Behavioral--physiological factors in the development and management of cancer

Generalised cancer, a function of the relative brainsize

The prevalence of spontaneous, generalised malignant tumours in 10 mammalian species was compared with their relative brain sizes (RBS), and the outcome, supported by the statistical significance, argues for the psyche as a contributing factor in cancer. The variation in life spans and metabolism of the species was subsequently equalised and applied to the statistics. The mediators are deductively suggested to be the sympathetic nervous system (SNS) and its neurotransmitter noradrenaline, which may exert a direct, lethal effect on tumours. The strain on the autonomous nervous system (ANS), dispersed throughout the brain, is assumed to be increasing with the increasing ratio of neurones belonging to 'receiving, processing and conscious areas' (RPCA), where the extension or density of ANS may be adapted to the dimensions of the body it supplies.Interference in neocortex and other parts of the brain, partly stress-induced, might cause dysfunction of ANS, which aggravates with a proportional increase of RBS.

Characteristics of adolescent cancer survivors who pursue postsecondary education

This study aimed to identify differences between adolescent cancer survivors who participate in postsecondary education and those who do not, as well as factors that helped these survivors to cope. American College Testing records for 129,824 adolescents were meshed with Iowa's Cancer Registry to identify Iowans who had received a diagnosis of cancer between the ages of 12 and 17 years. The potential subject pool contained 85 persons. A questionnaire was sent to the 28 persons who agreed to participate in the study, and 75% responded. Most of the respondents were girls with normal levels of physical function. Measures of adjustment and mood state indicated low distress levels. Fatigue was their area of highest distress. All the respondents were enrolled in education programs or had graduated. Help from family, friends, and teachers was seen as supportive, but lack of knowledge about their disease was cited most frequently by this same group as interfering with their coping. The respondents demonstrated more discipline, stamina, and commitment than was expected. However, the accrual protocol and respondents' comments revealed a stigmatization of patients with cancer by professional health workers, indicating a need to confront the value that health professionals place on this stigmatized population and health professionals' contribution to this societal posture.

Morbidity and mortality following bone marrow transplantation: Predictive utility of pre-BMT affective functioning, compliance, and social support stability

This study investigated the utility of 3 pretransplant psychological variables (affective functioning, compliance, social support stability) in predicting subsequent bone marrow transplantation (BMT) health outcomes. The pre-BMT psychological evaluations of 92 BMT recipients were coded along the specified psychological dimensions and used to predict post-BMT survival status and health-related quality of life. Data analyses showed that, in addition to medical risk status (low) and quality of the marrow graft (histocompatible), higher levels of pre-BMT affective functioning and social support stability significantly predicted survival status (i.e., alive) and higher levels of quality of life. These findings have important implications for the role of psychological assessment prior to BMT and the need for interventions designed to enhance psychological functioning and subsequent health outcomes following BMT.

Hierarchical cortical control of neuroimmunomodulatory pathways

The central nervous system and the immune system are both stimulus response systems with sophisticated memories mediating defence and adaptation to external and internal threats. There is mounting evidence that these two systems share their information in a bidirectional flow of cytokines, steroids, and neuropeptides. This review examines the influence of higher cognitive centres on immunity and highlights the central role played by the hypothalamus in enabling these two systems to function as an integrated unit to maintain homeostasis. The search for novel compounds that are capable of enhancing immunity by regulating these brain-immune feedback loops offers one of the most exciting areas for future neurobiological research.

Adaptive responses to illness and disability. Healthy denial

The authors attempt to understand the nature and sources of "resilience" by a comparison of three individuals who showed unusual courage in the face of death, illness, and congenital disability. Various adaptive traits that enabled them to function effectively and remain optimistic are discussed. The authors specifically consider the role of "healthy" denial and argue that it does not fully explain or account for their singular optimism confronting adversity. The term "resilience" is proposed to describe both the particular cognitive style of "hardiness" and the "ego strength" that characterize such patients. Possible sources and origins of resilience are suggested. Finally, implications for the treatment of such patients are considered.

Stress, immunity and illness--a review

Psychological factors have long been thought to play a contributing role in either the predisposition, onset or course of various physical illnesses. Recently, rapid advances in immunology have created interest in the interaction between psychosocial factors, behaviour and the immune system. This paper reviews some of the models proposed to explain the relationship between psychological variables and physical illness and presents evidence for a contribution of psychological factors to certain illnesses in which abnormalities in immunologic state are thought to be important. From a somewhat different perspective, animal studies have demonstrated complex effects of stress, on disease susceptibility. Recent human studies have demonstrated consistent immunologic changes in people undergoing acute naturally occurring psychological stress such as bereavement or an important examination. In humans, the effects of chronic stress may be different from acute stress, corresponding to the findings in animals. Abnormalities in immunologic functioning and physical illness are reviewed for different psychiatric disorders--depression, anorexia nervosa and schizophrenia; depression is the only disorder which consistently demonstrated immunologic changes. Possible mechanisms for the stress/immune-change relationship are suggested.

Development of agoraphobia after surviving cancer

We present a case conference on a 32-year-old accountant who developed embryonal carcinoma of the testis, two months after the birth of a son with a missing leg. His cancer was successfully treated with surgery and chemotherapy. After 5 years, when he was told that he need not be closely followed by his physicians anymore because he had been cured of cancer, he developed agoraphobia with panic attacks. This interfered with his occupational and social adjustment. His phobia was treated successfully with pharmacotherapy, behavior therapy, and psychotherapy. We explore the psychologic impact of cancer, the activation of separation anxiety and aggressive impulses after its successful treatment, the crippling nature of his agoraphobia, and the ingredients of his successful response to treatment.

Modification of the antitumor action of Corynebacterium parvum by stress

Social grouping and isolation of mice, in the presence of an acute stressor, were found to differentially affect the antitumor action of the immunological adjuvant Corynebacterium parvum. Socially grouped DBA/2j mice were injected intradermally with P815 mastocytoma ascites cells. Half the mice had a threshold dose of C. parvum admixed with the P815 cells. Half the mice in each of those conditions were given acute, inescapable electric footshock. In a second experiment, the stressed mice were socially isolated prior to the acute stress. Tumor growth itself was not affected by the stress procedures. C. parvum inhibited tumor growth in non-stressed and socially isolated, stressed mice. However, social grouping selectively negated the C. parvum effect resulting in tumor growth and mortality equivalent to mice not given the adjuvant. Psychological factors may be important to the development of concomitant immunity and the efficacy of immunotherapies.

Stress, affective disorders, and immune function

Increasing scientific evidence supports age-old observations that psychosocial factors are closely associated with the pathogenesis of certain physical and mental illnesses. The immune system appears to play a primary mediating role. Whereas acute stress may initiate a transient immunologically protective response, prolonged or poorly controlled psychosocial stressors may result in depression of different components of the immune system. These responses may be related to, or independent of, changes in the neuroendocrine system. As the rather prolific literature in this infant area of psychoneuroimmunology reveals, there are many complex levels of interaction that require further investigation. There is clearly a need for long-term prospective studies that will identify individuals at risk for those numerous diseases in which psychosocial factors and impaired immune function play a pathogenic role. In addition to correlating altered immune function over time with changes in the physical environment, these studies should include psychologic profiles, life-event inventories, and psychiatric interviews in an effort to delineate the role of psychosocial factors as the stimulus for and as the response to the disease process. One of the many positive outcomes of this multifactorial approach to illness is that it will alter the physician's approach to disease and thus to patients as they are evaluated and treated in the psychosocial context in which they live. As Hippocrates said, "It is more important to know what sort of a person has a disease than to know what sort of disease a person has."

Stress, behavior, and immunity: animal models and mediating mechanisms

Research with animal model systems demonstrates a causal relation between stress and disease susceptibility. The physiological sequelae of stressful stimulation vary with type of stressor, chronicity, and perceived control. Different patterns of endocrine secretion are thus associated with specific behavioral parameters. The immune system is regulated at several levels: genetic, cellular, hormonal, and neuronal. Stress and behavioral factors can modulate both cell-mediated and humoral immunity by impacting on the latter three levels of regulation. Both corticosteroids and catecholamines, released as part of the response to aversive stimulation, profoundly inhibit immune responsivity by binding directly to the lymphocyte surface or by releasing secondary mediators that increase the function of suppressor lymphocytes. In addition, there are direct neuroanatomical connections between the hypothalamus and lymphoid organs. Subtle changes in experimental design have yielded significant differences in results that have increased understanding of intermediary mechanisms. Such research complements psychoneuroimmunological and behavioral epidemiological studies in humans.