Stress management, leukocyte transcriptional changes and breast cancer recurrence in a randomized trial: An exploratory analysis.
Cognitive behavioral stress management (CBSM) is an empirically-validated group-based psychosocial intervention. CBSM is related to decreased self-reported indicators of psychological adversity during breast cancer treatment and greater disease-free survival (DFS) vs. a control condition. This study examined relationships between CBSM, DFS, and a potential biobehavioral pathway linking these variables in breast cancer patients through a gene expression composite representing the leukocyte conserved transcriptional response to adversity (CTRA).



Women with stage 0-IIIb breast cancer completed questionnaires and provided blood samples post-surgery. Participants were randomized to 10-week group-based CBSM or a psychoeducation control group and followed at 6 months, 12 months, and median 11 years. In total, 51 participants provided blood data for longitudinal analyses (CBSM n=28; Control n=23). Mixed model analyses examined CBSM effects on 6-12 month changes in CTRA expression (53 indicator genes representing pro-inflammatory, anti-viral and antibody production signaling). Cox regression models assessed the relationship between 6 and 12 month changes in CTRA expression and 11-year DFS.



Patients randomized to CBSM showed attenuated 6-12 month change in CTRA gene expression, whereas patients randomized to control showed increased CTRA expression (p=0.014). Average DFS was 5.92 years (SD=3.90). Greater 6-12 month CTRA increases predicted shorter 11-year DFS controlling for covariates (p=0.007).



CBSM attenuated CTRA gene expression during the initial year of breast cancer treatment. In turn, greater increases in CTRA gene expression predicted shorter long-term DFS. These findings identify a biobehavioral oncology pathway to examine in future work.
Dept. of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33124, USA; Dept. of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, USA. Electronic address: mantoni@miami.edu.
Michael H
MH
Antoni
Dept. of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33124, USA.
Laura C
LC
Bouchard
Center for Psychiatric Oncology and Behavioral Sciences, Dept. of Psychiatry, Massachusetts General Hospital Cancer Center, 55 Fruit St., Boston, MA 02114, USA.
Jamie M
JM
Jacobs
Dept. of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Miami, FL 33136, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, USA.
Suzanne C
SC
Lechner
Dept. of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33124, USA.
Devika R
DR
Jutagir
Dept. of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33124, USA.
Lisa M
LM
Gudenkauf
Dept. of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33124, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, USA.
Charles S
CS
Carver
Dept. of Psychological and Brain Sciences, University of Iowa, E 11 Seashore Hall, Iowa City, IA 52242, USA.
Susan
S
Lutgendorf
Dept. of Medicine, Division of Hematology-Oncology, University of California - Los Angeles School of Medicine, 11-934 Factor Bldg, Los Angeles, CA 90095, USA; Dept. of Psychiatry and Biobehavioral Sciences, University of California - Los Angeles School of Medicine, 11-934 Factor Bldg, Los Angeles, CA 90095, USA; Norman Cousins Center, University of California - Los Angeles, 11-934 Factor Bldg, Los Angeles, CA 90095, USA.
Steven W
SW
Cole
Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, USA; Dept. of Medicine, University of Miami Miller School of Medicine, 1600 NW 10th Ave., RMSB 3146A, Miami, FL 33136, USA.
Marc
M
Lippman
Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, USA; Dept. of Microbiology and Immunology, University of Miami Miller School of Medicine, 1600 NW 10th Ave., RMSB 3146A, Miami, FL 33136, USA.
Bonnie B
BB
Blomberg
D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007962:Leukocytes / Q000378:metabolism*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000523:psychology*; D009367:Neoplasm Staging; D013315:Stress, Psychological / Q000628:therapy*; D014158:Transcription, Genetic / Q000502:physiology*
Breast cancer recurrence; Cognitive behavioral stress management; Conserved transcriptional response to adversity; Disease-free survival; Leukocyte gene expression
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