Presurgical stress management improves postoperative immune function in men with prostate cancer undergoing radical prostatectomy.
ABSTRACT To assess whether stress management (SM) improved immune outcomes in men undergoing surgery for prostate cancer.
A total of 159 men were assigned randomly to a two-session presurgical SM intervention, a two-session supportive attention (SA) group, or a standard care (SC) group. Men in the SM group discussed their concerns about the upcoming surgery and were taught diaphragmatic breathing, guided imagery; they had an imaginal exposure to the day of surgery and learned adaptive coping skills. Men in the SA group discussed their concerns about the upcoming surgery and had a semistructured medical interview. Blood samples were collected at baseline (1 month before surgery) and 48 hours after surgery. Measures of mood (Profile of Mood States) were collected at baseline, 1 week pre surgery, and the morning of surgery.
Men in the SM group had significantly higher levels of natural killer cell cytotoxicity (p = .04) and higher levels of circulating proinflammatory cytokines (interleukin [IL]-12p70, p = .02; IL-1β, p = .02; tumor necrosis factor-α, p = .05) 48 hours post surgery than men in the SA group and higher levels of natural killer cell cytotoxicity (p = 0.02) and IL-1β (p = .05) than men in the SC group. Immune parameters increased for the SM group and decreased or stayed the same for the SA and SC groups. The SM group had significantly lower Profile of Mood States scores than the SC group (p = .006), with no other group differences between SA and SC groups. Changes in mood were not associated with immune outcomes.
The finding that SM leads to decreased presurgical mood-disturbance and increased immune parameters after surgery reveals the potential psychological and biological benefits of presurgical SM.
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ABSTRACT: Adjuvant endocrine therapy can improve disease-free survival and time before recurrence in breast cancer patients. However, it is associated with considerable side effects that negatively affect patients' quality of life and cause non-adherence. The recently demonstrated effect of individual expectations on side-effect development suggests that psychological factors play a role in the prevention of side effects. The aim of this study is to evaluate cognitive-behavioral side-effect prevention training (SEPT) for breast cancer patients. This article describes the study protocol and applied research methods.Methods/design: In a randomized controlled trial, 184 female breast cancer patients are assigned to receive either SEPT, standard medical care or a manualized supportive therapy at the start of adjuvant endocrine treatment. SEPT consists of three sessions of cognitive-behavioral training including psychoeducation to provide a realistic view of endocrine therapy, imagination-training to integrate positive aspects of medication into daily life, and side-effect management to enhance expectations about coping ability. Side effects three months after the start of endocrine therapy serve as primary outcomes. Secondary outcomes include quality of life, coping ability and patients' medication adherence. Patients' expectations (i.e., expectations about side effects, coping ability, treatment and illness) are analyzed as mediators. The optimization of expectations might be a potential pathway in health care to improve patients' quality of life during long-term medication intake. The results will provide implications for a possible integration of evidence-based prevention training into clinical practice.Trial registration: (NCT01741883).BMC Cancer 09/2013; 13(1):426. DOI:10.1186/1471-2407-13-426 · 3.32 Impact FactorThis article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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ABSTRACT: . As part of a new standard of quality cancer care, the Institute of Medicine has recommended inclusion of therapies that address psychosocial needs of cancer patients. A range of psychosocial therapies for managing acute and chronic stress have been developed for patients with cancer, based on the scientific framework of psychoneuroimmunology (PNI). The current review aimed to identify studies of new and emerging PNI-based psychosocial therapies in patients with cancer that have used neuroendocrine-immune biomarkers as outcomes. Specifically, this review aimed to evaluate studies based on the cancer populations involved, types of psychosocial therapies, and PNI measures employed. . Methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The PubMed, EMBASE, PsychINFO, CINAHL, and Google Scholar online databases were searched using combinations of keywords obtained from previous reviews of psychosocial interventions. Studies from 2001 to 2012 were included if they ( : ) were published in English, ( : ) used experimental or quasi-experimental designs, ( : ) evaluated psychosocial therapies, ( : ) involved cancer patients, and ( : ) reported results on at least one neuroendocrine or immune outcome measure. The search strategy identified 403 records and 2 stages of screening were used to eliminate irrelevant studies. . A total of 24 cancer-specific studies of psychosocial therapies that used PNI-based outcome measures were included in this review. Most studies included early-stage breast cancer patients, and 2 major types of therapies emerged, cognitive-behavioral therapies and complementary medical therapies. Durations of interventions ranged widely, from 1.3 hours over a single week to 27 hours over 18 weeks. Considerable diversity in PNI outcomes made statistical comparisons problematic. Studies of cognitive-behavioral therapies were found to have reported the most success in impacting PNI-based measures, which were typically functional measures of the immune system, for example, cytokines. . Several issues related to research methodology are discussed. Most important, studies examining dose-response associations and resource allocation are needed to guide future research. A standardized panel of psychosocial instruments and biomarkers for PNI-based studies would enhance comparability of findings across studies when evaluating this body of research and assist with integrating psychosocial therapies into the standard of cancer care.Integrative Cancer Therapies 10/2013; 13(2). DOI:10.1177/1534735413503548 · 2.01 Impact Factor
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ABSTRACT: Abstract Collective evidence points to a prominent role of stress in cancer growth and metastasis. Despite these results an etio-pathogenetic role has not been widely accepted. Reasons of controversies are the coexistence in stressed patients of high risk habits, the sample size, the heterogeneity and the retrospective origins of these studies. Experimental data and clinical observations argue about the possibility of an interaction between psychosocial events and tumours. However the number of involved variables and the long period of observation prevent with current technologies the definition of causal versus chaotic sequences of this hypothetical relationship. Psychotherapy may help to face up to stressful events, but its role e remains uncertain. Stress works through sympathetic nervous system and hypothalamic– pituitary–adrenal axis activation, along with related hormones, that have functionally and biologically significant impacts on the tumor microenvironment. This paper collects evidences through the hypothesis of correlation between stress, psychological factors and cancer focusing both on psychology and on molecular biology. Knowledge on stress induced neuroendocrine dynamics in the tumor microenvironment might allow the development of integrated pharmacological and bio-behavioral strategies to create more successful cancer therapies.10/2014; Denaro et al. Journal of Cancer Therapeutics & Research 2014, http://www.hoajonline.com/journals/pdf/2049-7962-3-4.pdf. DOI:10.7243/2049-7962-3-6