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.
Showing the most recent 10 out of 39 publications
