A structured psychiatric intervention for cancer patients: Changes over time in methods of coping and affective disturbance and in immunological parameters

Fawzy, Fawzy Ibrahim

doi:10.1016/0163-8343(91)90057-4

Cited by 251 publications

(422 citation statements)

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“…Application of the model to other chronic illnesses would require further refinement. Testing of the model might be additionally optimized when samples are as homogeneous as possible on other major dimensions, such as prognostic factors; such variables might be chosen for stratification or at least for documentation (e.g., the case with Breslow depth in the Fawzy et al, 1990Fawzy et al, , 1993. Selection of variables would be based on their unique importance to the disease site being studied.…”

Section: Methodology: Maximizing the Signal To Noise Ratiomentioning

confidence: 99%

“…This research progress in behavioral oncology-the prospect of randomly assigning individuals to conditions that will result in differential psychological and behavioral outcomes-provides one of the necessary conditions for an experimental test of the model. Therapy components for psychological interventions have included an emotionally supportive context to address fears and anxieties about the disease (e.g., Cain, Kohorn, Quinlan, Latimer, & Schwartz, 1986;Capone, Good, Westie, & Jacobson, 1980;Forester, Kornfeld, & Fleiss, 1985;Maguire, Brooke, Tait, Thomas, & Sellwood, 1983), information about the disease and treatment (e.g., Cain et al, 1986;Fawzy et al, 1990;Houts, Whitney, Mortel, & Bartholomew, 1986;Jacobs, Ross, Walker, & Stockdale, 1983;Maguire et al, 1983), behavioral coping strategies (e.g., role playing difficult discussions with family or the medical staff; Fawzy et al, 1990;Houts et al, 1986), cognitive coping strategies (Cain et al, 1986;Davis, 1986;Houts et al, 1986;Telch & Telch, 1986), relaxation training to lower "arousal" or enhance one's sense of control (Davis, 1986;Fawzy et al, 1990), and focused interventions for disease-specific problems (e.g., sexual functioning for gynecologic or breast cancer; Capone et al, 1980). It is more difficult to enumerate the intervention components that can affect health behaviors.…”

Section: Testing the Model Research Design: A Role For Experimental Tmentioning

confidence: 99%

“…All of the studies used extensive psychological assessments, but none examined behavioral variables (i.e., health behaviors and compliance). For the first study, Fawzy et al (1990) studied newly treated Stage I or II melanoma patients randomly assigned to either no intervention or a structured short-term (10 sessions) group support intervention. At posttreatment and the six-month follow-up, significant psychological and coping outcomes for the intervention subjects were evident, as well as increases in the percentage of large granular lymphocytes, the NK cell phenotype, an increase in NK cell numbers (as determined by markers), and other positive findings, such as interferon alpha-augmented NK activity.…”

Section: Testing the Model Research Design: A Role For Experimental Tmentioning

confidence: 99%

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A biobehavioral model of cancer stress and disease course.

Andersen¹,

Kiecolt‐Glaser²,

Glaser³

1994

American Psychologist

388

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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Section: Methodology: Maximizing the Signal To Noise Ratiomentioning

confidence: 99%

Section: Testing the Model Research Design: A Role For Experimental Tmentioning

confidence: 99%

Section: Testing the Model Research Design: A Role For Experimental Tmentioning

confidence: 99%

See 1 more Smart Citation

A biobehavioral model of cancer stress and disease course.

Andersen¹,

Kiecolt‐Glaser²,

Glaser³

1994

American Psychologist

388

246

View full text Add to dashboard Cite

show abstract

“…Importantly, interventions aimed at decreasing psychologic stress may ameliorate these effects. Fawzy et al have reported that a six-week psychosocial intervention in patients with early-stage malignant melanoma led to alterations in the immune system including increased percentages of NK cells, increased NK cell cytolytic activity, and decreased percentage of CD4 + helper T cells [38]. Patients in the intervention group demonstrated a significant increase in survival as compared to the control group, even at ten years after the intervention [39].…”

Section: Discussionmentioning

confidence: 99%

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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“…In studies in which support therapy was offered to the participants, the authors reported that quality of life and survival improved in the patients who participated in a psycho-educational support group. 22,26,27 Evaluation of QoL is crucial in the overall evaluation of patients, both with respect to treatment and follow-up. The development of instruments to evaluate this aspect should be encouraged, not only the translation and validation of existing instruments, but also the elaboration of new instruments specifically designed for different cultures or social groups, since evaluation of quality of life has become an integrated part of patient care.…”

Section: Discussionmentioning

confidence: 99%

Preditores de qualidade de vida em pacientes com melanoma cutâneo no serviço de dermatologia do Hospital de Clínicas de Porto Alegre

Barbato

Bakos

Bakos³

et al. 2011

An. Bras. Dermatol.

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BACKGROUNDS: Some symptoms present in melanoma patients are directly related to psychological stress, which emphasizes the need to evaluate quality of life (QoL) in these patients at all the stages of their disease. Objectives: The objective of this study was to evaluate quality of life in a sample of patients diagnosed with melanoma, using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. METHODS: A descriptive, cross sectional study was conducted between July and December, 2006 with all patients with skin melanoma receiving follow-up care at the Department of Dermatology of the Porto Alegre Teaching Hospital, Federal University of Rio Grande do Sul. RESULTS: Sixty patients were included in the study. Mean age was 55.6 years. Poor education level (primary school or less) was associated with a poorer FACT-G score. Patients with a family history of the disease had higher QoL scores in 3 of the 4 categories evaluated: physical, emotional and functional wellbeing (p<0.01). QoL scores were higher in married patients (82.42) compared to single patients (70.28) (p<0.01). Patients with metastases had lower scores in the functional wellbeing category and this difference was statistically significant. CONCLUSIONS: Factors related to the tumor, as well as gender, age and employment status, were not found to be predictive of quality of life in this sample. Quality of life scores were lower in the functional wellbeing domain in patients with metastases. Married patients are able to count on greater comfort and emotional support to help them deal with the diagnosis of melanoma. Patients with a family history of melanoma had significantly higher quality of life scores, while those with poor education levels had lower scores. Keywords: Dermatology; Quality of life indicators; Oncology; Melanoma; Quality of life; Resumo: FUNDAMENTOS: Alguns sintomas presentes nos pacientes com melanoma estão diretamente relacionados à tensão psicoló-gica, o que reforça a necessidade de avaliar a qualidade de vida em todas as fases da doença. OBJETIVOS: Avaliar a qualidade de vida dos pacientes diagnosticados com melanoma por meio do questionário Fact-G. MÉTODOS: Estudo descritivo transversal que incluiu todos os pacientes em seguimento no serviço de dermatologia do Hospital de Clínicas de Porto Alegre entre julho e dezembro de 2006. RESULTADOS: Sessenta pacientes foram incluídos. A idade média foi de 55,6 anos. O nível de escolaridade até primeiro grau foi correlacionado a escores mais baixos no Fact-G. Os pacientes com história familiar apresentaram maiores escores de QoL em três das quatro categorias avaliadas: bem-estar físico, emocional e funcional (P < 0,01). Pacientes casados mostraram melhor qualidade de vida (82,42) que os solteiros (70,28; P < 0,01). Os pacientes com metástase obtiveram uma menor pontuação no questionário no domínio bem-estar funcional. CONCLUSÕES: Os fatores relacionados ao tumor, assim como o sexo, a idade e a situação de emprego, não foram preditores de qualidade de vida. Pacient...

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A structured psychiatric intervention for cancer patients: Changes over time in methods of coping and affective disturbance and in immunological parameters

Cited by 251 publications

References 0 publications

A biobehavioral model of cancer stress and disease course.

A biobehavioral model of cancer stress and disease course.

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

Preditores de qualidade de vida em pacientes com melanoma cutâneo no serviço de dermatologia do Hospital de Clínicas de Porto Alegre

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