title: Distress reduction from a psychological intervention contributes to improved health for cancer patients.
abstract: OBJECTIVE
  Psychological interventions are efficacious in reducing emotional distress for cancer patients. However, it is not clear whether psychological improvements are, in turn, related to improved health. A clinical trial tests whether a psychological intervention for cancer patients can do so, and also tests two routes to achieve better health: (a) reducing patients' Emotional Distress, and/or (b) enhancing their functional immunity.
  
  
  METHODS
  Post-surgery, 227 breast cancer patients were randomized to intervention or assessment only Study Arms. Conducted in small groups, intervention sessions were offered weekly for 4 months and followed by monthly sessions for 8 months. Measures included psychological (distress), biological (immune), and health outcomes (performance status and evaluations of patient's symptomatology, including toxicity from cancer treatment, lab values) collected at baseline, 4 months, and 12 months.
  
  
  RESULTS
  A path model revealed that intervention participation directly improved health (p<.05) at 12 months. These effects remained when statistically controlling for baseline levels of distress, immunity, and health as well as sociodemographic, disease, and cancer treatment variables. Regarding the mechanisms for achieving better health, support was found for an indirect effect of distress reduction. That is, by specifically lowering intervention patients' distress at 4 months, their health was improved at 12 months (p<.05). Although the intervention simultaneously improved patients' T-cell blastogenesis in response to phytohemagglutinin (PHA), the latter increases were unrelated to improved health.
  
  
  CONCLUSIONS
  A convergence of biobehavioral effects and health improvements were observed. Behavioral change, rather than immunity change, was influential in achieving lower levels of symptomatology and higher functional status. Distress reduction is highlighted as an important mechanism by which health can be improved.
authors.affiliation: Department of Psychology and Comprehensive Cancer Center, 1835 Neil Avenue, The Ohio State University, Columbus, OH 43210-1222, USA. Andersen.l@osu.edu
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Andersen
authors.forename: William B
authors.initials: WB
authors.lastname: Farrar
authors.forename: Deanna
authors.initials: D
authors.lastname: Golden-Kreutz
authors.forename: Charles F
authors.initials: CF
authors.lastname: Emery
authors.forename: Ronald
authors.initials: R
authors.lastname: Glaser
authors.forename: Timothy
authors.initials: T
authors.lastname: Crespin
authors.forename: William E
authors.initials: WE
authors.lastname: Carson
mesh_terms: D000342:Affective Symptoms; D001943:Breast Neoplasms / Q000276:immunology* / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D007107:Immune System / Q000502:physiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000523:psychology; D011598:Psychoneuroimmunology; D011615:Psychotherapy, Group; D011788:Quality of Life; D013315:Stress, Psychological / Q000276:immunology* / Q000628:therapy*; D016896:Treatment Outcome