Mindfulness Based Stress Reduction for Psycho-Immune Dysregulation in Cancer

描述（由申请人提供）：乳腺癌是美国女性癌症死亡的第二大原因，每年有超过 39,000 名女性死于乳腺癌。乳腺癌的诊断和治疗会导致心理困扰、社会关系中断、焦虑、睡眠质量差、不确定性和对癌症复发的恐惧。这种痛苦可能超出治疗范围，并对健康相关的生活质量 (HRQOL) 产生不利影响。需要采取干预措施来阻止负面情绪及其生理后遗症的蔓延。心理神经免疫学 (PNI) 已证实社会心理困扰会损害免疫功能。我们已经证明，被诊断患有乳腺癌的女性有明显的社会心理困扰，并伴有自然杀伤细胞活性 (NKCA) 和细胞因子产生失调。这些观察结果尤其重要，因为这些形式的免疫功能的损害与肿瘤发生、原发性肿瘤生长和肿瘤转移的增加有关。转移性疾病是乳腺癌死亡的主要原因。基于正念的减压（MBSR）是一种身心干预措施，有望控制与癌症相关的痛苦。我们发现，MBSR 可减少乳腺癌患者在癌症诊断和治疗的脆弱期的神经内分泌应激激活，提高免疫功能和生活质量。本研究将采用随机对照设计，评估 MBSR 对心理社会困扰、神经内分泌应激激活、免疫功能和 HRQOL 的潜在益处。患有早期乳腺癌的女性将被随机分配接受为期 8 周的 MBSR 干预或对照条件。将在 MBSR 前、中、完成时和后获得免疫功能（NKCA 和细胞因子）、神经内分泌活动（唾液皮质醇和血浆儿茶酚胺）、心理社会反应和 HRQL 的评估。假设将测试MBSR是否可以改善女性对乳腺癌诊断和治疗的心理社会反应，减少神经内分泌应激激活，恢复免疫功能，并提高HRQOL。主要研究变量之间的关系将通过中介模型检验来探索。这些评估将在癌症诊断和治疗的关键时期进行，此时免疫功能的恢复最为重要。了解对像 MBSR 这样有前景的身心方法的心理-内分泌-免疫反应的轨迹和性质，并在明确的癌症人群中使用严格的设计，将为 PNI 科学和综合癌症护理做出重大贡献。公共卫生相关性：提高乳腺癌女性生活质量的替代或补充方法越来越受欢迎。然而，缺乏使用严格的科学设计对此类方法进行实证分析。因此，拟议的研究将在患有乳腺癌的女性群体中评估一种这样的方法，即基于正念的减压方法，并与一组匹配的未患癌症的女性进行比较。

DESCRIPTION (provided by applicant): Breast cancer is the second leading cause of cancer death in American women, with over 39,000 women dying of breast cancer yearly. Breast cancer diagnosis and treatment cause psychosocial distress, disrupted social relationships, anxiety, poor sleep, uncertainty, and fear of cancer recurrence. This distress can extend beyond treatment and adversely affect health-related quality of life (HRQOL). Interventions that stem the tide of negative emotions and their physiological sequelae are needed. Psychoneuroimmunology (PNI) has established that psychosocial distress impairs immune function. We have shown that women diagnosed with breast cancer have significant psychosocial distress that is accompanied by dysregulated natural killer cell activity (NKCA) and cytokine production. These observations are especially important in that impairment of these forms of immune function is associated with increased tumor initiation, primary tumor growth and tumor metastasis. Metastatic disease is the primary cause of death from breast cancer. Mindfulness based stress reduction (MBSR) is a mind-body intervention that shows promise for management of the distress associated with cancer. We show that MBSR reduces neuroendocrine stress activation and improves immune function and quality of life of breast cancer patients during the vulnerable period of cancer diagnosis and treatment. Using a randomized controlled design, this study will evaluate the potential benefits of MBSR on psychosocial distress, neuroendocrine stress activation, immune function, and HRQOL. Women with early stage breast cancer will be randomized to an 8-week MBSR intervention or a control condition. Assessments of immune function (NKCA and cytokines), neuroendocrine activity (salivary cortisol and plasma catecholamines), psychosocial response, and HRQL will be obtained pre-, mid-, at completion, and post-MBSR. Hypotheses will test whether MBSR can improve the psychosocial response of women to breast cancer diagnosis and treatment, reduce neuroendocrine stress activation, restore immune function, and increase HRQOL. The relationship among main study variables will be explored by mediation model testing. These assessments will be achieved during the critical period of cancer diagnosis and treatment when restoration of immune function is most significant. Understanding the trajectory and the nature of the psycho-endocrine-immune response to a promising mind-body approach like MBSR, using a rigorous design in a well-defined cancer population, will significantly contribute to the science of PNI and to integrative cancer care. PUBLIC HEALTH RELEVANCE: Alternative or complementary approaches that enhance the quality of life of women with breast cancer have grown in popularity. Yet, there is a lack of empirical analysis of such approaches using rigorous scientific design. The proposed study will so evaluate one such approach, mindfulness based stress reduction, in a population of women with breast cancer and in comparison to a matched group of women without cancer.