Brief Post-Surgical Stress Management Reduces Pro-Inflammatory Cytokines in Overweight and Obese Breast Cancer Patients Undergoing Primary Treatment

Abstract

Background: Overweight and obese (OW/OB) body mass index (BMI) is associated with greater inflammation and poorer outcomes in breast cancer (BC). Stress management interventions using cognitive behavioral therapy (CBT) and relaxation training (RT) have reduced inflammation in BC patients but have not been tested specifically in OW/OB patients undergoing primary treatment. We developed brief CBT and RT-based group interventions and tested their effects (vs time-matched Health Education [HE] control) on serum inflammatory cytokines (IL-6, IL-1β and TNF-α) in OW/OB vs normal weight (NW) BC patients during primary treatment. We hypothesized OW/OB women would show higher levels of inflammatory cytokines, and that stress management would decrease these cytokines more in OW/OB women than in NW women. Methods: Stage 0 -III BC patients were enrolled post-surgery and before initiating adjuvant therapy, were randomized to either 5 weeks of CBT, RT, or HE, and provided questionnaires and blood samples at baseline and 6-months. Serum cytokine levels were measured by ELISA. Repeated measures analysis of variance tested the interaction of condition by BMI by time in predicting cytokine levels over 6 months, controlling for age, stage, ethnicity, and income. Results: The sample (N = 153) majority was OW/OB (55.6%). We found differences in baseline IL-6 and IL-1β across BMI categories, with greater IL-6 (p < 0.005) and IL-1β (p < 0.04) in OW and OB vs NW women, but no difference between OW and OB women. There were no differences in baseline TNF-α among BMI groups. BMI category moderated the effect of brief stress management interventions on IL-6 changes over 6-months (p = 0.028): CBT/RT vs HE decreased IL-6 in OW/OB (p = 0.045) but not in NW patients (p = 0.664). There were no effects on IL-1β or TNF-α. Results could not be explained by differences in receipt of adjuvant therapy, prescription medications, or changes in physical activity. Conclusions: OW/OB women with newly diagnosed BC had significantly greater serum IL-6 and IL-1β than NW women post-surgery. Brief stress management delivered with primary treatment among OW/OB patients may reduce the increases in inflammatory markers known to accompany adjuvant treatments and could thus promote better outcomes. Clinical Trial Registration: NCT02103387.

Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors

“…Excessive weight is also associated with worse prognosis for breast cancer itself ( Barone et al 2021 ), with pre- and postmenopausal overweight and obese women having a greater likelihood of recurrence and mortality ( Chan et al 2014 , Protani et al 2010 ) and of developing a secondary cancer in the unaffected breast or at a separate primary site ( Majed et al 2011 ); these effects are all believed to be mediated, in part, by heightened inflammatory signaling. Recent work suggests that brief SMIs reduced serum IL-6 levels in obese and overweight breast cancer patients undergoing initial treatment ( Ream et al 2022 ). Large-scale trials should test the efficacy of SMIs for optimizing longer-term cardiovascular health and other consequences of CAA via improved immune regulation in this vulnerable population of cancer survivors.…”

Twenty-five Years at the Frontiers of Knowledge: A Quarter-century of “Frontiers in Bioscience”

“…These papers cover a wide range of studies on different species, from insects to amphibians, fish, pigs, rats and humans, originating from many different countries (the US, the UK, Spain, Australia, Italy, China, Korea, Germany, Canada, France etc, but also from low and medium income countries such as Lebanon and Bangladesh). Of the 22 papers, half are original research on highly diverse topics including a detailed analysis of signaling pathways in insect heart development [1], stress management in breast cancer patients [2], regulation of myelopoiesis in zebrafish [3], an analysis of heat shock protein expression in human glioblastomas [4], a new method for screening for human topoisomerase inhibitors using genetically-modified yeast [5], genetic influences on systemic iron levels in humans [6], transcriptomics studies on frog development [7], clinical studies on malnourished children with diarrhoea [8], a theoretical investigation of approaches to characterizing logic operations in model neurons, synapses, and neural circuits [9], the effects of methionine-restricted diets on the growth of pigs [10], and the effects of iron on kidney disease in rats [11]. The other half of the papers are reviews on an equally diverse range of topics, including drugs for Alzheimer's Disease [12], spheroid cell cultures [13], bioactive polyphenols [14], ribosome evolution [15], purinergic signaling in bone cancer [16], spontaneous regressions in cancer [17], genetic analyses of pituitary cancers [18], pharmacological chaperones [19], drug targeting for SARS-CoV-2 infection [20], calcium signaling in mesenchymal stem cells [21], and relationships between the control of circadian rhythm and neurodegeneration [22].…”