Stress and Immune Responses After Surgical Treatment for Regional Breast Cancer

Andersen, Barbara L.; Farrar, William B.; Golden-Kreutz, Deanna M.; Kutz, Leigh Ann; MacCallum, Robert C.; Courtney, Mary; Glaser, Ronald

doi:10.1093/jnci/90.1.30

Cited by 338 publications

(244 citation statements)

References 42 publications

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“…The data suggest that early intervention could not only enhance short-term QoL but would likely decrease the negative impact of stress on long-term QoL for these patients. Furthermore, our previous work has found that traumatic stress symptoms (IES scores) measured at diagnosis/ surgery are also associated with a broad band of immune effects, including decreased natural killer cell lysis, natural killer responsiveness to biologic response modifiers, and T-cell blastogenesis (Andersen et al, 1998). With stress at diagnosis/surgery having such sweeping effects, interventions aimed at reducing stress (i.e., relaxation training, stress management, coping skills) appear especially important.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Stress, Perceived Global Stress, and Life Events: Prospectively Predicting Quality of Life in Breast Cancer Patients.

Golden-Kreutz

Thornton²,

Gregorio³

et al. 2005

Health Psychology

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174

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The authors investigated the relationship between stress at initial cancer diagnosis and treatment and subsequent quality of life (QoL). Women (n = 112) randomized to the assessment-only arm of a clinical trial were initially assessed after breast cancer diagnosis and surgery and then reassessed at 4 months (during adjuvant treatment) and 12 months (postadjuvant treatment). There were 3 types of stress measured: number of stressful life events (K. A. Matthews et al., 1997), cancer-related traumatic stress symptoms (M. J. Horowitz, N. Wilner, & W. Alvarez, 1979), and perceived global stress (S. Cohen, T. Kamarck, & R. Mermelstein, 1983). Using hierarchical multiple regressions, the authors found that stress predicted both psychological and physical QoL (J. E. Ware, K. K. Snow, & M. Kosinski, 2000) at the follow-ups (all ps < .03). These findings substantiate the relationship between initial stress and later QoL and underscore the need for timely psychological intervention. Keywords stress; quality of life; breast cancerThe impact of a breast cancer diagnosis and its treatment on quality of life (QoL) is well documented (e.g., Ganz et al., 1996;Holzner et al., 2001). Shapiro et al. (2001), in their review of the relationship between QoL and psychosocial variables in breast cancer patients, noted that "the biomedical model of disease, though crucial, does not take into account all of the complex factors involved in cancer … a broader, more integrative framework, which includes psychosocial factors, is needed" (p. 502). The biobehavioral model of cancer stress and disease course offers such a framework (see Andersen, Kiecolt-Glaser, & Glaser, 1994, for a complete discussion). In this conceptual model, cancer diagnosis and cancer treatments are defined as objective, negative events. Although negative events do not always produce stress, data from many studies document severe acute stress at cancer diagnosis and treatment (e.g., Andersen, Anderson, & deProsse, 1989;Epping-Jordan et al., 1999;Maunsell, Brisson, & Deschenes, 1992). Even when stress declines from the peak at diagnosis (Edgar, Rosberger, & Nowlis, 1992), many QoL difficulties remain and new ones may arise during treatment and/or recovery (e.g., psychological distress; relationship, social, and occupational disruption; loss of physical stamina and fatigue; financial problems; Bleiker, Pouwer, van der Ploeg, Leer, & Ader, 2000;Ganz et al., 1996;Holzner et al., 2001). The biobehavioral model postulates that higher initial stress levels (i.e., stress at the time of cancer diagnosis and treatment) can, over time, contribute to lower QoL for cancer patients.To examine the hypothesized longitudinal relationship between stress and QoL, we used stress at initial diagnosis and surgical treatment as a predictor of QoL outcomes as patients received additional difficult treatments (i.e., chemotherapy, radiation) and as they recovered (i.e., when treatments ended and medical follow-up began). As the biobehavioral model does not specify or define stress per se, ...

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Section: Discussionmentioning

confidence: 99%

Traumatic Stress, Perceived Global Stress, and Life Events: Prospectively Predicting Quality of Life in Breast Cancer Patients.

Golden-Kreutz

Thornton²,

Gregorio³

et al. 2005

Health Psychology

Self Cite

174

155

View full text Add to dashboard Cite

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“…We previously reported that cancer-related stress correlated with impaired immunity in patients with invasive breast cancer [15]. This study of 116 patients after surgical resection of Stage II or Stage III breast cancer demonstrated decreased NK cell toxicity and T cell blastogenesis in patients exhibiting high levels of cancer-related psychological stress [15].…”

Section: Introductionmentioning

confidence: 87%

“…It has been extensively validated in studies of patients with diverse serious illnesses, including cancer [8,[13][14]. Significant reductions in cancer-associated psychological distress can be achieved with psychosocial interventions aimed at decreasing stress levels, strengthening social support networks, and improving coping and life management skills [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…This study of 116 patients after surgical resection of Stage II or Stage III breast cancer demonstrated decreased NK cell toxicity and T cell blastogenesis in patients exhibiting high levels of cancer-related psychological stress [15]. We subsequently conducted a randomized phase III trial testing the effects of psychological and behavioral interventions aimed at stress reduction in 227 women with surgically treated Stage II or Stage III breast cancer [16].…”

Section: Introductionmentioning

confidence: 99%

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Impaired Natural Killer Cell Lysis in Breast Cancer Patients with High Levels of Psychological Stress is Associated with Altered Expression of Killer Immunoglobin-Like Receptors

Varker¹,

Terrell²,

Welt³

et al. 2007

Journal of Surgical Research

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Background-We previously reported that cancer-related psychological stress is associated with reduced natural killer (NK) cell lysis. We hypothesized that reduced NK cell cytotoxicity in patients with increased levels of stress would correlate with alterations in the expression of inhibitory NK cell receptors (killer immunoglobulin-like receptors, or KIRs). The specific aim of this study was to examine KIR expression in patients with high or low levels of psychologic stress and correlate alterations in KIR expression with NK cell function.

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“…Fear and anxiety coupled with cancer-related intrusive thoughts, age, socio demographic characteristics and financial concerns along with a tendency towards negativity (neuroticism) may conspire to heighten a women's risk for psychologic distress which in turn can worsen the treatment related symptoms such as nausea and vomiting, pain and psychologic distress [2,3].This can lead to helplessness/hopelessness, sleep disturbances, poor antitumor immune response, decrease in overall and disease free survival with early relapse/recurrence and heightened distress [4].…”

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confidence: 99%