Abstract CN08-02: Psychological stress and disease progression

Abstract

Abstract A randomized clinical trial was designed to test the hypothesis that cancer patients coping with a cancer diagnosis but receiving a psychological intervention would have reduced risk for disease progression (1994). Patients (N=227) surgically treated for regional breast cancer participated. Before beginning adjuvant cancer therapies, patients were assessed with psychological and behavioral measures, had a health evaluation, and a 60 mL blood sample was drawn. Patients were randomized to Psychological Intervention or Assessment only 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. Earlier papers (2004, 2007) showed that, compared to the Assessment arm, the Intervention arm improved across all of the latter secondary outcomes. T cell blastogenesis was also enhanced. An interim paper (2007) clarified treatment mechanisms in the Intervention arm. First, patients were satisfied with the intervention, but it was group cohesion that related to better outcomes. Second, offering patients a stress conceptualization (Selye) and teaching them multiple coping strategies related to better health. Third, three relationships between treatment utilization and outcomes are noted: 1) Relaxation training was associated with both distress reduction and symptom lowering. 2) Patients' use of assertive communication with health care providers was associated with better health outcomes. 3) Intervention strategy use was also associated with fewer signs/symptoms and cancer treatment toxicities. After a median of 11 years follow-up, recurrence occurred for 62 of 212 (29%) women and death for 54 of 227 (24%). Intent to treat hazard analyses showed, as predicted, Intervention arm patients had a reduced risk of recurrence [Hazard Ratio (HR)=0.55, P=.034] and breast cancer death (HR=0.44, P=.016). Follow up papers (2009) have examined the covariation of inflammation and distress during the period of intervention delivery (2009) and in the months prior to recurrence diagnosis (2008). Learning Objective 1: Show that a randomized clinical trial has produced evidence that a behavioral intervention can reduce fatal and nonfatal regional breast cancer recurrence. Learning Objective 2: Demonstrate that patients' use of assertive communication with health care providers was associated with better health outcomes. Citation Information: Cancer Prev Res 2011;4(10 Suppl):CN08-02.