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Psychological, Behavioral, and Immune Changes After a Psychological Intervention: A Clinical Trial

From the Department of Psychology, Department of Surgery, Department of Molecular Virology, Immunology, and Medical Genetics, and Division of Medical Oncology, Department of Internal Medicine, College of Medicine, and Comprehensive Cancer Center, The Ohio State University; and Primetrics, Inc, Columbus, OH

Address reprint requests to Barbara L. Andersen, PhD, Department of Psychology, The Ohio State University, 1885 Neil Ave, Columbus, OH 43210-1222; e-mail: Andersen.1{at}osu.edu

PURPOSE: This randomized clinical trial tests the hypothesis that a psychological intervention can reduce emotional distress, improve health behaviors and dose-intensity, and enhance immune responses.

PATIENTS AND METHODS: We studied 227 women who were surgically treated for regional breast cancer. Before adjuvant therapy, women completed interviews and questionnaires assessing emotional distress, social adjustment, and health behaviors. A 60-mL blood sample was drawn for immune assays. Patients were randomly assigned to either the intervention group or assessment only group. The intervention was conducted in small patient groups, with one session per week for 4 months. The sessions included strategies to reduce stress, improve mood, alter health behaviors, and maintain adherence to cancer treatment and care. Reassessment occurred after completion of the intervention.

RESULTS: As predicted, patients receiving the intervention showed significant lowering of anxiety, improvements in perceived social support, improved dietary habits, and reduction in smoking (all P < .05). Analyses of adjuvant chemotherapy dose-intensity revealed significantly more variability (ie, more dispersion in the dose-intensity values) for the assessment arm (P < .05). Immune responses for the intervention patients paralleled their psychological and behavioral improvements. T-cell proliferation in response to phytohemagglutinin and concanavalin A remained stable or increased for the Intervention patients, whereas both responses declined for Assessment patients; this effect was replicated across three concentrations for each assay (all P < .01).

CONCLUSION: These data show a convergence of significant psychological, health behavior, and biologic effects after a psychological intervention for cancer patients.

Supported by American Cancer Society grant No. PBR-89, the Longaberger Company-American Cancer Society Grant for Breast Cancer Research grant No. PBR-89A, the US Army Medical Research Acquisition Activity grant Nos. DAMD17-94-J-4165, DAMD17-96-1-6294, and DAMD17-97-1-7062, National Institute of Mental Health grant No. RO1MH51487, National Cancer Institute grant No. RO1CA92704, P30 CA16058, and General Clinical Research Center grant No. MO1-RR0034.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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