Cancer Control Research5R01CA114718-05
Mccain, Nancy L.
PNI-BASED STRESS MANAGEMENT IN EARLY BREAST CANCER
DESCRIPTION (provided by applicant): A growing body of research with persons having chronic and potentially fatal illnesses such as cancer indicates that a variety of complementary "mind-body" interventions, including strategies for stress management, can not only mitigate psychological distress and improve coping skills, but also can enhance immune function through neuroendocrine-immune system modulation. Psychoneuroimmunology (PNI), the theoretical framework within which this proposal is grounded, is concerned with the mechanisms of multidimensional psychobehavioral-neuroendocrine-immune system interactions, including the influence of psychosocial, spiritual, and behavioral factors on health outcomes. To date, the majority of psycho behavioral studies in persons with cancer have not examined PNI-based biological indicators. While PNI-based research among persons with cancer is clearly indicated, the multiplicity and complexity of diseases and treatments render such research difficult, particularly in relation to the selection and measurement of appropriate biological markers. The customary immunological measures of lymphocyte proliferative function and natural killer cell cytotoxicity need to be augmented by investigations that may elucidate underlying mechanisms of immunosuppression, using measures such as patterns of cellular cytokine production. Additionally, the timing of such measures in relation to disease and treatment parameters must be carefully controlled and evaluated. This proposal directly addresses these issues by precisely controlling sample inclusion criteria, including medical treatment protocols, and by measuring multiple psycho behavioral, neuroendocrine, immunological, and health status variables over time. The proposed study is a randomized clinical trial involving 240 women receiving adjuvant chemotherapy for early breast cancer. The study is designed to test two psycho behavioral interventions, which we view holistically as mind-body-spirit interventions, and to evaluate multiple biological markers that may shed light on cancer- and treatment-specific mechanisms. The overarching hypothesis is that both tai chi training and spiritual growth group interventions will reduce perceived stress, enhance coping patterns, normalize levels of stress-related neuroendocrine mediators, attenuate immunosuppression, and enhance the adaptational outcomes of psychosocial functioning, quality of life, and physical health.