HOUSTONStress is an immediate reaction to cancer that generally
becomes more intensified during the course of the disease. Barbara L.
Andersen, PhD, Department of Psychology, Ohio State University,
Columbus, and her colleagues are conducting a study to examine the
effects of stress on the immune system in cancer patients.
Acute stress sets in at the very moment the disease is
diagnosed, and the experience of stress becomes more chronic as the
patient undergoes treatment and recovery, adjusts to lifestyle
changes, and copes with social and relationship issues, Dr.
Andersen said. We are examining how high levels of stress might
affect an ovarian cancer patients immune system, using breast
cancer patients as a model, and whether interventions to reduce
stress can improve quality of life.
Dr. Andersen discussed the study at the First Annual International
Conference for Ovarian Cancer, co-sponsored by The University of
Texas M.D. Anderson Cancer Center and Memorial Sloan-Kettering Cancer Center.
A number of studies over the years have shown that stress
downregulates immunity. The relationship between stress and
immunity has been documented in spouses of Alzheimers patients,
individuals going through bereavement, and even in medical students
taking medical exams, Dr. Andersen said.
Emotional distress brought on by a disturbance of a persons
psychological, physiological, and social well-being can create or
compound an unhealthy condition, she added.
The current study is exploring the possibility that biobehavioral
interventions may not only reduce stress and enhance the
patients quality of life but also have other important biologic benefits.
Women with stage II or III breast cancer are being recruited for the
study because of their difficult prognosis, the high rate of disease
recurrence, and the aggressiveness of adjuvant therapy. We felt
this group provided a relative model for a study of quality of life
in ovarian cancer patients, Dr. Andersen said. Patients are
randomized to assessment only or assessment and intervention.
The multicomponent biobehavioral intervention model is designed to
reduce stress, improve quality of life, increase positive health
behaviors, and improve compliance with medical treatment. Assessment
and intervention are begun when the patient is about to begin
chemotherapy, a time when, as Dr. Andersen explained, anxiety
and feelings of inadequacy are particularly high.
One of the components of the intervention model is progressive muscle
relaxation, in which patients are taught skills to help them release
physical tensions and emotional distress.
Another component of the program involves cognitive coping
strategies, in which patients are taught to cope with their situation
by redirecting their energies, restructuring their expectations, and
Patients are also taught how to mobilize their avenues of support,
which can be realized through friends, family members, and other
The model also attempts to increase positive health behaviors, Dr.
Andersen said. We recommend a low-fat, high-fiber diet and a
regular program of moderate exercise, such as a walking plan,
she said. The goal is to encourage a healthy lifestyle by
decreasing negative mood, reducing fatigue, and increasing the
patients energy level.
To improve compliance with treatment, patients are encouraged to
learn more about their disease condition and their treatment. We
give them information about the disease and train them how to
communicate better with doctors and nurses so that they get better
mileage out of appointments and consultations, she said.
Other, more focused components of the intervention are used to
address disease-specific problems that may affect the patients
overall quality of life, such as sexual issues, concerns about body
image, and hormonal changes.
The disease-specific concern we encounter most often is
sexuality, she said. In another study, Dr. Andersen and her
colleagues found that sexual self-concept was an independent,
predictive variable for sexual morbidity in women with gynecologic
How women perceive of themselves sexually has a huge bearing on
their sexual well-being, Dr. Andersen said. Some of these
women have sexual difficulties or a negative sexual self-image before
cancer. This group seems to be at higher risk for sexual problems
after disease occurrence.
Reduced Natural Killer Cell Lysis
The researchers plan to accrue 235 patients for the study. Dr.
Andersen reported that a relationship between stress and
downregulation of immunity has been seen in the first group of patients.
After only 40 patients, we began to detect trends that showed
some relationship between high levels of stress and low levels of
immunity, she said. We found that high levels of stress
lower natural killer cell lysis and have an adverse effect on some
other cellular functions.
Using a gamma-interferon assay, the researchers found that some
natural killer cells remained in lysis after the addition of
gamma-interferon and that this process was affected by the
patients level of stress. We knew that high levels of
stress correlated with downregulation of immunity, Dr. Andersen
Future studies will focus on determining which immunologic mechanism
accounts for the lower levels of natural killer cell lysis seen with