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Cancer Therapy: Clinical

Biobehavioral, Immune, and Health Benefits following Recurrence for Psychological Intervention Participants

Barbara L. Andersen, Lisa M. Thornton, Charles L. Shapiro, William B. Farrar, Bethany L. Mundy, Hae-Chung Yang and William E. Carson III
Barbara L. Andersen
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Lisa M. Thornton
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Charles L. Shapiro
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William B. Farrar
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Bethany L. Mundy
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Hae-Chung Yang
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William E. Carson III
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DOI: 10.1158/1078-0432.CCR-10-0278 Published June 2010
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This article has a correction. Please see:

  • Correction: Biobehavioral, Immune, and Health Benefits following Recurrence for Psychological Intervention Participants - August 31, 2010

Abstract

Purpose: A clinical trial was designed to test the hypothesis that a psychological intervention could reduce the risk of cancer recurrence. Newly diagnosed regional breast cancer patients (n = 227) were randomized to the intervention-with-assessment or the assessment-only arm. The intervention had positive psychological, social, immune, and health benefits, and after a median of 11 years the intervention arm was found to have reduced the risk of recurrence (hazard ratio, 0.55; P = 0.034). In follow-up, we hypothesized that the intervention arm might also show longer survival after recurrence. If observed, we then would examine potential biobehavioral mechanisms.

Experimental Design: All patients were followed; 62 recurred. Survival analyses included all 62. Upon recurrence diagnosis, those available for further biobehavioral study were accrued (n = 41, 23 intervention and 18 assessment). For those 41, psychological, social, adherence, health, and immune (natural killer cell cytotoxicity, T-cell proliferation) data were collected at recurrence diagnosis and 4, 8, and 12 months later.

Results: Intent-to-treat analysis revealed reduced risk of death following recurrence for the intervention arm (hazard ratio, 0.41; P = 0.014). Mixed-effects follow-up analyses with biobehavioral data showed that all patients responded with significant psychological distress at recurrence diagnosis, but thereafter only the intervention arm improved (P values < 0.023). Immune indices were significantly higher for the intervention arm at 12 months (P values < 0.017).

Conclusions: Hazards analyses augment previous findings in showing improved survival for the intervention arm after recurrence. Follow-up analyses showing biobehavioral advantages for the intervention arm contribute to our understanding of how improved survival was achieved. Clin Cancer Res; 16(12); 3270–8. ©2010 AACR.

Footnotes

  • Note: Trial registration: clinicaltrials.gov Identifier: SIBCP0350.

  • Received February 1, 2010.
  • Revision received April 5, 2010.
  • Accepted April 18, 2010.
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Clinical Cancer Research: 16 (12)
June 2010
Volume 16, Issue 12
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Biobehavioral, Immune, and Health Benefits following Recurrence for Psychological Intervention Participants
Barbara L. Andersen, Lisa M. Thornton, Charles L. Shapiro, William B. Farrar, Bethany L. Mundy, Hae-Chung Yang and William E. Carson III
Clin Cancer Res June 15 2010 (16) (12) 3270-3278; DOI: 10.1158/1078-0432.CCR-10-0278

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Biobehavioral, Immune, and Health Benefits following Recurrence for Psychological Intervention Participants
Barbara L. Andersen, Lisa M. Thornton, Charles L. Shapiro, William B. Farrar, Bethany L. Mundy, Hae-Chung Yang and William E. Carson III
Clin Cancer Res June 15 2010 (16) (12) 3270-3278; DOI: 10.1158/1078-0432.CCR-10-0278
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