The effect of psychosocial interventions for patients with cancer on psychoneuroimmunologic outcomes: A systematic review (#96)
Background - Cancer patients are prone to experience acute and chronic stress as a result of their diagnosis. This stress alone can lead to lower quality of life and, when coupled with cancer treatments, can lead to significant immune system impairment resulting in increased susceptibility to infection and secondary cancers. The negative impact of acute and chronic stress on the neuroendocrine and immune systems has been established and has given rise to the scientific framework of psychoneuroimmunology (PNI). Psychosocial interventions have been developed and tested to reduce stress and impact PNI based outcome measures, eg cortisol levels. The last systematic reviews of these data were published in 1998, thus we aimed to update these reviews and report on interventions published since 1998.
Methods– The PubMED/Medline, PsychINFO, CINHAL, Communication Mass Media Complete, Google Scholar and CANCERLIT online databases were searched using combinations of keywords obtained from previous reviews of psychosocial interventions. Studies were included if they, a) were published between 1998-2011, b) were conducted in cancer patients and c) reported psychological assessments and neuro-immune outcome measures.
Results– Of 14,700 titles identified, 20 cancer-specific, psycho-social interventions that used neuro-immune outcomes were include in the review. Three major types of interventions emerged, 1) cognitive-behavioral, 2) yoga and massage therapies, and 3) mindfulness-based stress reduction. Interventions durations ranged between 80 minutes and 11 days. There was little standardization of outcome measures across studies.Psychosocial interventions demonstrated success in altering functional measures of the immune system, such as cytokines.
Conclusions–Research examining dose-response and resource allocation is needed to guide future interventions. A collaborative effort to create a standardized panel of psychosocial instruments and biochemical measures for researchers to use would greatly enhance the ability to compare findings across studies, collectively evaluate this body of research, and examine the applications for clinical practice.