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Cancer and PNIChronic stress and depression may have detrimental affects on our hormone and nervous systems and through them may adversely affect our immune responses. For the technically minded, more precisely stress and depression may increase activity in the hypothalamic-pituitary-adrenal and sympathetic nervous system adrenal medullary axes and can negatively influence both cellular and molecular immune responses. This process may be implicated in development and progression of cancer (, ). These influences are moderated by the psychosocial and genetic milieu of any given individual. Generally, perceived stress and depression tend to decrease immune system functions such as the activity of cytotoxic T cells and natural killer cells that seem to be important in keeping tumor development and growth in check. Decreased stress is often correlated with increased natural killer cell activity. For example, a group of 113 women afflicted with breast cancer were assessed at diagnosis or surgery and at several times up to 18 months later (). Women who had the highest levels of perceived initial stress showed lowest levels of immune responses, and those who showed the most rapid decrease in subjective stress had the best immune system recovery. Evidence from randomized controlled trials is compelling that quality of life in cancer patients can be significantly improved by psychological interventions especially cognitive behavioral therapy, psychoeducational therapy, and supportive-expressive group therapy (). However, the evidence for improvement of survival by these psychological interventions is contradictory. Nevertheless, as with other chronic diseases, quality of life is essential to those afflicted. So, it would seem that substantial effort should be made to provide evidence-based psychological interventions for these patients. One of the most important influences on quality of life and perhaps survivability is the feeling of helplessness and hopelessness. Psychotherapy has been shown to be a significant way to provide help and hope (, ). It is also important to realize the detrimental impact on a child or on a spouse of a chronic illness in a loved one. The negative affect can be felt not only in the family but also in the person who is ill and coping with the disease. Of course, the loss of a loved one or a parent to a terminal illness can have a drastic effect on the family. These too are areas where a family-based strategy of psychological interventions can be very powerful (). There are few provisions for providing this support (), and it is seldom covered by insurance. Breast cancer is the number one cause of female cancer death. Once in their life, one out of eleven women will get the diagnosis of breast cancer. Psychological resilience may make the difference in accepting the idea of living with a potentially life threatening illness. Some evidence exist that psychosocial coping strategies and psychotherapy may prolong survival. At the very least, these interventions may decrease emotional distress, and enhance psychosexual functioning (). One review published in 2002 states that there is strong evidence that suggests that coping and psychosocial interventions can improve the psychological prognosis for breast cancer patients, even though the impact on the cancer itself is speculative (). One of the most promising stress management techniques, CBSM, has shown great potential in stress reduction in women with breast cancer () and men with prostate cancer (). Very importantly, in women with early stage breast cancer, a 10-week CBSM intervention resulted in decreased stress and improved immune response (). |
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