Dynamic Effects of CAM Techniques on Inflammation and Emotional States: An Integrative Single-Case Study on a Breast Cancer Survivor

Abstract

Background: This study on a breast cancer survivor investigated how episodic practice of various complementary and alternative medicine (CAM) techniques affected the dynamics of emotional states and urinary neopterin—an inflammation marker. Methods: The 49-year-old female patient (diagnosis: ductal breast carcinoma 5 years before study start, suffering from chronic fatigue and depression) collected her entire urine in 12-hour intervals (from about 8 a.m. to 8 p.m. and from about 8 p.m. to 8 a.m.) for 28 days. The resulting 55 consecutive urine samples were analyzed for neopterin and creatinine levels using HPLC. Also in 12-hour intervals, the patient filled out questionnaires on emotional states and everyday routine, including CAM practice. Weekly, she was interviewed to identify emotionally meaningful everyday incidents, including use of CAM techniques. Time series analysis consisted of ARIMA modeling and cross-correlational analyses. Results: Qualitative evaluation revealed that, with the exception of Tai Chi, all CAM techniques, that is, Jin Shin Jyutsu, music, physiotherapy and energy healing, were experienced as positive. Cross-correlational analyses showed that practice of such CAM techniques was followed first by significant ( P < .05) increases in positive mood and mental activity on the same day (lag 0) and then by decreases in positive mood after a total of 72 to 84 hours (+lag 6) and in mental activity after a total of 84 to 96 hours (+lag 7). Negative mood, by contrast, first decreased on the day of CAM practice (lag 0) and then increased after a total of 84 to 96 hours (+lag 7) following CAM. Moreover, urinary neopterin levels first increased on the day of CAM practice (lag 0) and then decreased after a total of 36 to 48 hours (+lag 3). Similar biphasic effects were also detected for irritation in response to CAM, although only partly significant. Conclusion: Cyclic psychophysiological response patterns following CAM practice were attributable to biopsychosocial feedback mechanisms involving personally meaningful experiences. As lower neopterin levels following CAM point to a health-promoting effect, the patient of this study may have actively contributed to her healing process through episodic CAM practice.

Case Report: Dynamic Interdependencies Between Complementary and Alternative Medicine (CAM) Practice, Urinary Interleukin-6 Levels, and Fatigue in a Breast Cancer Survivor

“…This integrative single-case study is part of a larger project on breast cancer survivors that examines the effects of emotionally meaningful incidents on stress system activity. Various results dealing with this patient have already been published (22,23,35,36).…”

“…Moreover, some increases in urinary IL-6 levels occurred in advance, i.e., up to 108-120 h (-lag 10, energy healing) or 120-132 h (-lag 11, physiotherapy) (Figures 2A-E), suggesting that the patient responded immunologically in anticipation of CAM practice. Indeed, weekly interviews revealed that several CAM techniques, such as energy healing, physiotherapy and choir rehearsals, had been planned by the patient days or even weeks in advance [see (23) for further details]. Concentration changes of stress system parameters in anticipation of the actual occurrence of an incident have repeatedly been found in integrative single-case studies (25,28,29).…”

“…The heterogeneous findings to date on the relationship between CAM practice and inflammatory markers and between CAM practice and CaRF may be due in part to methodological issues inherent in conventional biomedical research approaches (e.g., inadequate statistical power, diversity of cancer disease characteristics and treatment regimens, biased and heterogeneous composition of subjects, diverse biomarker examination materials, diversity with regard to CAM program frequency and duration, failure to consider the possibility of therapist effect, and usage of various forms of comparative control/placebo) (7,18,21). On a more basic level, we propose that the inconsistent findings are also attributable to the inadequacy of conventional research methods (e.g., pre-post design, standardized questionnaires) in grasping (a) the dynamic complexity of highly fluctuating (circulating) biomarkers such as IL-6 and (b) the complex psychosocial factors involved in the application of CAM use (e.g., personal meaning) (22)(23)(24)(25)(26).…”

“…Using this design, our recent publication on a breast cancer survivor provided evidence on the psychoimmunological influence of various CAM techniques experienced as positive (i.e., Jin Shin Jyutsu, music, physiotherapy, and energy healing). The patient, who suffered from depression and CaRF, engaged in CAM as part of her everyday life ( 23 ). With regard to her immune activity, statistical analysis of 55 consecutive 12-h measurements (28 days) revealed that urinary neopterin levels first increased on the day of CAM practice and then decreased after a total of 36–48 h. As cyclic responses in stress system markers are connected with meaningful everyday experiences ( 25 ) and neopterin is a reliable indicator of cellular immune activation ( 30 , 31 ), this study suggests that practicing CAM was meaningful to the patient and ultimately led to inflammation reduction ( 23 ).…”

“…The patient, who suffered from depression and CaRF, engaged in CAM as part of her everyday life ( 23 ). With regard to her immune activity, statistical analysis of 55 consecutive 12-h measurements (28 days) revealed that urinary neopterin levels first increased on the day of CAM practice and then decreased after a total of 36–48 h. As cyclic responses in stress system markers are connected with meaningful everyday experiences ( 25 ) and neopterin is a reliable indicator of cellular immune activation ( 30 , 31 ), this study suggests that practicing CAM was meaningful to the patient and ultimately led to inflammation reduction ( 23 ). Furthermore, CAM practice was followed by significant increases in positive mood and mental activity on the same day and then by decreases after a total of 72–84 h (positive mood) and 84–96 h (mental activity).…”