Psychologic Intervention Improves Survival for Breast Cancer Patients A Randomized Clinical Trial

Department of Psychology, Ohio State University, Columbus, OH 43210-1222, USA.
Cancer (Impact Factor: 4.89). 12/2008; 113(12):3450-8. DOI: 10.1002/cncr.23969
Source: PubMed


The question of whether stress poses a risk for cancer progression has been difficult to answer. A randomized clinical trial tested the hypothesis that cancer patients coping with their recent diagnosis but receiving a psychologic intervention would have improved survival compared with patients who were only assessed.
A total of 227 patients who were surgically treated for regional breast cancer participated. Before beginning adjuvant cancer therapies, patients were assessed with psychologic and behavioral measures and had a health evaluation, and a 60-mL blood sample was drawn. Patients were randomized to Psychologic Intervention plus assessment or Assessment only study arms. The intervention was psychologist led; conducted in small groups; and included strategies to reduce stress, improve mood, alter health behaviors, and maintain adherence to cancer treatment and care. Earlier articles demonstrated that, compared with the Assessment arm, the Intervention arm improved across all of the latter secondary outcomes. Immunity was also enhanced.
After a median of 11 years of follow-up, disease recurrence was reported to occur in 62 of 212 (29%) women and death was reported for 54 of 227 (24%) women. Using Cox proportional hazards analysis, multivariate comparison of survival was conducted. As predicted, patients in the Intervention arm were found to have a reduced risk of breast cancer recurrence (hazards ratio [HR] of 0.55; P = .034) and death from breast cancer (HR of 0.44; P = .016) compared with patients in the Assessment only arm. Follow-up analyses also demonstrated that Intervention patients had a reduced risk of death from all causes (HR of 0.51; P = .028).
Psychologic interventions as delivered and studied here can improve survival.

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Available from: Barbara Lee Andersen
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    • "The abatement of distress early in the diagnosis and treatment of cancer may have long-term beneficial effects. In her bio-behavioral model (Andersen et al., 2008), Andersen, stated that an important sequela of distress is (non)compliance. Many studies have shown a positive association between distress and decreased acceptance of and compliance with treatment (Ayres et al., 1994; Colleoni et al., 2000; Bui et al., 2005), which may, in turn, affect disease outcomes, the prevention of recurrence, and long-term survivorship. "
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    ABSTRACT: Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient’s knowledge (β = − 0.22), which, in turn, was positively associated with both attitudes toward breast cancer (β = 0.39) and coping self-efficacy (β = 0.36). Self-efficacy was then directly related to psychological distress (β = − 0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress.
    Full-text · Article · Jul 2015 · PeerJ
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    • "These interventions typically focus on reducing general distress and include cognitive behavior techniques, coping skills training, cognitive restructuring, relaxation training, and mindfulness techniques (Foley, Baillie, Huxter, Price, & Sinclair, 2010), as well as providing a supportive group setting (McGregor & Antoni, 2009). Positive outcomes for participants include mood improvement (Foley et al., 2010), increased use of emotionregulation strategies (Cameron, Booth, Schlatter, Ziginskas, & Harman, 2007), improvement in PTG (Garland, Carlson, Cook, Lansdell, & Speca, 2007), and reduced risk of breast cancer recurrence and death (Andersen et al., 2008). Nonetheless, despite their decrease in quality of life, not all cancer survivors utilize available psychosocial services (Shapiro et al., 2004). "
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    ABSTRACT: This study investigated the impact of a building-resilience intervention on coping and posttraumatic growth (PTG) in a convenience sample of 94 breast cancer survivors. PTG was divided into constructive and illusory components, based on the two-sided Janus face model (Maercker & Zoellner, ). We operationalized constructive PTG as an improvement in both PTG and coping, and illusory PTG as an improvement in PTG only. An 8-session group intervention was delivered to 49 women (mean age = 51.5 years, SD = 10.7) who completed self-report questionnaires at baseline and at 6 months follow-up; a control group of 45 women only completed questionnaires. More than half the participants (n = 53; 56.38%) reported increased PTG at 6 months (mean change = 0.56, SD = 0.48, η(2) = .58). The increase in both PTG and positive coping was significantly greater in the intervention group than the control group (B = 0.23 for PTG, and B = 0.35 for positive coping). Further, a higher proportion of constructive PTG (vs. illusory PTG) was reported by the participants in the intervention group (89.3%), as compared to the control group (56.3%; z = 2.57). The distinction between constructive and illusory PTG has clinical implications for interventions promoting coping and growth among cancer survivors. Copyright © 2015 International Society for Traumatic Stress Studies.
    Full-text · Article · May 2015 · Journal of Traumatic Stress
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    • "After a mean of 11 years of follow-up, breast cancer patients in the intervention arm were found to have a reduced risk of breast cancer recurrence (hazards ratio [HR] ϭ 0.55, p ϭ .034; Andersen et al., 2008). Among the patients in both arms who did have a recurrence, intervention-arm patients had a reduced risk of breast cancer death (HR ϭ 0.41, p ϭ .014; "
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    ABSTRACT: Over the last decade, there have been groundbreaking strides in our understanding of the multiple biological pathways by which psychosocial and behavioral factors can affect cancer progression. It is now clear that biobehavioral factors not only affect cellular immunity but both directly and indirectly modulate fundamental processes in cancer growth, including inflammation, angiogenesis, invasion, and metastasis. There is also an emerging understanding of how psychological and behavioral factors used in interventions can impact these physiological processes. This review outlines our current understanding of the physiological mechanisms by which psychological, social, and behavioral processes can affect cancer progression. The intervention literature is discussed, along with recommendations for future research to move the field of biobehavioral oncology forward. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Feb 2015 · American Psychologist
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