The adjustment process for cancer survivors may be burdensome and lengthy, but deteriorations in quality of life are underscored if they also have adverse health effects. In the general case, the immune system may be relevant to host resistance to progression and metastatic spread, but cancers etiologically linked to hormonal stimuli--such as breast eancer--may be particularly responsive to adverse, down-regulating factors. To guide the research, a Biobehavioral Model of cancer stress and disease course was proposed. The model includes psychological (stress and quality of life), behavioral (health behaviors and compliance), and biologic (neuroendocrine and immune) factors, and specifies the pathways by which health outcomes (e.g. disease endpoints--recurrence, disease free interval) might be affected. Funding was provided for accrual of women (N of 200) with stage II or III breast cancer to an experiment testing the Biobehavioral Model. Accrual is complete and women have been randomized between psychological/behavioral intervention and assessment only (no intervention) arms. Consistent with the Model, published data document that stress is related to decrements in quality of life and immune down regulation for women with cancer. Preliminary data from the initial follow ups (4 and 12 months) suggest that women being treated with the psychological intervention protocol show lowered stress, increased quality of life, more positive health behaviors and fewer negative ones, greater compliance, and an increase in immune responses, as predicted. The ultimate aim of the research is to test the hypothesis that intervention subjects will show a doubling (ratio of median durations = 2.0) in time to recurrence, with a .05 level of significance and power of 0.80, one-sided test. In this competitive renewal application, we request to continue follow up assessments for years 2-5 and begin follow up for years 6-10 when the risk for disease recurrence remains high. With this extension, we also propose to include a) endocrine assays for an analysis of stress/endocrine/immune relationships; b) a series of correlative cancer immunologic studies to further characterize the stress-related immune dysfunction in natural killer (NK) cell lysis associated with breast cancer; and, c) a prospective, controlled, biobehavioral study of cancer recurrence.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA092704-08
Application #
6612943
Study Section
Special Emphasis Panel (ZRG1-RPHB-3 (01))
Program Officer
Nelson, Wendy
Project Start
1996-09-30
Project End
2006-06-30
Budget Start
2003-07-01
Budget End
2004-06-30
Support Year
8
Fiscal Year
2003
Total Cost
$846,471
Indirect Cost
Name
Ohio State University
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
071650709
City
Columbus
State
OH
Country
United States
Zip Code
43210
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Gregorio, Sharla Wells-Di; Carpenter, Kristen M; Dorfman, Caroline S et al. (2012) Impact of breast cancer recurrence and cancer-specific stress on spouse health and immune function. Brain Behav Immun 26:228-33
Mundy-Bosse, Bethany L; Thornton, Lisa M; Yang, Hae-Chung et al. (2011) Psychological stress is associated with altered levels of myeloid-derived suppressor cells in breast cancer patients. Cell Immunol 270:80-7
Levin, Anna O; Carpenter, Kristen M; Fowler, Jeffrey M et al. (2010) Sexual morbidity associated with poorer psychological adjustment among gynecological cancer survivors. Int J Gynecol Cancer 20:461-70
Wu, Salene M; Andersen, Barbara L (2010) Stress generation over the course of breast cancer survivorship. J Behav Med 33:250-7
Carpenter, Kristen M; Fowler, Jeffrey M; Maxwell, G Larry et al. (2010) Direct and buffering effects of social support among gynecologic cancer survivors. Ann Behav Med 39:79-90
Andersen, Barbara L; Thornton, Lisa M; Shapiro, Charles L et al. (2010) Biobehavioral, immune, and health benefits following recurrence for psychological intervention participants. Clin Cancer Res 16:3270-8
Carpenter, Kristen M; Andersen, Barbara L; Fowler, Jeffrey M et al. (2009) Sexual self schema as a moderator of sexual and psychological outcomes for gynecologic cancer survivors. Arch Sex Behav 38:828-41

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