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St Fleur RG, St George SM, Feaster DJ, Lee TK, Antoni MH. Functions of Resiliency Traits and Processes in Differential Effects of CBSM on Quality of Life in Breast Cancer Survivors: A Moderated Mediation Model. Int J Behav Med 2024; 31:573-581. [PMID: 37389777 DOI: 10.1007/s12529-023-10194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Although there is evidence that cognitive behavioral therapy (CBT)-based group interventions can improve quality of life (QoL) in women undergoing treatment for breast cancer (BC) little is known about factors that mediate and moderate these effects. We examined a) the mediating role of benefit finding on QoL changes after a Cognitive Behavioral Stress Management (CBSM) intervention, and b) whether this mediation effect differed based on baseline optimism in the first year following surgery for BC. METHODS We used data from a prior CBSM trial in 240 women with stage 0-3 BC who completed measures of benefit finding (Benefit Finding Scale, BFS), QoL (Functional Assessment of Cancer Treatment, FACT-G), and optimism (Life Orientation Test-Revised) at baseline (2 - 10 weeks post-surgery), 6-months and 12-months after randomization. CBSM-related changes and mediation and moderation effects were assessed using latent growth curve models. RESULTS We found CBSM increased benefit finding (b = 2.65, p < 0.01), emotional (b = 0.53, p < 0.01), and functional QoL (b = 0.71, p < 0.05) over time. CBSM-related changes in emotional QoL were mediated by increased benefit finding (indirect effect = 0.68, 95% bootstrapped CI: 0.17, 1.56) but only among participants with low to moderate optimism at baseline. CONCLUSION CBSM intervention improved emotional QoL over the first year of breast cancer treatment by increasing benefit finding among women who reported low trait optimism suggesting those who will most likely benefit from improving benefit finding during this stressful period.
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Affiliation(s)
- Ruth G St Fleur
- Department of Epidemiology, Brown University School of Public Health, Rhode Island, Providence, USA.
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tae Kyoung Lee
- Department of Child Psychology and Education/Social Innovation Program, Sungkyunkwan University, Seoul, South Korea
| | - Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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Lau N, Palermo TM, Zhou C, Badillo I, Hong S, Aalfs H, Yi-Frazier JP, McCauley E, Chow EJ, Weiner BJ, Ben-Zeev D, Rosenberg AR. Mobile App Promoting Resilience in Stress Management for Adolescents and Young Adults With Cancer: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e57950. [PMID: 39079108 PMCID: PMC11322713 DOI: 10.2196/57950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/16/2024] [Accepted: 06/14/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at risk of poor psychosocial outcomes. AYAs grew up with the internet and digital technology, and mobile Health (mHealth) psychosocial interventions have the potential to overcome care access barriers. OBJECTIVE This pilot randomized controlled trial (RCT) aimed to establish the feasibility, acceptability, and preliminary efficacy of a fully automated mobile app version of the Promoting Resilience in Stress Management intervention (mPRISM). Promoting Resilience in Stress Management is an evidence-based intervention developed in collaboration with AYAs, based on stress and coping theory, resilience theory, and evidence-based coping strategies. We hypothesized that mPRISM would be feasible, acceptable, and appropriate. METHODS This is a parallel, 2-arm, single-site pilot RCT with a waitlist control design. The study will recruit 80 AYAs with cancer from a clinic. Eligible AYAs are aged 12 to 25 years, within 12 months of a new cancer diagnosis, receiving chemotherapy or radiation therapy, speak, read, or write in English, and are cognitively able to participate in study procedures. Recruitment by clinical research coordinators will occur remotely by phone, video, or text. Participants will be randomized to psychosocial usual care (UC) alone or UC plus mPRISM for an 8-week intervention period, and will remain unblinded to study condition. Enrolled participants will complete surveys at baseline before randomization, 8 weeks, and 3-month follow-up. Using a waitlist design, the UC arm will receive mPRISM upon completion of 3-month follow-up surveys. Those in the UC arm will complete 2 additional measurement points at immediate posttreatment and 3 months later. The primary outcomes of interest are feasibility, defined as ≥60% enrollment and ≥70% retention (ie, percentage of participants who completed the study), and "feasibility, acceptability, and appropriateness" as defined by cut-off scores ≥4/5 on 3 brief validated implementation outcome measures (feasibility of implementation measure, acceptability of intervention measure [AIM], intervention appropriateness measure [IAM]). We will apply top-box scoring for the implementation measures. Exploratory outcomes of interest include patient-reported health-related quality of life, resilience, distress, anxiety, depression, pain, and sleep. We will conduct an intention-to-treat analysis to compare the outcomes of the mPRISM arm versus the control arm with covariate-adjusted regression models. We will summarize individual digital usage metrics using descriptive statistics. RESULTS Since September 2023, we have enrolled 20 participants and recruitment is ongoing. CONCLUSIONS Although our previous work suggests AYAs with cancer are interested in mHealth psychosocial interventions, such interventions have not yet been sufficiently evaluated or implemented among AYA oncology patients. mPRISM may serve as a potential mHealth intervention to fill this gap. In this study, we will test the feasibility, acceptability, and preliminary efficacy of mPRISM. This work will inform future larger-scale RCTs powered for efficacy outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT05842902; https://clinicaltrials.gov/study/NCT05842902. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57950.
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Affiliation(s)
- Nancy Lau
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Isabel Badillo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Shannon Hong
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Homer Aalfs
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Joyce P Yi-Frazier
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Elizabeth McCauley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Eric J Chow
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
- Clinical Research and Public Health Sciences Divisions, Fred Hutch Cancer Center, Seattle, WA, United States
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Dror Ben-Zeev
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Gu L, Shen C, Zhao L, Li N, Wang R, Dai L, Chu Z. The relationship between fear of cancer recurrence and posttraumatic growth: a meta-analysis. Front Psychol 2024; 15:1373102. [PMID: 38887626 PMCID: PMC11181912 DOI: 10.3389/fpsyg.2024.1373102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/01/2024] [Indexed: 06/20/2024] Open
Abstract
Background Theoretically, stress is positively correlated with posttraumatic growth (PTG). However, evidence for a correlation between fear of cancer recurrence (FCR), a cancer-specific stressor, and PTG is mixed. The present study aimed to systematically investigate the overall effect size between the two and to explore moderators that may influence this relationship. Methods From the earliest available date to October 2023, a comprehensive search was conducted in seven databases. Correlation coefficients (r) were calculated using Stata software. Publication type, continent, trauma role, gender, FCR measurements, PTG measurements, sample size, age, and time since diagnosis were used to examine moderating effects. The National Heart, Lung, and Blood Institute's (NHLBI) assessment tool was used to evaluate study quality. Results A total of 14 studies, involving 17 samples and 3,701 participants, were included. The studies found a small association between FCR and PTG (r = 0.161, 95% CI: 0.070-0.249, p < 0.01) and large heterogeneity (I2 = 85.5%). The strength of the association varied according to the publication type and FCR measurement. Conclusion The current review suggests a small but significant positive correlation between FCR and PTG. Future studies would benefit from exploring additional moderators and the use of standardized, validated FCR measurement tools. Systematic review registration PROSPERO, identifier CRD42023460407.
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Affiliation(s)
- Lianqi Gu
- School of Nursing, Nanjing Medical University, Nanjing, China
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Shen
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Linlin Zhao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Na Li
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Rao Wang
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lili Dai
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiping Chu
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Tsai TC, Lee GG, Ting A, Antoni MH, Mendez A, Carver CS, Kim Y. Roles of benefit finding in psychological and inflammatory adjustments in persons with colorectal cancer: a prospective analysis on the multidimensionality of benefit finding. Psychol Health 2023:1-19. [PMID: 37488833 PMCID: PMC10805970 DOI: 10.1080/08870446.2023.2238280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/03/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE This study examined the unique associations of different dimensions of the resilience factor, benefit finding, on concurrent and prospective psychological and biological adjustment outcomes over the first year after a colorectal cancer diagnosis. METHODS AND MEASURES Individuals newly diagnosed with colorectal cancer (n = 133, mean age = 56 years old, 59% female, 46% Hispanic) completed questionnaires assessing the multidimensional aspects of benefit finding around 4 months post-diagnosis (T1). Psychological (depressive symptoms and life satisfaction) and biological [C-reactive protein (CRP) and interleukin-10 (IL-10)] adjustments were assessed at T1 and one-year post-diagnosis (T2). RESULTS Structural equation modeling revealed that at T1, greater reprioritization was concurrently related to higher depressive symptoms (p=.020). Lower acceptance, lower empathy, and greater positive self-view predicted higher life satisfaction at T2 (ps<.010). Additionally, lower empathy and greater family valuation predicted higher CRP at T2 (ps<.004), whereas greater positive self-view predicted higher IL-10 at T2 (p=.039). Greater overall benefit finding was associated with lower IL-10 at T1 (p=.013). CONCLUSION Various aspects of benefit finding differentially relate to psychological and inflammatory markers during the first year after diagnosis in persons with colorectal cancer. Interventions designed to specifically enhance positive self-view may promote both the psychological and biological health of individuals with cancer.
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Affiliation(s)
- Thomas C. Tsai
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
| | - Gabriela G. Lee
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
| | - Amanda Ting
- VA Palo Alto Health Care, 3801 Miranda Ave., Palo Alto, CA 94304
| | - Michael H. Antoni
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
| | - Armando Mendez
- University of Miami Miller School of Medicine, 1600 NW 10 Ave., Miami, FL, United States 33136
| | - Charles S. Carver
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
| | - Youngmee Kim
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
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Wang Y, Liu S, Zhang Y, Zhu G, Wang H, Xu B, Xie Y, Yang S. Effect of traditional Chinese medicine on postoperative depression of breast cancer: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1019049. [PMID: 37426820 PMCID: PMC10327430 DOI: 10.3389/fphar.2023.1019049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Background: Depression is one of the common complications in patients with postoperative breast cancer (BC). Conventional therapies for postoperative depression of BC always have modest treatment outcomes and undesirable side effects. Clinical practice and many studies have shown that traditional Chinese medicine (TCM) has a good effect on postoperative depression of BC. This meta-analysis aimed to assess the clinical effect of TCM as an add-on treatment for postoperative depression of BC. Methods: A systematic and thorough search was conducted on eight online electronic databases up to 20 July 2022. The control group received conventional therapies, and intervention groups received what control groups received plus TCM treatment. Review Manager 5.4.1 was used for statistical analysis. Results: Nine RCTs involved 789 participants who met the inclusion standards. The results showed the intervention group was better at decreasing the score of the Hamilton rating scale for depression (HAMD) (mean difference, MD = -4.21, 95% CI -5.54 to -2.88) and the self-rating depression scale (SDS) (MD = -12.03, 95% CI -15.94 to -8.13), improving clinical efficacy (RR = 1.25, 95% CI 1.14-1.37), increasing the levels of 5-hydroxytryptamine (5-HT) (MD = 0.27, 95% CI 0.20-0.34), dopamine (DA) (MD = 26.28, 95% CI 24.18-28.77), and norepinephrine (NE) (MD = 11.05, 95% CI 8.07-14.04), and influencing the immune index, including the levels of CD3+ (MD = 15.18, 95% CI 13.61-16.75), CD4+ (MD = 8.37, 95% CI 6.00-10.74), and CD4+/CD8+ (MD = 0.33, 95% CI 0.27-0.39). The level of CD8+ (MD = -4.04, 95% CI -11.98 to 3.99) had no obvious difference between the two groups. Conclusion: The meta-analysis stated that a therapeutic regimen involving TCM could better improve the depression status in postoperative BC.
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St Fleur RG, Ream M, Walsh EA, Antoni MH. Cognitive behavioral stress management affects different dimensions of benefit finding in breast cancer survivors: a multilevel mediation model. Psychol Health 2023:1-20. [PMID: 36855864 PMCID: PMC10471786 DOI: 10.1080/08870446.2023.2184840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023]
Abstract
Objective. This study aimed to confirm the multidimensionality of benefit finding (BF), or silver linings within the cancer experience, assess the effects of Cognitive Behavioral Stress Management (CBSM) on those dimensions, and test the mediating role of perceived stress management skills targeted by CBSM.Methods. This secondary analysis used data from 240 women with stage 0-III breast cancer who completed measures of BF (Benefit Finding Scale) and perceived stress management skills (PSMS) at baseline, 6-months, and 12-months post-randomization into CBSM or a psycho-education condition. We tested a six-factor BF model using Confirmatory Factor Analysis and assessed CBSM-related changes in BF and PSMS using Hierarchical Linear Models. We included significantly affected BF dimensions in mediation models.Results. A six-factor model of BF had good fit [χ2(212) = 391.5, p < .001; CFI = 0.94; RMSEA = 0.06; SRMR = 0.04]. CBSM positively affected changes in personal growth (β = 0.06, p = .01), social relations (β = 0.05, p = .05), and worldview (β = 0.05, p = .02) BF. Perceived relaxation skill increases significantly mediated changes in personal growth (β = 0.03, p = .04) and social relations (β = 0.03, p = .04).Conclusion. Some aspects of perceived stress management skills appear to account for specific BF dimensions and should be considered in future efforts to develop interventions to modulate BF.
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Affiliation(s)
- Ruth G. St Fleur
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Molly Ream
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Emily A. Walsh
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Michael H. Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Antoni MH, Moreno PI, Penedo FJ. Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors. Annu Rev Psychol 2023; 74:423-455. [PMID: 35961041 PMCID: PMC10358426 DOI: 10.1146/annurev-psych-030122-124119] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cancer diagnosis and treatment constitute profoundly stressful experiences involving unique and common challenges that generate uncertainty, fear, and emotional distress. Individuals with cancer must cope with multiple stressors, from the point of diagnosis through surgical and adjuvant treatments and into survivorship, that require substantial psychological and physiological adaptation. This can take a toll on quality of life and well-being and may also promote cellular and molecular changes that can exacerbate physical symptoms and facilitate tumor growth and metastasis, thereby contributing to negative long-term health outcomes. Since modifying responses tostressors might improve psychological and physiological adaptation, quality of life, and clinical health outcomes, several randomized controlled trials have tested interventions that aim to facilitate stress management. We review evidence for the effects of stress management interventions on psychological and physiological adaptation and health outcomes in cancer patients and survivors and summarize emerging research in the field to address unanswered questions.
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Affiliation(s)
- Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida, USA;
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Patricia I Moreno
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, Florida, USA;
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
- Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
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Jassim GA, Doherty S, Whitford DL, Khashan AS. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev 2023; 1:CD008729. [PMID: 36628983 PMCID: PMC9832339 DOI: 10.1002/14651858.cd008729.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer. SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. MAIN RESULTS We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies. AUTHORS' CONCLUSIONS Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.
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Affiliation(s)
- Ghufran A Jassim
- Department of Family & Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | - Sally Doherty
- Psychiatry, Royal College of Surgeons in Ireland- Medical University of Bahrain (RCSI Bahrain), Busaiteen, Bahrain
| | | | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
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Arpawong TE, Sakuma KLK, Espinoza L, Huh J. Longitudinal Examination of an Ethnic Paradox of Stress and Mental Health in Older Black and Latinx Adults. Clin Gerontol 2023; 46:27-46. [PMID: 35320059 PMCID: PMC9500116 DOI: 10.1080/07317115.2022.2056102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To explain the ethnic paradox of mental health in aging, we evaluated whether Black and Latinx older adults experience (1) fewer depressive symptoms (DepSx), but more physical problems, and (2) greater psychological resilience as a result of life stressors than White older adults. METHODS DepSx, physical health, and recent stress were obtained biennially from 25,893 older adults (77% White, 15% Black, 9% Latinx) in the U.S. Health and Retirement Study, across 16 years. Psychological resilience, lifetime stress, and discrimination experiences were available for 13,655 individuals. We conducted mixed-effects and linear regression analyses. RESULTS For Blacks and Latinxs, experiencing more-than-usual stress events was associated with less increase in DepSx compared to Whites, although on average Blacks and Latinxs experience more DepSx. Black adults showed worse physical health than White adults and weaker effects of stress on psychological resilience despite experiencing more stress of all types. Findings were mixed for Latinxs. CONCLUSIONS Studying effects of time-varying stress on changes in health and multiple stressors on psychological resilience by race/ethnicity elucidates mechanisms for later-age health disparities. CLINICAL IMPLICATIONS Cross-sectional evaluations of stress and psychological health in a clinical setting may provide incomplete appraisals of health risks for Black and Latinx older Americans.
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Affiliation(s)
- Thalida Em Arpawong
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Kari-Lyn K. Sakuma
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Lilia Espinoza
- Department of Public Health, California State University, Fullerton, CA, USA
| | - Jimi Huh
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
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Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies. Auton Neurosci 2023; 244:103052. [PMID: 36525900 DOI: 10.1016/j.autneu.2022.103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Postural Orthostatic Tachycardia Syndrome (POTS) is a chronic health condition affecting mostly women of childbearing age, and significantly impacting their health and quality of life. It is currently poorly understood with no approved licensed treatments. The aim of this systematic review was to contextualize the symptom burden of POTS, and review factors associated with this burden that may guide future treatments. The specific questions were (1) How does symptom burden in POTS compare to the burden in other long term conditions (LTCs), (2) Which factors are associated with POTS symptom burden, and (3) Which interventions show promise in reducing symptom burden in POTS. DATABASES AND DATA TREATMENT Electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, APA PsycArticles, OpenGrey) were searched from inception to January 2022 for observational studies reporting on the association between any biological, psychological or social factors and symptom burden, and randomized controlled trials reporting on interventions for symptom burden in adults with POTS. Two reviewers independently conducted eligibility screening, data extraction and quality assessment. A narrative synthesis was undertaken. RESULTS/CONCLUSION 5159 entries were screened for eligibility. Twenty-nine studies were included (1372 participants with POTS of a total sample size of 2314, 17 High-, 12 Medium-quality), seventeen were observational and twelve were randomized controlled experimental and intervention trials. Overall methodological quality of the evidence was medium-high but heterogeneity was high and sample sizes modest, allowing moderately robust conclusions. Orthostatic symptom burden was higher in POTS than other LTCs. Serum activity against adrenergic α1 receptors, physical functioning, depression, catastrophizing, prolonged cognitive stress testing and anxiety were significantly associated with symptom burden in medium-high quality studies. Preliminary medium-high quality evidence from predominantly proof-of-concept (n = 11) studies and one 3-month 2 × 2 factorial design trial suggest that compression garments, propranolol, pyridostigmine, desmopressin, and bisoprolol may hold promise in reducing symptom burden. Directions for future research include investigating associated factors over time, the development of complex interventions which address both biological and psychosocial factors associated with symptom burden, and effectiveness trials of these interventions. SIGNIFICANCE POTS symptom burden is high, particularly in relation to orthostatic intolerance when compared to other long-term conditions (LTCs). Despite this burden, there are no effectiveness randomized controlled trials of treatment to reduce symptoms in POTS. This review provides a starting point to understanding researched biological and psychosocial factors associated with this burden. There was however inconsistency in the measurement of symptom burden, lowering the confidence of cross-study inferences. A coherent definition of POTS symptom range, severity and impact along with a validated and reliable POTS-specific instrument is currently lacking. A standardized questionnaire to assess POTS symptom burden as a core outcome measure will help clarify future research and clinical practice.
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Alawna M, Mohamed AA. An integrated intervention combining cognitive-behavioural stress management and progressive muscle relaxation improves immune biomarkers and reduces COVID-19 severity and progression in patients with COVID-19: A randomized control trial. Stress Health 2022; 38:978-988. [PMID: 35393715 PMCID: PMC9111066 DOI: 10.1002/smi.3151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/26/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Abstract
COVID-19 is a world disaster. In response to COVID-19 quarantine, stress, anxiety, and depression may easily develop which negatively affect immunity and decrease the patient's response against the COVID-19 virus. This study investigated the effect of an integrated intervention combining cognitive-behavioural stress management (CBSM) and progressive muscle relaxation (PMRs) on immune biomarkers and disease severity and progression in patients with COVID-19 and the period to which these changes last. Thirty patients with mild or moderate COVID-19 were randomly distributed into intervention and control groups. The intervention group performed an integrated intervention combining CBSM and PMRs. There were three outcome measures including blood immune markers, salivary immunoglobulin A, and Wisconsin scale (WIS). Two-week post-intervention, there were significant differences between groups in the WIS total score, Leucocytes, Lymphocytes, Interleukin-6, and Immunoglobulin-A. While there were non-significant differences between both groups in Interleukin-10 and TNF-α. The significant differences between groups in the WIS total score, Leucocytes, Lymphocytes, Interleukin-6, and Immunoglobulin-A significantly continued 1 week as a follow-up. This study concluded that performing an integrated intervention combining CBSM and PMRs for 2 weeks significantly increases immune biomarkers mainly Leucocytes, Lymphocytes, Interleukin-10, and Interleukin-6 along with S-IgA. Also, this protocol significantly decreases disease severity and associated stress, anxiety, and depression; and enhances the quality of life in patients with COVID-19. The study was retrospectively registered with NCT04998708.
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Affiliation(s)
- Motaz Alawna
- Department of Health SciencesFaculty of Graduate SciencesArab American UniversityJeninPalestine
| | - Ayman A. Mohamed
- Department of Basic SciencesFaculty of Physical TherapyBeni‐Suef UniversityBeni SuefEgypt
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12
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Effects of Cognitive Behavioral Stress Management Delivered by a Virtual Human, Teletherapy, and an E-Manual on Psychological and Physiological Outcomes in Adult Women: An Experimental Test. MULTIMODAL TECHNOLOGIES AND INTERACTION 2022. [DOI: 10.3390/mti6110099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Technology may expand the reach of stress management to broader populations. However, issues with engagement can reduce intervention effectiveness. Technologies with highly social interfaces, such as virtual humans (VH), may offer advantages in this space. However, it is unclear how VH compare to telehealth and e-manuals at delivering psychological interventions. This experiment compared the effects of single laboratory session of Cognitive Behavioral Stress Management (CBSM) delivered by a VH (VH-CBSM), human telehealth (T-CBSM), and an e-manual (E-CBSM) on psychological and physiological outcomes in a community sample of stressed adult women. A pilot randomized controlled trial (RCT) with a parallel, mixed design was conducted. Adult women (M age =43.21, SD = 10.70) who self-identified as stressed were randomly allocated to VH-CBSM, T-CBSM, or E-CBSM involving one 90 min session and homework. Perceived stress, stress management skills, negative affect, optimism, relaxation, and physiological stress were measured. Mixed factorial ANOVAs and pairwise comparisons with Bonferroni correction investigated main and interaction effects of time and condition. Participants’ data (N = 38) were analysed (12 = VH-CBSM; 12 = T-CBSM; 14 = E-CBSM). Each condition significantly improved stress, negative affect, optimism, relaxation, and physiological stress over time with large effect sizes. No significant differences were found between conditions on outcomes. Overall, all three technologies showed promise for remotely delivering CBSM in a controlled setting. The findings suggest feasibility of the VH-CBSM delivery approach and support conducting a fully powered RCT to examine its effectiveness when delivering a full 10-week CBSM intervention.
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Walsh EA, Antoni MH, Popok PJ, Moreno PI, Penedo FJ. Effects of a randomized-controlled trial of cognitive behavioral stress management: Psychosocial adaptation and immune status in men with early-stage prostate cancer. Gen Hosp Psychiatry 2022; 79:128-134. [PMID: 36375341 PMCID: PMC9729459 DOI: 10.1016/j.genhosppsych.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Targets of intervention in cognitive behavioral stress management (CBSM), such as benefit finding (BF) and perceived stress management skills (PSMS), may counteract stress-related changes that impact the immune system. This study tested whether BF, PSMS, and optimism influence the effects of CBSM on immune status in men with prostate cancer. METHODS Men with prostate cancer were randomized to receive CBSM or a psychoeducation (PE) control comparison (NCT05486754). Life Orientation Test-Revised assessed baseline optimism. The Benefit Finding Scale and Measure of Current Status measured BF and PSMS after CBSM. T-cells and T-helper cells captured immune status change at baseline and 6-months post-CBSM. MPlus and SPSS (PROCESS) tested condition effects and moderated mediation, controlling for covariates. RESULTS 256 primarily middle-aged, White Non-Hispanic or Hispanic men enrolled. PSMS mediated CBSM effects on T-cell and T-helper cell percentage, such that T-cell and T-helper cell percentages were reduced in men in CBSM versus PE via PSMS. Optimism moderated this mediation with the mediating effect of PSMS only observed among men with average optimism versus those with low or high optimism. CONCLUSION Baseline psychological characteristics, as well as limited specificity of immune measurement, could explain the conditional effects in this sample. TRIAL REGISTRATION NCT05486754.
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Affiliation(s)
- Emily A Walsh
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL 33146, United States of America.
| | - Michael H Antoni
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL 33146, United States of America; Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States of America
| | - Paula J Popok
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL 33146, United States of America
| | - Patricia I Moreno
- Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States of America; Department of Public Health Sciences, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, United States of America
| | - Frank J Penedo
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor, Coral Gables, FL 33146, United States of America; Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, United States of America
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14
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Stressful Life Events and Distress in Breast Cancer: A 5-Years Follow-Up. Int J Clin Health Psychol 2022; 22:100303. [PMID: 35572072 PMCID: PMC9055056 DOI: 10.1016/j.ijchp.2022.100303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background/Objective Method Results Conclusions
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15
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Zhu P, Chen C, Liu X, Gu W, Shang X. Factors associated with benefit finding and mental health of patients with cancer: a systematic review. Support Care Cancer 2022; 30:6483-6496. [PMID: 35391575 DOI: 10.1007/s00520-022-07032-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This systematic review was performed to identify the association between benefit finding (BF) and anxiety, depression, and distress, as well as to find factors related to BF in adult cancer patients. METHODS Five English databases and four Chinese databases were searched to identify eligible articles about BF in adult cancer patients from inception to 4 July 2021. Literature screening, data extraction, and quality assessment were carried out by two reviewers independently according to the inclusion and exclusion criteria. Qualitative synthesis was used to summarize the results. RESULTS Twenty-one studies involving 9601 cancer patients were included in this study. Qualitative analysis showed that BF was negatively related to anxiety, depression, and distress. Factors associated with BF included sociodemographic factors, disease-related factors, and psychological and environmental factors. CONCLUSIONS Healthcare providers should pay attention to the summarized factors of BF and construct intervention programs based on the controllable factors to improve BF in adult cancer patients, thus promoting the recovery of patients.
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Affiliation(s)
- Pingting Zhu
- School of Nursing, Yangzhou University, Hanjing County, 136 Jiangyang Middle Road, Yangzhou City, 225009, Jiangsu Province, China.
- Jiangsu Key Laboratory of Zoonosis, Hanjing County, 136 Jiangyang Middle Road, Yangzhou City, 225009, Jiangsu Province, China.
| | - Chen Chen
- School of Nursing, Yangzhou University, Hanjing County, 136 Jiangyang Middle Road, Yangzhou City, 225009, Jiangsu Province, China
| | - Xinyi Liu
- School of Nursing, Yangzhou University, Hanjing County, 136 Jiangyang Middle Road, Yangzhou City, 225009, Jiangsu Province, China
| | - Weina Gu
- Department of Oncology, Guangling Country, Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou City, 225001, Jiangsu Province, China
| | - Xingchen Shang
- School of Nursing, Yangzhou University, Hanjing County, 136 Jiangyang Middle Road, Yangzhou City, 225009, Jiangsu Province, China
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16
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Early Social Enrichment Modulates Tumor Progression and p53 Expression in Adult Mice. Biomolecules 2022; 12:biom12040532. [PMID: 35454121 PMCID: PMC9032412 DOI: 10.3390/biom12040532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 12/07/2022] Open
Abstract
Epidemiological evidence indicates that stress and aversive psychological conditions can affect cancer progression, while well-being protects against it. Although a large set of studies have addressed the impact of stress on cancer, not much is known about the mechanisms that protect from cancer in healthy psychological conditions. C57BL/6J mouse pups were exposed to an environmental enrichment condition consisting of being raised until weaning by the biological lactating mother plus a non-lactating virgin female (LnL = Lactating and non-Lactating mothers). The Control group consisted of mice raised by a single lactating mother (L = Lactating). Four months after weaning, mice from LnL and L conditions were exposed to intramuscular injection of 3-methylcolantrene (3MCA), a potent tumorigenic drug, and onset and progression of 3MCA-induced fibrosarcomas were monitored over time. Pups from the LnL compared to the L group received more parental care and were more resilient to stressful events during the first week of life. In association, the onset of tumors in LnL adults was significantly delayed. At the molecular level, we observed increased levels of wild-type p53 protein in tumor samples of LnL compared to L adults and higher levels of its target p21 in healthy muscles of LnL mice compared to the L group, supporting the hypothesis of potential involvement of p53 in tumor development. Our study sustains the model that early life care protects against tumor susceptibility.
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Chang A, Sloan EK, Antoni MH, Knight JM, Telles R, Lutgendorf SK. Biobehavioral Pathways and Cancer Progression: Insights for Improving Well-Being and Cancer Outcomes. Integr Cancer Ther 2022; 21:15347354221096081. [PMID: 35579197 PMCID: PMC9118395 DOI: 10.1177/15347354221096081] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/17/2022] Open
Abstract
The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.
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Affiliation(s)
- Aeson Chang
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia
| | - Erica K. Sloan
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Peter MacCallum Cancer Centre, Division of Surgery, Melbourne, VIC, Australia
| | - Michael H. Antoni
- Departments of Psychology, Psychiatry, and Behavioral Sciences, and Cancer Control Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Jennifer M. Knight
- Department of Psychiatry and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Telles
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Susan K. Lutgendorf
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
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18
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Lassmann I, Dinkel A, Marten-Mittag B, Jahnen M, Schulwitz H, Gschwend JE, Herkommer K. Benefit finding in long-term prostate cancer survivors. Support Care Cancer 2021; 29:4451-4460. [PMID: 33447865 PMCID: PMC8236447 DOI: 10.1007/s00520-020-05971-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/22/2020] [Indexed: 01/09/2023]
Abstract
Purpose Benefit finding (BF) represents possible positive changes that people may experience after cancer diagnosis and treatment and has proven to be valuable to the psychological outcome. Knowledge of such beneficial consequences of prostate cancer (PCa) is limited in long-term survivors (> 5 years). Thus, the present study investigated the occurrence of benefit finding (BF) and its determinants in a large sample of (very-) long-term PCa survivors. Methods BF was assessed in 4252 PCa survivors from the German database “Familial Prostate Cancer” using the German version of the Benefit Finding Scale (BFS). Associations between BF and sociodemographic, clinical, and psychosocial (e.g., depressive and anxiety symptoms and perceived severity of the disease experience) variables were analyzed using hierarchical multiple linear regression analysis. Results Mean age at survey was 77.4 years (SD = 6.2) after a mean follow-up of 14.8 years (SD = 3.8). Mean BFS score was 3.14 (SD = 1.0); the prevalence of moderate-to-high BF (score ≥ 3) was 59.7%. Younger age at diagnosis, lower educational level, and higher perceived severity of the disease experience were predictive of BF. Objective disease severity or family history of PCa was not uniquely associated with BF. Conclusions BF occurs in older, (very-) long-term PCa survivors. Our findings suggest that the self-asserted severity of the disease experience in a patient’s biography is linked to BF in the survivorship course above all tangible sociodemographic and clinical factors. Implications for cancer survivors PCa survivors may express BF regardless of clinical disease severity. Treating urologists should consider inquiring BF to enrich a patient’s cancer narrative.
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Affiliation(s)
- Irène Lassmann
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Langerstr. 3, 81675, Munich, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Langerstr. 3, 81675, Munich, Germany
| | - Matthias Jahnen
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Helga Schulwitz
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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The Effects of Cognitive-Behavioral Stress Management for Breast Cancer Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Cancer Nurs 2020; 43:222-237. [PMID: 32195709 DOI: 10.1097/ncc.0000000000000804] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Treatment for breast cancer can be stressful for patients. Cognitive-behavioral stress management (CBSM) interventions aim to improve patients' skills in coping with stress and buffer against the negative effects of cancer. OBJECTIVES This meta-analysis aimed to demonstrate the impact of CBSM on breast cancer patients. METHODS We searched PubMed, EMBASE, the Cochrane Database, ScienceDirect, MEDLINE, CENTRAL, CINAHL, and PsycNET for randomized controlled trials (RCTs) published up to November 21, 2017. We then performed a meta-analysis of RCTs that compared CBSM for patients with breast cancer with a 1-day psychoeducation seminar, wait-list controls, or standard care. RESULTS Eighteen RCTs with 2564 participants were ultimately included. The results showed that CBSM can increase Measure of Current Status relaxation scores, benefit finding, and positive affect and decrease serum cortisol, anxiety, depression, thought avoidance and intrusion, and negative mood. However, it appears to have no effect on stress or mood disturbance. CONCLUSIONS Cognitive-behavioral stress management appears to be beneficial for breast cancer patients. Further high-quality RCTs are needed to clarify if any other factors are influenced by CBSM intervention. IMPLICATIONS FOR PRACTICE Cognitive-behavioral stress management can help breast cancer patients develop skills to increase relaxation, benefit finding, and positive affect; CBSM may provide a buffer against the negative effects of cancer. Further, CBSM may help breast cancer patients replace negative thoughts, improve their thought processes and behaviors, and maintain social support using cognitive and interpersonal coping skills. Nurses should be aware of the benefits of CBSM in their day-to-day care of breast cancer patients.
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Borgi M, Collacchi B, Ortona E, Cirulli F. Stress and coping in women with breast cancer:unravelling the mechanisms to improve resilience. Neurosci Biobehav Rev 2020; 119:406-421. [PMID: 33086128 DOI: 10.1016/j.neubiorev.2020.10.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
Breast cancer diagnosis, surgery, adjuvant therapies and survivorship can all be extremely stressful. In women, concerns about body image are common as a result of the disease and can affect interpersonal relationships, possibly leading to social isolation, increasing the likelihood for mood disorders. This is particularly relevant as women are at greater risk to develop anxiety and depressive symptoms in response to highly stressful situations. Here we address the mechanisms and the pathways activated as a result of stress and contributing to changes in the pathophysiology of breast cancer, as well as the potential of stress management factors and interventions in buffering the deleterious effects of chronic stress in a gender perspective. An improved understanding of the biological mechanisms linking stress-management resources to health-relevant biological processes in breast cancer patients could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve cancer outcomes, ultimately offering a unique opportunity to improve contemporary cancer treatments.
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Affiliation(s)
- Marta Borgi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Barbara Collacchi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Elena Ortona
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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21
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Zeligman M, Ataga J, Shaw Z. Posttraumatic Growth in Trauma Survivors: Associations With Attachment to God and God Representation. COUNSELING AND VALUES 2020. [DOI: 10.1002/cvj.12135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Melissa Zeligman
- Department of Counselor Education and School Psychology University of Central Florida
| | - Jasmaine Ataga
- Department of Counseling and Psychological Services Georgia State University
- Now at College of Education University of Florida at Gainesville
| | - Zoe Shaw
- Department of Counseling and Psychological Services Georgia State University
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22
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Toledo G, Ochoa CY, Farias AJ. Religion and spirituality: their role in the psychosocial adjustment to breast cancer and subsequent symptom management of adjuvant endocrine therapy. Support Care Cancer 2020; 29:3017-3024. [PMID: 33034750 DOI: 10.1007/s00520-020-05722-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Distress from being diagnosed with breast cancer can impact a woman's decision to continue taking adjuvant endocrine therapy (AET). The purpose of this study is to explore how religion and/or spirituality influence women's psychosocial adjustment to breast cancer and subsequent symptom management among women on active AET. METHODS Semi-structured in-depth interviews were conducted with breast cancer survivors (n = 19) from California and Texas. Interview questions prompted discussion about AET and how women adjusted to a breast cancer diagnosis and treatment with AET. Interview transcripts were analyzed with a deductive grounded theory approach, and an inductive constant comparison approach was used to identify the sources of religion and spirituality. RESULTS Religion supported women in their psychosocial adjustment to breast cancer by offering them a sense of purpose and meaning in life. It helped women make sense of their AET treatment as they persisted with it despite experiencing adverse side-effects. Spirituality played a prominent role in women's mental and physical wellbeing by facilitating positive and calm attitudes, which lessened women's fear during their cancer diagnosis and treatment. CONCLUSION We identified that religion and/or spirituality helps women with their adjustment to breast cancer and influences their continued use and management of side-effects from AET. IMPLICATIONS FOR BREAST CANCER SURVIVORS This study illustrates the importance of developing meaning-centered interventions that harness religion and spirituality to help women cope with AET. Our findings support the development of interventions that work to enhance AET persistence among breast cancer survivors.
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Affiliation(s)
- Gabriela Toledo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.,UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Carol Y Ochoa
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Preventive Medicine, The Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles, CA, USA.
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Shields GS, Spahr CM, Slavich GM. Psychosocial Interventions and Immune System Function: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Psychiatry 2020; 77:1031-1043. [PMID: 32492090 PMCID: PMC7272116 DOI: 10.1001/jamapsychiatry.2020.0431] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Recent estimates suggest that more than 50% of all deaths worldwide are currently attributable to inflammation-related diseases. Psychosocial interventions may represent a potentially useful strategy for addressing this global public health problem, but which types of interventions reliably improve immune system function, under what conditions, and for whom are unknown. OBJECTIVE To address this issue, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) in which we estimated associations between 8 different psychosocial interventions and 7 markers of immune system function, and examined 9 potential moderating factors. DATA SOURCES PubMed, Scopus, PsycInfo, and ClinicalTrials.gov databases were systematically searched from February 1, 2017, to December 31, 2018, for all relevant RCTs published through December 31, 2018. STUDY SELECTION Eligible RCTs included a psychosocial intervention, immune outcome, and preintervention and postintervention immunologic assessments. Studies were independently examined by 2 investigators. Of 4621 studies identified, 62 were eligible and 56 included. DATA EXTRACTION AND SYNTHESIS Data were extracted and analyzed from January 1, 2019, to July 29, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Data were extracted by 2 investigators who were blind to study hypotheses and analyses, and were then analyzed using robust variance estimation. Analysis included 8 psychosocial interventions (behavior therapy, cognitive therapy, cognitive behavior therapy [CBT], CBT plus additive treatment or mode of delivery that augmented the CBT, bereavement or supportive therapy, multiple or combined interventions, other psychotherapy, and psychoeducation), 7 immune outcomes (proinflammatory cytokine or marker levels, anti-inflammatory cytokine levels, antibody levels, immune cell counts, natural killer cell activity, viral load, and other immune outcomes), and 9 moderating factors (intervention type, intervention format, intervention length, immune marker type, basal vs stimulated markers, immune marker measurement timing, disease state or reason for treatment, age, and sex). MAIN OUTCOMES AND MEASURES The primary a priori outcomes were pretest-posttest-control (ppc) group effect sizes (ppc g) for the 7 immunologic outcomes investigated. RESULTS Across 56 RCTs and 4060 participants, psychosocial interventions were associated with enhanced immune system function (ppc g = 0.30, 95% CI, 0.21-0.40; t50.9 = 6.22; P < .001). Overall, being randomly assigned to a psychosocial intervention condition vs a control condition was associated with a 14.7% (95% CI, 5.7%-23.8%) improvement in beneficial immune system function and an 18.0% (95% CI, 7.2%-28.8%) decrease in harmful immune system function over time. These associations persisted for at least 6 months following treatment and were robust across age, sex, and intervention duration. These associations were most reliable for CBT (ppc g = 0.33, 95% CI, 0.19-0.47; t27.2 = 4.82; P < .001) and multiple or combined interventions (ppc g = 0.52, 95% CI, 0.17-0.88; t5.7 = 3.63; P = .01), and for studies that assessed proinflammatory cytokines or markers (ppc g = 0.33, 95% CI, 0.19-0.48; t25.6 = 4.70; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that psychosocial interventions are reliably associated with enhanced immune system function and may therefore represent a viable strategy for improving immune-related health.
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Affiliation(s)
| | - Chandler M. Spahr
- Department of Psychology, San Diego State University, San Diego, California
| | - George M. Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Steel JL, Antoni M, Pathak R, Butterfield LH, Vodovotz Y, Savkova A, Wallis M, Wang Y, Jing H, Grammer E, Burke R, Brady M, Geller DA. Adverse childhood experiences (ACEs), cell-mediated immunity, and survival in the context of cancer. Brain Behav Immun 2020; 88:566-572. [PMID: 32339603 PMCID: PMC7415584 DOI: 10.1016/j.bbi.2020.04.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Adverse childhood experiences (ACEs) have been shown to be associated with increased risk of mortality. The biobehavioral mechanisms linking adverse events and survival in cancer patients remain unclear. The aims of the study were to: (1) examine the rates and types of early adverse events in patients diagnosed with cancer; (2) investigate the association of adverse events with circulating cytokines, representing immune status of the patient; and (3) test whether immune markers mediated the association between early adverse events and survival while adjusting for other factors that are associated with immunity (e.g., fatigue) and survival (e.g., depression). PATIENTS AND METHODS The patients were recruited from an outpatient oncology clinic. Patients were administered a battery of questionnaires including the Traumatic Events Survey and the Center for Epidemiological Studies-Depression scale. Blood was collected and serum levels of cytokines were assessed to characterize immune status. Descriptive statistics, Mann-Whitney U tests and Cox regression were performed to address study aims. RESULTS Of the 408 patients, 66% reported at least one ACE. After adjusting for demographic, disease-specific factors, and psychological/behavioral factors; having had a major upheaval between parents during childhood or adolescence was associated with poorer survival [β = -0.702, HR = 0.496, p = 0.034]. Lower levels of interleukin-2 (IL-2) explained, in part, the link between this early adverse event and poorer survival as when IL-2 was entered into the model, a major upheaval between one's parents and survival was no longer significant [β = -0.612, HR = 0.542, p = 0.104]. CONCLUSION Having experienced an ACE was associated with lower IL-2 levels-a growth factor for anti-inflammatory T-regulatory lymphocytes-central in contemporary immunotherapy, as well as poorer survival in those diagnosed with cancer. Since lower IL-2 levels also explained, in part, the link between the ACE involving parental upheaval and survival, there is support for a psychoneuroimmunological model of disease course in this vulnerable population.
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Affiliation(s)
- Jennifer L. Steel
- University of Pittsburgh, Department of Surgery, Psychiatry, and Psychology
| | | | | | | | | | | | | | - Yisi Wang
- University of Pittsburgh, Department of Surgery
| | - Hui Jing
- University of Pittsburgh, Department of Surgery
| | | | - Robin Burke
- University of Pittsburgh, Department of Surgery
| | - Mya Brady
- University of Pittsburgh, Department of Surgery
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Emotional distress, brain functioning, and biobehavioral processes in cancer patients: a neuroimaging review and future directions. CNS Spectr 2020; 25:79-100. [PMID: 31010446 DOI: 10.1017/s1092852918001621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Despite emerging evidence that distress and adversity can contribute to negative health outcomes in cancer, little is known about the brain networks, regions, or circuits that can contribute to individual differences in affect/distress states and health outcomes in treated cancer patients. To understand the state-of-the-science in this regard, we reviewed neuroimaging studies with cancer patients that examined the associations between negative affect (distress) and changes in the metabolism or structure of brain regions. Cancer patients showed changes in function and/or structure of key brain regions such as the prefrontal cortex, thalamus, amygdala, hippocampus, cingulate cortex (mainly subgenual area), hypothalamus, basal ganglia (striatum and caudate), and insula, which are associated with greater anxiety, depression, posttraumatic stress disorder (PTSD) symptoms, and distress. These results provide insights for understanding the effects of these psychological and emotional factors on peripheral stress-related biobehavioral pathways known to contribute to cancer progression and long-term health outcomes. This line of work provides leads for understanding the brain-mediated mechanisms that may explain the health effects of psychosocial interventions in cancer patients and survivors. A multilevel and integrated model for distress management intervention effects on psychological adaptation, biobehavioral processes, cancer pathogenesis, and clinical outcomes is proposed for future research.
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Maitlis S. Posttraumatic Growth at Work. ANNUAL REVIEW OF ORGANIZATIONAL PSYCHOLOGY AND ORGANIZATIONAL BEHAVIOR 2020. [DOI: 10.1146/annurev-orgpsych-012119-044932] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The phenomenon of posttraumatic growth—the transformative positive change that can occur as a result of a struggle with great adversity—has been a focus of interest for psychologists for more than two decades. Research on work-related posttraumatic growth has concentrated primarily on contexts that are inherently traumatic, either through direct exposure to trauma, such as in the military, or through secondary trauma, such as in professions that provide care for traumatized others. There is also an emerging literature on posttraumatic growth in “ordinary” work. Organized into seven sections, this review draws on the research on posttraumatic growth in response to both personal and work-based adversity to build a model of work-related posttraumatic growth. Later sections raise challenges in the study of posttraumatic growth at work and identify critical future research directions. Practical implications for organizations and their members are considered throughout the review and are summarized at the end.
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Affiliation(s)
- Sally Maitlis
- Saïd Business School, University of Oxford, Oxford OX1 1HP, United Kingdom
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Abstract
OBJECTIVE To determine whether psychological intervention (PI) changes the levels of immune indicators in cancer patients. METHODS We conducted a systematic search published up to July 2018, followed by a manual search. Randomized controlled trials were included. Two reviewers independently screened and extracted data, which were analyzed using Review manager 5.3. RESULTS Twenty-nine studies were included including four kinds of PI. Only stress management didn't result in immune changes; only cognitive behavior therapy affect NK cell activity. PI did not change immune indicators on cancer patients who completed therapy. Compared to patients not receiving PI, those received PI had significantly higher NK cell count and activity in whole blood; and serum levels of IL-2, IL-4, IFN-γ, lgA, and lgG. However, the differences in the serum levels of IL-6, IL-10, TNF-α, and IgM were not significant (P > .05), and the changes recorded for the CD3, CD4, and CD8 cell count, and CD4/CD8 ratios were inconsistent. CONCLUSIONS Although there are considerable evidences of PI's immune effect, but its magnitude was moderate. Therefore, it may be premature to conclude whether PI affects immunity of cancer patients. Further research is warranted, with special focus on the PI types and treatment methods.
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Affiliation(s)
- Ping Zhang
- Children's Hospital of Chongqing Medical University, Chongqing
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei
- China International Science and Technology Cooperation base of China Development and Critical Disorders, Chongqing Key Laboratory of Paediatric
- Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Lin Mo
- Children's Hospital of Chongqing Medical University, Chongqing
| | - Xia Li
- Children's Hospital of Chongqing Medical University, Chongqing
- China International Science and Technology Cooperation base of China Development and Critical Disorders, Chongqing Key Laboratory of Paediatric
- Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Qiyao Wang
- Children's Hospital of Chongqing Medical University, Chongqing
- China International Science and Technology Cooperation base of China Development and Critical Disorders, Chongqing Key Laboratory of Paediatric
- Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
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Schakel L, Veldhuijzen DS, Crompvoets PI, Bosch JA, Cohen S, van Middendorp H, Joosten SA, Ottenhoff THM, Visser LG, Evers AWM. Effectiveness of Stress-Reducing Interventions on the Response to Challenges to the Immune System: A Meta-Analytic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:274-286. [PMID: 31387109 PMCID: PMC6878733 DOI: 10.1159/000501645] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/21/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is consistent evidence showing an interplay between psychological processes and immune function in health and disease processes. OBJECTIVES The present systematic review and meta-analysis aims to provide a concise overview of the effectiveness of stress-reducing psychological interventions on the activation of immune responses in both healthy subjects and patients. METHODS Included are 3 types of challenges: in vivo, in vitro, and psychophysiological. Such challenges are designed to mimic naturally occurring immune-related threats. RESULTS A systematic literature search was conducted using PubMed, EMBASE, and PsychInfo, resulting in 75 eligible studies. The risk of bias was assessed with the Cochrane risk-of-bias tool. Across all studies, a small-to-medium effect size was found for the effects of psychological interventions on optimization of the immune function (g = 0.33; 95% CI 0.22-0.43). While the largest effects were found for in vivo immune-related challenges (g = 0.61; 95% CI 0.34-0.88; especially on studies that incorporated skin tests and wound healing), studies incorporating psychophysiological challenges and in vitro immune-related stimulations similarly suggest more optimal immune responses among those receiving stress-reducing interventions (g = 0.28; 95% CI 0.15-0.42). CONCLUSION These findings showed substantial heterogeneity depending on the type of challenge, the study populations, and the intervention types. These data demonstrate support for the effectiveness of stress-reducing psychological interventions in improving immunity in studies that tested immune function by means of incorporating an in vivo,in vitro, or psychophysiological challenge. Future research should more consistently incorporate challenges into the study design to gather more insights in the mechanisms underlying the optimized immune function following a psychological intervention. This is also relevant for clinical practice, as psychological interventions can possibly supplement, or at least partially replace, current drug treatments in various somatic conditions to reduce side effects.
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Affiliation(s)
- Lemmy Schakel
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands,
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands,
| | - Dieuwke S Veldhuijzen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Paige I Crompvoets
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sheldon Cohen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Simone A Joosten
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Cheng L, Meiser B. The relationship between psychosocial factors and biomarkers in cancer patients: A systematic review of the literature. Eur J Oncol Nurs 2019; 41:88-96. [DOI: 10.1016/j.ejon.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 02/06/2023]
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Hagerty SL, Ellingson JM, Helmuth TB, Bidwell LC, Hutchison KE, Bryan AD. An Overview and Proposed Research Framework for Studying Co-Occurring Mental- and Physical-Health Dysfunction. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 14:633-645. [PMID: 31173535 PMCID: PMC6778441 DOI: 10.1177/1745691619827010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mental- and physical-health conditions co-occur at a rate much higher than chance. Of patients who have a mental-health condition, more than half also have a physical disease, and these cases are associated with increased human suffering and societal cost. Comorbidity research to date has focused on co-occurring mental- and physical-health disorders separately, and relatively little research has examined the co-occurrence of mental- and physical-health dysfunction. In addition, even less is known about why mental- and physical-health dysfunction co-occurs or how to treat these cases. Thus, the aims of this article are to highlight the need for research at the intersection of physical- and mental-health dysfunction and to provide guidance on how to research cases of comorbidity. Toward these ends, we begin by presenting a selective overview of the possible role of biological processes in the co-occurrence of physical- and mental-health dysfunction using specific illustrative examples. Specifically, we outline how biological processes within the immune system and gastrointestinal system could underlie depression, irritable bowel syndrome, and their co-occurrence. We then advance and discuss a proposed research framework, including methodological and analytic guidance, that researchers could use when studying the phenomenon of co-occurring physical- and mental-health dysfunction.
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Affiliation(s)
- Sarah L. Hagerty
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | | | - Timothy B. Helmuth
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | | | - Kent E. Hutchison
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Angela D. Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder
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31
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Antoni MH, Dhabhar FS. The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer 2019; 125:1417-1431. [PMID: 30768779 PMCID: PMC6467795 DOI: 10.1002/cncr.31943] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/22/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
Abstract
The range of psychosocial stress factors/processes (eg, chronic stress, distress states, coping, social adversity) were reviewed as they relate to immune variables in cancer along with studies of psychosocial interventions on these stress processes and immune measures in cancer populations. The review includes molecular, cellular, and clinical research specifically examining the effects of stress processes and stress-management interventions on immune variables (eg, cellular immune function, inflammation), which may or may not be changing directly in response to the cancer or its treatment. Basic psychoneuroimmunologic research on stress processes (using animal or cellular/tumor models) provides leads for investigating biobehavioral processes that may underlie the associations reported to date. The development of theoretically driven and empirically supported stress-management interventions may provide important adjuncts to clinical cancer care going forward.
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Affiliation(s)
- Michael H. Antoni
- Department of Psychology, University of Miami and Sylvester Comprehensive Cancer Center, University of Miami School of Medicine
| | - Firdaus S. Dhabhar
- Department of Psychiatry and Behavioral Sciences, and Sylvester Comprehensive Cancer Center, University of Miami School of Medicine
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32
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Boyle CC, Cole SW, Dutcher JM, Eisenberger NI, Bower JE. Changes in eudaimonic well-being and the conserved transcriptional response to adversity in younger breast cancer survivors. Psychoneuroendocrinology 2019; 103:173-179. [PMID: 30703712 DOI: 10.1016/j.psyneuen.2019.01.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/10/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The conserved transcriptional response to adversity (CTRA), characterized by increased expression of proinflammatory genes and decreased expression of antiviral and antibody-related genes, is upregulated in the context of chronic adversity and distress and has been linked to cancer progression. Several studies suggest that the CTRA may also be down-regulated in association with some positive psychological states, particularly eudaimonic well-being. However, it is not clear if the link between inter-individual differences in the CTRA and eudaimonic well-being can be extended to intra-individual change. Using a standardized mindfulness-based intervention, the current study tested whether mindfulness-related increases in eudaimonic well-being related to intra-individual reduction in the CTRA in a sample of younger breast cancer survivors. METHODS Participants were 22 women who had been diagnosed and treated for early-stage breast cancer at or before age 50 (Mage = 46.6 years) and had no evidence of active disease. Women completed self-report questionnaires and provided peripheral blood samples before and after a 6-week mindfulness meditation intervention. Regression analyses were used to quantify associations between the magnitude of change in eudaimonic well-being and the magnitude of change in the global CTRA score. RESULTS Women reported significant increases in eudaimonic well-being and showed decreased expression of the pro-inflammatory subcomponent of the CTRA from pre- to post-intervention. The magnitude of increase in eudaimonic well-being was associated with the magnitude of decrease in the composite CTRA score, and this relationship was driven primarily by increased expression of the antiviral/antibody-related CTRA subcomponent. While the intervention was also associated with reduced depressive symptoms, there was no association between change in depressive symptoms and change in the overall CTRA composite score or either of its subcomponents. CONCLUSIONS Results are consistent with the hypothesis that eudaimonic well-being may be an important mechanism in interventions aimed at enhancing health in vulnerable groups, and contribute to our understanding of how psychological well-being may influence physical health in cancer patients.
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Affiliation(s)
- Chloe C Boyle
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, United States.
| | - Steve W Cole
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, United States; Department of Psychiatry and Biobehavioral Sciences, UCLA, United States; Division of Hematology-Oncology, Department of Medicine, UCLA School of Medicine
| | - Janine M Dutcher
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Naomi I Eisenberger
- Department of Psychology, University of California, Los Angeles, CA, United States
| | - Julienne E Bower
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, United States; Department of Psychiatry and Biobehavioral Sciences, UCLA, United States; Department of Psychology, University of California, Los Angeles, CA, United States
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33
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Abrahão CA, Bomfim E, Lopes-Júnior LC, Pereira-da-Silva G. Complementary Therapies as a Strategy to Reduce Stress and Stimulate the Immunity of Women With Breast Cancer. J Evid Based Integr Med 2019; 24:2515690X19838897. [PMID: 31023076 PMCID: PMC6487750 DOI: 10.1177/2515690x19838897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The stress associated with cancer development leads to disturbances in the hypothalamic-pituitary-adrenal axis and suppresses important facets of the immune response. The use of complementary therapies in the treatment of women with breast cancer has demonstrated therapeutic benefits that entail improvements in the patients’ quality of life. The objective of this article is to present evidence on the use of complementary therapies as a stress reduction strategy and on its stimulating effects on the immune system of women with breast cancer. This is a reflexive updating article that will support the health professionals’ understanding on the use of complementary therapies in breast cancer care. The use of complementary therapies in the treatment of women with breast cancer has significantly improved these subjects’ stress, depression, fatigue, anxiety, and consequently, their quality of life, as well as their immune response, which is mainly illustrated by the increased number and cytotoxic activity of natural killer cells. Clinicians, health professionals and patients need to be cautious about using complementary therapies and fully understand the real benefits and risks associated with each therapy. Little or no supporting evidence is available to clarify the effects on the immune system of women with breast cancer, and the consequent therapeutic benefits obtained through the use of these practices.
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Affiliation(s)
| | - Emiliana Bomfim
- 2 University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Abrahão CA, Bomfim E, Lopes-Júnior LC, Pereira-da-Silva G. Complementary Therapies as a Strategy to Reduce Stress and Stimulate Immunity of Women With Breast Cancer. J Evid Based Integr Med 2019; 24:2515690X19834169. [PMID: 30917682 PMCID: PMC6440038 DOI: 10.1177/2515690x19834169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The stress associated with cancer development leads to disturbances in the hypothalamic-pituitary-adrenal axis and suppresses important facets of the immune response. The use of complementary therapies in the treatment of women with breast cancer has demonstrated therapeutic benefits that entail improvements in the patients’ quality of life. The objective of this article is to present evidence on the use of complementary therapies as a stress reduction strategy and on its stimulating effects on the immune system of women with breast cancer. This is a reflexive updating article that will support the health professionals’ understanding on the use of complementary therapies in breast cancer care. The use of complementary therapies in the treatment of women with breast cancer has significantly improved these subjects’ stress, depression, fatigue, anxiety, and, consequently, their quality of life, as well as their immune response, which is mainly illustrated by the increased number and cytotoxic activity of natural killer cells. Clinicians, health professionals, and patients need to be cautious about using complementary therapies and fully understand the real benefits and risks associated with each therapy. Little or no supporting evidence is available to clarify the effects on the immune system of women with breast cancer, and the consequent therapeutic benefits obtained through the use of these practices.
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Affiliation(s)
| | - Emiliana Bomfim
- 2 University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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35
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Li X, Ye L, Tian L, Huo Y, Zhou M. Infertility-Related Stress and Life Satisfaction among Chinese Infertile Women: A Moderated Mediation Model of Marital Satisfaction and Resilience. SEX ROLES 2019. [DOI: 10.1007/s11199-019-01032-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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36
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Ochoa Arnedo C, Sánchez N, Sumalla EC, Casellas-Grau A. Stress and Growth in Cancer: Mechanisms and Psychotherapeutic Interventions to Facilitate a Constructive Balance. Front Psychol 2019; 10:177. [PMID: 30778323 PMCID: PMC6369350 DOI: 10.3389/fpsyg.2019.00177] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/18/2019] [Indexed: 12/14/2022] Open
Abstract
Post-traumatic stress and growth are common responses to adverse life events such as cancer. In this article, we establish how cancer becomes a "fertile land" for the emergence of stress and growth responses and analyze the main mechanisms involved. Stress-growth responses on adjusting to cancer is potentially determined by factors like the phase of the illness (e.g., initial phases vs. period of survivorship), patient's coping strategies, meaning-making, and relationships with significant others. We also review the mechanisms of constructive and adaptative stress-growth balances in cancer to study the predictors, interrelated associations, triggering mechanisms, long-term results, and specific trajectories of these two responses to cancer. Finally, we update the evidence on the role of these stress-growth associations in psychologically adjusting to cancer. Together with this evidence, we summarize preliminary results regarding the efficacy of psychotherapeutic interventions that aim to facilitate a constructive psychological balance between stress and growth in cancer patients. Recommendations for future research and gaps in knowledge on stress-growth processes in this illness are also highlighted. Researchers are encouraged to design and use psychotherapeutic interventions according to the dynamic and changeable patients' sources of stress and growth along the illness. Relevant insights are proposed to understand the inconsistency of stress-growth literature and to promote psychotherapeutic interventions to facilitate a constructive balance between these key responses in cancer.
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Affiliation(s)
- Cristian Ochoa Arnedo
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.,Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain
| | | | - Enric C Sumalla
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Casellas-Grau
- Psycho-oncology Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
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Jones DR, Johnson JA, Graham-Engeland JE, Park CL, Smyth JM. Is Perceived Growth Associated with Momentary Indicators of Health and Well-Being in People with Asthma or Rheumatoid Arthritis? Appl Psychol Health Well Being 2018; 10:254-271. [PMID: 29673088 DOI: 10.1111/aphw.12129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Perceived growth (PG) refers to perceptions of positive changes that unfold over time after experiencing trauma. Higher PG is often associated with positive long-term health, but the processes through which PG may influence health are unclear. The present study examines two potential pathways among individuals living with asthma or RA: (1) by promoting momentary indicators of health and well-being in everyday life, and (2) by buffering against stress. METHOD In a micro-longitudinal design, 128 participants with asthma (n = 97) or rheumatoid arthritis (n = 31) reported perceived growth using the Post-Traumatic Growth (PTG) Inventory and subsequently completed ecological momentary assessments (EMAs) for one week. Participants were signaled five times a day to report on health-related indicators, including affect, disease interference, social interactions, and stress. RESULTS Multilevel modeling revealed that higher PTG was associated with significantly less negative affect and greater positive affect in everyday life. There were no significant associations between PTG and momentary disease interference, pleasantness of social interactions, or stress, nor evidence that PTG buffered against effects of stress on health-related outcomes. CONCLUSIONS This research highlights the utility of examining PG in everyday life. Results suggest that closer examination of momentary affect as a process by which PG may facilitate positive health outcomes is warranted.
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Kapogiannis A, Tsoli S, Chrousos G. Investigating the Effects of the Progressive Muscle Relaxation-Guided Imagery Combination on Patients with Cancer Receiving Chemotherapy Treatment: A Systematic Review of Randomized Controlled Trials. Explore (NY) 2018; 14:137-143. [PMID: 29506956 DOI: 10.1016/j.explore.2017.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 09/27/2017] [Accepted: 10/23/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous systematic reviews indicate that progressive muscle relaxation (PMR) and guided imagery (GI) are both effective interventions to decrease the psychological impact and to alleviate the adverse events in cancer patients undergoing chemotherapy treatment. To date, no review studies have investigated the effectiveness of a combination of PMR and GI. AIM To systematically review the current state of knowledge regarding the effects of the PMR-GI combination on cancer patients receiving chemotherapy. METHODS A search for relevant records was carried out in four electronic databases (AMED, Cochrane Library, Pubmed and Scopus). After removing the duplicates 342 publications were screened and 71 were considered as potentially relevant. The flow of information of this study was in line with the PRISMA statement. Original articles investigating the application of both PMR and GI through a randomized trial on patients receiving chemotherapy were included. Those using PMR or GI alone and those combining other techniques together with PMR and GI were excluded. The trials' quality was assessed using the Jadad Scale. RESULTS Eight papers reporting the results of seven independent trials were finally included. All of them included only breast cancer patients, apart from a single trial using a mixed sample of breast and prostate cancer patients. Seven of the included trials reported beneficial effects on mental state (mood, anxiety, and depression) and on toxicity (nausea and vomiting). Three trials reported an effect on biomarkers (heart rate, blood pressure, cortisol, and immunity). Four trials scored three of five points on the Jadad Scale, two trials scored two points and a single trial scored zero. CONCLUSIONS Independent trials indicate that the PMR-GI combination is an effective way to tackle the impact of nausea and vomiting and to improve patients' mental state. However, studies involving other types of primary tumors would be useful because seven of the eight clinical trials only included breast cancer patients. Future research on the identification of potential effects on disease-related parameters (e.g., cytokines and disease-recurrence) and on patient survival is highly needed.
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Affiliation(s)
- August Kapogiannis
- Postgraduate Course Science of Stress and Health Promotion, School of Medicine, University of Athens, Soranou Ephession 4, GR 115-27 Athens, Greece
| | - Sofia Tsoli
- Postgraduate Course Science of Stress and Health Promotion, School of Medicine, University of Athens, Soranou Ephession 4, GR 115-27 Athens, Greece.
| | - George Chrousos
- Postgraduate Course Science of Stress and Health Promotion, School of Medicine, University of Athens, Soranou Ephession 4, GR 115-27 Athens, Greece
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Wang AW, Hoyt MA. Benefit finding and diurnal cortisol after prostate cancer: The mediating role of positive affect. Psychooncology 2018; 27:1200-1205. [PMID: 29351368 DOI: 10.1002/pon.4647] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Benefit finding (BF) has exhibited a salutary effect on psychological adjustment to cancer. However, few studies have examined its relationship with physiology or have examined BF in men with cancer. This study investigated whether BF is associated with hypothalamic-pituitary-adrenal axis activity (ie, diurnal salivary cortisol) in men treated for prostate cancer. Positive affect (PA) is proposed as a potential pathway linking BF to diurnal salivary cortisol. METHODS A sample of 66 men treated for localized prostate cancer within the prior 2 years completed questionnaires and collected salivary cortisol 3 times per day over 3 consecutive days. Hierarchical linear modeling was used for estimating the effects of BF and PA on cortisol responses as measured by diurnal slope and area under the curve (AUCg). Confidence intervals for indirect effects were estimated using the Monte Carlo method for mediation testing. RESULTS BF was significantly associated with diurnal cortisol slope, controlling for body mass index and age (B = -.12, P = .03), such that greater BF was associated with steeper cortisol slope. Analyses revealed that PA mediated the effect of BF on cortisol slope (Monte Carlo estimation 95% CI = -0.087, -0.001); negative affect did not mediate this relationship. BF was not significantly associated with AUCg. CONCLUSIONS Deriving more benefit from one's experience with prostate cancer is associated with a healthier diurnal cortisol rhythm. Through its potential to enhance PA, the relationship of BF and physiological processes underscores the health relevant value of BF in prostate cancer survivors.
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Affiliation(s)
- Ashley W Wang
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Michael A Hoyt
- Department of Psychology, Graduate Center, City University of New York, New York, NY, USA
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Zhu L, Ranchor AV, Helgeson VS, van der Lee M, Garssen B, Stewart RE, Sanderman R, Schroevers MJ. Benefit finding trajectories in cancer patients receiving psychological care: Predictors and relations to depressive and anxiety symptoms. Br J Health Psychol 2017; 23:238-252. [DOI: 10.1111/bjhp.12283] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/05/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Lei Zhu
- Department of Health Psychology; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
- School of Psychology; Shaanxi Normal University; Xi'an China
| | - Adelita V. Ranchor
- Department of Health Psychology; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
| | - Vicki S. Helgeson
- Department of Psychology; Carnegie Mellon University; Pittsburgh Pennsylvania USA
| | - Marije van der Lee
- Centre for Psycho-Oncology; Helen Dowling Institute; Bilthoven the Netherlands
| | - Bert Garssen
- Centre for Psycho-Oncology; Helen Dowling Institute; Bilthoven the Netherlands
| | - Roy E. Stewart
- Department of Public Health; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
| | - Robbert Sanderman
- Department of Health Psychology; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
- Department of Psychology Health & Technology; University of Twente; Enschede the Netherlands
| | - Maya J. Schroevers
- Department of Health Psychology; University of Groningen; University Medical Center Groningen; Groningen the Netherlands
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Fisher HM, Jacobs J, Taub CJ, Lechner S, Lewis JE, Carver CS, Blomberg BB, Antoni MH. How changes in physical activity relate to fatigue interference, mood, and quality of life during treatment for non-metastatic breast cancer. Gen Hosp Psychiatry 2017; 49:37-43. [PMID: 28583700 PMCID: PMC5681387 DOI: 10.1016/j.genhosppsych.2017.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/15/2017] [Accepted: 05/27/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Physical activity (PA) following surgery for breast cancer may improve depressive symptoms and quality of life (QoL) via reduction in fatigue-related daily interference (FRDI). Less is known about how change in PA may relate to these psychosocial factors throughout the course of treatment. In a secondary analysis of a previous psychosocial intervention trial, we examined relationships between change in PA, depressive symptoms, and functional QoL, as mediated by change in FRDI, and whether naturally occurring change in PA provided benefit independent of the intervention. METHOD Women (N=240) with non-metastatic stage 0-III breast cancer were randomized to cognitive-behavioral stress management (CBSM) or a control 2-10weeks post-surgery. PA, FRDI, clinician-rated depressive symptoms, self-reported depressed mood, and functional QoL were assessed at baseline and three months post-intervention. RESULTS Increased PA was associated with reductions in clinician-rated depressive symptoms, depressed mood, and improved QoL, mediated by a reduction in FRDI. This was above and beyond the effect of CBSM. CONCLUSIONS Increased PA may mitigate FRDI and improve depressive symptoms and functional QoL for women undergoing breast cancer treatment, beyond effects of a psychosocial intervention. Benefits of an integrated PA and psychosocial approach should be investigated further.
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Affiliation(s)
- Hannah M. Fisher
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, United States
| | - Jamie Jacobs
- Massachusetts General Hospital, Center for Psychiatric Oncology and Behavioral Sciences, Boston, MA, 02114, United States,Harvard Medical School, Boston, MA, 02115, United States
| | - Chloe J. Taub
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, United States
| | - Suzanne Lechner
- Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, United States,Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
| | - John E. Lewis
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
| | - Charles S. Carver
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, United States,Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
| | - Bonnie B. Blomberg
- Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, United States,Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
| | - Michael H. Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, United States,Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, 33136, United States,Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, United States
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Ramos C, Costa PA, Rudnicki T, Marôco AL, Leal I, Guimarães R, Fougo JL, Tedeschi RG. The effectiveness of a group intervention to facilitate posttraumatic growth among women with breast cancer. Psychooncology 2017; 27:258-264. [DOI: 10.1002/pon.4501] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/06/2017] [Accepted: 07/13/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Catarina Ramos
- WJCR-William James Center for Research; ISPA-University Institute; Lisbon Portugal
| | | | - Tânia Rudnicki
- Capes Foundation Ministry of Education of Brazil-Brasília/DF-Brazil; Faculdade da Serra Gaúcha-FSG-Caxias do Sul/RS; Brazil
| | | | - Isabel Leal
- WJCR-William James Center for Research; ISPA-University Institute; Lisbon Portugal
| | | | - José Luís Fougo
- Centro de Mama; Centro Hospitalar de São João; Oporto Portugal
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Simoneau TL, Kilbourn K, Spradley J, Laudenslager ML. An evidence-based stress management intervention for allogeneic hematopoietic stem cell transplant caregivers: development, feasibility and acceptability. Support Care Cancer 2017; 25:2515-2523. [PMID: 28283805 DOI: 10.1007/s00520-017-3660-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/06/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Caregivers of cancer patients face challenges impacting their physical, psychological and social well-being that need attention in the form of well-designed and tested interventions. We created an eight-session individual stress management intervention for caregivers of allogeneic hematopoietic stem cell transplant (Allo-HSCT) recipients. This intervention, tested by randomized control trial, proved effective in decreasing distress. Herein, we describe the intervention including theoretical framework, development, and elements of fidelity. Implementation challenges along with recommendations for refinement in future studies are discussed with the goal of replication and dissemination. METHODS Seventy-four of 148 caregivers received stress management training following randomization. The intervention occurred during the 100-day post-transplant period when caregivers are required. The training provided integrated cognitive behavioral strategies, psychoeducation, and problem-solving skills building as well as use of a biofeedback device. RESULTS Seventy percent of caregivers completed all eight sessions indicating good acceptability for the in-person intervention; however, most caregivers did not reliably use the biofeedback device. The most common reason for drop-out was their patient becoming gravely ill or patient death. Few caregivers dropped out because of study demands. The need for flexibility in providing intervention sessions was key to retention. CONCLUSION Our evidence-based stress management intervention for Allo-HSCT caregivers was feasible. Variability in acceptability and challenges in implementation are discussed and suggestions for refinement of the intervention are outlined. Dissemination efforts could improve by using alternative methods for providing caregiver support such as telephone or video chat to accommodate caregivers who are unable to attend in-person sessions.
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Affiliation(s)
- Teresa L Simoneau
- VA Eastern Colorado Healthcare System, 1020 Johnson Rd., Golden, CO, 80401, USA.
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Janet Spradley
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark L Laudenslager
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Watanabe H. The Mediating Effects of Benefit Finding on the Relationship Between the Identity Centrality of Negative Stressful Events and Identity Achievement. IDENTITY 2017. [DOI: 10.1080/15283488.2016.1268536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hitomi Watanabe
- Department of Psychology, Doshisha University, Kyotanabe, Japan
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Lutgendorf SK, Andersen BL. Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. ACTA ACUST UNITED AC 2016; 70:186-97. [PMID: 25730724 DOI: 10.1037/a0035730] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the last decade, there have been groundbreaking strides in our understanding of the multiple biological pathways by which psychosocial and behavioral factors can affect cancer progression. It is now clear that biobehavioral factors not only affect cellular immunity but both directly and indirectly modulate fundamental processes in cancer growth, including inflammation, angiogenesis, invasion, and metastasis. There is also an emerging understanding of how psychological and behavioral factors used in interventions can impact these physiological processes. This review outlines our current understanding of the physiological mechanisms by which psychological, social, and behavioral processes can affect cancer progression. The intervention literature is discussed, along with recommendations for future research to move the field of biobehavioral oncology forward.
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Zhang JW, Chen S. Self-Compassion Promotes Personal Improvement From Regret Experiences via Acceptance. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2016; 42:244-58. [PMID: 26791595 DOI: 10.1177/0146167215623271] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Why do some people report more personal improvement from their regret experiences than others? Three studies examined whether self-compassion promotes personal improvement derived from recalled regret experiences. In Study 1, we coded anonymous regret descriptions posted on a blog website. People who spontaneously described their regret with greater self-compassion were also judged as having expressed more personal improvement. In Study 2, higher trait self-compassion predicted greater self-reported and observer-rated personal improvement derived from recalled regret experiences. In Study 3, people induced to take a self-compassionate perspective toward a recalled regret experience reported greater acceptance, forgiveness, and personal improvement. A multiple mediation analysis comparing acceptance and forgiveness showed self-compassion led to greater personal improvement, in part, through heightened acceptance. Furthermore, self-compassion's effects on personal improvement were distinct from self-esteem and were not explained by adaptive emotional responses. Overall, the results suggest that self-compassion spurs positive adjustment in the face of regrets.
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The Role of Stress Management in the Relationship between Purpose in Life and Self-Rated Health in Teachers: A Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070719. [PMID: 27438843 PMCID: PMC4962260 DOI: 10.3390/ijerph13070719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/29/2016] [Accepted: 07/12/2016] [Indexed: 11/30/2022]
Abstract
Background: To examine whether stress management mediates the relationship between purpose in life and self-rated health status (SRH). Methods: A cross-sectional survey was conducted among 6840 teachers in 2013 in Guangzhou, China. Purpose in life was assessed through the Purpose in Life Subscale of the Psychological Well-being Scale. Stress management was assessed using the eight-item questionnaire adapted from the Health-promoting Lifestyle Profile II. SRH was assessed by the Suboptimal Health Measurement Scale Version 1.0. The mediation hypothesis was tested by the structural equation model for path analysis. Results: It was found that purpose in life had direct and indirect effects on SRH. The path analysis showed the total effect (β = 0.563) of purpose in life on SRH was comprised of a direct effect (β = 0.319) and an indirect effect (β = 0.244), which was mediated by stress management. Conclusions: By supporting the mediation hypothesis, our results indicate that stress management mediated the effect of purpose in life on SRH. Enhancement of teachers’ purpose in life and improvement of training skills of stress management should be incorporated in the strategy of improving teachers’ health.
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Andersen BL, Goyal NG, Westbrook TD, Bishop B, Carson WE. Trajectories of Stress, Depressive Symptoms, and Immunity in Cancer Survivors: Diagnosis to 5 Years. Clin Cancer Res 2016; 23:52-61. [PMID: 27407091 DOI: 10.1158/1078-0432.ccr-16-0574] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/06/2016] [Accepted: 07/03/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Five-year disease endpoint trajectories are available for every cancer site. In contrast, there are few longitudinal, biobehavioral studies of survivors extending beyond the first or second year following diagnosis. This gap is addressed with stress, depressive symptom, and immunity data from breast cancer patients followed continuously for 5 years. EXPERIMENTAL DESIGN Women (N = 113) diagnosed and surgically treated for breast cancer and awaiting adjuvant therapy completed self-report measures of stress and depressive symptoms and provided blood for immune assays [natural killer cell cytotoxicity (NKCC) and T-cell blastogenesis]. Assessments (N = 12) were repeated every 4 to 6 months for 5 years. RESULTS Multiphase linear mixed models show phases of change and identified specific time points of change. Cancer stress shows two distinct phases of decline, with the change point being 12 months. In contrast, a steep decline in depressive symptoms occurs by 7 months, with stable, low levels thereafter. NKCC shows a steady upward trajectory through 18 months and upper limit stability thereafter, whereas there was no reliable trajectory for T-cell blastogenesis. CONCLUSIONS For the first time, trajectories and specific time points of change in biobehavioral data for breast cancer survivors are provided, traced through 5 years. Following diagnosis, the breast survivor experience is one of a co-occurrence of change (recovery) in psychologic and innate immunity markers from diagnosis to18 months, and a pattern of stability (depression, NKCC) or continued improvement (stress) through year 5. These data provide new directions for survivorship care and detail of the biobehavioral trajectory. Clin Cancer Res; 23(1); 52-61. ©2016 AACR.
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Antoni MH, Lutgendorf S. Psychosocial Factors and Disease Progression in Cancer. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2016. [DOI: 10.1111/j.1467-8721.2007.00472.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Psychosocial factors such as stress, personality, and social support relate to differences in disease progression in cancer patients. Neuroendocrine substances associated with psychosocial factors may regulate immune responses to cancer, as well as regulate the activity of oncogenic (cancer-causing) viruses, DNA-repair processes, and the expression in tumor cells of genes that may affect the tumor's growth and metastasis. Biobehavioral oncology research seeks to understand how these psychosocial factors, and interventions designed to modify them, become neurohormonal changes that alter cell signaling and tumor growth, viral oncogenesis, and immune responses. We review the empirical basis for psychosocial factors and biobehavioral processes in cancer progression and suggest future research.
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Affiliation(s)
- Michael H. Antoni
- Departments of Psychology and Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center, University of Miami
| | - Susan Lutgendorf
- Departments of Psychology and Obstetrics and Gynecology and The Holden Comprehensive Cancer Center, University of Iowa
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Ramos C, Leal I, Tedeschi RG. Protocol for the psychotherapeutic group intervention for facilitating posttraumatic growth in nonmetastatic breast cancer patients. BMC Womens Health 2016; 16:22. [PMID: 27142443 PMCID: PMC4855893 DOI: 10.1186/s12905-016-0302-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 04/26/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Breast cancer can be perceived as a traumatic event with disturbing effects on psychological domains such as depression, anxiety, and Posttraumatic Stress Disorder. In contrast, growing evidence has shown that posttraumatic growth can occur as a result of coping with breast cancer. Challenging the assumptive world, deliberate rumination, and emotional disclosure are recognized as strong predictors of posttraumatic growth. Group interventions may also increase social support, distress disclosure, and posttraumatic growth. The aim of this study is to evaluate how group-based interventions can facilitate posttraumatic growth and promote improved psychosocial adjustment to breast cancer. This article describes the study protocol and the applied research methods. METHODS To measure the impact of a group-based intervention on posttraumatic growth, a multi-center randomized control trial was developed for Portuguese breast cancer patients. 205 women with nonmetastatic breast cancer (stages 1 to 3) were recruited for the study and were randomly assigned either to the experimental group, which participated in an 8-session group intervention, or to the control group. Psychosocial variables, which consisted of posttraumatic growth, illness perception, stressfulness of the event, Posttraumatic Stress Disorder, core beliefs, rumination, social support, and distress disclosure were measured at three time points. The designated points in time for the assessments were baseline, 6 months post-intervention, and follow-up (12 months after baseline). DISCUSSION This study is the first trial to assess the efficacy of a group-based intervention designed to facilitate posttraumatic growth following a breast cancer diagnosis. If proven to be effective, group-based intervention could be recommended as a complementary program to be included in hospital health-care and clinical practice. TRIAL REGISTRATION The trial was registered on 28/10/2013 at the Current Controlled Trials ( ISRCTN02221709 ).
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Affiliation(s)
- Catarina Ramos
- WJCR-William James Center for Research, ISPA - University Institute, Rua Jardim do Tabaco, 34, 1149-041, Lisbon, Portugal.
| | - Isabel Leal
- WJCR-William James Center for Research, ISPA - University Institute, Rua Jardim do Tabaco, 34, 1149-041, Lisbon, Portugal
| | - Richard G Tedeschi
- Department of Psychology, University of North Carolina, Charlotte, NC, USA
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