Mindfulness Based Stress Reduction for Psycho-Immune Dysregulation in Cancer

基于正念的减压治疗癌症心理免疫失调

• 批准号: 7916531
• 负责人: Linda Janusek
• 金额: $ 30.66万
• 依托单位: LOYOLA UNIVERSITY CHICAGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7916531
• 关键词: Affect; Aftercare; American; Anxiety; Breast Cancer Treatment; Cancer Etiology; Cancer Patient; Cancer Survivorship; Catecholamines; Cause of Death; Cessation of life; Diagnosis; Disease; Distress; Early treatment; Educational process of instructing; Effectiveness; Emotions; Endocrine; Enrollment; Evaluation; Exhibits; Fright; Health; Hormones; Hydrocortisone; Hypothalamic structure; Immune; Immune response; Immunosuppression; Impairment; Individual; Intervention; Living Wills; Malignant Neoplasms; Matched Group; Mediation; Mind-Body Intervention; Modeling; Natural Killer Cells; Nature; Neoplasm Metastasis; Neurosecretory Systems; Operative Surgical Procedures; Outcome; Pattern; Phase; Physiological; Pituitary Gland; Plasma; Population; Primary Neoplasm; Production; Proliferating; Psychological Stress; Psychoneuroimmunology; Publishing; Quality of life; Radiation therapy; Randomized; Reporting; Research Design; Salivary; Sampling; Science; Sleep; Staging; Stress; System; Testing; Time; Uncertainty; Woman; Women' s Group; biological adaptation to stress; breast cancer diagnosis; cancer care; cancer diagnosis; cancer recurrence; cancer therapy; cohort; comparative; coping; critical period; cytokine; design; experience; health related quality of life; immune function; improved; malignant breast neoplasm; meetings; mindfulness-based stress reduction; neoplastic cell; programs; psychologic; psychosocial; public health relevance; response; restoration; skills; social; stem; survivorship; tumor; tumor growth; tumor initiation; tumor progression

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.

描述(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、睡眠不佳、不确定以及对癌症复发的恐惧。这种痛苦可能超出治疗范围，并对与健康相关的生活质量(HRQOL)产生不利影响。需要采取干预措施，遏制负面情绪的浪潮及其生理后遗症。心理神经免疫学(PNI)已经证实，心理社会压力会损害免疫功能。我们已经证明，被诊断为乳腺癌的女性有明显的心理社会痛苦，伴随着自然杀伤细胞活性(NKCA)和细胞因子产生的失调。这些观察结果尤其重要，因为这些形式的免疫功能受损与肿瘤起始、原发肿瘤生长和肿瘤转移增加有关。转移性疾病是乳腺癌死亡的主要原因。基于正念的压力减轻(MBSR)是一种身心干预，显示出管理与癌症相关的痛苦的希望。我们发现，在癌症诊断和治疗的脆弱时期，MBSR降低了神经内分泌应激激活，并改善了乳腺癌患者的免疫功能和生活质量。使用随机对照设计，本研究将评估MBSR在心理社会困扰、神经内分泌应激激活、免疫功能和HRQOL方面的潜在益处。患有早期乳腺癌的妇女将随机接受为期8周的MBSR干预或对照条件。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的评估将在MBSR前、中期、完成时和后进行。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实现，此时免疫功能的恢复最为重要。在明确定义的癌症人群中使用严格的设计，了解对像MBSR这样有前途的心身方法的心理内分泌免疫反应的轨迹和性质，将对PNI的科学和综合癌症护理做出重大贡献。公共卫生相关性：提高乳腺癌妇女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这些方法进行实证分析。这项拟议的研究将评估一种这样的方法，即基于正念的压力减轻，在一组患有乳腺癌的女性中进行，并与一组匹配的非癌症女性进行比较。