Prognostic risk assessment in primary breast cancer by behavioral and immunological parameters.

Levy, Sandra M.; Herberman, Ronald B.; Maluish, Annette M.; Schlien, Bernadene; Lippman, Marc E.

doi:10.1037/0278-6133.4.2.99

Cited by 221 publications

(108 citation statements)

References 18 publications

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“…21,37 Although the association between impaired NCA and the development of breast cancer has not been established, research on humans and other species points to a significant role of NCA in preventing the development of cancer, including breast cancer, and its metastases. [1][2][3][4]8,9 Additional studies doc- norepinephrine levels and state anxiety, (d) IL-2-induced NCA and emotion-focused coping, (e) IL-2-induced NCA and problem-focused coping, (f) IL-2-induced NCA and perceived control, (g) norepinephrine levels vs. perceived control, (h) IL-2 secretion and perceived control, (i) norepinephrine levels and IL-2-induced NCA and (j) epinephrine levels and IL-2 secretion. In general, correlations are done with data from both DBCP and controls, whereas correlations with perceived control (f-h) are done for DBCP only.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] NCA has also been demonstrated to be an independent prognostic marker in patients with cancer. 8,9 Imai et al 10 showed that selected lifestyle factors, such as maintaining body weight, not smoking, increasing intake of green vegetables and moderate alcohol consumption, may have an effect on natural cytotoxicity and that NCA can be increased by altering several lifestyle factors. Other studies have shown that restricted lifestyle changes, such as increasing exercise, losing weight and reducing fat and alcohol intake, are associated with a significant reduction in breast cancer risk (reviewed by Chlebowski 11 ).…”

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confidence: 99%

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Increased emotional distress in daughters of breast cancer patients is associated with decreased natural cytotoxic activity, elevated levels of stress hormones and decreased secretion of Th1 cytokines

Cohen

Klein²,

Kuten³

et al. 2002

Intl Journal of Cancer

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DBCP who are aware of their increased risk of developing breast cancer may suffer from high emotional distress. Chronic stress may interfere with NCA and low NCA is associated with increased cancer risk. We studied 80 DBCP and 47 age-and education-matched healthy females (controls). Heparinized venous blood (30 ml) was drawn from all subjects between 8 and 9 A.M., and each participant answered a set of psychologic questionnaires. In addition, the firstmorning urine sample was collected. DBCP scored significantly higher in emotional distress compared to controls. Levels of stress hormones in DBCP were higher and in vitro secretion of IL-2, IL-12 and IFN-␥ lower compared to controls. NCA against NK-resistant (MCF-7, COLO-205, U937) and NK-sensitive (K562) cell lines was significantly lower in DBCP and much less augmented by in vitro preincubation with IL-2 or IL-12 compared to controls. NCA and in vitro Th1 cytokine secretion were inversely correlated with the degree of emotional distress and the level of stress hormones in blood or urine. High emotional distress and elevated levels of stress hormones are associated with impaired immune surveillance functions in DBCP. This may contribute to the increased risk of DBCP to develop breast cancer. An interventional trial to enhance coping and reduce stress levels may help to decrease the risk for breast cancer onset in DBCP. © 2002 Wiley-Liss, Inc. Key words: chronic stress; daughters of breast cancer patients; natural cytotoxic activity; Th1 cytokines; stress hormonesThe critical question in immunosurveillance against cancer, which has so far remained unanswered, is whether differences between individuals with regard to immunologic host-defense mechanisms can predict the future development of cancer. Various in vivo studies in humans and mice have shown the significant role of different natural cytotoxic lymphocyte populations in preventing the development of cancer or its metastases. 1-4 However, only a few studies have investigated NCA of peripheral blood lymphocytes among healthy individuals in a general population or those at increased risk of developing cancer. 5-7 NCA has also been demonstrated to be an independent prognostic marker in patients with cancer. 8,9 Imai et al. 10 showed that selected lifestyle factors, such as maintaining body weight, not smoking, increasing intake of green vegetables and moderate alcohol consumption, may have an effect on natural cytotoxicity and that NCA can be increased by altering several lifestyle factors. Other studies have shown that restricted lifestyle changes, such as increasing exercise, losing weight and reducing fat and alcohol intake, are associated with a significant reduction in breast cancer risk (reviewed by Chlebowski 11 ).Whether emotional distress is associated with the onset of cancer in general and of breast cancer in particular has long been debated. Some studies have suggested that the overall prevalence of breast cancer is increased in women who have experienced stressful life events. 12,13 In contrast, the...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Increased emotional distress in daughters of breast cancer patients is associated with decreased natural cytotoxic activity, elevated levels of stress hormones and decreased secretion of Th1 cytokines

Cohen

Klein²,

Kuten³

et al. 2002

Intl Journal of Cancer

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“…Although it is not an endpoint, the extent of disease at initial diagnosis (i.e., number of positive nodes) is important prognostically. Levy et al (1985) found self-reports of fatigue (POMS) obtained shortly following initial treatment to be a predictor of nodal status in women with breast cancer, but there was no effect for fatigue if NK cell levels were first entered into the regression equation. We also examined disease progression to the lymph nodes in women with gynecologic cancer (Roberts et al, 1994).…”

Section: Biological Pathwaysmentioning

confidence: 99%

“…Subjects were women with cervical (Stage I, n = 27; Stage II, n = 10) or endometrial (Stage I, n = 17; Stage II, n = 4) cancer assessed on two occasions (separated by approximately one week) following their diagnosis and prior to treatment. Distress measures included selfreported distress (POMS) and interviewer-rated distress and disturbance of affect (a modified version of a Schedule for Affective Disorders and Shizophrenia-SADS; Endicott & Spitzer, 1978-interview) to address inconsistencies in previous research (e.g., Levy, Herberman, Maluish, Schlein, & Lippman, 1985). Twenty age-matched healthy women were included to validate emotional distress indicators.…”

Section: Biological Pathwaysmentioning

confidence: 99%

“…In an early study by Levy et al (1985), 75 women with Stage I or II breast cancer were assessed following surgery (lumpectomy or mastectomy with node dissection) and before initiation of other therapy. Women who were rated as better adjusted to their illness but who reported higher fatigue (as assessed with the POMS) had lower NK cell levels.…”

Section: Biological Pathwaysmentioning

confidence: 99%

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A biobehavioral model of cancer stress and disease course.

Andersen¹,

Kiecolt‐Glaser²,

Glaser³

1994

American Psychologist

386

246

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Approximately 1 million Americans are diagnosed with cancer each year and must cope with the disease and treatments. Many studies have documented the deteriorations in quality of life that occur. These data suggest that the adjustment process is burdensome and lengthy. There is ample evidence showing that adults experiencing other long-term stressors experience not only high rates of adjustment difficulties (e.g., syndromal depression) but important biologic effects, such as persistent downregulation of elements of the immune system, and adverse health outcomes, such as higher rates of respiratory tract infections. Thus, deteriorations in quality of life with cancer are underscored if they have implications for biological processes, such as the immune system, relating to disease progression and spread. Considering these and other data, a biobehavioral model of adjustment to the stresses of cancer is offered, and mechanisms by which psychological and behavioral responses may influence biological processes and, perhaps, health outcomes are proposed. Finally, strategies for testing the model via experiments testing psychological interventions are offered.Cancer is a major health problem, accounting for 23% of all deaths in the United States. Although death rates from heart diseases, stroke, and other conditions have been decreasing, deaths due to cancer have risen 20% in the past 30 years (American Cancer Society [ACS], 1993). This "big picture" holds for the major sites of disease, including lung, breast, and prostate cancer, for which death rates have shown large increases. The number-one killer, lung cancer, has shown huge increases in age-adjusted death rates in the past 30 years-an increase of 121% for men and 415% for women. The second most common site of cancer for men, prostate, has shown a 12% increase in the death rate. For women, breast cancer accounts for 32% of all new cases. During this decade alone, more than 1.5 million women (1 in 9) will be diagnosed and 30% of these women will die from the disease. Other sobering statistics indicate that since 1980 there has been a 24% increase in breast cancer incidence; despite major clinical studies (including trials of dramatic treatments, e.g., bone marrow transplantation), breast cancer mortality rates have been stable for the past 20 years. In sum, increasing numbers of individuals are being diagnosed, undergo difficult therapies, and somehow cope with 5-year relative survival rates of 53% for White Americans and 38% for Black Americans (ACS, 1993).Although there are notable exceptions (e.g., Bard & Sutherland, 1952;Fox, 1976), research programs conducted by psychologists on the behavioral and psychological aspects of cancer did not begin in earnest until the late 1970s. Yet considerable advances have been made in describing the difficulties cancer patients face and examining the processes of adjustment (see discussions in Andersen, 1989; Cancer, 1991, Vol. 67, No. 3 Supplement) NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manus...

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Mind Matters in Cancer Survival

Spiegel¹

2011

JAMA

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The very name "psychooncology" implies interaction between brain and body. One of the most intriguing scientific questions for the field is whether or not living better may also mean living longer. Randomized intervention trials examining this question will be reviewed. The majority show a survival advantage for patients randomized to psychologically effective interventions for individuals with a variety of cancers, including breast, melanoma, gastro-intestinal, lymphoma, and lung cancers. Importantly for breast and other cancers, when aggressive anti-tumor treatments are less effective, supportive approaches appear to become more useful. This is highlighted by a recent randomized clinical trial of palliative care for non-small cell lung cancer patients.There is growing evidence that disruption of circadian rhythms, including rest-activity patterns and hypothalamic-pituitary-adrenal (HPA) axis function, affects cancer risk and progression. Women with metastatic breast cancer have flatter than normal diurnal cortisol patterns, and the degree of loss of daily variation in cortisol predicts earlier mortality. Mechanisms by which abnormal cortisol patterns affect metabolism, gene expression, and immune function are reviewed. The HPA hyperactivity associated with depression can produce elevated levels of cytokines that affect the brain. Tumor cells can, in turn, co-opt certain mediators of inflammation such as NFkB, IL-6, and angiogenic factors to promote metastasis. Also, exposure to elevated levels of norepinephrine triggers release of vascular endothelial growth factor (VEGF) which facilitates tumor growth. Therefore the stress of advancing cancer and management of it is associated with endocrine, immune, and autonomic dysfunction that has consequences for host resistance to cancer progression.The field of psycho-oncology is hung up on the hyphen in its name. How do we understand the link between mind and body? Is that hyphen merely an arrow to the left, indicating that cancer in the body affects the mind? Can it be an arrow to the right as well, mind affecting the course of cancer? We know that social support affects survival, 1 including that with cancer. 2 Also, people tend to die after rather than before their birthdays and major holidays. 3,4 Depression worsens survival outcome with cancer. 5,6 Yet we have been understandably delicate about mind-body influence, not wanting to claim too much, or to provide unwitting support for overstated claims that wishing away cancer or picturing white blood cells killing cancer cells would actually do it. That arrow to the right is a connection, not a superhighway. Yet in our desire to be respected members of the oncology community we have often minimized a natural ally in the battle against cancer -the patient's physiological stress coping mechanisms. Even at the end of life, helping patients face death, make informed decisions about level of care, and controlling pain and distress is not only humane but appears to be medically more effective than simply carrying ...

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Prognostic risk assessment in primary breast cancer by behavioral and immunological parameters.

Cited by 221 publications

References 18 publications

Increased emotional distress in daughters of breast cancer patients is associated with decreased natural cytotoxic activity, elevated levels of stress hormones and decreased secretion of Th1 cytokines

Increased emotional distress in daughters of breast cancer patients is associated with decreased natural cytotoxic activity, elevated levels of stress hormones and decreased secretion of Th1 cytokines

A biobehavioral model of cancer stress and disease course.

Mind Matters in Cancer Survival

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