MBSR for Stress-Related Immune Dysregulation in Cancer

描述（由申请人提供）：无论预后如何，癌症诊断都会产生情绪困扰。被诊断为乳腺癌的女性报告抑郁，对自己的未来不确定，以及对癌症复发的不切实际的恐惧。来自精神神经免疫学（PNI）多学科领域的大量证据表明，情绪困扰损害免疫功能。因此，癌症诊断的经历及其相关的治疗不仅可能使癌症患者在心理上处于危险之中，而且可能使他们在免疫上处于危险之中。我们已经证明，被诊断患有乳腺癌的女性，无论是侵入性的还是非侵入性的，都有明显的心理困扰，这种困扰一直持续到癌症治疗的整个过程和之后。此外，这些女性表现出明显的自然杀伤细胞活性（NKCA）降低以及细胞因子产生失调。这些观察结果尤其重要，因为最近来自基因缺失动物的证据表明自然杀伤细胞（NK）和细胞因子转移受损。因此，这些形式的免疫功能的损害可能导致癌症控制的减少。总的来说，这些观察结果表明，癌症的诊断和治疗会产生心理和免疫上的后遗症，对癌症患者产生负面影响。越来越多的癌症患者寻求全面的癌症治疗方法。正念减压是一种身心行为干预，有望成为一种自我管理与不良医疗条件相关的痛苦的技术。最近，正念减压疗法在一组不同类型的癌症患者中被证明可以减轻压力和情绪障碍的症状。在HIV感染者中，我们已经证明MBSR可以改善免疫功能。因此，有一个强有力的理由来评估正念减压作为一种改善癌症相关免疫失调和心理困扰的手段。这个探索性R21项目的目的是评估正念减压作为一种身心方法，将改善癌症相关的免疫失调和心理困扰。两种假设将被检验：1)与未参加MBSR的乳腺癌患者相比，参加MBSR项目的乳腺癌患者的免疫功能将得到改善。2)与没有参加正念减压的乳腺癌患者相比，参加正念减压的乳腺癌患者的压力和情绪障碍有所减少。诊断为早期癌症的妇女（N=96）将接受保乳手术，放疗和他莫昔芬治疗，将被纳入并随机分配到MBSR计划或对照组（常规护理）。免疫功能（NKCA和细胞因子产生）和心理困扰（感知压力和情绪）将在正念减压前、正念减压中期、正念减压完成时和正念减压后1个月进行评估。将确定组内和组间结果测量的差异。通过这种方式，正念减压将作为一种PNI（身心方法）来评估，以对抗癌症诊断和治疗的负面心理和免疫后果。这种方法不仅有可能更好地控制癌症，而且有可能提高癌症患者的生活质量。

DESCRIPTION (provided by applicant): No matter what the prognosis, cancer diagnosis produces emotional distress. Women diagnosed with breast cancer report depression, uncertainty about their future, and unrealistic fears of cancer recurrence. Extensive evidence from the multi-disciplinary field of psychoneuroimmunology (PNI) has demonstrated that emotional distress impairs immune function. Therefore, the experience of cancer diagnosis and its' associated treatments may not only place the cancer patient at risk psychologically but may also place them at risk immunologically. We have shown that women diagnosed with breast cancer, of either an invasive or non-invasive form, have significant psychological distress that continues throughout and beyond cancer treatment. Moreover, these women exhibit a significant and concomitant reduction in natural killer cell activity (NKCA) as well as a dysregulation in cytokine production. These observations are especially important in that recent evidence from gene depleted animals has shown impaired natural killer (NK) cell and cytokine metastasis. Hence, impairments in these forms of immune function may lead to reductions in cancer control. As a whole, these observations suggest that cancer diagnosis and its' treatment produce psychological as well as immunological sequelae that negatively impact the cancer patient. Increasingly, individuals with cancer seek holistic approaches to cancer care. MBSR is a mind-body, behavioral-intervention that shows promise as a technique to self-manage the distress associated with adverse medical conditions. Recently, MBSR was shown to reduce symptoms of stress and mood disturbance in a heterogeneous group of cancer patients. In HIV infected individuals, we have shown MBSR to improve immune function. Thus, there is a strong rationale to evaluate MBSR as a means by which to improve cancer-related immune dysregulation and psychological distress. The purpose of this exploratory R21 project is to evaluate MBSR as a mind-body approach that will improve cancer associated immune dysregulation and psychological distress. Two hypotheses will be tested: 1) Women, undergoing treatment for breast cancer, who participate in the MBSR program will exhibit improvements in immune function compared to women, undergoing treatment for breast cancer, who do not participate in MBSR. 2) Women, undergoing treatment for breast cancer, who participate in the MBSR program will report decreased perceived stress and mood disturbance compared to women, undergoing treatment for breast cancer, who do not participate in MBSR. Women (N=96) diagnosed with early stage cancer who will be treated with breast conserving surgery, radiotherapy, and tamoxifen, will be enrolled and randomly assigned to an MBSR program or to a control group (usual care). Immune function (NKCA and cytokine production) and psychological distress (perceived stress and mood) will be assessed pre-MBSR, mid-MBSR, at the completion of MBSR, and 1 month following MBSR. Within and between group differences in outcome measures will be determined. In this manner MBSR will be evaluated as a PNI, mind body approach, to counter the negative psychological and immunological aftermath of cancer diagnosis and treatment. Such an approach has the potential to lead to not only better cancer control but also to a better quality of life for cancer.