Sep. 1, 1999 COLUMBUS, Ohio -- Women with breast cancer who participated in a psychological intervention program showed lower levels of a stress hormone and higher levels of a antibody that fights breast tumors than did other patients, a new study has found.
In addition, women in the program were more likely than others to get the full dosage of their chemotherapy, and showed lower levels of depression and reported higher quality of life.
The results suggest that the program -- which included training in relaxation, stress reduction, and coping strategies -- may not only aid women psychologically, but may also help them fight their disease, said Barbara Andersen, leader of the study and professor of psychology at Ohio State University.
"The bright and encouraging news is that psychological interventions have reliable biological effects that can benefit women with breast cancer," Andersen said.
"To our knowledge, these are the first experimental data to show a link between psychological interventions and an immune response directly related to fighting breast cancer." She presented the results Aug. 21 in Boston in an invited address at the annual meeting of the American Psychological Association. Andersen and her colleagues examined 115 women with Stage II or Stage III breast cancer. Half of the women were enrolled in the intervention, which included social support, training in progressive muscle relaxation, encouragement to exercise regularly and information on improving diet. The other half didn't participate in the intervention. Researchers found that women in the intervention program showed significantly lower levels of the stress hormone cortisol at four and eight months after surgery than did breast-cancer patients who didn't participate. (Cortisol levels were about one-quarter lower in program participants at eight months.) "Stress hormones such as cortisol are known to depress the immune system, so it is very significant the women who participated in the program show lower levels of cortisol," Andersen said. Program participants also showed significantly higher levels (about one-quarter higher) of an antibody to mucin, a chemical which at high levels is associated with the severity and progression of breast cancer. Andersen said mucin antibody levels declined in both groups during the stress of chemotherapy. However, women who participated in the intervention program generally saw their antibody levels rebound at eight and 12 months after surgery. But antibody levels remained low for non-participants. The fact that the mucin antibody response was stronger in program participants suggests that other anti-tumor responses may also be stronger in these women. "We suspect that the overall immune response is stronger in women who took part in the intervention," Andersen said. Another encouraging finding was that program participants also received a significantly larger dose of some chemotherapy drugs -- methotrexate and 5-FU -- than did other patients. Although women in both groups were initially prescribed similar doses of chemotherapy drugs, Andersen said women who didn't receive the intervention were more likely to have their dosage reduced because of severe nausea and vomiting or because they simply refused the treatment. For example, women in the intervention group who didn't comply with their chemotherapy were about 10 times less likely to say it was because of nausea or vomiting. Overall, about twice as many non-participants refused chemotherapy as did program participants. "The intervention program helps women tolerate their chemotherapy better so they can stay on track and receive the full dosage," Andersen said. The program also helped women on a wide variety of psychological and social measures, Andersen said. Compared to other patients, participants reported less depression, more energy and even more social support from their friends. "We're finding that stress and distress can be significantly reduced in breast-cancer patients and that these effects are linked to lowering of stress hormones, a stronger immune response, and a better quality of life," Andersen said. This study is part of the ongoing Stress and Immunity Breast Cancer Project headed by Andersen. Other investigators include Olivera Finn of the University of Pittsburgh and William Malarkey and William Farrar of Ohio State. Charles Emery, also of Ohio State, presented some of the exercise-related results at the APA meeting. Among those funding the study are the American Cancer Society, The Longaberger Company, U.S. Army Medical Research, National Institute of Mental Health, the Walther Cancer Foundation, and Ohio State's Elizabeth Gee Fund.
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