Effects of psychological interventions on systemic levels of inflammatory biomarkers in humans: A systematic review and meta-analysis

The purpose of the present investigation was to systematically review randomized controlled trials examining the effects of psychological interventions on inflammatory biomarkers in adult populations and to quantitatively analyze those effects by meta-analysis. Two researchers independently searched key electronic databases, selected eligible publications, extracted data, and evaluated methodological quality. Nineteen randomized controlled trials examining a total of 1510 participants were included. The overall combined effect size from pre to post psychological intervention on pro-inflammatory biomarker levels was statistically significant, showing an attenuating effect, although of a small magnitude (s' g = 0.15, p = .008, CI [0.04-0.26]). However, this effect was not maintained into the follow-up period (g < -0.01, p = .964, CI [-0.19-0.18]). Looking at the individual biomarkers assessed across studies, only C-reactive protein (CRP) was found to significantly decrease following psychological intervention. A number of moderation analyses were conducted, none of which reached statistical significance. However, the numerically largest - and significant - within-group effect size was obtained for the group of studies that had preselected participants based on elevated psychological distress (g = 0.29, p = .047). In conclusion, psychological interventions appear efficacious in reducing pro-inflammatory biomarker levels. Future studies are recommended to carefully select individuals based on inflammatory (e.g., the presence of low-grade inflammation) and/or psychological (e.g., psychological distress) criteria.

Auricular Point Acupressure to Manage Aromatase Inhibitor-Induced Arthralgia in Postmenopausal Breast Cancer Survivors: A Pilot Study

PURPOSE/OBJECTIVES

To assess the feasibility of auricular point acupressure to manage aromatase inhibitor-induced arthralgia.
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DESIGN

Wait list control design.
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SETTING

Outpatient clinics and oncology center.
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SAMPLE

20 women with aromatase inhibitor-induced arthralgia.
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METHODS

After baseline data were collected, participants waited one month before they received acupressure once per week for four weeks at a convenient time. The baseline data served as the control comparison. Self-reported measures and blood samples were obtained at baseline, at preintervention, weekly during the intervention, and at post-intervention.
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MAIN RESEARCH VARIABLES

The primary outcomes included pain intensity, pain interference, stiffness, and physical function. Inflammatory cytokines and chemokines were tested.
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FINDINGS

After the four-week intervention, participants reported decreases in worst pain and pain interference, and improvements in physical function, cancer-related symptom severity, and interference. The proinflammatory cytokines and chemokines displayed a trend of a mean percentage reduction. The anti-inflammatory cytokine interleukin-13 increased from pre- to postintervention.
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CONCLUSIONS

Auricular point acupressure is feasible and may be effective in managing arthralgia in breast cancer survivors.
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IMPLICATIONS FOR NURSING

Nurses can administer acupressure in clinical settings, which could enhance the management of aromatase inhibitor-induced arthralgia and contribute to a shift from traditional disease-based biomedical models to a broader, integrative, medical paradigm for managing aromatase inhibitor-induced arthralgia.

Pilot Randomized Controlled Trial of Auricular Point Acupressure to Manage Symptom Clusters of Pain, Fatigue, and Disturbed Sleep in Breast Cancer Patients

BACKGROUND

Current management for a symptom cluster of pain, fatigue, and disturbed sleep in breast cancer patients has limited effects.

OBJECTIVE

The purposes of this prospective, randomized controlled pilot study were to (1) assess the feasibility and tolerability of auricular point acupressure (APA) intervention to manage pain, fatigue, and sleep disturbance in breast cancer patients and (2) provide an initial appraisal of effect size as compared with a control intervention.

METHODS

Thirty-one participants were randomized into either an active APA group (n = 16) or a control APA group (n = 15), which included the sham APA treatment not related to the symptoms. All participants received the APA once a week for 4 weeks. Self-report measures were obtained at baseline, weekly during intervention, at end of intervention, and at a 1-month follow-up.

RESULTS

For the 4-week of APA treatment, the retention rate was 88% for the active APA group and 73% for the control APA group. After 4 weeks of APA, participants in the active APA treatment had reported a reduction of 71% in pain, 44% in fatigue, 31% in sleep disturbance, and 61% in interference with daily activities. The control APA group experienced some moderate reduction in these symptoms.

CONCLUSION

Given that this was a pilot study with a small sample size, results must be interpreted with caution.

IMPLICATIONS FOR PRACTICE

Our results suggest that APA may provide an inexpensive and effective complementary approach for the management of symptom clusters for breast cancer patients, and further study is warranted.

Abstract PD4-04: Psychosocial factors related to interruptions in adjuvant hormonal therapy among women with breast cancer: The breast cancer quality of care study (BQUAL)

Background. Adjuvant hormonal therapy (HT) for hormone-sensitive breast cancer decreases risk of breast cancer recurrence and improves survival. However, some women are non-adherent to this life-saving treatment.

Methods. In a cohort of women recruited at diagnosis of breast cancer in an integrated healthcare system, we investigated factors related to HT interruption (≥90 day gap). Serial interviews were conducted at baseline and during treatment to examine psychological factors as well as sociodemographic factors, tumor characteristics, and treatment factors. A series of multivariate models assessed potential predictors of HT interruptions.

Results. Of the 569 women in our cohort who initiated HT, 137 (24%) interrupted it, including 18 (3%) who did so prior to the first follow-up interview. In a multivariate analysis of clinical and demographic factors, only household income remained associated with HT interruption (OR 0.42, 95%CI 0.24-0.76). At first follow-up, after controlling for income, race and age, lower scores on all quality of life subscales, lower scores on global treatment satisfaction, and poorer scores on the intrusive and avoidant thought subscales of the Impact of Events scale were associated with higher odds of HT interruptions (P&lt;0.001 for all predictors). Scores on social support and on interpersonal processes of care measures were not associated with HT interruptions. However, a higher score on the single question "How often did your doctor speak too fast?" was associated with higher risk of HT interruptions (OR 1.32, p=0.02).

Conclusions: Patients under greater duress and those with lower physical, functional, emotional or social quality of life appeared to be at the highest risk of HT interruption and thus received poorer quality care. A better understanding of psychological factors that can result in poor quality care may pave the way to targeted interventions to improve adherence.

Citation Format: Hershman DL, Kushi LH, Hillyer GC, Coromilis E, Buono D, Lamerato LE, Bovbjerg DH, Mandelblatt8 JS, Tsai W-Y, Jacobson JS, Wright JD, Neugut AI. Psychosocial factors related to interruptions in adjuvant hormonal therapy among women with breast cancer: The breast cancer quality of care study (BQUAL). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-04.

Assessment of hot flushes and vaginal dryness among obese women undergoing bariatric surgery

OBJECTIVE

Menopausal symptoms are associated with a negative impact on the quality of life, leading women to seek medical treatment. Obesity has been linked to higher levels of menopausal symptoms such as hot flushes. This assessment will explore whether the prevalence and bother of hot flushes and vaginal dryness change from pre- to post-bariatric surgery among obese midlife women.

METHODS

This study is a longitudinal analysis of data from 69 women (ages 35-72 years) undergoing bariatric surgery with reported reproductive histories and menopausal symptoms at preoperative and 6-month postoperative visits. Prevalence of and degree of bother of hot flushes and vaginal dryness at pre- and post-surgery were compared using McNemar's test and Wilcoxon signed-rank test.

RESULTS

The reported degree of bother of symptoms associated with hot flushes decreased from pre- to post-surgery (p < 0.01). There was no significant change in the prevalence of hot flushes or vaginal dryness in the overall study sample.

CONCLUSIONS

The degree of bother of symptoms associated with hot flushes among midlife women may decrease after bariatric surgery. These results highlight important secondary gains, including less bothersome menopausal symptoms, for women who choose bariatric surgery for weight loss.

Associations between estrogen receptor-negative breast cancer and timing of reproductive events differ between African American and European American women

The effects of reproductive factors on breast cancer risk seem to differ by estrogen receptor (ER) status. Menarche and first live birth (FLB) tend to occur at younger ages in African Americans (AA) than European Americans (EA), and could play a role in breast cancer disparities. In the Women's Circle of Health Study, a case-control study of breast cancer in EA and AA women, in-person interviews were conducted to collect epidemiologic data, including reproductive histories. Data on ER status, abstracted from pathology reports, were available for 814 AA and 538 EA breast cancer cases, and were analyzed with 1015 AA and 715 EA controls, to evaluate associations between subgroups and age at menarche, age at FLB, and the interval between those ages. Among AA women, later age at menarche (≥14 years) was associated with reduced risk of both ER(+) and ER(-) breast cancer, with ORs strongest for ER(-) disease [OR = 0.57; 95% confidence interval (CI), 0.37-0.88]; associations were weaker and nonsignificant for EA women. There were no significant associations with age at FLB, but AA women with a FLB within 15 years of menarche had increased risk of ER(-) disease (OR = 2.26; 95% CI, 1.29-3.95), with no significant associations among EAs. In our data, earlier age at menarche and shorter intervals until FLB are associated with ER(-) breast cancer in AA women; differential distributions by race of these and other reproductive risk factors could contribute to the higher prevalence of ER(-) breast cancer in AA women. Cancer Epidemiol Biomarkers Prev; 23(6); 1115-20. ©2014 AACR.

Ethnic, racial and cultural identity and perceived benefits and barriers related to genetic testing for breast cancer among at-risk women of African descent in New York City

BACKGROUND

Due to disparities in the use of genetic services, there has been growing interest in examining beliefs and attitudes related to genetic testing for breast and/or ovarian cancer risk among women of African descent. However, to date, few studies have addressed critical cultural variations among this minority group and their influence on such beliefs and attitudes.

METHODS

We assessed ethnic, racial and cultural identity and examined their relationships with perceived benefits and barriers related to genetic testing for cancer risk in a sample of 160 women of African descent (49% self-identified African American, 39% Black-West Indian/Caribbean, 12% Black-Other) who met genetic risk criteria and were participating in a larger longitudinal study including the opportunity for free genetic counseling and testing in New York City. All participants completed the following previously validated measures: (a) the multi-group ethnic identity measure (including ethnic search and affirmation subscales) and other-group orientation for ethnic identity, (b) centrality to assess racial identity, and (c) Africentrism to measure cultural identity. Perceived benefits and barriers related to genetic testing included: (1) pros/advantages (including family-related pros), (2) cons/disadvantages (including family-related cons, stigma and confidentiality concerns), and (3) concerns about abuses of genetic testing.

RESULTS

In multivariate analyses, several ethnic identity elements showed significant, largely positive relationships to perceived benefits about genetic testing for breast and/or ovarian cancer risk, the exception being ethnic search, which was positively associated with cons/disadvantages, in general, and family-related cons/disadvantages. Racial identity (centrality) showed a significant association with confidentiality concerns. Cultural identity (Africentrism) was not related to perceived benefits and/or barriers.

CONCLUSIONS

Ethnic and racial identity may influence perceived benefits and barriers related to genetic testing for breast and/or ovarian cancer risk among at-risk women of African descent. Genetic counseling services may want to take into account these factors in the creation of culturally-appropriate services which best meet the needs of this heterogenous population.

Emotional expressivity and intrusive cognitions in women with family histories of breast cancer: Application of a cognitive processing model

OBJECTIVES

Women with family histories of breast cancer exhibit significant distress and intrusive cognitions about cancer. The role of intrusive cognitions in adjustment to chronic stressors is unclear. While they may be a source of distress in themselves, they may also be part of a cognitive processing strategy that aids in the adaptation process, particularly if they are accompanied by more deliberate processing such as emotional expression. Applying cognitive processing models of stress, the present study examined the role of dispositional emotional expressivity in intrusive cognitions about breast cancer and distress in women dealing with the stressful experience of having a family history of breast cancer. Two competing hypotheses were tested: (1) emotional expressivity is associated with reduced intrusive cognitions and thus lower distress; (2) emotional expressivity buffers the relations between intrusive cognitions and distress.

DESIGN

Using a cross-sectional design, hypotheses were addressed with multiple regression analyses according to established methods.

METHOD

Healthy women (N = 104) who had one or more first-degree relatives with breast cancer were recruited from cancer screening programs. They completed questionnaires regarding family history of cancer, emotional expressivity, distress, and intrusive cognitions.

RESULTS

Emotional expressivity was not associated with reduced intrusive cognitions (Hypothesis 1) but moderated the relations between intrusive cognitions and distress (Hypothesis 2).

CONCLUSIONS

The data further our understanding of cognitive processing theories of stress and underline the importance of including emotional expression in interventions, helping women to process the stressful experiences associated with having family histories of breast cancer.

An admixture scan in 1,484 African American women with breast cancer

African American women with breast cancer present more commonly with aggressive tumors that do not express the estrogen receptor (ER) and progesterone receptor (PR) compared with European American women. Whether this disparity is the result of inherited factors has not been established. We did an admixture-based genome-wide scan to search for risk alleles for breast cancer that are highly differentiated in frequency between African American and European American women, and may contribute to specific breast cancer phenotypes, such as ER-negative (ER-) disease. African American women with invasive breast cancer (n = 1,484) were pooled from six population-based studies and typed at approximately 1,500 ancestry-informative markers. We investigated global genetic ancestry and did a whole genome admixture scan searching for breast cancer-predisposing loci in association with disease phenotypes. We found a significant difference in ancestry between ER+PR+ and ER-PR- women, with higher European ancestry among ER+PR+ individuals, after controlling for possible confounders (odds ratios for a 0 to 1 change in European ancestry proportion, 2.84; 95% confidence interval, 1.13-7.14; P = 0.026). Women with localized tumors had higher European ancestry than women with non-localized tumors (odds ratios, 2.65; 95% confidence interval, 1.11-6.35; P = 0.029). No genome-wide statistically significant associations were observed between European or African ancestry at any specific locus and breast cancer, or in analyses stratified by ER/PR status, stage, or grade. In summary, in African American women, genetic ancestry is associated with ER/PR status and disease stage. However, we found little evidence that genetic ancestry at any one region contributes significantly to breast cancer risk or hormone receptor status.

Psychological stress and antibody response to influenza vaccination: a meta-analysis

Vaccination is an important public health strategy for reducing the risk of influenza at the societal level. However, at the individual level, not everyone is protected by vaccination, and increases in antibody titers may fail to reach protective levels. Several recent studies suggest that psychological stress may contribute to these individual differences. Exploring this hypothesis, we conducted a meta-analysis of 13 studies examining the influence of psychological stress on antibody responses following influenza vaccination. The studies were identified through systematic searches in MEDLINE and PsychINFO and included a total of 1158 men and women. In five studies, the increased antibody levels of caregivers following vaccination were compared to those of non-caregivers. The remaining studies focused on associations between self-reported stressful life events or perceived stress and increased antibody titers following vaccination. The meta-analysis revealed a significant negative association between psychological stress and antibody responses to influenza vaccination. While effect sizes were similar across different indicators of stress, antibody responses to the A/H1N1 and B-influenza types appeared to be more sensitive to stress than the A/H3N2 type. It was investigated whether the association between stress and antibody response differed between young and elderly, and the results revealed significant negative associations between stress and peak antibody titers in both age groups. These findings suggest the importance of additional research to explore responsible mechanisms and possible contributions of stress to the public health problem of inadequate responses to vaccination.

Effects of dopamine D2 receptor (DRD2) and transporter (SLC6A3) polymorphisms on smoking cue-induced cigarette craving among African-American smokers

Cue-induced craving for addictive substances has long been known to contribute to the problem of persistent addiction in humans. Research in animals over the past decade has solidly established the central role of dopamine in cue-induced craving for addictive substances, including nicotine. Analogous studies in humans, however, are lacking, especially among African-American smokers, who have lower quit rates than Caucasian smokers. Based on the animal literature, the study's objective was to test the hypothesis that smokers carrying specific variants in dopamine-related genes previously associated with risk for addictive behaviors would exhibit heightened levels of cigarette craving following laboratory exposure to cues. To this end, cigarette craving was induced in healthy African-American smokers (n=88) through laboratory exposure to smoking cues. Smokers carrying either the DRD2 (D2 dopamine receptor gene) TaqI A1 RFLP or the SLC6A3 (dopamine transporter gene) 9-repeat VNTR polymorphisms had stronger cue-induced cravings than noncarriers (Ps <0.05 and 0.01, respectively). Consistent with the separate biological pathways involved (receptor, transporter), carriers of both polymorphisms had markedly higher craving responses compared to those with neither (P<0.0006), reflecting additive effects. Findings provide support for the role of dopamine in cue-induced craving in humans, and suggest a possible genetic risk factor for persistent smoking behavior in African-American smokers.

Stress-induced cigarette craving: effects of the DRD2 TaqI RFLP and SLC6A3 VNTR polymorphisms

Animal models have long implicated dopamine in stress-induced craving for a variety of addictive substances. However, translational studies of dopamine, stress and craving in humans are lacking. Based on the animal literature, this study's objective was to test the hypothesis that cigarette smokers carrying specific variants in dopamine-related genes would have heightened levels of cigarette craving following exposure to a laboratory stressor. Cigarette craving induced by controlled exposure to a laboratory stressor was assessed in healthy adult smokers (n=108) recruited by advertisement. Significantly stronger stress-induced cigarette craving was found for individuals carrying either the DRD2 (D2 dopamine receptor gene) A1, or the SLC6A3 (dopamine transporter gene) nine-repeat allelic variants. Stress-induced craving was markedly higher for those carrying both alleles, compared to those with neither, consistent with the separate biological pathways involved (receptor, transporter). Findings provide strong support for the possibility that dopamine involvement in stress-induced craving well established in animal models also applies to humans, and suggest a potential genetic risk factor for persistent smoking behavior.

Stronger endocrine responses after brief psychological stress in women at familial risk of breast cancer

Recent research has linked exposure to chronic stress to altered acute stress responses and suggests a sensitizing effect of chronic stress leading to a stronger endocrine and cardiovascular response to acute stressors. Substantial evidence indicates that familial breast cancer risk is a chronic life stressor with higher levels of self reported distress. In this study, we investigated whether the endocrine response to a brief psychological stressor was stronger for women at familial risk for breast cancer. Thirty-six women at normal risk of breast cancer (FR- Stress Group) and 17 women at familial risk (FR+ Stress Group) underwent a brief psychological laboratory stress test (speech task and mental arithmetic) over a 15 min period. Thirty women at normal risk not subjected to the stressful task served as controls (FR- Control Group). Plasma epinephrine, norepinephrine and cortisol were measured at baseline, directly after the stress test (15 min) and at 30 min and 45 min post baseline. Heart rate data confirmed the effectiveness of the stress regimen. While there were no significant baseline group differences in the endocrine parameters, the response curves for the familial risk group revealed stronger epinephrine and cortisol reactivity to the stress test, as confirmed by significant group by time interactions. Norepinephrine levels showed a similar pattern, but results did not reach significance. These findings are in line with previous research documenting the facilitating effects of chronic stressors on acute stress response in animals and humans and provide the first evidence in the literature of a heightened endocrine reactivity to acute psychological stress in women at familial risk of breast cancer. The heightened endocrine reactivity to the experimental tasks seen here suggests that these women may experience stronger responses to stressors in their daily lives. According to the recently proposed concept of allostatic load, repeated overly strong stress responses may cumulatively have negative health implications.

How should we measure blood pressure in the doctor's office?

BACKGROUND

Blood pressure is the most ubiquitous diagnostic recording made in the doctor's office, but the measurement is subject to a number of sources of bias, which may lead to over- or underestimation. The current study examined the systematic influence of the way in which the measurements were taken - by the physician, by a nurse, or with the patient sitting alone, using an automated device.

SUBJECTS AND METHODS

Blood pressure was measured in 17 essential hypertensive and 10 white-coat hypertensive individuals. On separate clinic visits, measurements were taken by the attending physician, by a nurse and using an automated device (Arteriosonde 1216).

RESULTS

A repeated-measures ANOVA revealed that, for systolic pressure, there was a significant effect of measurement modality on blood pressure. Physician systolic pressures were on average approximately 10 mmHg higher than those taken by a nurse, nurse pressures being approximately 7 mmHg higher than those recorded using Arteriosonde. The effect on diastolic pressure was similar but smaller, and no nurse-Arteriosonde difference was observed.

CONCLUSIONS

We conclude that the routine clinical assessment of blood pressure would be more representative of daily ambulatory pressure if an automated device, without doctor or nurse present, were used.

Specific response expectancies predict anticipatory nausea during chemotherapy for breast cancer

Clinical research has demonstrated that large numbers of chemotherapy patients continue to experience nausea in the clinic prior to infusions. A better understanding of the mechanisms responsible for such anticipatory nausea (AN) is likely to provide critical information for identifying intervention targets. In the present study the authors investigated the contribution of expectancy, history of nausea, and distress to AN in 60 women with Stage I or II breast cancer receiving standard adjuvant chemotherapy. The predictors were each independently associated with AN (p < .05). However, only expectations significantly predicted AN in simultaneous regression analyses. Results suggest that interventions to reduce AN during chemotherapy should target patients' expectations.

Social support, intrusive thoughts, and quality of life in breast cancer survivors

This study explores the moderating effect of social support on the relationship between cancer-related intrusive thoughts and quality of life. Sixty-four breast cancer survivors completed self-report measures of appraisal social support (the disclosure of thoughts and feelings to significant others), cancer-related intrusive thoughts, and quality of life. Controlling for demographic and treatment variables, the negative impact of cancer-related intrusive thoughts on both physical and mental quality of life measures was moderated by appraisal social support. For women with high levels of appraisal support, cancer-related intrusive thoughts had no significant relationship with quality of life. However, for women with low levels of appraisal support, the relationship between cancer-related intrusive thoughts and quality of life was significant and negative. These results suggest that appraisal social support can mitigate the impact of traumatic life events.

Development of common cold symptoms following experimental rhinovirus infection is related to prior stressful life events

Previous studies of rhinovirus infection indicate that about one third of the persons with confirmed viral infection do not show evidence of cold symptoms. Factors that determine which infected individuals will develop colds are not known. Using a rhinovirus inoculation protocol, the authors explored the possible role of recent life events, current mood, and perceived stress in the development of symptoms in individuals known to be infected. As part of a larger study, 17 subjects were exposed to a rhinovirus and were individually isolated for 5 consecutive days; cold symptoms, mucus weights, and tissue use were monitored on a daily basis during this period. Although all 17 subjects had confirmed rhinovirus infection, only 12 subjects developed clinical colds, as indicated by self-reported symptoms and by objective symptom indices. The average number of reported major life events for the previous year was significantly higher for those who developed colds than for those who did not (p < .05). Measures of affect and perceived stress before the inoculation were not different for those who did and did not develop colds. Complementing recent research demonstrating psychosocial influences on experimental infection rates, these results provide evidence that the development of cold symptomatology in experimentally infected individuals is related to prior life events.

Age and perceived stress independently influence daily blood pressure levels and variation among women employed in wage jobs

The purpose of this study was to examine whether age and perceived stress were independent factors affecting blood pressure variation associated with changing daily microenvironments among women employed outside the home. The subjects of this study were 91 women from the same workplace (age 33.8 +/- 8.5 years; range 18.2-49.3 years) who wore an ambulatory blood pressure monitor over the course of one workday. Blood pressure averages were calculated at work (11 am to 3 pm), home (6 pm to approximately 10 pm), and during sleep (approximately 10 pm to 6 am). The stressfulness of the work and home microenvironments was rated by self-report on a scale of 0 (low) to 10 (high). A repeated measures analysis of covariance was used to assess the cross-classified effects of perceived stress (work stressed [work > home stress; N = 41], home stressed [home > work stress; N = 39], and equally stressed [work = home stress; N = 11]) and age group (18.0-29.9 years, N = 31; 30-39.9 years, N = 34; 40-49.9 years, N = 26) on the blood pressure averages with daily environment as a within-subject factor and measures of body fat and menstrual phase as covariates. Work-stressed women had higher systolic blood pressure at work, home, and during sleep than home-stressed women (127 vs 119, P < 0.001; 124 vs 119, P < 0.05, and 111 vs 104, P < 0.005). There were similar patterns for diastolic blood pressure. Age showed a U-shaped relationship, with women in the 30-39.9 year age range generally having lower systolic and diastolic blood pressures at work (P < 0.05), home (P < 0.10), and during sleep (P < 0.05) than younger and older age groups. The interaction between age group and perceived stress level was not significant, so that the variation in blood pressure associated with perceived stress (work stressed, home stressed, and equally stressed) was similar in each age group. Although blood pressure changes with age, environment-related stress, particularly job-related stress, continues to have a significant effect on daily blood pressure variation. However, data also indicate that blood pressure measured during the day may not necessarily show a linear increase with age.

Looking forward and back: distress among women at familial risk for breast cancer

Healthy women with family histories of breast cancer in a first-degree relative (FH+) have been reported to exhibit higher levels of breast cancer-related distress than women without family histories of breast cancer (FH-). Recent data suggest that this may be particularly true for women who had a parent die of cancer. In line with theories emphasizing the psychological impacts of past stressors and concerns for the future, the present study examined the hypotheses that past cancer stressors (i.e. maternal breast cancer caregiving and death, "Looking Back") and perceptions of one's own heightened future risk for developing the disease ("Looking Forward") would predict current levels of distress. One hundred forty-eight healthy women (57 FH+, 91 FH-) recruited from large medical centers in the New York City area completed measures of breast cancer-related distress, general psychological distress, and items assessing whether or not they had taken care of their mother with breast cancer or had had their mother die from the disease. Consistent with previous research, results indicated that FH+ women whose mothers had died of breast cancer had significantly higher breast cancer-related distress than either FH+ women whose mothers had not died of breast cancer or FH- women (p < .05). Further analyses revealed that FH+ women who had cared for their mothers with breast cancer had higher cancer-related distress than women who did not (p < .01), and that FH+ women whose experience included both caregiving and the death of their mother from breast cancer had the highest levels of cancer-related distress (p < .01) and depressive symptoms (p < .05). Findings also indicated that FH+ women with heightened perceptions of risk for breast cancer had higher levels of distress, independent of past stressors. These findings suggest that psychosocial interventions for women with family histories of breast cancer might be appropriately focused on these issues.

It won't happen to me: lower perception of heart disease risk among women with family histories of breast cancer

BACKGROUND

The threat that breast cancer poses to American women, particularly to women with family histories of the disease, has received widespread attention in both medical and popular literatures. While this emphasis may have laudable consequences on breast cancer screening, it may also have a negative consequence, obscuring women's recognition of their risks for other health threats, such as heart disease. This study examined the possibility that women with family histories of breast cancer may be particularly susceptible to overestimating their risks of breast cancer while minimizing their risks of cardiovascular disease.

METHODS

Healthy women with (n = 73) and without n = 104) family histories of breast cancer (64% African American, 26% Caucasian, 10% other ethnicities, mean age 41.7 years) were recruited from medical centers in New York City, and completed questionnaires concerning their family histories and perceptions of risk.

RESULTS

Consistent with the study hypothesis, women with family histories of breast cancer had significantly higher perceived lifetime risk of breast cancer (P<0.0002) but lower perceived lifetime risk of heart disease (P<0.002) than women without family histories. Additionally, women with family histories of breast cancer had lower perceived colon cancer risk (P<0.02), suggesting that women with family histories of breast cancer may be underestimating their risks for a variety of diseases.

CONCLUSION

The emphasis on breast cancer risk, especially for women with family histories of the disease, may need to be balanced by educational efforts concerning women's risk of other diseases, particularly cardiovascular disease.

Intrusive thoughts and psychological distress among breast cancer survivors: global meaning as a possible protective factor

Previous research has consistently demonstrated a positive association between intrusive thoughts about stressful experiences and psychological distress. The strength of this relation, however, has varied considerably across studies. To examine the possibility that an individual's sense of global meaning (i.e., the existential belief that one's life has purpose and order) may moderate the relation between intrusive thoughts and psychological distress, the authors conducted telephone assessments of 61 women who had survived breast cancer. Results confirmed that the frequency of intrusive thoughts was positively related to psychological distress. Global meaning, moreover, moderated the relation between intrusive thoughts and psychological distress consistent with the authors' hypotheses. Among women with lower global meaning, more frequent intrusive thoughts were associated with higher psychological distress. No association was found between intrusive thoughts and psychological distress among those participants with higher global meaning.

Psychological distress, health beliefs, and frequency of breast self-examination

Although monthly breast self-examination (BSE) is recommended for early breast cancer detection, most women do not comply. Few studies have examined the impact of psychological distress on BSE frequency. Recent research suggests that it may be particularly important to examine the role of distress in the recently identified phenomenon of BSE overperformance (> 1/month). One hundred thirty-five healthy women with and without family histories of breast cancer completed sociodemographic, health belief, general and cancer-specific psychological distress, and BSE frequency questionnaires. The central finding of the study was that BSE underperformance and overperformance had two distinct sets of predictors: health beliefs, specifically barriers against BSE and low confidence in BSE performance, were related to BSE underperformance, while higher levels of psychological distress, particularly cancer-specific intrusive thoughts, were related to BSE overperformance. Findings underscore the need to evaluate BSE under- and overperformance separately and to develop problem-specific interventions to increase compliance with monthly BSE.

Patients' pretreatment expectations of chemotherapy-related nausea are an independent predictor of anticipatory nausea

Based on extensive research with animals, classical conditioning theorists have come to regard contingency as the primary factor in the development of conditioned responses. However, recent experimental work with humans has suggested the possibility that participant expectations may also directly contribute to the development of conditioned responses. To date, this phenomenon has not been investigated in clinical settings. Anticipatory nausea (AN) in chemotherapy patients, widely viewed as the best established example of classical conditioning in clinical medicine, provides an opportunity to examine the contributions of patient expectations to the development of a conditioned response outside the laboratory. The present study of 59 breast cancer patients supported the hypothesis that pretreatment patient expectations make a significant (p < .03) contribution to the development of AN after statistically controlling for the strongest conditioning predictor, contingency. These data imply that patient expectations should be considered when evaluating conditioned responses to aversive medical treatments.

Predictors of intrusive thoughts and avoidance in women with family histories of breast cancer

Having a family history of cancer is an important predictor of lifetime cancer risk. Individuals with family histories of cancer have been reported to experience symptoms of general distress and to have frequent intrusive thoughts and avoidance regarding cancer. To date, little is known about predictors of such distress. A relation between perception of cancer risk and distress has been suggested, but the possibility that prior cancer-related events may contribute to distress in these women has received little attention. The major aim of the study was to examine the contribution of the past experience of the death of a parent from cancer to distress in women at familiar risk for breast cancer. Women with family histories of breast cancer (Risk Group, N = 46) were assessed on the day of their yearly mammography screening and four to eight weeks after normal result notification in order to confirm the generalizability of their distress. Their levels of intrusive thoughts, avoidance, and perceived lifetime risk for breast cancer were significantly higher than those of women with no family histories of cancer who were not undergoing mammography (Comparison Group, N = 43), and this was true on both assessment days. Among the women in the Risk Group, those whose parent(s) had died of cancer had the highest levels of intrusive thoughts, avoidance, and perceived risk. Results suggested that perceived risk mediated the effect of this event on intrusive thoughts and avoidance regarding breast cancer. The findings are discussed in terms of theories of cognitive responses to traumatic and stressful life events. Implications for future research and interventions are discussed.

Classically conditioned changes in plasma cortisol levels induced by dexamethasone in healthy men

Animal research has indicated that the activity of the hypothalamic-pituitary-adrenal axis can be influenced by classical (Pavlovian) conditioning procedures. To test the hypothesis that alterations in plasma cortisol levels can be conditioned in humans, the present study used a prospective, randomized, double-blind, placebo-controlled design in which a distinctively flavored beverage was paired with p.o. administration of dexamethasone. Twenty-five healthy men were randomly assigned to one of two groups. During the conditioning phase of the study, subjects in the experimental group received three conditioning trials (pairings of a distinctively flavored beverage with a capsule containing 5 mg dexamethasone) separated by 1 wk recovery periods. Subjects in the control group were treated identically, except that the capsule contained a placebo. During the test phase, all subjects underwent a test day (reexposure to the distinctively flavored beverage before receiving a placebo capsule) and a comparison day (no exposure to the beverage or the capsule). Plasma cortisol was assessed repetitively before and after administration of the beverage and capsule, as were possible confounding factors, including: behavioral variables, psychological distress, aversive reactions to the beverage, and expectations of treatment. After reexposure to the beverage and administration of a placebo capsule (conditioned stimuli), the experimental group had significantly higher levels of plasma cortisol than the control group, after controlling for variability in baseline levels of cortisol (F(5,60)=3.09; P=0.015) that could not be explained by differences in other study variables. No differences in cortisol levels were found on the comparison day. These results support the study hypothesis that changes in plasma cortisol levels can be classically conditioned in humans by pairing a distinctive beverage with p.o. administration of dexamethasone.

Imagery in human classical conditioning

Many clinical strategies use patients' imagery to explore and treat phobic and posttrauma reactions, however little attention has been paid to the underlying assumption that imagery of relevant stimuli may help maintain conditioned behavior. In this article, the authors examine the premise that mental images can potentiate and substitute for physical stimuli in human classical conditioning. The authors review empirical evidence to detail the role of images of conditioned stimuli (CS) and unconditioned stimuli (US) during pre-exposure to stimuli, the actual pairing of the CS and US, and extinction when the CS is presented alone. The evidence suggests that mental imagery can facilitate or diminish the outcome of classical conditioning in humans and, more tentatively, that mental images can substitute for actual US and CS in autonomic conditioning. They argue that researchers should explore the role of mental imagery in conditioning through the use of advances in the measurement of imagery. Finally, they analyze anxiety and trauma reactions as examples of how applied areas can be used to explore and benefit from developments in this area.

Imagery in human classical conditioning

Many clinical strategies use patients' imagery to explore and treat phobic and posttrauma reactions, however little attention has been paid to the underlying assumption that imagery of relevant stimuli may help maintain conditioned behavior. In this article, the authors examine the premise that mental images can potentiate and substitute for physical stimuli in human classical conditioning. The authors review empirical evidence to detail the role of images of conditioned stimuli (CS) and unconditioned stimuli (US) during pre-exposure to stimuli, the actual pairing of the CS and US, and extinction when the CS is presented alone. The evidence suggests that mental imagery can facilitate or diminish the outcome of classical conditioning in humans and, more tentatively, that mental images can substitute for actual US and CS in autonomic conditioning. They argue that researchers should explore the role of mental imagery in conditioning through the use of advances in the measurement of imagery. Finally, they analyze anxiety and trauma reactions as examples of how applied areas can be used to explore and benefit from developments in this area.

The development of anticipatory nausea in patients receiving adjuvant chemotherapy for breast cancer

Previous research on anticipatory nausea in cancer patients has focused on its occurrence in the clinic before chemotherapy infusions. The present study is the first, to our knowledge, to examine the development of anticipatory nausea across eight chemotherapy infusions for three time periods (night before, morning of, and immediately prior to each infusion). Based on classical conditioning experiments conducted with animal subjects, we hypothesized that the severity of anticipatory nausea would increase as the time for scheduled infusions approached. Eighty-two women diagnosed with Stage I or II breast cancer were assessed for the intensity of anticipatory nausea at three time periods prior to eight scheduled infusions of outpatient adjuvant chemotherapy. Analyses indicated a significant interaction between number of infusions experienced and temporal proximity to the infusion, supporting the hypothesis. Changes in the severity of anticipatory nausea across infusions were consistent with conditioned learning predictions. These results contribute to a growing recognition of the importance of conditioning principles for understanding side effects of chemotherapy for cancer and may have implications for the management of side effects secondary to a variety of pharmacotherapies in clinical practice.

Role of nausea in the development of aversions to a beverage paired with chemotherapy treatment in cancer patients

Previous experimental research has demonstrated that patients can develop conditioned aversions to foods and beverages after a single pairing with chemotherapy administration for cancer. The present study used a prospective longitudinal design to examine the role of posttreatment nausea in the development of learned food aversions in these patients. Chemotherapy patients sampled a distinctive beverage immediately prior to their first and second chemotherapy infusions. We assessed nausea, and other chemotherapy side effects, for the 24-h period following chemotherapy administration. Food aversion, at the second infusion, was assessed in terms of behavior (decreased consumption) and affect (decreased hedonic rating). Consistent with previous research, patients showed both decreased consumption and decreased hedonic rating after a single chemotherapy infusion. Nausea was found to be related to decreases in hedonic rating, but not to decreases in consumption. No other treatment side effects predicted either decreased consumption or hedonic rating. These results are consistent with the hypothesis that there is a special link between nausea and changes in affective response to food items. These results also highlight the unique opportunities for studying food aversion formation in the oncology setting.

Conditioned reactions to cancer chemotherapy: percent reinforcement predicts anticipatory nausea

Current theorizing on classical conditioning has emphasized the role of contingent relations between the conditioned and unconditioned stimuli in the development of conditioned responses. The present study is the first to examine the relevance of this concept to our understanding of the phenomenon of anticipatory nausea in cancer chemotherapy patients. Anticipatory nausea in patients receiving emetogenic chemotherapy has been cited as an example of the importance of classical conditioning in clinical medicine. Outpatient chemotherapy can be viewed as a series of conditioning trials in which the previously neutral stimuli of the clinic (conditioned stimuli) are associated with chemotherapy infusions and postinfusion nausea. Reexposure to these clinic stimuli alone is sufficient to elicit nausea (conditioned response) in some patients prior to subsequent infusions. In the present study we examined whether differences among patients in percent reinforcement (the percentage of infusions followed by nausea) would predict anticipatory nausea, which was assessed at the sixth infusion. Results were consistent with the hypothesis. Percent reinforcement was positively correlated with the incidence of anticipatory nausea. Comparison of patients with and without anticipatory nausea (t-test and hierarchical logistic regression analysis) confirmed that percent reinforcement was a significant predictor of anticipatory nausea, independent of other factors previously reported to be involved.

Selective modulation of cell adhesion molecules on lymphocytes by bromelain protease 5

Human peripheral blood mononuclear cells from healthy donors were treated ex vivo with the proteolytic enzyme bromelain and studied by flow cytometry. Bromelain-treated lymphocytes exhibited 60-90% reduced cell surface staining for CD44 and CD62-L molecules. While the staining for molecules CD16, CD56 and CD49d was unaffected, a moderate increase (10-40%) in expression of the beta(2)-integrins CD11a-c was seen. This selective modulation of cell adhesion molecules (CAM) was seen on T cells and NK cells, as well. The selective modulation of CAM may help explain some of the clinical effects observed after bromelain treatment in patients suffering from chronic inflammatory disease, HIV and cancer.

Sources of anticipatory emotional distress in women receiving chemotherapy for breast cancer

BACKGROUND

The contribution of classical conditioning processes to patients' distress before chemotherapy infusions (anticipatory distress) was compared to other potential sources of distress (e.g., trait anxiety). We hypothesized that posttreatment distress (putative unconditioned response) would become a stronger predictor of anticipatory distress as patients underwent more treatment infusions (putative conditioning trials).

MATERIALS AND METHODS

Fifty women with early stage breast cancer, undergoing standard chemotherapy, completed questionnaires in the clinic prior to each of eight consecutive treatment infusions, as well as telephone interviews to assess side effects following infusions.

RESULTS

Consistent with the conditioning hypothesis, posttreatment distress became significantly related to anticipatory distress at the fourth infusion and became the strongest predictor by the sixth. Path analysis indicated that posttreatment distress had a direct influence on anticipatory distress, and that trait anxiety had an indirect influence by influencing apprehension about chemotherapy which, in turn, directly predicted anticipatory distress.

CONCLUSIONS

The results of the present study contribute to an emerging view of anticipatory distress as a conditioned response in chemotherapy patients. Results demonstrate that conditioning factors may be one of the strongest predictors of anticipatory distress in the later phases of chemotherapy treatment.

Conditioned emotional distress in women receiving chemotherapy for breast cancer

This study investigated whether women undergoing outpatient chemotherapy for breast cancer can develop classically conditioned emotional distress. Women scheduled to begin chemotherapy were randomly assigned either to an experimental group (exposed to a distinctive stimulus before each chemotherapy infusion) or a control group. After repeated infusions of chemotherapy, patients' responses to the distinctive stimulus were assessed in a location not associated with chemotherapy administration. At the test trial, experimental group patients showed evidence of increased emotional distress (self-reported on a visual analog scale) after the presentation of the distinctive stimulus, whereas control group patients did not. Post hoc analyses indicated that these increases in distress were not secondary to other conditioned responses (e.g., nausea, taste aversion). Thus, results supported the hypothesis that the pairing of a distinctive stimulus with chemotherapy would result in the development of a conditioned emotional response.

Conditioned emotional distress in women receiving chemotherapy for breast cancer

This study investigated whether women undergoing outpatient chemotherapy for breast cancer can develop classically conditioned emotional distress. Women scheduled to begin chemotherapy were randomly assigned either to an experimental group (exposed to a distinctive stimulus before each chemotherapy infusion) or a control group. After repeated infusions of chemotherapy, patients' responses to the distinctive stimulus were assessed in a location not associated with chemotherapy administration. At the test trial, experimental group patients showed evidence of increased emotional distress (self-reported on a visual analog scale) after the presentation of the distinctive stimulus, whereas control group patients did not. Post hoc analyses indicated that these increases in distress were not secondary to other conditioned responses (e.g., nausea, taste aversion). Thus, results supported the hypothesis that the pairing of a distinctive stimulus with chemotherapy would result in the development of a conditioned emotional response.

Anticipatory anxiety in women receiving chemotherapy for breast cancer

This study examined (a) the prevalence and course of anxiety before the 1st 6 infusions of cancer chemotherapy and (b) the contribution of trait anxiety, side effect expectations, and prior occurrence of posttreatment side effects to anxiety before infusions. Fifty-three women receiving adjuvant chemotherapy for breast cancer participated. Anxiety was most prevalent and intense before the 1st infusion. Trait anxiety predicted anxiety before both the 1st and subsequent infusions. Prior occurrence of posttreatment nervousness also predicted anxiety before subsequent infusions, even after accounting for trait anxiety and other posttreatment side effects. Results are discussed in terms of the role that anxiety proneness, response expectancy, and classical conditioning may play in the development of anxiety before repeated chemotherapy infusions.

Coping with chemotherapy for breast cancer

Relations among coping, physical symptoms, and affect were investigated in 43 women undergoing adjuvant chemotherapy for breast cancer. Patients were assessed at the same point in their treatment so that the time for which coping was reported would be equivalent across individuals. Patients were asked how they coped specifically with chemotherapy, rather than how they coped with cancer in general, to make the domain specific. Positive and negative affect were assessed separately, using a scale free of somatic content. Relations between coping and affect were consistent with prior studies that have employed a general approach to assessing coping. Coping correlates of positive and negative mood differed. When the relations between physical symptoms and affect were examined, physical symptoms were related to negative affect but not to positive affect. Findings are discussed in terms of their implications for coping with cancer as well as their implications for the general coping literature.

Stress and humoral immunity: a review of the human studies

Many studies have examined the relationship between stress and immunity, however, only a few have explored associations between stress and humoral immunity. In our review of this literature, three ways of characterizing the response of the humoral immunity system to stress were identified: total immunoglobulins, antibody to latent viruses and antibody to vaccines. These studies provide some support for the hypothesis that stress affects humoral immunity, particularly response to latent virus, but further research is required to confirm these observations. Several directions for future research are proposed.

Formation of food aversions in cancer patients receiving repeated infusions of chemotherapy

Patients receiving emetogenic chemotherapy for cancer have been found to develop aversions to normal dietary items consumed in close temporal relation to treatment administrations. These aversions are presumed to develop via conditioning processes as demonstrated in experimental studies of food aversion learning. The present study used a prospective, longitudinal design to evaluate the possible role of conditioning in the formation of aversions to normal dietary items in women receiving adjuvant chemotherapy for breast cancer. Patients were monitored for the development of aversions to foods and beverages consumed in the 24 hr periods before and after each of eight consecutive chemotherapy infusions beginning with the initial infusion. Data on the prevalence, course, and prediction of aversions to normal dietary items are reported. These results pointed to similarities and differences between aversions formed to normal dietary items during chemotherapy treatment and aversions formed to taste stimuli during experimental conditioning studies. In addition to their theoretical significance, results also suggest possible strategies for preventing the clinical problem of aversions to normal dietary items in chemotherapy patients.

Anticipatory anxiety in women receiving chemotherapy for breast cancer

This study examined (a) the prevalence and course of anxiety before the 1st 6 infusions of cancer chemotherapy and (b) the contribution of trait anxiety, side effect expectations, and prior occurrence of posttreatment side effects to anxiety before infusions. Fifty-three women receiving adjuvant chemotherapy for breast cancer participated. Anxiety was most prevalent and intense before the 1st infusion. Trait anxiety predicted anxiety before both the 1st and subsequent infusions. Prior occurrence of posttreatment nervousness also predicted anxiety before subsequent infusions, even after accounting for trait anxiety and other posttreatment side effects. Results are discussed in terms of the role that anxiety proneness, response expectancy, and classical conditioning may play in the development of anxiety before repeated chemotherapy infusions.

Familial cancer, emotional distress, and low natural cytotoxic activity in healthy women

BACKGROUND

We investigated the possibility that healthy individuals with a family history of cancer may have lower levels of natural cytotoxic activity and examined the possible contribution of distress-induced immune suppression.

MATERIALS AND METHODS

Forty-three healthy women, recruited without regard to their family histories of cancer, came to the laboratory on two consecutive days. On each day, subjects completed questionnaires and provided blood samples for assessment of natural cytotoxic activity.

RESULTS

1) Women with a history of cancer in one or more first degree relatives had lower levels of natural cytotoxic activity than women without cancer in first degree relatives. 2) There were no differences in demographic, health, or behavioral variables, but we could not rule out differences in emotional distress. 3) Independent of family history, women with higher levels of distress had lower natural cytotoxic activity. 4) When the contribution of this distress-induced immune suppression was statistically removed, natural cytotoxic activity remained lower in women with cancer in first degree relatives.

CONCLUSIONS

These findings raise the possibility that reductions in systemic natural cytotoxic activity, in conjunction with heritable defects in the preneoplastic cell, may contribute to increased cancer risk in individuals with a family history of cancer.

Nausea induced by mental images of chemotherapy

BACKGROUND

Although anecdotal reports indicate that patients with cancer undergoing chemotherapy can become nauseated outside the chemotherapy clinic when they think or talk about treatment, this phenomenon has not been investigated systematically.

METHODS

A series of experimental analyses with individual patients was conducted to explore the possibility that mental images of chemotherapy can elicit nausea in patients who, during the course of their treatment, experienced nausea in anticipation of chemotherapy infusions. Occurrence and intensity of nausea were examined in each patient in response to three imagery scenes: pastoral, a nonchemotherapy medical procedure, and chemotherapy.

RESULTS

Eight of 10 patients with clinically documented histories of anticipatory nausea to clinic stimuli experienced nausea when they imagined chemotherapy. They did not become nauseated when they imagined non-chemotherapy medical procedures. For the four patients without prior anticipatory nausea, imaginal reexposure to chemotherapy did not elicit nausea.

CONCLUSIONS

Results provide evidence that mental images of chemotherapy elicit nausea in patients with histories of anticipatory nausea and suggest that cognitive factors may play a more important role in the occurrence of chemotherapy side effects than previously recognized.

An experimental analysis of classically conditioned nausea during cancer chemotherapy

This study investigated classical conditioning in women undergoing outpatient adjuvant chemotherapy for breast cancer. Breast cancer chemotherapy outpatients were randomly assigned either to an Experimental Group (exposed to a distinctive stimulus before each infusion of chemotherapy) or to a Control Group. After repeated infusions of chemotherapy, patients' responses to the experimental stimulus were assessed in a location not associated with chemotherapy. Experimental Group patients had increased nausea (self-reported on a visual analog scale) following the presentation of the experimental stimulus at this test trial, whereas Control Group patients did not. Two other measures of nausea corroborated these results. Post hoc statistical analyses confirmed predictions based on conditioning theory. This conditioning model of anticipatory nausea bears witness to the relevance of classical conditioning in clinical medicine.

Treatment related psychological distress during adjuvant chemotherapy as a conditioned response

Patients receiving cycles of cytotoxic chemotherapy for cancer often experience noxious side effects following treatments and may develop classically conditioned side effects, such as anticipatory nausea and vomiting (ANV) during the course of repeated infusions. The present study explored the possibility that classical conditioning processes may also contribute to treatment related psychological distress. Sixty-six patients, scheduled for adjuvant chemotherapy for breast cancer (stages I, II, IIIa), agreed to participate. Patients were assessed in the clinic on the first day of every chemotherapy cycle and in their homes three to five days before their final cycle. Patients experienced considerable psychological distress during the course of chemotherapy, and particularly before the first infusion. Prior to the last cycle of chemotherapy, psychological distress was significantly higher in the clinic environment than in patients' homes. Consistent with classical conditioning, psychological distress did not escalate over the days before treatment, but rather increased abruptly when patients returned to the clinic. The results of the present study indicate that several factors are involved in patients' anticipatory psychological distress and highlight the potential contribution that conditioning processes may make to patients' emotional distress in the clinic environment.

"Cross-wiring" of the immune response in old mice: increased autoantibody response despite reduced antibody response to nominal antigen

Older humans and experimental animals have been repeatedly found to have higher titers of autoantibodies than do younger individuals despite the impaired responses of older individuals to foreign antigens. The studies reported here were designed to examine the relationship between these two age-related changes in antibody responses. Antibody response to foreign antigen was measured concurrently with autoantibody response in the same mice. Old mice (18-24 months old) had decreased responses to foreign antigens and increased responses to bromelain-treated syngeneic erythrocytes, compared to young mice (2 months old). In vitro mixing experiments were consistent with the possibility that suppressor cell activity in spleen cells from old mice reduce the antibody response to foreign antigen but not to autologous antigen. The results support an emerging view that age-associated changes in immune responses are the result of dysregulation rather than exhaustion of the immune system.

Physiologic and psychobehavioral research in oncology

A major thrust in research in psychosocial oncology is the study of the interaction of psychologic and physiologic variables. This discussion reviews the current status and future directions of such research. Areas addressed include pain, nausea and vomiting with chemotherapy, sexuality, effects of cancer on psychologic and neuropsychologic function, impact of psychologic factors on cancer and its treatment, and psychoneuroimmunology. In addition, specific recommendations for strategies to facilitate research in these areas of psychosocial oncology are proposed.

Psychoneuroimmunology. Implications for oncology?

Accumulating evidence indicates that the central nervous system (CNS) may regulate the activity of the immune system. Although the overall significance of the immune system in cancer remains controversial, psychosocial influences on immune function could potentially provide a mechanism to account for some of the reports of an association between psychosocial factors and cancer prognosis.

Anticipatory immune suppression and nausea in women receiving cyclic chemotherapy for ovarian cancer

Nausea and immune function were assessed in 20 cancer patients in the hospital prior to chemotherapy and compared with assessments conducted at home. Proliferative responses to T-cell mitogens were lower for cells isolated from hospital blood samples than for home samples obtained several days earlier. Patients also experienced increased nausea in the hospital. Hierarchical multiple regression analyses indicated that decreased immune function in the hospital was not related to increased anxiety. The observed anticipatory immune suppression is consistent with the hypothesis that chemotherapy patients may develop conditioned immune suppression as well as conditioned nausea after repeated pairings of hospital stimuli with the emetic and immunosuppressive effects of chemotherapy.

Anticipatory immune suppression and nausea in women receiving cyclic chemotherapy for ovarian cancer

Nausea and immune function were assessed in 20 cancer patients in the hospital prior to chemotherapy and compared with assessments conducted at home. Proliferative responses to T-cell mitogens were lower for cells isolated from hospital blood samples than for home samples obtained several days earlier. Patients also experienced increased nausea in the hospital. Hierarchical multiple regression analyses indicated that decreased immune function in the hospital was not related to increased anxiety. The observed anticipatory immune suppression is consistent with the hypothesis that chemotherapy patients may develop conditioned immune suppression as well as conditioned nausea after repeated pairings of hospital stimuli with the emetic and immunosuppressive effects of chemotherapy.