Psychological intervention and health outcomes among women treated for breast cancer: A review of stress pathways and biological mediators

Breast cancer is a common cancer among American women. The diagnosis, treatment, and the challenges of survivorship all have potential to increase women's levels of distress to levels that might influence their adaptation and possibly the course of their disease. Psychological distress can influence tumor progression via many different pathways (e.g., genetic changes, immune surveillance, pro-angiogenic processes). Psychological intervention has been shown to facilitate psychological adaptation to breast cancer. But can psychological intervention influence cancer relevant biological outcomes among breast cancer survivors? We review the literature on how psychological intervention can influence cancer relevant biological outcomes among breast cancer patients. We limited the present review to randomized controlled trials reported in the past 6 years that tested the effects of psychological intervention on biological dependent variables among patients with non-metastatic breast cancer. There are data to suggest that psychological intervention can influence neuroendocrine (e.g., cortisol) and immune function indicators, especially lymphocyte proliferation and TH1 cytokine production. Future psychological intervention studies should also focus on more newly discovered stress-tumor pathways (e.g., neuroendocrine processes promoting tumor growth and metastasis) and follow larger cohorts of the more vulnerable patients over longer periods to evaluate the biobehavioral mechanisms and lasting effects of these interventions on health and quality of life. (C) 2008 Elsevier Inc. All rights reserved.