Psychological, Behavioral, and Immune Changes After a Psychological Intervention: A Clinical Trial

Abstract

Purpose-This randomized clinical trial tests the hypothesis that a psychological intervention can reduce emotional distress, improve health behaviors and dose-intensity, and enhance immune responses.Patients and Methods-We studied 227 women who were surgically treated for regional breast cancer. Before adjuvant therapy, women completed interviews and questionnaires assessing emotional distress, social adjustment, and health behaviors. A 60-mL blood sample was drawn for immune assays. Patients were randomly assigned to either the intervention group or assessment only group. The intervention was conducted in small patient groups, with one session per week for 4 months. The sessions included strategies to reduce stress, improve mood, alter health behaviors, and maintain adherence to cancer treatment and care. Reassessment occurred after completion of the intervention.Results-As predicted, patients receiving the intervention showed significant lowering of anxiety, improvements in perceived social support, improved dietary habits, and reduction in smoking (all P < .05). Analyses of adjuvant chemotherapy dose-intensity revealed significantly more variability (ie, more dispersion in the dose-intensity values) for the assessment arm (P < .05). Immune responses for the intervention patients paralleled their psychological and behavioral improvements. T-cell proliferation in response to phytohemagglutinin and concanavalin A remained stable or increased for the Intervention patients, whereas both responses declined for Assessment patients; this effect was replicated across three concentrations for each assay (all P < .01).Conclusion-These data show a convergence of significant psychological, health behavior, and biologic effects after a psychological intervention for cancer patients.

Dissemination of an evidence-based treatment for cancer patients: training is the necessary first step

“…The institutes included sessions discussing intervention adaptation, another departure from typical CE programs. Adaptation was included as it was anticipated that trainees would have different patient populations than the newly diagnosed breast cancer patients with which the BBI was validated [22]. Moreover, implementation of an innovation (such as an EBT) typically requires some adaptation of the innovation, the setting, or both [33].…”

“…A randomized clinical trial (RCT: BBI plus assessment vs. assessment only) accrued consecutive patients (n=227) with newly diagnosed regional (stage II or III) breast cancer. Tests of the efficacy [22][23][24][25] demonstrated significant reductions in distress and improvements in social adjustment, health behaviors (diet, smoking cessation), treatment adherence, health, and enhanced T cell immunity for participants in the BBI arm. Tests of the disease endpoint of the trial-recurrence-found that patients in the BBI arm had reduced risk of breast cancer recurrence [hazard ratio (HR)=0.55, p=0.034] [23].…”

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

“…Patients were randomized to receive either psychosocial intervention or assessment only. As predicted, patients in the intervention group demonstrated psychological and behavioral improvements over time [16]. T cell proliferation in response to phytohemagglutinin (PHA) and concavalin A (con A) remained stable or increased for patients in the intervention group, whereas both responses declined for patients in the assessment group.…”

“…It has been extensively validated in studies of patients with diverse serious illnesses, including cancer [8,[13][14]. Significant reductions in cancer-associated psychological distress can be achieved with psychosocial interventions aimed at decreasing stress levels, strengthening social support networks, and improving coping and life management skills [15][16][17].…”

“…This study of 116 patients after surgical resection of Stage II or Stage III breast cancer demonstrated decreased NK cell toxicity and T cell blastogenesis in patients exhibiting high levels of cancer-related psychological stress [15]. We subsequently conducted a randomized phase III trial testing the effects of psychological and behavioral interventions aimed at stress reduction in 227 women with surgically treated Stage II or Stage III breast cancer [16]. Patients were randomized to receive either psychosocial intervention or assessment only.…”