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社会困扰，破坏社会关系，焦虑，睡眠不佳，不确定性和对癌症复发的恐惧。这种痛苦可能会超出治疗范围，并对健康相关的生活质量（HRQOL）产生不利影响。我们需要采取干预措施，遏制负面情绪的浪潮及其生理后果。心理神经免疫学（PNI）已经确定，心理社会痛苦损害免疫功能。我们已经表明，诊断为乳腺癌的妇女有显着的心理困扰，伴随着失调的自然杀伤细胞活性（NKCA）和细胞因子的生产。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增加的肿瘤起始、原发性肿瘤生长和肿瘤转移相关。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，有望用于管理与癌症相关的痛苦。我们发现，正念减压疗法可以减少神经内分泌应激激活，提高乳腺癌患者在癌症诊断和治疗的脆弱时期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疗法对心理社会困扰、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到为期8周的MBSR干预或对照组。将在MBSR前、中、完成时和后评估免疫功能（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。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，提高HRQOL。主要研究变量之间的关系将通过中介模型检验进行探讨。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。了解心理-内分泌-免疫反应的轨迹和性质，以一种有前途的身心方法，如正念减压疗法，使用严格的设计，在一个明确的癌症人群，将显着有助于PNI的科学和综合癌症护理。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，即基于正念的减压，在乳腺癌女性人群中进行，并与一组匹配的无癌症女性进行比较。

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.