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Kang DH, McArdle T, Park NJ, Weaver MT, Smith B, Carpenter J. Dose Effects of Relaxation Practice on Immune Responses in Women Newly Diagnosed With Breast Cancer: An Exploratory Study. Oncol Nurs Forum 2011; 38:E240-52. [DOI: 10.1188/11.onf.e240-e252] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Epidemiologic evidence increasingly has supported the role of biobehavioral risk factors such as social adversity, depression, and stress in cancer progression. This review describes in vitro, in vivo, and clinical studies demonstrating relationships between such processes and pathways involved in cancer progression. These include effects on the cellular immune response, angiogenesis, invasion, anoikis, and inflammation. Biobehavioral factors have been shown to contribute to the cross talk between tumor and host cells in the tumor microenvironment, and stress effects on host cells such as macrophages seem to be critical for many pathways involved in tumor progression. Some effects are bidirectional in that tumor-derived inflammation seems to affect central nervous system processes, giving rise to vegetative symptoms and contributing to dysregulation of the hypothalamic-pituitary-adrenal axis with downstream effects on inflammatory control. Findings to date are reviewed, and fruitful areas for future research are discussed.
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Gramotnev DK, Gramotnev G. Psychological stress and psychosomatic treatment: major impact on serious blood disorders? Neuroimmunomodulation 2011; 18:171-83. [PMID: 21311203 DOI: 10.1159/000323282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 12/01/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To demonstrate evidence of possible major impacts of psychological stress and psychosomatic interventions on myeloproliferative blood disorders and develop new approaches for the unification and quantified analysis of stress and psychosomatic treatments. METHODS This 3.5- year longitudinal study was based upon the regular blood tests of a person with myelofibrosis who experienced severe and repeated work-related psychological stress and was subjected to psychosomatic treatment in the form of regular (approximately 4 h per day) self-hypnosis sessions. Statistical data analysis was conducted on the basis of an introduced concept of generalized stress that mathematically unifies psychological stress and psychosomatic treatment. RESULTS Severe stress and psychosomatic treatment were statistically shown to have a major (dominant) impact on blood platelet counts well described by an exponential dependence on cumulative levels of generalized stress. The typical relaxation time for the impacts of both stress and treatment was shown to be approximately 2 months. Only approximately 12% of the total variation in platelet counts could be attributed to factors other than psychological stress and psychosomatic treatment. The psychosomatic intervention resulted in a consistent reduction of high platelet counts from approximately 1,400 x 10⁹ l⁻¹ to approximately the middle of the normal range, with other blood parameters being either approximately stable or showing indications of a strengthening immune system. CONCLUSIONS Our findings give hope for a possible development of psychosomatic treatments of at least some blood disorders. They also indicate a highly instrumental role of platelets in the quantified analysis of stress, psychosomatic interventions, and their neuroimmunological pathways.
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Affiliation(s)
- Dmitri K Gramotnev
- Centre for Psychosomatic Treatment, The University of Queensland, Brisbane, QLD 4034, Australia.
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Brain metastases of mouse mammary adenocarcinoma is increased by acute stress. Brain Res 2010; 1366:204-10. [DOI: 10.1016/j.brainres.2010.09.085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 09/21/2010] [Accepted: 09/23/2010] [Indexed: 12/22/2022]
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Benish M, Ben-Eliyahu S. Surgery as a double-edged sword: a clinically feasible approach to overcome the metastasis-promoting effects of surgery by blunting stress and prostaglandin responses. Cancers (Basel) 2010; 2:1929-51. [PMID: 24281210 PMCID: PMC3840453 DOI: 10.3390/cancers2041929] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 11/14/2010] [Accepted: 11/23/2010] [Indexed: 12/22/2022] Open
Abstract
Surgery remains an essential therapeutic approach for most solid malignancies, including breast cancer. However, surgery also constitutes a risk factor for promotion of pre-existing micrometastases and the initiation of new metastases through several mechanisms, including the release of prostaglandins and stress hormones (e.g., catecholamines and glucocorticoids). However, the perioperative period also presents an opportunity for cell mediated immunity (CMI) and other mechanisms to eradicate or control minimal residual disease, provided that the deleterious effects of surgery are minimized. Here, we discuss the key role of endogenous stress hormones and prostaglandins in promoting the metastatic process through their direct impact on malignant cells, and through their deleterious impact on anti-cancer CMI. We further discuss the effects of anesthetic techniques, the extent of surgery, pain alleviation, and timing within the menstrual cycle with respect to their impact on tumor recurrence and physiological stress responses. Last, we suggest an attractive perioperative drug regimen, based on a combination of a cyclooxygenase (COX)-2 inhibitor and a β-adrenergic blocker, which we found effective in attenuating immune suppression and the metastasis-promoting effects of surgery in several tumor models. This regimen is clinically applicable, and could potentially promote disease free survival in patients operated for breast and other types of cancer.
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Affiliation(s)
- Marganit Benish
- Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv 69978, Israel.
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Schuler LA, Auger AP. Psychosocially influenced cancer: diverse early-life stress experiences and links to breast cancer. Cancer Prev Res (Phila) 2010; 3:1365-70. [PMID: 21084258 DOI: 10.1158/1940-6207.capr-10-0238] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This perspective on Boyd et al. (beginning on page 1398 in this issue of the journal) discusses recent published research examining the interplay between social stress and breast cancer. Cross-disciplinary studies using genetically defined mouse models and established neonatal and peripubertal paradigms of social stress are illuminating biological programming by diverse early-life experiences for the risk of breast cancer. Understanding the mechanisms underlying this programming can lead to the identification of risk factors and sensitive developmental windows, enabling improved prevention and treatment strategies for this devastating disease.
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Affiliation(s)
- Linda A Schuler
- Department of Comparative Biosciences, School of Veterinary Medicine, 2015 Linden Drive, University of Wisconsin-Madison, Madison, WI 53706, USA.
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Lutgendorf SK, Sood AK, Antoni MH. Host factors and cancer progression: biobehavioral signaling pathways and interventions. J Clin Oncol 2010; 28:4094-9. [PMID: 20644093 PMCID: PMC2940426 DOI: 10.1200/jco.2009.26.9357] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 05/25/2010] [Indexed: 01/06/2023] Open
Abstract
Whereas evidence for the role of psychosocial factors in cancer initiation has been equivocal, support continues to grow for links between psychological factors such as stress, depression, and social isolation and progression of cancer. In vitro, in vivo, and clinical studies show that stress- related processes can impact pathways implicated in cancer progression, including immuno-regulation, angiogenesis, and invasion. Contributions of systemic factors, such as stress hormones to the crosstalk between tumor and stromal cells, appear to be critical in modulating downstream signaling pathways with important implications for disease progression. Inflammatory pathways may also be implicated in fatigue and other factors related to quality of life. Although substantial evidence supports a positive effect of psychosocial interventions on quality of life in cancer, the clinical evidence for efficacy of stress-modulating psychosocial interventions in slowing cancer progression remains inconclusive, and the biobehavioral mechanisms that might explain such effects are still being established. This article reviews research findings to date and outlines future avenues of research in this area.
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Affiliation(s)
- Susan K. Lutgendorf
- From the Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; University of Texas M. D. Anderson Comprehensive Cancer Center, Houston, TX; and the Sylvester Cancer Center, University of Miami, Miami, FL
| | - Anil K. Sood
- From the Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; University of Texas M. D. Anderson Comprehensive Cancer Center, Houston, TX; and the Sylvester Cancer Center, University of Miami, Miami, FL
| | - Michael H. Antoni
- From the Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; University of Texas M. D. Anderson Comprehensive Cancer Center, Houston, TX; and the Sylvester Cancer Center, University of Miami, Miami, FL
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Zalewski MA, Beikman S, Ferrari S, Slavish K, Rosenzweig M. Breast Cancer Follow-Up: Strategies for Successful Collaboration between Cancer Care Specialists and Primary Care Providers. J Nurse Pract 2010. [DOI: 10.1016/j.nurpra.2010.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Depression, cortisol, and suppressed cell-mediated immunity in metastatic breast cancer. Brain Behav Immun 2009; 23:1148-55. [PMID: 19643176 DOI: 10.1016/j.bbi.2009.07.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 07/22/2009] [Accepted: 07/22/2009] [Indexed: 11/22/2022] Open
Abstract
Cancer treatment is known to have significant immuno-suppressive/dysregulatory effects. Psychological distress and depression, which often accompany cancer diagnosis and treatment, can also suppress or dysregulate endocrine and immune function. Cell-mediated immunity (CMI) is critical for protection against a host of pathogens to which cancer patients may be particularly susceptible. CMI is also important for defense against some tumors. This study explored relationships among depressive symptoms, cortisol secretion, and CMI responses in 72 women with metastatic breast cancer. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D). Saliva was sampled throughout the day over a 3-day period to obtain a physiologic index of diurnal cortisol concentrations and rhythmicity, which is associated with breast cancer survival time. CMI for specific antigens was measured following intradermal administration of seven commonly encountered antigens (tuberculin, tetanus, diphtheria, Streptococcus, Candida, Trichophyton, and Proteus). Analyses adjusting for relevant medical and treatment variables indicated that women reporting more depressive symptoms showed suppressed immunity as measured by lower average induration size. Women with higher mean diurnal cortisol concentrations also showed suppressed immunity as indicated by a decreased number of antigens to which positive reactions were measured. This study highlights the relationships among depression, stress, and immune function in the context of advanced breast cancer.
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Ist psychischer Stress ein Risikofaktor bei der Entstehung und Entwicklung von Tumoren? ONKOLOGE 2009. [DOI: 10.1007/s00761-009-1654-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Beatty L, Lee C, Wade TD. A prospective examination of perceived stress as a mediator of the relationship between life-events and QOL following breast cancer. Br J Health Psychol 2009; 14:789-804. [PMID: 19267960 DOI: 10.1348/135910709x412459] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study prospectively investigated the relationship between life-events, perceived stress, and quality of life (QOL) following breast cancer diagnosis, using the bio-behavioural model of cancer stress as a framework. DESIGN A longitudinal, self-report design was used. METHODS Three waves of data from 10,543 mid-aged Australian women (aged 45-50 at Survey 1) were collected over 5 years as part of a population-based survey. From this group a subsample (N=140) were identified who did not have breast cancer at Survey 1, but who subsequently developed breast cancer. Random regression growth curve analyses were used to investigate whether perceived stress mediated the relationship between initial life-events and change in QOL functioning overtime. RESULTS Prospective evidence was generated for each of the three criteria for testing mediation. As the number of life-events before breast cancer increased, women were significantly more likely to experience corresponding increases in perceived stress over the 5-year period. As the level of perceived stress before breast cancer increased, women were more likely to experience deteriorations overtime in role emotional, role physical, vitality, bodily pain, physical functioning, and social functioning. As the number of life-events before breast cancer increased, women were at significant risk of experiencing deteriorations overtime in bodily pain, social functioning, role emotional, and vitality. Mediational analyses revealed that perceived stress fully mediated the relationship between initial life-events and two QOL domains; role-emotional and social functioning. CONCLUSION Results partially supported the bio-behavioural model of cancer stress, but the model does not appear to fit the data as well as predicted, and may require revision.
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Affiliation(s)
- Lisa Beatty
- School of Psychology, Flinders University, Adelaide, South Australia, Australia.
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Theoharides TC, Rozniecki JJ, Sahagian G, Jocobson S, Kempuraj D, Conti P, Kalogeromitros D. Impact of stress and mast cells on brain metastases. J Neuroimmunol 2008; 205:1-7. [DOI: 10.1016/j.jneuroim.2008.09.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/12/2008] [Accepted: 09/15/2008] [Indexed: 01/20/2023]
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Beswick S, Affleck P, Elliott F, Gerry E, Boon A, Bale L, Nolan C, Barrett JH, Bertram C, Marsden J, Bishop DT, Newton-Bishop JA. Environmental risk factors for relapse of melanoma. Eur J Cancer 2008; 44:1717-25. [PMID: 18602256 PMCID: PMC2583252 DOI: 10.1016/j.ejca.2008.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 05/17/2008] [Accepted: 05/19/2008] [Indexed: 11/22/2022]
Abstract
Aim To identify lifestyle factors affecting risk of relapse. Methods A comparison of 131 relapsed melanoma patients with 147 non-relapsers. Results Relapsers were more likely to report financial hardship using a number of different measures including access to holidays and feeling financially insecure (odds ratio (OR) 5.7, 95% confidence interval (CI) (1.5, 21.4)). Relapsers worked longer hours (mean 37 h per week compared with 31, p = 0.02). There was no reported difference in stress associated with recent life events. There was no effect of housing quality, employment factors or body mass index (BMI) on risk of relapse. There was a protective effect of antibiotics in the peri-operative period. Conclusion The study provides preliminary evidence for adverse effects of chronic financial hardship, but not recent stressful events on cancer relapse. As these data were collected in a retrospective case–control study subject to recall bias, the data must now be explored in a prospective study.
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Affiliation(s)
- Samantha Beswick
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Paul Affleck
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Faye Elliott
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Edwina Gerry
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Andy Boon
- Leeds Teaching Hospitals, NHS Trust, United Kingdom
| | - Linda Bale
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Clarissa Nolan
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Jennifer H. Barrett
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Chandra Bertram
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Jerry Marsden
- University Hospital Birmingham, NHS Foundation Trust, United Kingdom
| | - D. Timothy Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
| | - Julia A. Newton-Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Molecular Medicine, Cancer Research UK Clinical Centre at Leeds, St James’s University Hospital, Leeds LS9 7TF, United Kingdom
- Corresponding author: Tel.: +44 113 2064668; fax: +44 113 234 0183.
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