June 8, 2010 Stress-reducing psychological intervention helps to increase survival and quality of life among women with recurrent breast cancer over the long-term, according to results of a Phase III study published in Clinical Cancer Research, a journal of the American Association for Cancer Research.
"Patients in the intervention arm evidenced significant emotional improvement and more favorable immune responses in the year following recurrence diagnosis. In contrast, stress remained unabated and immunity significantly declined in the assessment-only group," said lead researcher Barbara L. Andersen, Ph.D., professor in the department of psychology at the Ohio State University, Columbus, and a researcher at the Ohio State University Comprehensive Cancer Center -- James Cancer Hospital and Solove Research Institute.
Psychological stress leads to disruptions in quality of life, health behaviors and immunity, all of which contribute to poorer health outcomes.
In a previously conducted study, The Stress and Immunity Breast Cancer Project, Andersen and colleagues reported that after an average of 11 years of follow-up, women who received psychological intervention had a 45 percent reduced risk of breast cancer recurrence, demonstrating positive effects. For this follow-up, they tested the same hypothesis with the endpoint being death from breast cancer.
Participants included 227 women with newly diagnosed Stage II or III breast cancer; they were randomized to receive a psychological intervention or assessment only. Psychological intervention included the following clinical objectives for patients: understand the nature of cancer stress; learn tangible ways to reduce stress and improve quality of life; maintain adherence and follow-up to cancer care; enhance communication with medical care providers; increase well-being during treatment, facilitate recovery and improve overall health.
During follow-up, 62 women were diagnosed with recurrent breast cancer. After recurrence, women who had earlier received the psychological intervention had a 59 percent reduction in the risk of dying of breast cancer.
According to Andersen, these results "show enduring benefits from the psychological intervention that were never previously considered or observed," and suggest that the intervention's mechanisms affected patients' risks for recurrence and for breast cancer death.
"Survival advantages occurred above and beyond the improvements from state-of-the-science oncology treatments received at an NCI-designated comprehensive cancer center," Andersen said. "An empirically supported psychological intervention for cancer patients can yield robust gains of enduring quality, and ones that may include important health benefits."
Sarah Gehlert, Ph.D., E. Desmond Lee professor of racial and ethnic diversity, The Brown School, Washington University, St. Louis, said the results of this study are unique because they provide longitudinal evidence of the benefits of psychological intervention in this study population, and are based on a solid theoretical base.
"We currently have few empirically supported psychosocial interventions for use with women who have been diagnosed with breast cancer," she said. "An intervention that increased survival would be incredibly valuable. It represents a new tool for improving the lives of women with breast cancer."
Gehlert, who is not affiliated with this study, believes this research will provide a template for future health services research in breast cancer.
"Dr. Andersen's intervention provides a strong model for translation in breast cancer research," she said. "These results are extremely heartening, because it shows that a psychological intervention can have long-term positive effects."
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- Barbara L. Andersen, Lisa M. Thornton, Charles L. Shapiro, William B. Farrar, Bethany L. Mundy, Hae-Chung Yang, and William E. Carson III. Biobehavioral, Immune, and Health Benefits Following Recurrence for Psychological Intervention Participants. Clin Cancer Res, 1078-0432.CCR-10-0278; June 8, 2010 DOI: 10.1158/1078-0432.CCR-10-0278
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