Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer

Abstract

Background: A diagnosis of breast cancer and treatment are psychologically stressful events, particularly over the first year after diagnosis. Women undergo many demanding and anxiety-arousing treatments such as surgery, radiation and chemotherapy. Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes (neuroendocrine and immune) that are relevant for health outcomes in breast cancer patients.

Methods: Women with Stages 1-3 breast cancer recruited 4-8 weeks after surgery were randomized to either a 10-week group-based cognitive behavioral stress management (CBSM) intervention or a 1-day psychoeducational control group and completed questionnaires and late afternoon blood samples at study entry and 6 and 12 months after assignment to experimental condition.

Results: Of 128 women initially providing psychosocial questionnaire and blood samples at study entry, 97 provided complete data for anxiety measures and cortisol analysis at all time points, and immune assays were run on a subset of 85 of these women. Those assigned to a 10-week group-based CBSM intervention evidenced better psychosocial adaptation (lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms) and physiological adaptation (lower cortisol, greater Th1 cytokine [interleukin-2 and interferon-gamma] production and IL-2:IL-4 ratio) after their adjuvant treatment compared to those in the control group. Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period. Th1 cytokine regulation changes held only over the initial 6-month period.

Conclusions: This intervention may have facilitated a "recovery or maintenance" of Th1 cytokine regulation during or after the adjuvant therapy period. Behavioral interventions that address dysregulated neuroendocrine function could play a clinically significant role in optimizing host immunologic resistance during a vulnerable period.

Figure 1

Experimental design and flow diagram of participation

Figure 2

Means (and SEM) for Impact of Event Scale Intrusive Thoughts scores (Panel A) and Hamilton Rating Scale-Anxiety scores (Panel B) in breast cancer patients assigned to the intervention or control condition at T1 (study entry),T2 (6-month follow-up), and T3 (12-month follow-up).

Figure 3

Natural-log (ln) transformed means (and SEMs) for production of IL-2 (Panel A) and IFN-γ (Panel B) in breast cancer patients assigned to the intervention or control condition at T1 (study entry), T2 (6-month follow-up), and T3 (12-month follow-up).