Presurgical Stress Management Improves Postoperative Immune Function in Men With Prostate Cancer Undergoing Radical Prostatectomy

ArticleinPsychosomatic Medicine 73(3):218-25 · April 2011with13 Reads
DOI: 10.1097/PSY.0b013e31820a1c26 · Source: PubMed
  • 41.47 · University of Texas MD Anderson Cancer Center
  • 35.08 · University of Texas MD Anderson Cancer Center
  • 32.85 · University of Texas MD Anderson Cancer Center
  • 38.49 · University of Texas MD Anderson Cancer Center
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.
    • "(Supplementary appendix three) [Bailey et al. 2004, Beard et al. 2011, Berglund et al. 2003, Campbell et al. 2007, Carmack-Taylor et al. 2004, Cohen et al. 2011, Giesler et al. 2005, Gilts et al. 2013, Helgesen et al. 2006, Johnson et al.1988, 1989 &1996, Kim et al. 2002, Lepore & Helgeson 1999, Lepore et al. 2003, Loiselle et al. 2010, Manne et al. 2011, Mishel et al. 2002 & 2003, Molton et al. 2008, Northouse et al. 2007, Parker et al. 2009, Penedo et al. 2004, Scura et al. 2004, Templeton & Coates 2014, Trager et al. 2013, Walker et al. 2013, Weber et al. 2004, Yung et al. 2002In the qualitative review 20 papers describing 20 unique studies were included in the synthesis. (Supplementary appendix three) [Boehmer & Babayan 2005, Broom 2005, Carter et al. 2011, Chambers et al. 2012, Ervik et al. 2010, Galbraith et al. 2012, Matsunga et al. 2004, Milne et al. 2008professional discussion, homework, peer discussion, formal buddy support, cognitive behavioural therapy, cognitive restructuring, psychoeducation, reiki and relaxation. "
    [Show abstract] [Hide abstract] ABSTRACT: Aims: To present a methodological exemplar of integrating findings from a quantitative and qualitative review on the same topic to provide insight into components of care that contribute to supportive care that is acceptable to men with prostate cancer. Background: Men with prostate cancer are likely to live a long time with the disease, experience side effects from treatment and therefore have ongoing supportive care needs. Quantitative and qualitative reviews have been published but the findings have yet to be integrated. Design: Integration of quantitative and qualitative synthesised evidence. Data source: Two previously published systematic reviews. Review methods: Synthesised evidence on supportive care for men with prostate cancer was integrated from two previously published systematic reviews: a narrative quantitative review and a qualitative review with thematic synthesis. These two streams of synthesised evidence were synthesised using concurrent narrative summary. Data from both reviews were used to develop a set of propositions from which a summary of components of care that likely to contribute to supportive care acceptable to men with prostate cancer were identified. Results: Nine propositions were developed which covered men's supportive care focusing on the role of health professionals. These propositions were used to compose nine components of care likely to lead to supportive care that is acceptable to men with prostate cancer. Some of these components are no/low cost such as developing a more empathic personalised approach, but more specific approaches need further investigation in randomised controlled trials e.g. online support. Conclusion: This methodological exemplar demonstrates the integration of quantitative and qualitative synthesised data to determine components of care likely to lead to provision of supportive care acceptable to men with prostate cancer. This article is protected by copyright. All rights reserved.
    Full-text · Article · Jul 2016
    • "More recently, immunological effects of psychosocial interventions have been reported in prostate cancer and gynecological cancer patients. One study showed a 2-session stress management intervention (deep breathing, guided imagery and adaptive coping skills) offered to men prior to surgery for prostate cancer related to decreases in mood disturbance and increases in NKCC one week pre-to 48 h post-surgery [38]. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Oct 2014
    • "It serves to distinguish specific effects of SEPT from psychological placebo effects [43]. Supportive therapy [44] as a manualized, non-specific psychological intervention has been previously used in clinical trials [45]. It includes common factors such as elicitation of affect, treatment context, empathy, reflective listening, and feeling understood. "
    [Show abstract] [Hide abstract] 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).
    Full-text · Article · Sep 2013
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