Intervention program boosts health, reduces symptoms in breast cancer patients

Psychological interventions for cancer patients do more than just ease emotional distress - they directly improve health, new research suggests.

A study of 227 breast cancer patients found that those who participated in a psychological intervention program were rated as having better health by a research nurse a full year after the program started.

One particularly important result was that patients who exercised received a higher dose of their chemotherapy drug, possibly improving their overall treatment.

'Patients who participated in the program showed fewer and less severe symptoms, and functioned better than those who didn't take part,' said Barbara Andersen, co-author of the study and professor of psychology at Ohio State University.

'These were independent health evaluations by nurses who didn't know which patients were participating in the psychological intervention, so we know the effects were real and significant.'

The results were reported in recent issues of the Journal of Consulting and Clinical Psychology and Brain, Behaviour, and Immunity.

Participants in the study were breast cancer patients at the Ohio State University Medical Centre. All had been diagnosed with Stage II or Stage III breast cancer, had received mastectomies, and underwent chemotherapy during the course of the study.

Half the patients received the intervention, in which they met weekly in groups of 8 to 12 with a clinical psychologist. These sessions, which lasted four months, included training on relaxation and coping with stress, strategies to improve health behaviours, information on the value of exercise, communication skills for dealing with physicians, and other related issues. After four months of these weekly meetings, participants met monthly for another eight months.

At the beginning of the study, and again at 4 and 12 months, trained research nurses evaluated the participants' health and physical functioning using a standard 100-point scale used in cancer patients.

Results showed that after 12 months, those who participated in the intervention increased their functioning score by 7 percent, compared to only 1 percent in the group that didn't participate.

Disease symptoms and signs and treatment side effects increased by 29 percent in those who didn't participate in the intervention, but only 14 percent in those who did take part.

'These changes were big enough to be clinically important,' Andersen said. 'When patients have better health, they have less emotional distress, better quality of life, and are more likely to follow through on their treatment.'

In the Journal of Consulting and Clinical Psychology paper, the researchers studied exactly which parts of the intervention were most helpful in improving the health and functioning of patients.

Results showed that the use of relaxation techniques was most effective in controlling stress. Learning relaxation, as well as techniques to communicate with doctors, strategies for increasing physical activity and how to deal with stress all were related with fewer symptoms and signs associated with disease.

In addition, participants who exercised as part of the intervention received a significantly higher dose of taxol - their chemotherapy drug - than did women who exercised less or not at all.

'The actual dosage differences were substantial,' Andersen said. Those who exercised regularly received 99 percent dose intensity, compared to 88 percent for those patients who were less active.

While all the women were prescribed the same relative levels of taxol, some women received less than the prescribed amount because of side effects related to taxol use, such as high fever, infections, and loss of sensation in hands and feet. Women with severe symptoms would get a reduced dose of taxol or had longer intervals between taxol treatments.

'Women who exercised regularly tolerated the taxol treatment better, had less severe symptoms and received an increased dose intensity compared to others,' Andersen explained.

Researchers also tested blood samples from the participants to determine if the intervention had any effect on measures of immune function. Results showed that women in the intervention did indeed show signs of improved immune function compared to those who did not participate. However, these improvements were not linked to better health.

'We still don't know the clinical relevance of the improvements in immune function,' she said. 'We will continue to look at the participants to see whether these immune changes have any impact on the progression of the disease.'

Other authors of the studies, all at Ohio State at the time of the research, included William Farrar, Deanna Golden-Kreutz, Charles Emery, Ronald Glaser, Timothy Crespin, William Carson III and Rebecca Shelby.

The studies were supported by grants from the American Cancer Society; Longaberger Company-American Cancer Society Grant for Breast Cancer Research; U.S. Army Medical Research Institute; National Institute of Mental Health; National Cancer Institute; and the Walther Cancer Institute.