Stress, Immunity, and Cervical Cancer: Biobehavioral Outcomes of a Randomized Clinical Trail

Abstract

Purpose: Cancer diagnosis and treatment imparts chronic stressors affecting quality of life (QOL) and basic physiology. However, the capacity to increase survival by improving QOL is controversial. Patients with cervical cancer, in particular, have severely compromised QOL, providing a population well-suited for the evaluation of novel psychosocial interventions and the exploration of mechanisms by which modulation of the psychoneuroimmune axis might result in improved clinical outcomes. Experimental Design: A randomized clinical trial was conducted in cervical cancer survivors that were enrolled at z13 and <22 months after diagnosis (n = 50), comparing a unique psychosocial telephone counseling (PTC) intervention to usual care. QOL and biological specimens (saliva and blood) were collected at baseline and 4 months post-enrollment. Results: The PTC intervention yielded significantly improved QOL (P = 0.011). Changes in QOL were significantly associated with a shift of immune systemT helper type 1and 2 (Th1/Th2) bias, as measured by IFN-g/interleukin-5 ELISpot T lymphocyte precursor frequency; improved QOL being associated with increasedTh1bias (P = 0.012). Serum interleukin-10 and the neuroendocrine variables of cortisol and dehydroepiandrosterone revealed trends supporting this shift in immunologic stance and suggested a PTC-mediated decrease of the subject's chronic stress response. Conclusions: This study documents the utility of a unique PTC intervention and an association between changes in QOL and adaptive immunity (T helper class).These data support the integration of the chronic stress response into biobehavioral models of cancer survivorship and suggests a novel mechanistic hypotheses by which interventions leading to enhanced QOL could result in improved clinical outcome including survival.The association between cancer patient survival and performance status at diagnosis, i.e., baseline quality of life (QOL), is well documented. Patient-reported outcomes, broadly addressed as QOL variables, are now integral components of cancer clinical trials (1) and highlight opportunities for psychosocial interventions to improve these outcomes for patients with cancer. Whether effective psychosocial interventions improve both patient QOL and survival remains controversial (2 -10). Nevertheless, any potential cancerspecific survival benefit implies improved control of occult micrometastatic disease (11) and the immune system is a prime candidate effector for this biological antitumor activity. The recognition of cross-talk between neurologic, neuroendocrine, and immune systems has given rise to the concept of psychoneuroimmunology, the psychoneuroimmune axis, and the so-called ''mind-body '' connection (5, 12 -15). This conceptual framework provides a foundation for biobehavioral paradigms (16 -18) and for the postulation of potential mechanisms by which a psychosocial intervention might influence cancer patient survival (2,5,11,17,18).Various studies evaluating if psychosocial interventions could affect ...

Psychosocial Therapies for Patients With Cancer

“…There were 3 studies that did not involve any personal interactions with participants (3/24, 12.5%). Of these, 2 studies delivered their intervention exclusively through phone-conversations 66,79 and one study delivered an expressive writing therapy through oral and written instructions given to the patients and followed-up with patients through a phone call. 7 The interventions delivered entirely through phone conversations consisted of one study that used a telephone conference call to deliver group therapy, 66 and another study that conducted individual telephone counseling sessions with participants.…”

“…78 Finally, a cognitive-behavioral study also included counseling for relationship and sexual problems faced by their participants. 79 (b) Complementary medical therapies involved activities such as yoga, meditation, qigong, mindfulness-based stress reduction (MBSR) and massage ( Table 2). In this group of therapies, 5 studies emphasized stress management through meditation.…”

Tissue Expression, Serum and Salivary Levels of IL-10 in Patients with Head and Neck Squamous Cell Carcinoma

“…In a study conducted by Nelson et al on cervical cancer, salivary and serum levels of IL-10 were evaluated and it was shown that serum level of IL-10 was higher in patients than controls, but the salivary level showed no significant difference and did not have any relationship with any of the clinicopathologic factors (Nelson et al, 2008).…”

Family focused grief therapy: The therapy of choice in palliative care

“…Studije koje su se na velikim uzorcima bavile procenom kvaliteta života onkoloških pacijenata sa uznapredovalom bolešću, a koji su imali dostupno i palijativno zbrinjavanje, pokazale su značajnu povezanost između kvaliteta života i dužine preživljava-nja (Tan, Novotny, & Kaur,2008). Bio-psiho-socijalni pristup pacijentima sa uznapredovalim onkološkim bolestima, koji je u osnovi modela palijativnog zbrinjavanja, može neposredno da utiče na poboljšanje kvaliteta života pacijenata, što posredno ima uticaja na psihoneuroimunološki nivo funkcionisanja i fiziološke pokazatelje stanja (Nelson, Wenzel, & Osann, 2008).…”