精神介入提供乳癌患者長期健康好處
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
June 16, 2010 — 根據一項發表於6月16日臨床癌症研究期刊的隨機分派控制研究結果，精神介入提供乳癌患者長期健康好處。
來自密蘇里州聖路易斯華盛頓大學伯朗學院的Sarah Gehlert博士，當被要求提供獨立評論時，在一篇新聞稿中表示，我們目前沒有太多經驗性精神介入用於診斷罹患乳癌的女性。增加存活率的介入將會是非常有價值的，這代表改善乳癌女性患者生活的一種新工具。
這一項過去研究，壓力與免疫力乳癌計畫（the Stress and Immunity Breast Cancer Project），目的在於確認精神介入是否可以降低227位新診斷罹患局部乳癌患者的再發率。參與者們隨機分派僅接受評估或是評估合併精神介入。
介入的目的在於讓病患們了解癌症壓力的天性；學習降低壓力的特定策略，以及增進生活品質；維持癌症照護醫從性與後續追蹤；改善與健康照護提供者的溝通；並改善治療期間的健康程度、加速恢復、以及提升整體健康。
在後續追蹤（追蹤時間中位數為11年）中，介入組的癌症再發風險較低（危險比值[HR]為0.55；P=0.034），還有其他正面精神、社會、免疫與健康好處。研究者們推測，介入組病患於再發後也有比較長的存活時間，促使我們研究潛在的生物行為機轉。
在227位女性中，有62位乳癌再發，而被納入存活分析中。在41位有後續生物行為評估追蹤的患者中，21位在介入組，18位在僅接受評估組。在再發診斷以及4、8與12個月後，這41位女性接受精神與免疫測試，包括自然殺手細胞毒性以及T細胞複製評估。也收集社會、醫從性以及健康相關數據。
根據意向分析，介入組再發後死亡風險是較低的（HR為0.41；P=0.014）。根據以生物行為數據進行混合效應後續追蹤，再發診斷時，所有病患都有顯著的精神憂慮，但是接下來的改善僅發生於介入組（P值<0.023）。在12個月時，介入組的免疫功能顯著較好（P值<0.017）。
主要作者、來自俄亥俄州立大學整合研究中心，哥倫比亞詹姆士癌症醫院與索洛夫研究機構的Barbara L. Anderson博士表示，介入組患者在診斷再發後的一年間，顯示出顯著的情緒改善以及較好的免疫反應。相反的，僅接受評估組，壓力仍然沒有減弱且免疫力顯著地下降。
Gehlert博士表示，Anderson博士的介入提供了乳癌研究轉變一個很強大的模式。這些結果是非常鼓舞人心的，因為這顯示了精神介入可以有長期的正面效應。
這項限制包括樣本數目相對較小。
Anderson博士的結論是，存活上的好處發生在NCI（國家癌症機構）設計的整合癌症中心接受先進科學腫瘤治療之上與之外。經驗性地提供癌症患者精神介入可以產生強大的持久品質，且可能包括重要的健康好處。
美國癌症醫學會；Longaberger公司-美國癌症學會乳癌研究基金；美國陸軍醫學研究取得活動；國家精神健康機構；以及國家癌症機構贊助這項研究。試驗作者們表示沒有相關資金上的往來。
Psychological Intervention Offers Long-Term Health Benefits for Women With Breast Cancer
By Laurie Barclay, MD
Medscape Medical News
June 16, 2010 — A psychological intervention offers long-term health benefits for women with breast cancer, according to the results of a randomized controlled trial study reported in the June 15 issue of Clinical Cancer Research.
"We currently have few empirically supported psychosocial interventions for use with women who have been diagnosed with breast cancer," said Sarah Gehlert, PhD, from the Brown School at Washington University in St. Louis, Missouri, in a news release when asked for independent comment. "An intervention that increased survival would be incredibly valuable. It represents a new tool for improving the lives of women with breast cancer."
The initial goal of a previously conducted study, the Stress and Immunity Breast Cancer Project, was to determine if a psychological intervention could lower the risk for breast cancer recurrence among 227 women newly diagnosed with regional breast cancer. Participants were randomly assigned to receive an evaluation only or an evaluation with psychological intervention.
Goals of the intervention were for patients to understand the nature of cancer stress; to learn specific strategies to decrease stress and to enhance quality of life; to maintain cancer care adherence and follow-up; to improve communication with healthcare providers; and to increase well-being during treatment, facilitate recovery, and improve overall health.
After follow-up (median duration, 11 years), the risk for recurrence was lower in the intervention group (hazard ratio [HR], 0.55; P = .034), and other positive psychological, social, immune, and health benefits were also noted. The investigators postulated that patients in the intervention group might also have longer survival duration after recurrence, prompting investigation of potential biobehavioral mechanisms.
Of the 227 women, 62 had recurrent breast cancer and were included in the survival analyses. Of 41 women available for further biobehavioral assessment, 21 were in the intervention group, and 18 were in the evaluation-only group. At recurrence diagnosis and at 4, 8, and 12 months later, these 41 women underwent psychological and immune testing, including assessment of natural killer cell cytotoxicity and T-cell proliferation. Social, adherence, and health data were also collected.
For the intervention group, the risk for death after recurrence was lower, based on intent-to-treat analysis (HR, 0.41; P = .014). At recurrence diagnosis, all patients had significant psychological distress, but subsequent improvement occurred only in the intervention group (P values < .023), based on mixed-effects follow-up analyses with biobehavioral data. At 12 months, immune function was significantly better in the intervention group (P values < .017).
"Patients in the intervention arm evidenced significant emotional improvement and more favorable immune responses in the year following recurrence diagnosis," said lead author Barbara L. Andersen, PhD, from the Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute in Columbus. "In contrast, stress remained unabated and immunity significantly declined in the assessment-only group."
"Dr. Andersen's intervention provides a strong model for translation in breast cancer research," Dr. Gehlert said. "These results are extremely heartening, because it shows that a psychological intervention can have long-term positive effects."
Limitations of this study include relatively small sample size.
"Survival advantages occurred above and beyond the improvements from state-of-the-science oncology treatments received at an NCI [National Cancer Institute]-designated comprehensive cancer center," Dr. Andersen concluded. "An empirically supported psychological intervention for cancer patients can yield robust gains of enduring quality, and ones that may include important health benefits."
The American Cancer Society; Longaberger Company-American Cancer Society Grant for Breast Cancer Research; US Army Medical Research Acquisition Activity; National Institute of Mental Health; and National Cancer Institute supported this study. The study authors have disclosed no relevant financial relationships.
Clin Cancer Res. 2010;16:3270-3278.
