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.
