This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.1.To examine the impact of a psychological/behavioral intervention on the psychosocial and clinical outcomes for breast cancer recurrence patients, a biobehavioral model of cancer stress and disease course is proposed (Andersen, Kiecolt-Glaser, & Glaser, 1994) and provides a conceptual basis for the research. All of the variables in the model have been operationalized, and further, tailored to the unique stresses of breast cancer. The specific components of the intervention come from literatures on interventions to enhance quality of life (see Andersen, 1992 for a review), interventions which impact immunity (see Kiecolt-Glaser et al., 1985; Kiecolt-Glaser & Glaser, 1992, for a review), and other specific behavioral interventions for women with breast cancer (e.g. the importance of low fat diet in breast cancer; Chlebowski, Blackburn, Buzzard, Rose, et al., 1993). This design provides a test of both psychological and behavioral variables influencing health outcomes directly via the intervention and a test of a specific mechanism--alteration in immune function--for health effects for women with breast cancer. 2. Hypotheses will be tested in three areas. In Area I, hypotheses involve group differences on psychological, behavioral, health, endocrine and immune outcomes. Specifically, we hypothesize that: (Ia) Intervention subjects that have recurred will report significantly better psychological outcomes, specifically lowered stress and enhanced quality of life. Intervention subjects will also be less vulnerable to the specific sequelae of breast cancer treatment such as disrupted sexual self concept. (Ib) Intervention subjects will demonstrate significantly improved health behavior outcomes, including higher rates of positive health behaviors (e.g. physical exercise, lower fat intake), lower rates of negative health behaviors (e.g. alcohol intake), and better compliance with cancer therapy and medical follow up. (Ic) Intervention subjects will have significantly better endocrine and immune function. (Id) The intervention group will have better health outcomes, lower rates and/or slower cancer progression. In Area II we will test the relationships among the variables specified in the biobehavioral model, including the following: (IIa) the prediction of immune function from the psychological variables (e.g. increased stress is significantly correlated with immune changes, such as decreased NK activity); and, (IIb) the role of the immune variables as a mediator linking psychological/behavioral variables to disease outcomes (i.e. stress is related to increases in stress hormone responses and decreases in functional immunity which are, in turn, related to shorter disease free interval). In Area III we will examine individual differences. We will determine change over time for individuals in each group and test for individual differences related to change in immunity or differential health outcomes. Specifically, we hypothesize the following: (IIIa) We will test whether or not differences between women in their level of social support may moderate psychological or immune responses or health outcomes, e.g. women with greater levels of social support may manifest higher levels of NK activity and/or lower rates or slower disease progression; (IIIb) We will test whether or not differences in personality characteristics might influence vulnerability to lowered immunity or illness progression, e.g. individuals high in extraversion, low in neuroticism, high in openness or high in conscientiousness may have better health outcomes; and (IIIc) Finally, we will examine the medical stratification factors (i.e. number of positive lymph nodes, estrogen receptor status, menopause status) to determine if the effectiveness of the psychological intervention interacts with them.
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