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Ability to Cope with Stress may Play Role in Cancer Progression

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By Joel B. Finkelstein • • December 2, 2002

Health Behavior News Service

A review of the mind-body connection in breast cancer patients reveals that the stress of the diagnosis may make the disease worse, but also suggests that good coping style may aid treatment and outcome.

"Interventions focused on improving women's ability to cope with breast cancer diagnosis, treatment and recovery may have beneficial effects on emotional adjustment and potentially on physiological processes," say Linda J. Luecken, Ph.D., of Arizona State University and Bruce E. Compas, Ph.D., currently of Vanderbilt University and formerly with the University of Vermont.

The authors draw from several studies and lines of evidence to show that stress, mental state and coping style all work together to affect biological factors such as immune function and hormone levels, both of which play roles in cancer progression. Their article appears in the December issue of the Annals of Behavioral Medicine.

While stress, distress, depression, anxiety and post-traumatic stress disorder have all been linked to reduced immune function and altered hormone balance, healthy coping has been shown to both improve these factors and could potentially affect cancer outcomes, they say.

Symptoms of anxiety and depression affect 30 percent to 40 percent of women at first diagnosis of breast cancer. PTSD is estimated to affect 3 percent to 10 percent of these women. Virtually all breast cancer patients experience some level of stress and distress, often due to intrusive thoughts that can follow them for months to years after their diagnosis.

The researchers define coping as "conscious, volitional efforts to regulate one's cognitive, behavioral, emotional and physiological responses to stress and stressful aspects of the environment."

They describe active coping as taking a direct and rational approach to dealing with a problem, while passive coping involves indirect approaches such as avoidance, withdrawal and wishful thinking.

Studies have shown that people who adopt active coping strategies have better immune function and lower cortisol levels, and just the opposite for people who use passive coping strategies.

"There is clear evidence that interventions can have positive effects on emotional adjustment, functional adjustment and treatment of disease-related symptoms (e.g. pain, nausea, coughing)," the authors say.

A more limited body of research suggests that such interventions have a measurable effect on immune function and cortisol levels. Likewise, there is some preliminary evidence that psychotherapeutic approaches can reduce recurrence and improve survival times. Survival benefits of psychological treatment have not been clearly demonstrated, however, suggesting the need for further research, Luecken and Compas remark.

Both active coping and effective psychological treatment can also aid cancer treatment by ensuring that women more closely follow their cancer treatment regimens, they say.

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