Stress a Significant Determinant of Breast Cancer Outcomes

Psychological distress is a major side effect of cancer and its treatment—both for the patient and family members. This tumultuous state of mind can trigger inflammatory reactions in the body, which previous research showed, can be lowered by an intervention called cognitive-behavioral stress management (CBSM). Now, the same group of researchers at the University of Miami Miller School of Medicine have found that providing these stress management skills early in breast cancer treatment can improve survival and expand the period to disease recurrence.

Two-hundred and forty women were randomized either to a 10-week, group-based CBSM intervention—where they learned techniques like muscle relaxation and deep breathing—or to a 1-day psychoeducational training. These women, recruited 2 to 10 weeks post their surgery for non-metastatic stage 0 to 3b breast cancer, were recruited during the period between 1998 and 2005. Following a baseline assessment at recruitment, study participants were assessed 6, 12 months, and 5 years post-enrollment. They were then contacted in 2013, which was a median of 11 years post-recruitment (8 to 15-year range) to participate in a long-term follow-up study to assess medical status, including chart reviews to confirm recurrence and to gather diagnostic- and treatment-related information. Group differences in all-cause mortality, breast cancer-specific mortality, and disease-free interval were analyzed.

The analysis found that women assigned to the CBSM intervention had longer survival, compared with the control group who received psychoeducational counseling. Women in the CBSM group had a reduced the risk of all-cause mortality (hazard ratio (HR), 0.21; 95 % confidence interval (CI), 0.05-0.93; P = .040). Among those who had invasive disease, breast cancer-specific mortality and disease-free intervals were significantly improved. CBSM participation was associated with lower odds of breast cancer mortality (HR, 0.08; 95% CI, 0.01-0.49, P = .006) and greater disease-free survival (HR, 0.24; 95% CI, 0.07-0.82, P = .011).

The authors claim that early CBSM can have lasting effects on disease progression of women diagnosed with breast cancer. Being a group-based, manualized, feasible intervention, CBSM can be readily implemented in clinical oncology settings to improve quality of life and reduce depressive symptoms in these patients, they write.

Further research would of course require measuring clinical endpoints—such as changes in neuroendocrine, immune, inflammatory, and other tumor-promoting processes—as primary outcomes of this intervention. These studies are ongoing, where the authors are monitoring inflammatory gene expression during and after stress management and its association with disease outcomes over a period of 15 years.

Senior study author Michael H. Antoni, PhD, said, “Our work is unique in that more than one-third of the participants were of an ethnic minority, compared to mostly non-Hispanic White women studied in prior research, which means that the findings may be generalizable to the larger population of breast cancer patients. Our overarching goal is to improve survivorship and health outcomes by reaching patients early in the cancer treatment process and providing them the tools they need to manage current and future challenges on their journey.”