Trait anxiety and anticipatory immune reactions in women receiving adjuvant chemotherapy for breast cancer

Abstract

We compared peripheral blood cell counts as well as mitogen activity and natural killer-cell activity in women undergoing adjuvant chemotherapy for breast cancer in the hospital prior to chemotherapy with assessment at home 2 days earlier. Patients compared to controls had an increased number of white blood cell counts in the hospital as compared to those at home, mediated by an increased total number of granulocytes. Among patients, those with high compared to low trait anxiety evidenced immune system changes. Total number of monocytes were reduced in patients with high compared to low trait anxiety and natural killer-cell activity tended to be compromised in the high anxiety group. Helper/inducer T-cells isolated from hospital blood samples were lower in patients with high as compared to low trait anxiety, while no difference was observed in samples taken at home. Conditioned nausea was associated with trait anxiety and patients with as compared to without conditioned nausea displayed immune changes similar to changes observed as a function of trait anxiety. State anxiety measured at the hospital did not relate to immune measures. The observed increase in granulocytes is consistent with an interpretation both in terms of conditioning and anticipatory stress. The anticipatory immunosuppression in patients with high compared to low trait anxiety is consistent with the hypothesis that chemotherapy patients may develop conditioned immunosuppression after repeated pairings of treatment-related stimuli with the unconditioned immunosuppressive effect of chemotherapy.