Biobehavioral outcomes following psychological interventions for cancer patients.

Abstract

Psychological interventions for adult cancer patients have primarily focused on reducing stress and enhancing quality of life. However, there has been expanded focus on biobehavioral outcomeshealth behaviors, compliance, biologic responses, and disease outcomes-consistent with the Biobehavioral Model of cancer stress and disease course. The author reviewed this expanded focus in quasi-experimental and experimental studies of psychological interventions, provided methodologic detail, summarized findings, and highlighted novel contributions. A final section discussed methodologic issues, research directions, and challenges for the coming decade.Cancer remains a significant national problem, with over 1 million Americans diagnosed each year. The adjustment process for cancer survivors may be burdensome and lengthy, and deteriorations in quality of life are underscored if they also have adverse health effects. A previous review noted the significant quality-of-life gains that can be achieved with psychological interventions (Andersen, 1992), a conclusion echoed here. In this review, I look more broadly and include biobehavioral responses and disease outcomes as areas important for intervention efforts. Although there are proportionately fewer studies that have included the latter, multimodal interventions and assessment of psychological, behavioral, and biologic mechanisms are the pathways for future research.The Biobehavioral Model of cancer stress and disease course (Andersen, Kiecolt-Glaser, & Glaser, 1994) provides the organizational framework for the discussion. Represented in Figure 1, the model includes psychological (e.g., stress and quality of life), behavioral (e.g., health behaviors and compliance), and biologic (e.g., neuroendocrine and immune) components and specifies the pathways by which health outcomes (e.g., disease endpoints-recurrence, disease free interval) might be affected. A complete discussion of the model is available elsewhere , as only brief summaries are provided prior to each section.Studies conducted since 1992 with adult cancer patients are reviewed; selected investigations prior to that period are included because of their importance, novelty, or absence from the earlier article focusing on quality of life (Andersen, 1992). Each component of the model is considered as an outcome following psychological interventions. Prior to each, I review descriptive findings and highlight prominent correlational investigations. For all experimental studies, accrual and retention rates and patient characteristics are provided, as these areas are in need of methodologic attention, as discussed later in the article. Although tedious at times, specific techniques of interventions are provided to enable the reader to distinguish among those with similar labels. Quasi-experimental designs are included for emerging areas. With few exceptions, all studies included psychological outcomes, but in the first section, I focus on studies with only these endpoints. Figure 1). Cancer survivors report con...

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