What’s New in Psychology?

Stress Awareness and Coping techniques Can Help Women Navigate the Challenges of Breast Cancer         

Jim Windell

           Except for skin cancer, breast cancer is the most common cancer in women in the United States. Each year, according to the American Cancer Society, about 297,790 new cases of invasive breast cancer will be diagnosed in women. And nearly 43,700 women will die from breast cancer. Clearly, most women diagnosed with breast cancer will survive.

          But for those survivors there are many emotional challenges, including anxiety, depression and distress. That is not only a fact, says Michael Antoni, Ph.D., a lead investigator in a cancer control research program, but he goes on to say that some work has suggested that chronic distress can affect neuroendocrine signaling, producing stress hormones that could promote poorer cancer outcomes.

           Researchers, like Antoni, professor of psychology, and the first author of a paper published recently in the Annual Review of Psychology on how stress reduction approaches can improve outcomes for cancer patients, have found that stress-activated hormones, such as cortisol and norepinephrine, have been shown to impair the body’s immune response to cancer, increase inflammatory signaling and potentially hasten metastasis.

           Antoni is leading research at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine showing how stress reduction approaches, such as cognitive behavioral therapy (CBT) and relaxation training, can improve outcomes for cancer patients. The Cancer Control Research Program study team, which includes Patricia Moreno, Ph.D., Sylvester’s lead of evidence-based survivorship supportive care and assistant professor in the Department of Public Health Sciences, and Frank Penedo, Ph.D., associate director, Cancer Survivorship and Translational Behavioral Sciences, and director of Cancer Survivorship and Supportive Care, also showed that psychological interventions reduce stress and promote emotional well-being, which may ultimately prolong survival.

           “People who receive these interventions have increased antiviral immunity signaling and decreased inflammatory signaling,” said Dr. Antoni. “It’s complicated, because chemotherapy, surgery, and radiation all increase inflammation on their own; however, people who received stress management showed smaller increases in inflammation than those not receiving a stress management intervention.”

           Much of the stress management research conducted at Sylvester has focused on breast and prostate cancer patients, and the long-term results have been encouraging. Using the state of Florida’s tumor registry, researchers have shown that stress management enhances survival in breast cancer patients. Many of these findings involve CBT, which focuses on actively changing thoughts and behavior, along with common relaxation techniques, such as deep breathing or meditation.

            “We teach patients to discern between controllable and uncontrollable stressors,” said Dr. Moreno. “For controllable stressors, CBT techniques help them become aware of how they respond to the stressors and develop adaptive coping strategies. For uncontrollable stressors, relaxation techniques and social support help them manage their emotional responses.”

            Sylvester clinicians are working to better integrate stress management into routine care. Currently, patients are referred based on their symptoms and care needs through My Wellness Check, which is part of a national trend to make these approaches more accessible.

           “It’s been well documented that these techniques promote adjustment for breast and other cancer patients,” said Dr. Penedo. “They are now being incorporated into large, comprehensive NCI-funded trials.”

           Early stress management studies were mostly conducted with face-to-face groups and the Sylvester center has tested a five-week version that is more convenient and did show efficacy, changing psychological and immunologic outcomes. The next step, according to Antoni, is telehealth. The group is currently studying whether group Zoom interventions could also deliver improved outcomes.

           “Telehealth may be the best way to integrate these approaches into oncology care without patients having to schedule extra time, travel, etc.,” said Dr. Antoni. “We’re going to be titrating the interventions into smaller doses and studying different ways to deliver them to see if that still moves the dial.”

           To read the original article, find it with this reference:

Antoni, M.H., Moreno, P.I., & Penedo, F.J. (2023). Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors. Annual Review of Psychology 74:1, 423-455.