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Stress reduction may help cancer patients

Kaplan is a Times staff writer.

Psychological counseling, muscle relaxation and other strategies for reducing stress in breast cancer patients can cut their risk of death from the disease by more than half, according to a study published online Monday in the journal Cancer.

The study also found that psychological interventions reduced the risk that tumors would come back by 45%. Even when tumors returned, patients who received the counseling had six more cancer-free months compared with those who did not.

The researchers, led by psychology professor Barbara Andersen of Ohio State University, focused on stress reduction as a primary reason why patients appeared to benefit from group counseling sessions.

But other scientists said there still wasn’t enough evidence to support that idea.

“You have to be a little cautious in interpreting these results,” said Dr. Smita Bhatia, director of the Center for Cancer Survivorship at City of Hope in Duarte, who wasn’t involved in the study. “There is obviously some effect which is persisting long-term; it just needs to be teased out more which part of the program is doing it.”

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The notion that psychological treatment can prolong the lives of cancer patients “has been controversial for many years,” said Michael Stefanek, director of the American Cancer Society’s Behavioral Research Center, who also wasn’t involved in the study.

Two recent studies that focused on women with early-stage breast cancer found no survival advantage, and he cautioned patients against expecting counseling to prolong their lives.

In the latest study, researchers recruited 227 women who had lumpectomies or modified radical mastectomies and tracked them for a median of 11 years.

The women were divided into two groups, one of which met with a pair of psychologists 26 times during the first year after surgery. Both groups received standard medical follow-up care.

The counseling sessions were aimed at helping patients “reduce distress and improve quality of life,” the study said.

The psychologists taught patients a progressive muscle relaxation technique to reduce physical stress. They discussed strategies for combating the fatigue brought on by chemotherapy, helped them be more assertive with doctors and nurses so that they could act on their medical concerns instead of stewing over them, and encouraged them to devote their energy to fun activities while finding friends and family who could help with chores like washing dishes, Andersen said.

Patients were also counseled about the importance of daily exercise, cutting fat from their diets and quitting smoking.

Over the course of the study, 19 of the 114 patients who received counseling died of breast cancer compared with 25 of the 113 patients who didn’t. Overall, the psychological intervention reduced the risk of death from breast cancer by 56%.

Andersen said it wasn’t clear exactly how the counseling was helping patients. One theory is that stress activates hormones such as catecholamines and glucocorticoids, and prolonged exposure to them can be taxing to the immune system, she said.

The researchers measured the levels of two chemicals in the patients’ blood that correspond with the activity of T cells, which are important for fighting infections.

“You want that T cell response to be strong, and it was stronger in the intervention group,” Andersen said.

But Paige McDonald, chief of the Basic and Biobehavioral Research Branch at the National Cancer Institute in Bethesda, Md., said the study didn’t have enough data to show convincingly that the immune system was to blame.

Experts said the improvements could have been the result of the healthy lifestyle changes that the counseled patients were encouraged to adopt. The types of follow-up care they got could have made a difference as well.

“You always want to know what the active ingredients are in the intervention,” said McDonald, whose institute was the primary funder of the study.

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karen.kaplan@latimes.com


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