The goal is to determine the impact of a prayer intervention on neuroendocrine markers of stress and on attendant immune function in African American women with early stage breast cancer. The study is based on the scientific premise that the stress of having breast cancer alters natural neuroendocrine-mediated immunoprotective mechanisms and may increase the likelihood of tumor recurrence. We propose that this cascade may be partially ameliorated by a prayer intervention in African American women with a strong propensity to use spiritual healing. African American women have a poor prognosis at every stage of breast cancer diagnosis and are more vulnerable to the stress associated with attendant diagnosis and treatment from a CAM perspective, strong psychosocial group support as well as mindful meditation may positively modulate the negative neuroendocrine and immune consequences of chronic stress in cancer. Prayer interventions offer both meditation-like and group supportive elements. Based on abysmal physical and psychosocial outcomes in African American women with breast cancer and their almost 100% use of prayer for coping, we propose to determine the extend to which a personal and group prayer intervention improves neuroendocrine and immune responses in African American women with breast cancer treated locally with surgery and irradiation. A prayer intervention (n=40) will be initiated 1-2 months post-radiation and compared to a randomly assigned """"""""wait listed"""""""" control group (n=40) 1 and 6 months after baseline. We will examine changes in (a) neuroendocrine markers of stress including plasma ACTH and cortisol responses to intravenous corticotropin releasing hormone, 24-hour urinary free cortisol, and the cortisol circadian rhythm using salivary cortisol, (b) parameters of immune response including CD4/CD8 T cell subset changes in the peripheral blood, NK cell activity using NK cells isolated from peripheral blood lymphocytes and assayed for lytic function against the NK cell target, K562, the total number of monocytes in the peripheral blood, and peripheral blood lymphocyte proliferation and cytokine release in response to breast cancer-specific antigens including HER-2/neu, MUC-1, MAGE 3, and (c) perceived stress, psychosocial functioning, and quality of life. Statistical analyses will include multivariate ANCOVA models to examine differences between groups in change scores observed within the groups, where each woman will serve as her own control. We also plan to establish this group as a cohort for long-term tumor surveillance to be compared with a race, age, and stage matched reference group.
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