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A Pilot Randomized Trial Assessing the Effect of a Psychoeducational Intervention on Psychoneuroimmunological Parameters Among Patients With Nonmetastatic Breast Cancer

Stanzer, Stefanie, PhD; Andritsch, Elisabeth, MSc; Zloklikovits, Silke, MSc; Ladinek, Verena, MSc; Farkas, Clemens, MSc; Augustin, Thomas, PhD; Obermayer-Pietsch, Barbara, MD; Samonigg, Hellmut, MD; Bauernhofer, Thomas, MD

doi: 10.1097/PSY.0000000000000656

Objective The aim of this study was to determine a potential benefit of the specific psychoeducational intervention “Learning to Live with Cancer” (LTLWC) for patients with operated nonmetastatic breast cancer, with respect to psychological variables and endocrine and immune parameters.

Methods Fifty-two postmenopausal women with operated stage I to III breast cancer were randomized to either a breast cancer intervention group (BCIG, n = 30) who immediately began participating in the LTLWC intervention program or to a breast cancer control group (BCCG, n = 22). Matched healthy women were asked to participate as a noncancer comparison group (n = 26). All participants were evaluated at three different time points (t1–t3) using a set of standardized questionnaires and blood samples were taken to analyze immune cell subsets and stress hormone levels.

Results A significant reduction in trait anxiety/State Trait Anxiety Inventory score was observed in the BCIG (t1: median = 35.0 [interquartile range = 28.0–38.0] versus t3: median = 26.0 [interquartile range = 18.5–37.0], p = .0001) compared with the BCCG (t1: median = 41.0 [interquartile range =32.75–49.0]; t3: median = 38.5 [interquartile range = 30.75–46.5], p = .01524; p interaction = .001). In parallel, a significant rise of serotonin levels (t1: median = 66.5 ng/ml [interquartile range = 11.50–106.00] versus t3: median = 80.5 ng/ml [interquartile range =59.00–118.00], p = .00008) as well as a significant reduction of the elevated number of Treg cells at baseline (t1: median = 4.45% [interquartile range = 4.00–5.33] versus t3: median = 2.80% [interquartile range = 2.68–3.13], p < .00001) were observed in the BCIG versus no change in the BCCG. A significant statistical association between reduced trait anxiety and decreased Treg cell number could be demonstrated in the BCIG (r = .62, p < .01).

Conclusions The observed results of this study provide preliminary support for the efficacy of the LTLWC program in significantly improving psychoneuroimmunological parameters in patients with nonmetastatic breast cancer.

From the Division of Oncology (Stanzer, Andritsch, Zloklikovits, Ladinek, Farkas, Samonigg, Bauernhofer), Department of Internal Medicine, Medical University of Graz, Graz, Austria; Institute of Medical Technologies and Health Management (Augustin), Joanneum Research Graz, Graz, Austria; and Division of Endocrinology and Metabolism (Obermayer-Pietsch), Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Address correspondence to Thomas Bauernhofer, MD, Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria. E-mail:

Supplemental Content

Stanzer and Andritsch contributed equally to this work.

Received for publication July 12, 2017; revision received September 27, 2018.

Copyright © 2019 by American Psychosomatic Society
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