Interaction of psychosocial and physical risk factors in the causation of mammary cancer, and its prevention through psychological methods of treatment

Impact of a Multimodal and Combination Therapy on Self-Regulation and Internal Coherence in German Breast Cancer Survivors With Chronic Cancer-Related Fatigue: A Mixed-Method Comprehensive Cohort Design Study

Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients' satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P < .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P < .01). Pearson's correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = -0.60). Qualitative feedback confirmed patients' benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients' satisfaction and qualitative feedback they help refine treatment.

Inhibition of emotional needs and emotional wellbeing predict disease progression of chronic hepatitis C patients: an 8-year prospective study

Background

The role of psycosocial factors in the disease progression of chronic hepatitis C (CHC) patients remains unclear. The aim of the present study was to prospectively evaluate the prognostic value of behavioral patterns and the quality of life (QOL) of patients with CHC.

Methods

Two hundred and forty Japanese CHC patients (mean age 62.4 years) were assessed for behavioral patterns (Stress Inventory), QOL (Functional Assessment of Chronic Illness Therapy-Spiritual), and known prognostic factors at baseline then followed for a maximum of 8 years for disease progression, defined as either the first diagnosis of hepatocellular carcinoma (HCC) or hepatitis-related death.

Results

Forty-nine events occurred during the study period (46 newly diagnosed HCC cases, three hepatitis-related deaths). In a Cox proportional hazard model including known prognostic factors and treatment-related factors as time-dependent variables, behavioral patterns associated with inhibition of emotional needs (hazard ratio (HR): 1.35; 95 % confidence interval (CI): 1.02–1.77; p = 0.036) and QOL, representing emotional wellbeing (HR 0.60; 95 % CI 0.37–0.98; p = 0.041), were each associated with the risk of disease progression.

Conclusion

Psychosocial factors such as behavioral patterns relevant to the inhibition of emotional needs and emotional wellbeing independently affect the clinical course of patients with CHC.

Electronic supplementary material

The online version of this article (doi:10.1186/s13030-016-0075-3) contains supplementary material, which is available to authorized users.

Impact of autonomic and self-regulation on cancer-related fatigue and distress in breast cancer patients--a prospective observational study

PURPOSE

Cancer-related fatigue (CRF) has a major impact on the quality of life in breast cancer patients (BC). So far, only a few prospective studies have investigated the effect of adaptive salutogenic mechanisms on CRF. The aim of our study was to evaluate the possible prospective influence of autonomic Regulation (aR) and self-regulation (SR) on CRF and distress in long-term survivors.

METHODS

95 BC and 80 healthy female controls (C) had been included in the observational study between 2000 and 2001 and completed the questionnaires on aR, SR and Hospital Anxiety and Depression Scale (HADS). Of these, 62 BC, and 58 C participated in the re-evaluation 6.6 years later: 16 participants were deceased (14 BC and 2 C). During follow-up, participants were requested to answer questions involving (Cancer Fatigue Scales) CFS-D, aR, SR and HADS. Multiple regression analysis was used to evaluate the influence of aR, SR, age, Charlson co-morbidity-index and diagnosis on CFS-D and HADS, and to select further potentially relevant factors.

RESULTS

High aR values showed significant effects, namely inverse relationships with CFS-D, cognitive fatigue, anxiety and depression. SR showed a reduced influence on anxiety and depression (all p < 0.05).

CONCLUSIONS

Autonomic regulation might have an independent, reductive influence on global fatigue, cognitive fatigue and--together with self-regulation--it seems to have a protective influence on anxiety and depression. The connection between these parameters is still unclear and awaits further evaluation.

IMPLICATION FOR CANCER SURVIVORS

AR seems to be a prognostic factor in breast cancer survivors, capable of reducing cancer-related fatigue and self-regulation distress as well. Further research is necessary in order to show how aR can be improved by therapeutic interventions.

A comparative study of self-regulation in substance dependent and non-dependent individuals

BACKGROUND

Several factors influence the beginning and maintenance of substance use. The purpose of this study was to examine as well as to compare 'self-regulation' in both substance dependent and non-substance dependent individuals.

METHOD

In a cross-sectional study 228 (118 substance dependent and 110 with no history of using substance) participants aged 16-55 were recruited. All of the participants were asked to complete the Self-Regulation Inventory (SRI-25) and a demographic characteristics data checklist. Data was analyzed using descriptive statistics (frequency, mean and standard deviation) and the t-test.

RESULTS

The results showed significant differences between substance dependent and non- substance dependent groups in all the scales of the self-regulation inventory including positive actions, controllability, expression of feelings and needs, assertiveness, and well-being seeking (p<0.01).

CONCLUSION

Self-regulation and self-control skills in drug dependent individuals are lower than those without substance dependence individuals. It is concluded that substance use may related to a deficiency in self-control and regulation of feelings. Therefore, for prevention and treatment of substance dependence disorder, it is necessary to work out and exploit strategies that include the improvement of self-regulation.

Perceived mental stress in women associated with psychosomatic symptoms, but not mortality: observations from the Population Study of Women in Gothenburg, Sweden

Purpose

To investigate possible association between mental stress and psychosomatic symptoms, socioeconomic status, lifestyle, as well as incident mortality in a middle-aged female population followed over 37 years.

Methods

A prospective observational study initiated in 1968–1969, including 1462 women aged 60, 54, 50, 46, and 38 years, with follow-ups in 1974–1975, 1980–1981, and 2000–2001, was performed. Measures included self-reported mental stress as well as psychosomatic symptoms and smoking, physical activity, total cholesterol, S-triglycerides, body mass index, waist–hip ratio, blood pressure, socioeconomic status and mortality.

Results

Smoking, not being single, and not working outside home were strongly associated with reported mental stress at baseline. Women who reported high mental stress in 1968–1969 were more likely to report presence of abdominal symptoms (odds ratio [OR] = 1.85, 95% confidence interval [CI]: 1.39–2.46), headache/migraine (OR = 2.04, 95% CI: 1.53–2.72), frequent infections (OR = 1.75, 95% CI: 1.14–2.70), and musculoskeletal symptoms (OR = 1.70, 95% CI: 1.30–2.23) than women who did not report mental stress. Women without these symptoms at baseline 1968–1969, but with perceived mental stress were more likely to subsequently report incident abdominal symptoms (OR = 2.15, 95% CI: 1.39–3.34), headache/migraine (OR = 2.27, 95% CI: 1.48–3.48) and frequent infections (OR = 2.21, 95% CI: 1.12–4.36) in 1974–1975 than women without mental stress in 1968–1969. There was no association between perceived mental stress at baseline and mortality over 37 years of follow-up.

Conclusion

Women reporting mental stress had a higher frequency of psychosomatic symptoms than women who did not report these symptoms. Not working outside home and smoking rather than low socioeconomic status per se was associated with higher stress levels. Perception of high mental stress was not associated with increased mortality.

Do people believe combined hazards can present synergistic risks?

The risk attributable to some hazard combinations can be greater than the sum of the risk attributable to each constituent hazard. Such "synergistic risks" occur in several domains, can vary in magnitude, and often have harmful, even life-threatening, outcomes. Yet, the extent to which people believe that combined hazards can present synergistic risks is unclear. We present the results of two experimental studies aimed at addressing this issue. In both studies, participants examined synergistic and additive risk scenarios, and judged whether these were possible. The results indicate that the proportion of people who believe that synergistic risks can occur declines linearly as the magnitude of the synergistic risk increases. We also find that people believe, despite scientific evidence to the contrary, that certain hazard combinations are more likely to present additive or weakly synergistic risks than synergistic risks of higher magnitudes. Furthermore, our findings did not vary as a simple function of hazard domain (health vs. social), but varied according to the characteristics of the specific hazards considered (specified vs. unspecified drug combinations). These results suggest that many people's beliefs concerning the risk attributable to combined hazards could lead them to underestimate the threat posed by combinations that present synergistic risks, particularly for hazard combinations that present higher synergistic risk magnitudes. These findings highlight a need to develop risk communications that can effectively increase awareness of synergistic risks.

Does self-regulation and autonomic regulation have an influence on survival in breast and colon carcinoma patients? results of a prospective outcome study

Background

Cancer Related Fatigue (CRF) and circadian rhythm have a great impact on the quality of life (HRQL) of patients with breast (BC) and colon cancer (CRC). Other patient related outcomes in oncology are measured by new instruments focusing on adaptive characteristics such as sense of coherence or self-regulation, which could be more appropriate as a prognostic tool than classical HRQL. The aim of this study was to assess the association of autonomic regulation (aR) and self-regulation (SR) with survival.

Methods

146 cancer patients and 120 healthy controls took part in an initial evaluation in 2000/2001. At a median follow up of 5.9 years later, 62 of 95 BC, 17 of 51 CRC patients, and 85 of 117 healthy controls took part in the follow-up study. 41 participants had died. For the follow-up evaluation, participants were requested to complete the standardized aR and SR questionnaires.

Results

On average, cancer patients had survived for 10.1 years with the disease. Using a Cox proportional hazard regression with stepwise variables such as age, diagnosis group, Charlson co-morbidity index, body mass index (BMI)) aR and SR. SR were identified as independent parameters with potential prognostic relevance on survival While aR did not significantly influence survival, SR showed a positive and independent impact on survival (OR = 0.589; 95%-CI: 0.354 - 0.979). This positive effect persisted significantly in the sensitivity analysis of the subgroup of tumour patients and in the subscale 'Achieve satisfaction and well-being' and by tendency in the UICC stages nested for the different diagnoses groups.

Conclusions

Self-regulation might be an independent prognostic factor for the survival of breast and colon carcinoma patients and merits further prospective studies.

Subjective judgements of synergistic risks: a cognitive reasoning perspective

Mounting evidence that certain hazard combinations present synergistic risks for adverse outcomes, including violent crime, cancer, and species extinction, highlights the importance of understanding the risk attributable to combined hazards. However, previous studies indicate that individuals often misjudge synergistic risks as additive or sub-additive risks, and there is little research that explores the cognitive reasoning that may lead individuals to make such judgements. This study aims to fill this gap. Participants were asked to review several scenarios that described the risk magnitude presented by a combined hazard. They were required to judge whether each scenario was possible and to explain the reasoning that led to their judgement. The results show that many participants demonstrated an awareness of synergistic risk and that their reasoning was typically characterized by rudimentary knowledge of an underlying causal mechanism for the increased risk (e.g., a chemical reaction between drugs). Conversely, several participants adopted a line of reasoning that precluded the concept of synergistic risk. Many of these participants appeared to employ an additive model of risk, corresponding to the notion of 'adding' one hazard to another. Contrary to much previous research, we found little evidence to indicate that people tend to employ a sub-additive model of risk for combined hazards. Implications for future research and the improvement of risk communications concerning synergistic risks are discussed.

Link between personality and cancer

Personality refers to an individual's enduring and pervasive personal motivation, emotion, interpersonal style, attitudes and behavior that are stable over a long time after young adulthood. In relation to the cancer trajectory, three basic and one other personality traits have been studied with some frequency, namely neuroticism, extraversion, conscientiousness and optimism. The considerable stability of personality over time makes it a potential long-acting etiological factor for the development of cancer. However, the studies performed so far do not give much support to personality as a causative factor for cancer. Some studies of cancer survival have found significant associations between lower optimism and higher neuroticism with shorter survival. More mental distress and fatigue and poorer quality of life is significantly associated with higher neuroticism and lower optimism at cancer screening, diagnosis and primary treatment, short- and long-term follow-up and towards the end of life. Neuroticism is a strong predictor of post-traumatic stress disorder triggered by cancer as a life-threatening experience eventually leading to negative personality changes. To what extent cancer leads to positive personality changes (post-traumatic growth) is currently unsettled. Basic personality traits are strongly associated with lifestyle, which is considered an important etiological factor for the development of cancer. The methodological problems in the study of personality and cancer are considerable, and many research designs used so far may have been too simplistic. Studies of potential biomarkers for personality traits combined with inflammation markers of cellular carcinogenesis in longitudinal designs could be promising for the future. High neuroticism is important for the clinical management of cancer patients and should gain more attention from oncologists in the future.

Influence of stressors on breast cancer incidence in the Women's Health Initiative

OBJECTIVE

To examine associations among life events stress, social support, and breast cancer incidence in a cohort of postmenopausal women. DESIGN AND MAIN OUTCOME MEASURE: Women's Health Initiative observational study participants, breast cancer free at entry, who provided assessment of stressful life events, social support, and breast cancer risk factors, were prospectively followed for breast cancer incidence (n = 84,334).

RESULTS

During an average of 7.6 years of follow-up, 2,481 invasive breast cancers were diagnosed. In age-adjusted proportional hazards models, 1 stressful life event was associated with increased risk, but risk decreased with each additional stressful life event. After adjustment for confounders the decreasing risk was not significant. Stressful life events and social support appeared to interact in relation to breast cancer risk such that women who had greater number of stressful life events and low social support had a decreased risk of breast cancer.

CONCLUSIONS

This study found no independent association between stressful life events and breast cancer risk. The results are compatible with a more complex model of psychosocial factors interacting in relation to breast cancer risk.

Psychoneuroimmunology

Psychoneuroimmunology (PNI) is a discipline that has evolved in the last 40 years to study the relationship between immunity, the endocrine system, and the central and peripheral nervous systems. In this manner, neurotransmitters, hormones, and neuropeptides have been found to regulate immune cells, and these in turn are capable of communicating with nervous tissue through the secretion of a wide variety of cytokines. Of critical importance is the effect of products of the CNS and nerves on the maintenance of the delicate balance between cell-mediated (Th1) and humoral (Th2) immune responses. A good example of how this concept operates in vivo becomes evident when analyzing the effects of stressors. Chronic stress affects significantly the function of the immune system as well as modifies the evolution of a variety of skin diseases, as psychosocial interventions have proved to be effective in their therapy.

Individual Patient Data Meta-analysis of Survival and Psychosomatic Self-regulation from Published Prospective Controlled Cohort Studies for Long-term Therapy of Breast Cancer Patients with a Mistletoe Preparation (Iscador)

Mistletoe preparations such as Iscador are in common use as complementary/anthroposophic medications for many cancer indications, particularly for solid cancers. The efficacy is still discussed controversially. This paper presents an individual patient data meta-analysis of all published prospective matched-pair studies with breast cancer patients concerned with long-term application of a complementary/anthroposophic therapy with the mistletoe preparation Iscador. Six sets of data were available for individual patient meta-analysis of breast cancer patients, matched according to prognostic factors into pairs with and without mistletoe (Iscador) therapy. The main outcome measures were overall survival and psychosomatic self-regulation. Overall survival was almost significant in favor of the Iscador group in the combined data set of the randomized studies: estimate of the hazard ratio with 95% confidence interval 0.59 (0.34, 1.02). Overall survival was highly significant in the combined data set of the non-randomized studies: 0.43 (0.34, 0.56). In the combined analysis of the randomized studies, improvement of psychosomatic self-regulation, as a measure of autonomous coping with the disease, was highly significant in favor of the Iscador group: estimate of the median difference 0.45 (0.15, 0.80), P = 0.0051. The analyzed studies show that therapy with Iscador might prolong overall survival and improve psychosomatic self-regulation of breast cancer patients.

Hydrocortisone down-regulates the tumor suppressor gene BRCA1 in mammary cells: a possible molecular link between stress and breast cancer

Psychological stress has been correlated with breast cancer development in numerous epidemiological studies. However, physiological and molecular models which may account for this association are not readily available. We have found that the stress hormone hydrocortisone (cortisol) down-regulates the expression of the breast cancer susceptibility gene BRCA1 in the nonmalignant mouse mammary cell line EPH4. This effect is concentration-dependent, is reliant on the continuous presence of hydrocortisone, and is not affected by the addition of lactogenic hormones, or growth conditions. Hydrocortisone was also found to negate a known positive effect of estrogen on BRCA1 expression and, therefore, may interfere with estrogen-related signaling in mammary epithelial cells. The repressive effect of hydrocortisone is diminished or lost in the mouse mammary lines HC-11 and SP1, respectively, suggesting regulation of the BRCA1 may differ between lines. We have uncovered two promoter regulatory sites, which are involved in BRCA1 regulation by hydrocortisone, namely the RIBS and UP regulatory elements. Binding of the transcription factor GABP to both sites is lost upon hydrocortisone addition, though the levels of these factors are not altered by hydrocortisone treatment. Because BRCA1 activity is important for a number of intracellular pathways involved in prevention of tumorigenesis, its observed down-regulation may represent a novel molecular mechanism for cortisol's involvement in breast cancer development.

Prospective controlled cohort studies on long-term therapy of cervical cancer patients with a mistletoe preparation (Iscador)

BACKGROUND

Mistletoe preparations such as Iscador are commonly used in complementary medication for many cancer indications, particularly solid cancers. The efficacy of this complementary therapy is still controversial.

OBJECTIVE

Does longterm therapy with Iscador show any effect on survival, tumor progression and psychosomatic self-regulation of patients with cervical cancer?

PATIENTS AND METHODS

Prospective recruitment and long-term follow-up was carried out in 3 controlled cohort studies: In a randomized matched-pair study (19 pairs), cervical cancer patients with distant metastases and no mistletoe therapy were matched for prognostic factors. By paired random allocation, one of the patients was recommended mistletoe therapy by the attending physician. In 2 non-randomized matched-pair studies, cervical cancer patients without (102) and with (66) metastases, who already received mistletoe therapy, were matched with control patients without Iscador therapy.

RESULTS

For survival, the non-randomized studies showed significant effects in favor of Iscador therapy: hazard ratio (HR) estimate and 95% confidence interval (CI): 0.23 (0.14-0.39) and 0.37 (0.17-0.80), respectively. An effect of long-term Iscador therapy on tumor progression was not seen. Psychosomatic self-regulation in the Iscador group improved significantly within 12 months compared with the control group in the randomized as well as in 1 non-randomized study (cervical cancer without metastases): estimate of the median difference and 95% CI: 0.70 (0.15-1.05) and 0.25 (0.15-0.35), respectively.

CONCLUSION

Iscador may have the effect of prolonging overall survival of cervical cancer patients. In the short term, psychosomatic self-regulation increases more markedly under complementary Iscador therapy than under conventional therapy alone.

Prospective controlled cohort studies on long-term therapy of breast cancer patients with a mistletoe preparation (Iscador)

BACKGROUND

Mistletoe preparations such as Iscador (Weleda, Schwäbisch Gmünd, Germany) are commonly used in complementary and alternative / anthroposophic medicine for many cancer indications, particularly for solid cancers. Efficacy of this complementary therapy is still controversial.

OBJECTIVE

Does long-term therapy with Iscador show any effect on survival, tumor progression and psychosomatic self-regulation of patients with breast cancer?

PATIENTS AND METHODS

Prospective recruitment and long-term follow-up of two controlled cohort studies: (1) Randomized matched-pair study (38 pairs): breast cancer patients without any recurrences or metastases and no mistletoe therapy were matched for prognostic factors. By pairwise random allocation, one of the patients was suggested mistletoe therapy to be applied by the attending physician. (2) Non-randomized matched-pair study (84 pairs): breast cancer patients without recurrences or metastases that already received mistletoe therapy were matched to control patients without Iscador therapy.

RESULTS

For overall survival, the nonrandomized study shows significant effects in favor of Iscador therapy: hazard ratio HR estimate and 95% confidence interval CI: 0.43 (0.27-0.68). The effect of long-term Iscador therapy on tumor progression as measured by the time to local recurrences, lymphatic or distant metastases in breast cancer patients without any such events at first diagnosis, is in most cases significant in favor of the Iscador group, in the randomized as well as in the non-randomized study. Psychosomatic self-regulation in the Iscador group improves significantly within 12 months compared with the control group in the randomized as well as in the non-randomized study: estimate of the median difference and 95% CI: 0.35 (0.05-0.60), respectively 0.20 (0-0.35).

CONCLUSION

Iscador shows a clinically relevant effect on breast tumor progression as measured by overall survival as well as by the time to recurrences, lymphatic or distant metastases. In the short term, psychosomatic self-regulation increases more markedly under complementary Iscador therapy than under conventional therapy alone.

Does stress exacerbate liver diseases?

Although anecdotal comments on detrimental effects of psychosocial stress on liver diseases can be found even in the early literature, only recently has scientific evidence been reported. The present article reviewed such evidence to demonstrate how stress exacerbates liver diseases. A search of the literature from the last two decades was performed using MEDLINE by pairing 'psychological stress' with 'liver' or 'hepatitis.' Additional research was conducted by screening the bibliographies of articles retrieved in the MEDLINE search. The search results showed that the principal effectors of the activated hypothalamic-pituitary-adrenal (HPA) axis, glucocorticoids, can exert a facilitative effect on the hepatic inflammatory response and even increase the risk of developing hepatocellular carcinoma. For certain liver diseases, defective HPA axis activation, which probably contributed to the exacerbation of the liver disease, has been reported. The efferent sympathetic/adrenomedullary system mainly contributes to the stress-induced exacerbation of liver diseases via its neurotransmitters, the catecholamines. In contrast, the efferent parasympathetic nervous system elicits an inhibitory effect on the development of hepatic inflammation. In conclusion, the pathophysiological interaction between stress and the liver appears to be regulated by the complex, dynamic networks of both the endocrine and autonomic nervous systems, which implies a further need for basic research into the involved mechanisms and for clinical evidence to apply psychosocial support to patients with chronic liver diseases.

[Reduction of endogenous regulation in internal medicine patients]

BACKGROUND

General health-related questionnaires on quality of life do not satisfactorily distinguish between healthy and sick people. One of the reasons cited for this lack is too much mental influence. This is why we developed a questionnaire on endogenous regulation (eR) that reflects the regulatory state of various vegetative functions.

OBJECTIVE

The current study examines whether the short version eR questionnaire is able to distinguish between healthy people and internal medicine patients.

PATIENTS AND METHODS

408 participants were included in the study (284 females, 124 males). Among these were patients with colorectal cancer (n = 49), breast cancer (n = 95), diabetes mellitus (type 1: n = 20, type 2: n = 40), coronary disease (n = 39), rheumatoid illnesses (n = 28) and multimorbid patients (n = 22) as well as a healthy control group (n = 115). In addition to the eR questionnaire the study also used the Hospital Anxiety and Depression Scale (HADS), the short questionnaire on self-regulation and questions on the vegetative status.

RESULTS

The healthy control group showed the highest eR, with an estimated average of M = 29.8. Patients with breast cancer, diabetes mellitus type 2, coronary disease and rheumatoid illnesses reveal a significantly lowered eR. Multimorbid patients show the lowest eR. Patients with cancer of the colon and diabetes type 1 were measured at M = 27.9 and M = 27.3 respectively and showed no significantly lowered estimated average compared to the control group. A high eR significantly correlates (p < 0.002) with the following parameters: low levels of anxiety (r = 49) and depression (r = 0.36), high self-regulation (r = 0.34), morning type (r = 0.40), less congestive perspiration (r = 0.38), less shivering (r = 0.23), dysmenorrhoea (r = 0.38) and allergies (r = 0.17).

CONCLUSION

Healthy people show the highest, multimorbid patients the lowest eR. Consistent relations to health, illness, heat regulation and personality presence have been shown. Further studies to clarify clinical relevance are necessary.

Meta-analysis of the effects of psychosocial interventions on survival time in cancer patients

OBJECTIVE

To provide a quantitative summary of effects of psychosocial interventions on cancer survival, and to present an overview of methodological and reporting aspects of the studies.

METHOD

Electronic searches and manual searches of reference lists from review articles and retrieved papers. Two coders independently coded study, participant, treatment, and outcome characteristics of the studies meeting selection criteria.

RESULTS

Thirteen journal articles published between 1989 and 2003 reporting results from 14 controlled intervention studies were included. Results are based on data obtained from 2626 subjects. Effect sizes [hazard ratios (HR)] were heterogeneous and random effects models were used in the analyses. The total mean inverse-variance-weighted HR was 0.85 (95% CI: 0.65-1.11). Randomized studies (n=8) showed no overall treatment effect (HR: 0.77, 95% CI: 0.56-1.06), neither did the nonrandomized studies (HR: 1.00, 95% CI: 0.61-1.62). Interventions using individual treatment (n=3) were, however, found to be effective (HR: 0.55, 95% CI: 0.43-0.70) but interventions using group treatment (n=9) were ineffective (HR: 0.97, 95% CI: 0.73-1.27). Group treatments of breast cancer (n=6) were ineffective (HR: 0.95, 95% CI: 0.69-1.31).

CONCLUSION

A definite conclusion about whether psychosocial interventions prolong cancer survival seems premature. Future studies should use randomization to avoid self-selection of patients with poor prognosis. Interventions should focus on a single diagnosis, take into account known risk factors, and describe their interventions thoroughly.

Psychosocial Stress, Personality, and the Severity of Chronic Hepatitis C

This cross-sectional study examined the association between the severity of chronic hepatitis C and the type 1 personality, which has been shown by Grossarth-Maticek to be strongly related to the incidence of cancer and mortality. Sixty-nine patients with chronic hepatitis C completed the Stress Inventory, a self-report questionnaire to measure psychosocial stress and personality, and were classified into three groups according to hepatitis severity: group A, chronic hepatitis C with a normal serum alanine aminotransferase level; group B, chronic hepatitis C with an elevated alanine aminotransferase level; and group C, liver cirrhosis. Each of four scales related to the type 1 personality--low sense of control, object dependence of loss, unfulfilled need for acceptance, and altruism--was significantly and positively associated with hepatitis severity. The type 1 score, calculated as the average of these scales, was also strongly related to hepatitis severity (p<0.0001), and adjustment for age, sex, education level, smoking, drinking, and duration brought no attenuation into the association. Chronic psychosocial stress relevant to the type 1 personality may also influence the course of chronic hepatitis C.

The relationships of a rationality/antiemotionality personality scale to mortalities of cancer and cardiovascular disease in a community population in Japan

OBJECTIVE

Grossarth-Maticek et al. reported that an individual's level on a rationality/antiemotionality (R/A) personality was strongly predictive of cancer, ischemic heart disease and stroke mortality. To investigate the relationships of an individual's level on the R/A personality to cancer and cardiovascular disease mortality in Japan, we conducted a population-based cohort study.

METHOD

A self-administered questionnaire was distributed to 36990 Japanese residents in September 1992. The response rate was 90.3%. Data from 13226 males and 14880 females were analyzed. Dates and causes of death through December 31, 1999 were obtained for deceased participants.

RESULTS

The results from multivariate hazard ratios (HRs) revealed that males scoring in the middle level compared to those scoring in the lower level of the R/A personality scale decreased their risk of death from cancer and cardiovascular diseases after controlling for covariates.

CONCLUSIONS

The level on the R/A personality scale may affect mortality from cancer and cardiovascular diseases differently in Japan.

Afrontamiento y calidad de vida. Un estudio de pacientes con cáncer

Este trabajo es parte de un estudio longitudinal llevado a cabo en pacientes con cáncer y su objetivo es analizar la calidad de vida y su relación con las estrategias de afrontamiento. Se evidencia la necesidad de explorar y describir estos aspectos para obtener una mirada integradora del vivenciar de los enfermos neoplásicos, en función de un futuro trabajo interdisciplinario. Los sujetos fueron obtenidos en un hospital de Mar del Plata, Argentina. Fueron administrados un Cuestionario de Calidad de Vida, un Inventario de Respuestas de Afrontamiento y una entrevista semiestructurada que indaga variables sociodemográficas y psicológicas. Se muestran las relaciones entre las estrategias utilizadas por los pacientes para afrontar la enfermedad y su percepción de la calidad de vida. Son halladas fuertes correlaciones entre las estrategias de evitación y el deterioro en la mayoría de las dimensiones de la calidad de vida. Para concluir, se efectúan reflexiones e hipótesis al respecto.

Social identity and health: an intergroup communication approach to cancer

This article describes the ways in which group identifications and stereotypes can inform our understanding of cancer prevention and treatment as well as more general social processes surrounding the experience of cancer. From a perspective grounded in social identity theory, we describe the ways in which understanding primary identities (i.e., those associated with large social collectives such as cultural groups), secondary identities (i.e., those associated with health behaviors), and tertiary identities (i.e., those associated with cancer) can help explain certain cancer-related social processes. We forward a series of propositions to stimulate further research on this topic.

Mistletoe and cancer: controversies and perspectives

Extracts and preparations from the tree parasitic plant mistletoe (Viscum album L.) have been used in the treatment of cancer for decades. Numerous preclinical and in vitro studies have reported immunostimulatory, cytotoxic, and proapoptotic effects. Translation of these effects into clinical response continues to pose a problem. While a number of clinical studies have found improvement in quality of life (QOL), data on the efficacy of mistletoe to prolong survival are conflicting and of variable quality. Clinical trial data regarding the toxicity and pharmacokinetics of mistletoe components with known in vitro or preclinical activity are lacking. Mistletoe is a widely used form of complementary and alternative medicine (CAM) for cancer treatment, and research into its use poses the challenges of translation of preclinical data into demonstrable clinical efficacy and investigating CAM approaches as a component of complex cancer treatment systems.

Perceived cancer causes: use of complementary and alternative therapy

PURPOSE

The objectives of this report are to describe beliefs about general and personal cancer causes among patients with cancer who use and do not use complementary and alternative medicine (CAM), to compare these beliefs with current epidemiologic knowledge, and to explore associations between these beliefs and choice of CAMs. DESCRIPTION OF INTERVIEWS: The authors conducted a semistructured interview with 143 patients with cancer, who were identified via the Hawaii Tumor Registry and had participated in a survey on CAM use. By design, the majority of interviewees (85%) were CAM users. A qualitative data analysis was performed.

RESULTS

Genetics, environment, and diet were among the most common perceived general causes of cancer, whereas psychosocial factors were by far the most common perceived personal causes. CAM users were more likely than nonusers to name environment, immune system, and stress as cancer causes. Compared with the epidemiologic literature, study participants were less likely to mention tobacco use and more likely to consider environmental exposures, psychosocial factors, immunologic mechanisms, and physical injury as causes of cancer. Furthermore, the interviews suggest that causal thinking may be related to the type of CAM used.

CLINICAL IMPLICATIONS

Given the discrepancy between popular cancer theories and current scientific knowledge, the challenge for the healthcare provider is to listen and try to understand the patient's beliefs about cancer etiology. Understanding the patient's beliefs about their disease is important in providing the support and information they need to make effective decisions about their medical care.