Preservation of immune function in cervical cancer patients during chemoradiation using a novel integrative approach

Abstract

Patients receiving chemoradiation for cervical cancer are at risk for distress, chemoradiation-related side-effects, and immunosuppression. This prospective randomized clinical trial examined effects of a complementary therapy, Healing Touch (HT), versus relaxation training (RT) and usual care (UC) for (1) supporting cellular immunity, (2) improving mood and quality of life (QOL), and (3) reducing treatment-associated toxicities and treatment delay in cervical cancer patients receiving chemoradiation. Sixty women with stages IB1 to IVA cervical cancer were randomly assigned to receive UC or 4 ×/weekly individual sessions of either HT or RT immediately following radiation during their 6-week chemoradiation treatment. Patients completed psychosocial assessments and blood sampling before chemoradiation at baseline, weeks 4 and 6. Multilevel regression analyses using orthogonal contrasts tested for differences between treatment conditions over time. HT patients had a minimal decrease in natural killer cell cytotoxicity (NKCC) over the course of treatment whereas NKCC of RT and UC patients declined sharply during chemoradiation (group by time interaction: p = 0.018). HT patients showed greater decreases in two different indicators of depressed mood (CES-D depressed mood subscale and POMS depression scale) compared to RT and UC (group by time interactions: p<0.05). No between group differences were observed in QOL, treatment delay, or clinically-rated toxicities. HT may benefit cervical cancer patients by moderating effects of chemoradiation on depressed mood and cellular immunity. Effects of HT on toxicities, treatment delay, QOL, and fatigue were not observed. Long-term clinical implications of findings are not known.

Figure 1

Experimental design and flow diagram of study participation.

Figure 2

NK cell cytotoxicity (NKCC: percent specific lysis at 100:1 E:T) in cervical cancer patients randomized to Healing Touch (■), relaxation (▲) or usual care (●) during chemoradiation. HT patients show relative preservation of NKCC over time (p=0.52); both control groups show significant drops in NKCC during treatment (RT: p=0.002, usual care: p=0.001). Orthogonal contrast for HT vs. RT/UC groups at Week 6 (p=.002).

Figure 3

Center for Epidemiological Studies Depression (CES-D) total scores in cervical cancer patients randomized to Healing Touch (■), relaxation (▲) or usual care (●) during chemoradiation. HT patients show a significant drop in depression over time (p = 0.03) and mean values are in the non-depressed range (mean scores below 16) at week 6. Mean RT and UC scores remain in the depressed range at week 6.