Effects of Psychosocial Treatment in Prolonging Cancer Survival May Be Mediated by Neuroimmune Pathways

Abstract

Research has provided growing evidence of links between the social environment and cancer progression. Indeed, social support in the form of marriage, frequent daily contact with others, and the presence of a confidant may all have protective value against cancer progression. Furthermore, retrospective data suggest that major stressful life events are more prevalent in patients with relapse or malignancy, and thus may contribute to cancer morbidity. Initial studies of the effects of psychosocial intervention with cancer patients have provided some promising results. In three randomized prospective trials, protective effects of psychosocial interventions on cancer progression have been confirmed, while one matching and one randomized study showed no survival effect after psychosocial treatment. Though more research is clearly needed in this area, this body of evidence suggests that psychosocial factors have potentially powerful modulating effects on the course of disease. Here we review evidence of one possible mechanism whereby psychosocial factors may influence disease-resistance capabilities: the neuroimmune connection. Suppressive effects of stress on immune function are well documented, and these effects have been shown to be modulated by social support. Thus, it is reasonable to hypothesize that supportive social relationships may buffer the effects of cancer-related stress on immunity, and thereby facilitate the recovery of immune mechanisms that may be important for cancer resistance. Data addressing this hypothesis are reviewed.

Perioperative Use of β-blockers and COX-2 Inhibitors May Improve Immune Competence and Reduce the Risk of Tumor Metastasis

“…In cancer patients, distress was associated with impaired CMI, including impaired NKCA, 53 which could contribute to tumor progression. 54 In conclusion, controlling exaggerated inflammatory reactions and physiological and psychological sympathetic responses is suggested by the current and by other studies. The advantages of the specific drug regimen used herein (etodolac and propranolol) are its evident promising outcomes in an animal model, minimal or no side effects, and relatively easy and safe use of established and inexpensive drugs.…”

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

“…Our demonstration that a PTC intervention could be successfully delivered and lead to a statistically significant, clinically meaningful improvement in QOL in this compromised cancer survivor population (32) supports the investigation of broader application of this therapeutic modality. Numerous biological pathways involving the psychoneuroimmune axis have been advanced as potential mechanisms affecting the biological behavior of cancer (11,17,18,43) and for psychosocial intervention-associated cancer patient survival benefits (44). These include endocrine and neuroendocrine shifts (14) that could lead to changes in the hormonal milieu with potential effects on cancer-specific survival of hormone responsive tumors.…”

“…Elevated cortisol levels seen with either acute or chronic stress have welldocumented effects on the immune system (19). Similarly, stress levels of DHEA or DHEA sulfate are more variable, but the ratio of cortisol/DHEA is elevated in stressed populations and has been reported to be associated with Th1/Th2 immunologic profiles, with lower ratios associated with more prominent Th1 immune stance (48 -50).Several variations on the biobehavioral model have been proposed (11,15,16,44) to provide a conceptual framework for potential mind-body connections in patients with cancer. The long-term disruption in QOL seen in many cancer patient populations can be considered to be indicative of chronic stressors.…”

Potential role of mind-body therapies in cancer survivorship

“…56,57 Targeting stress-related variables with psychosocial interventions has been an important emphasis in cancer-care models. [58][59][60][61][62][63][64][65][66] Although the conventional approach to addressing high stress levels in cancer survivors has largely been through supportive group programs, there are significant challenges in recruiting participants to these programs, despite availability, particularly in hard-to-reach populations. 24 Hence, high levels of unmet psychosocial needs continue to persist among cancer survivors.…”