This application is for a 5-year Center for Psycho-Oncology Research (CPOR) grant to conduct behavioral, psychological, social, and biomedical research on the interrelationships among cognition, emotion, biological processes, and physical health in patients with different forms of cancer including breast cancer, prostate cancer and AIDS-related cervical neoplasia. The Center will systematically evaluate the efficacy group-based Cognitive Behavioral Stress Management (CBSM) intervention in Projects 1, 2 and 3., and a pharmacological hormonal treatment in Project 4, for improving quality of life and physical health in patients with different types of cancer or carcinogenic processes associated with reproductive health or hormonal functioning. These include women with breast cancer, older men with prostate cancer, and women at high risk for cervical cancer due to co-infection with Human Immunodeficiency Virus (HIV+) AND Human Papillomavirus (HPV+). Our prior work has shown that CBSM intervention can improve mood, change cognitions and build coping resources; that it modulates the output of sympathetic nervous system (SNS), Hypothalamic Pituitary Adrenal (HPA), and Hypothalamic Pituitary Gonadal (HPG) hormones; and that it helps normalize immunologic status in different populations. The Center will directly address these issues through four (4) randomized clinical trials as follows. Project 1 will (a) evaluate the effects of CBSM intervention on psychological distress, quality of life and biopsy- determined level of cervical cellular atypia; and (b) examine the putative psycho-biological mediators (psychosocial, endocrine, and immunologic changes) on intervention effects observed. Project 2 will (a) investigate the effects of CBSM intervention and quality of life and disease status (change in CA15-3) antigen levels) in women with early-mid stage breast, and (b) examine the putative psycho-biological mediators of intervention effects observed. Project 3 will (a) investigate the effects of CBSM in combination with Viagra (sildenafil citrate) on quality of life and physical health in older men with prostate cancer, and (b) examine the putative psycho-biological mediators of intervention effects observed. Project 4 will (a) evaluate the effects of estrogen therapy (chronic low-dose oral 17- beta estradiotherapy) on mood and quality of life, and physical health in patients with metastatic prostate cancer, and (b) examine the putative psycho-biological mediators of intervention effects observed. The Center will also support and conduct pilot studies of interventions in men and women with other cancers, and will also develop and test other forms of intervention as well as Spanish translations of CBSM for Spanish- speaking Breast and Prostate cancer patients.
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