PNI and Decision Making in Women Diagnosed with DCIS

描述（由申请人提供）：乳腺癌的诊断以及乳腺癌治疗的负担都使女性处于可能损害癌症相关免疫功能的情绪困扰的风险中。在过去的十年中，由于筛查性乳房X线摄影的广泛使用，被诊断为导管原位癌（DCIS）的妇女人数有所增加。DCIS是一个日益增长的临床管理挑战，因为对DCIS自然史的了解有限。因此，患有DCIS的女性面临着艰难的治疗选择，不仅必须权衡癌症复发的风险，还要权衡她们的个人价值观。值得注意的是，很少有人了解被诊断患有DCIS的女性的心理需求。我们的初步数据表明，患有DCIS的女性有情绪障碍，焦虑和感知压力水平升高，并伴有免疫失调。这种心理反应对癌症控制机制的影响是相当大的。来自心理神经免疫学（PNI）多学科领域的大量证据表明，情绪困扰损害免疫功能，包括NK细胞活性和细胞因子平衡。NK细胞和细胞因子参与癌症控制并有助于保护个体免于肿瘤起始、原发性肿瘤生长、肿瘤转移以及感染性疾病。因此，拟议的研究将使用PNI框架来调查新诊断为DCIS的女性的心理和免疫反应的动态。此外，还将评价治疗决策对这些妇女的心理-内分泌-免疫反应的作用。具体目标是：1）在诊断和治疗前后的4个时间段，评估情绪障碍、焦虑和心理压力增加对诊断为DCIS（0期）乳腺癌的女性免疫功能的影响。2)确定决策冲突是否介导情绪障碍，焦虑和心理压力对诊断为DCIS的女性免疫功能的影响。3)通过确定（a）决策特征（决策风格、控制偏好和满意度）是否调节诊断为DCIS的女性所经历的决策冲突水平，以及（B）决策冲突是否调节诊断为DCIS的女性所报告的情绪障碍、焦虑和心理压力，评价诊断为DCIS的女性的心理压力和决策的中介和调节模型。将入组新诊断为DCIS的女性（N=122）。将采用前瞻性重复测量设计评价DCIS女性患者在诊断、治疗和治疗后随访阶段的情绪、状态焦虑、心理应激、血清皮质醇和免疫功能（NK细胞和细胞因子）。结果将根据时间进行分析，并与一组匹配的无癌症妇女进行比较。所获得的知识将通过深入了解认知因素（决策）对DCIS女性的心理-内分泌-免疫反应的作用来推进PNI科学。这一见解可用于指导管理决策冲突的方法的发展，这将减少乳腺癌患者以及其他面临高风险治疗决策的人群的心理困扰并支持免疫功能。

DESCRIPTION (provided by applicant): Both the diagnosis of breast cancer as well as the burden of breast cancer treatment put women at risk for emotional distress that may impair cancer-related immune function. The past decade has witnessed an increase in the number of women diagnosed with ductal carcinoma in situ (DCIS) due to the widespread use of screening mammography. DCIS is a growing clinical management challenge as there is limited knowledge of the natural history of DCIS. As a result women with DCIS face difficult treatment choices that must be weighed against not only the risk of cancer recurrence but also their personal values. Remarkably, there is little understanding of the psychological needs of women diagnosed with DCIS. Our preliminary data suggest that women with DCIS have elevated levels of mood disturbance, anxiety, and perceived stress, which are accompanied by immune dysregulation. The implication of such a psychological response upon cancer control mechanisms is considerable. Extensive evidence from the multidisciplinary field of psychoneuroimmunology (PNI) has demonstrated that emotional distress impairs immune function, including NK cell activity and cytokine balance. NK cells and cytokines participate in cancer control and contribute to the protection of an individual from tumor initiation, primary tumor growth, tumor metastasis, and also infectious disease. Therefore, the proposed study will use a PNI framework to investigate the dynamics of the psychological and immunological response of women newly diagnosed with DCIS. In addition, an evaluation will be made of the role of treatment decision-making on the psycho-endocrine-immune response of these women. The specific aims are to: 1) Evaluate the effect of increased mood disturbance, anxiety, and psychological stress on immune function in women who are diagnosed with DCIS (Stage 0) breast cancer at 4 time periods surrounding diagnosis and treatment. 2) Determine whether decisional conflict mediates the effects of mood disturbance, anxiety, and psychological stress on immune function in women who are diagnosed with DCIS. 3) Evaluate a mediation and moderation model of psychological stress and decision making in women diagnosed with DCIS by determining whether: (a) decision making characteristics (decision style, control preference, and satisfaction) moderate the level of decisional conflict experienced by women diagnosed with DCIS and (b) decisional conflict mediates mood disturbance, anxiety, and psychological stress reported by women diagnosed with DCIS. Women newly diagnosed with DCIS (N=122) will be enrolled. A prospective repeated measures design will be used to evaluate mood, state anxiety, psychological stress, serum cortisol, and immune function (NK cells and cytokines) of women with DCIS across the phases of diagnosis, treatment, and post-treatment follow-up. Results will be analyzed with respect to time and in comparison to a group of matched women without cancer. The knowledge obtained will advance the science of PNI by providing insight to the role of a cognitive factor (decision making) on the psycho-endocrine-immune response in women with DCIS. This insight may be used to guide the development of ways to manage decision conflict, which will reduce psychological distress and support immune function in women with breast cancer, as well as other populations facing high stakes treatment decisions.