed at sustained attention on a single focus or mantra.) Structured mindfulness meditation programs such as that used by Shao et al. and MBSR include didactic and experiential instruction in a number of formal mindfulness practices, practices aimed at strengthening participants\' awareness of their own thoughts, feelings, bodily sensations, inner and outer selves (). The formal practices offer a variety of approaches, such as sitting meditation, walking meditation, mindful movement, body awareness, etc. During formal practices, participants select a focus for their attention and when they notice that their attention has drifted from the focus, they are directed to bring themselves back to the present task (the practice) with an open and non-judgmental attitude. Through these practice experiences, participants increase their ability to sustain attention and become more aware of their cognitive, affective, and somatic predispositions and habits, as well as the transient nature of thoughts, feelings, and sensations. Interestingly, through these practices and increased awareness over the eight-week programs, participants often become more actively engaged in altering their predispositions and habits, both during formal practice and “off the cushion” in day-to-day and moment-to-moment life, many describing fundamental shifts in awareness and self-regulation (). The enhanced awareness itself, with an open and non-judgmental attitude, seems to allow for meta-cognitive changes and opportunities to respond to situations differently than in the past. The impact of mindfulness instruction on individual experience and investigation of its mechanism has been explored in the biomedical literature through the years. A meta-analysis of 47 actively-controlled trials with 3515 participants showed that participation in mindfulness instruction programming is effective for improving self-reported symptoms of anxiety, depression, and pain (). In addition to changes in reported in affect and pain, researchers have noted improvements in coping processes, with reductions in rumination, a process in which negative thoughts and scenarios are repeatedly reviewed (). Further, Jain showed that decreases in rumination mediated the beneficial effect of the MBSR program on depressive symptoms (). Physiologic changes have also been described in trials of the eight-week MBSR program, including improvements in the important stress hormone cortisol () and in age-related DNA telomere maintenance activity ().