Mindfulness Based Stress Reduction for Psycho-Immune Dysregulation in Cancer

描述（由申请人提供）：乳腺癌是美国妇女癌症死亡的第二大原因，每年有超过39,000名妇女死于乳腺癌。乳腺癌的诊断和治疗导致心理社会困扰、社会关系中断、焦虑、睡眠不良、不确定和对癌症复发的恐惧。这种痛苦可以延伸到治疗之外，并对健康相关生活质量（HRQOL）产生不利影响。需要采取干预措施，遏制负面情绪及其生理后遗症。心理神经免疫学（PNI）已经确定，心理社会困扰损害免疫功能。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损害与肿瘤起始、原发性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。正念减压（MBSR）是一种身心干预方法，有望治疗与癌症相关的痛苦。本研究表明，在乳腺癌诊断和治疗的易感期，正念减压可降低神经内分泌应激激活，改善乳腺癌患者的免疫功能和生活质量。采用随机对照设计，本研究将评估正念减压对心理社会困扰、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为8周的正念减压干预组和对照组。评估免疫功能（NKCA和细胞因子），神经内分泌活性（唾液皮质醇和血浆儿茶酚胺），心理社会反应和HRQL将在mbsr之前，中期，完成时和之后获得。假设将检验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，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讨。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显著。了解心理-内分泌-免疫对一种有前途的身心疗法（如正念减压疗法）的反应轨迹和本质，在明确定义的癌症人群中使用严格的设计，将对PNI科学和综合癌症治疗做出重大贡献。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，缺乏对这些方法进行严格的科学设计的实证分析。这项拟议的研究将评估一种这样的方法，即以正念为基础的减压，在乳腺癌女性人群中进行，并与一组匹配的非癌症女性进行比较。

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.