Biobehavioral, Immune, and Health Benefits following Recurrence for Psychological Intervention Participants
Biobehavioral, Immune, and Health Benefits following Recurrence for Psychological Intervention Participants
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DOI：
10.1158/1078-0432.ccr-10-0278
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发表时间：
2010-06-15
影响因子：
11.5
通讯作者：
Carson, William E., III
中科院分区：
文献类型：
--
作者：
Andersen, Barbara L.;Thornton, Lisa M.;Carson, William E., III
目的：一项临床试验旨在验证心理干预可降低癌症复发风险这一假设。新确诊的局部乳腺癌患者（n = 227）被随机分配到干预加评估组或仅评估组。该干预在心理、社会、免疫和健康方面具有积极效果，在中位随访11年后，发现干预组降低了复发风险（风险比，0.55；P = 0.034）。在后续研究中，我们假设干预组在复发后可能也会有更长的生存期。如果观察到这种情况，我们将研究潜在的生物行为机制。
实验设计：对所有患者进行随访，其中62例复发。生存分析包括全部62例患者。在复发确诊时，收集可进一步进行生物行为研究的患者（n = 41，23例来自干预组，18例来自评估组）。对于这41例患者，在复发确诊时以及之后的4、8和12个月收集心理、社会、依从性、健康和免疫（自然杀伤细胞毒性、T细胞增殖）数据。
结果：意向性分析显示干预组在复发后的死亡风险降低（风险比，0.41；P = 0.014）。结合生物行为数据的混合效应随访分析表明，所有患者在复发确诊时都有明显的心理痛苦反应，但此后只有干预组有所改善（P值<0.023）。干预组在12个月时的免疫指标显著更高（P值<0.017）。
结论：风险分析进一步证实了先前的发现，即干预组在复发后生存期得到改善。显示干预组具有生物行为优势的随访分析有助于我们理解生存期是如何得到改善的。《临床癌症研究》；16(12)；3270 - 3278。（C）2010美国癌症研究协会。
Purpose: A clinical trial was designed to test the hypothesis that a psychological intervention could reduce the risk of cancer recurrence. Newly diagnosed regional breast cancer patients ( n = 227) were randomized to the intervention-with-assessment or the assessment-only arm. The intervention had positive psychological, social, immune, and health benefits, and after a median of 11 years the intervention arm was found to have reduced the risk of recurrence ( hazard ratio, 0.55; P = 0.034). In follow-up, we hypothesized that the intervention arm might also show longer survival after recurrence. If observed, we then would examine potential biobehavioral mechanisms.Experimental Design: All patients were followed; 62 recurred. Survival analyses included all 62. Upon recurrence diagnosis, those available for further biobehavioral study were accrued ( n = 41, 23 intervention and 18 assessment). For those 41, psychological, social, adherence, health, and immune ( natural killer cell cytotoxicity, T-cell proliferation) data were collected at recurrence diagnosis and 4, 8, and 12 months later.Results: Intent-to-treat analysis revealed reduced risk of death following recurrence for the intervention arm ( hazard ratio, 0.41; P = 0.014). Mixed-effects follow-up analyses with biobehavioral data showed that all patients responded with significant psychological distress at recurrence diagnosis, but thereafter only the intervention arm improved ( P values < 0.023). Immune indices were significantly higher for the intervention arm at 12 months ( P values < 0.017).Conclusions: Hazards analyses augment previous findings in showing improved survival for the intervention arm after recurrence. Follow-up analyses showing biobehavioral advantages for the intervention arm contribute to our understanding of how improved survival was achieved. Clin Cancer Res; 16( 12); 3270-8. (C) 2010 AACR.