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Dose Effects of Relaxation Practice on Immune Responses in Women Newly Diagnosed With Breast Cancer: An Exploratory Study
Purpose/Objectives: To determine the dose effects of relaxation practice on immune responses and describe the types of relaxation techniques preferred and the extent of relaxation practice over 10 months.
Design: Descriptive, prospective, repeated measures.
Setting: An interdisciplinary breast clinic at a university-affiliated comprehensive cancer center in the United States.
Sample: 49 women with newly diagnosed breast cancer and undergoing adjuvant therapy who participated in a stress management intervention.
Methods: Relaxation practice was assessed twice a month for 10 months with immune measurements (e.g., natural killer cell activity; lymphocyte proliferation; interferon [IFN]-g; interleukin [IL]-2, -4, -6, and -10) at the beginning and end of 10-month practice.
Main Research Variables: Relaxation practice (representing the concepts of stress and adherence), relaxation technique, and immune response.
Findings: After adjusting for covariates, the extent of relaxation practice significantly contributed to the variance of natural killer cell activity, lymphocyte proliferation, IL-4, and IL-10 responses in a positive direction; the higher the relaxation practice, the higher the immune responses. In comparison, IFN-g, IL-2, and IL-6 responses were not affected. The deep-breathing method was most preferred by participants, followed by progressive relaxation and imagination or visualization. The mean weekly frequency of relaxation practice was 5.29 (SD = 3.35), and the mean duration of relaxation practice was 19.16 (SD = 10.81) minutes per session.
Conclusions: Persistent relaxation practice may have positive effects on multiple immune responses in a dose-dependent manner.
Implications for Nursing: Allowing the choice of preferred techniques and emphasizing the importance of long-term adherence, a relaxation program may need to be routinely offered to women under high stress.
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References
Alhassan, S., Kim, S., Bersamin, A., King, A. C., & Gardner, C. D. (2008). Dietary adherence and weight loss success among overweight women: Results from the A to Z weight loss study. International Journal of Obesity, 32, 985-991. http://dx.doi.org/10.1038/ijo.2008.8
Andoniou, C. E., Andrews, D. M., & Degli-Esposti, M. A. (2006). Natural killer cells in viral infection: More than just killers. Immunological Reviews, 214, 239-250. http://dx.doi.org/10.1111/j.1600-065X.2006.00465.x
Antoni, M. H. (2003). Stress management effects on psychological, endocrinological, and immune functioning in men with HIV infection: Empirical support for a psychoneuroimmunological model. Stress, 6, 173-188. http://dx.doi.org/10.1080/1025389031000156727
Antoni, M. H., Lehman, J. M., Kilbourn, K. M., Boyers, A. E., Culver, J. L., Alferi, S. M., … Carver, C. S. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20(1), 20-32.
Arduino, S., Tessarolo, M., Bellino, R., Colombatto, S., Leo, L., Wierdis, T., & Lanza, A. (1996). Reduced IL-2 level concentration in patients with breast cancer as a possible risk factor for relapse. European Journal of Gynaecological Oncology, 17, 535-537.
Bachelot, T., Ray-Coquard, I., Menetrier-Caux, C., Rastkha, M., Duc, A., & Blay, J. Y. (2003). Prognostic value of serum levels of interleukin 6 and of serum and plasma levels of vascular endothelial growth factor in hormone-refractory metastatic breast cancer patients. British Journal of Cancer, 88, 1721-1726.
Becknell, B., & Caligiuri, M. A. (2008). Natural killer cells in innate immunity and cancer. Journal of Immunotherapy, 31, 685-692. http://dx.doi.org/10.1097/CJI.0b013e318182de23
Blais, Y., Gingras, S., Haagensen, D. E., Labrie, F., & Simard, J. (1996). Interleukin-4 and interleukin-13 inhibit estrogen-induced breast cancer cell proliferation and stimulate GCDFP-15 expression in human breast cancer cells. Molecular and Cellular Endocrinology, 121(1), 11-18. http://dx.doi.org/10.1016/0303-7207(96)03843-9
Bleiker, E. M., Pouwer, F., van der Ploeg, H. M., Leer, J. W., & Adèr, H. J. (2000). Psychological distress two years after diagnosis of breast cancer: Frequency and prediction. Patient Education and Counseling, 40, 209-217. http://dx.doi.org/10.1016/S0738-3991(99)00085-3
Bozcuk, H., Uslu, G., Samur, M., Yildiz, M., Özben, T., Özdogan, M., … Savas, B. (2004). Tumour necrosis factor-alpha, interleukin-6, and fasting serum insulin correlate with clinical outcome in metastatic breast cancer patients treated with chemotherapy. Cytokine, 27(2-3), 58-65. http://dx.doi.org/10.1016/j.cyto.2004.04.002
Brittenden, J., Heys, S. D., Ross, J., & Eremin, O. (1996). Natural killer cells and cancer. Cancer, 77, 1226-1243. http://dx.doi.org/10.1002/(SICI)1097-0142(19960401)77:7<1226AID-CNCR2>3…
Caligiuri, M. A. (2008). Human natural killer cells. Blood, 112, 461-469. http://dx.doi.org/10.1182/blood-2007-09-077438
Carlson, L. E., Speca, M., Faris, P., & Patel, K. D. (2007). One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, Behavior, and Immunity, 21, 1038-1049. http://dx.doi.org/10.1016/j.bbi.2007.04.002
Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2003). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65, 571-581. http://dx.doi.org/10.1097/01.PSY.0000074003.35911.41
Claesson, M., Birgander, L. S., Jansson, J. H., Lindahl, B., Burell, G., Asplund, K., & Mattsson, C. (2006). Cognitive-behavioural stress management does not improve biological cardiovascular risk indicators in women with ischaemic heart disease: A randomized-controlled trial. Journal of Internal Medicine, 260, 320-331. http://dx.doi.org/10.1111/j.1365-2796.2006.01691.x
Claesson, M., Birgander, L. S., Lindahl, B., Nasic, S., Aström, M., Asplund, K., & Burell, G. (2005). Women's hearts-Stress management for women with ischemic heart disease: Explanatory analyses of a randomized controlled trial. Journal of Cardiopulmonary Rehabilitation, 25(2), 93-102. http://dx.doi.org/10.1097/00008483-200503000-00009
Cohen, S. (1995). Psychological stress and susceptibility to upper respiratory infections. American Journal of Respiratory and Critical Care Medicine, 152(4, Pt. 2), S53-S58.
Corwin, E. J. (2000). Understanding cytokines. Part I: Physiology and mechanism of action. Biological Research for Nursing, 2(1), 30-40. http://dx.doi.org/10.1177/109980040000200104
Cruess, D. G., Antoni, M. H., McGregor, B. A., Kilbourn, K. M., Boyers, A. E., Alferi, S. M., … Kumar, M. (2000). Cognitive-behavioral stress management reduces serum cortisol by enhancing benefit finding among women being treated for early stage breast cancer. Psychosomatic Medicine, 62, 304-308.
Davis, M., Eshelman, E. R., & McKay, M. (1998). The relaxation and stress reduction workbook (4th ed.). Oakland, CA: New Harbinger
Dew, M. A., Dabbs, A. D., Myaskovsky, L., Shyu, S., Shellmer, D. A., DiMartini, A. F., … Greenhouse, J. B. (2009). Meta-analysis of medical regimen adherence outcomes in pediatric solid organ transplantation. Transplantation, 88, 736-746. http://dx.doi.org/10.1097/TP.0b013e3181b2a0e0
Diggle, P. J., Liang, K. Y., & Zeger, S. L. (1994). Analysis of longitudinal data. New York, NY: Oxford University Press.
Di Santo, J. P. (2008). Natural killer cells: Diversity in search of a niche. Nature Immunology, 9, 473-475.
Elsässer-Beile, U., von Kleist, S., & Gallati, H. (1991). Evaluation of a test system for measuring cytokine production in human whole blood cell cultures. Journal of Immunological Methods, 139, 191-195. http://dx.doi.org/10.1016/0022-1759(91)90188-L
Elsässer-Beile, U., von Kleist, S., Sauther, W., Gallati, H., & Mönting, J. S. (1993). Impaired cytokine production in whole blood cell cultures of patients with gynaecological carcinomas in different clinical stages. British Journal of Cancer, 68(1), 32-36. http://dx.doi.org/10.1038/bjc.1993.282
Epping-Jordan, J. E., Compas, B. E., Osowiecki, D. M., Oppedisano, G., Gerhardt, C., Primo, K., & Krag, D. N. (1999). Psychological adjustment in breast cancer: Processes of emotional distress. Health Psychology, 18, 315-326. http://dx.doi.org/10.1037/0278-6133.18.4.315
Erlen, J. A., & Sereika, S. M. (2006). Fidelity to a 12-week structured medication adherence intervention in patients with HIV. Nursing Research, 55(2, Suppl.), S17-S22. http://dx.doi.org/10.1097/00006199-200603001-00004
Fappa, E., Yannakoulia, M., Pitsavos, C., Skoumas, I., Valourdou, S., & Stefanadis, C. (2008). Lifestyle intervention in the management of metabolic syndrome: Could we improve adherence issues? Nutrition, 24, 286-291. http://dx.doi.org/10.1016/j.nut.2007.11.008
Forkan, R., Pumper, B., Smyth, N., Wirkkala, H., Ciol, M. A., & Shumway-Cook, A. (2006). Exercise adherence following physical therapy intervention in older adults with impaired balance. Physical Therapy, 86, 401-410.
Glaser, R. (2005). Stress-associated immune dysregulation and its importance for human health: A personal history of psychoneuroimmunology. Brain, Behavior, and Immunity, 19, 3-11. http://dx.doi.org/10.1016/j.bbi.2004.06.003
Golden-Kreutz, D. M., Thornton, L. M., Wells-Di Gregorio, S., Frierson, G. M., Jim, H. S., Carpenter, K. M., … Anderson, B. L. (2005). Traumatic stress, perceived global stress, and life events: Prospectively predicting quality of life in breast cancer patients. Health Psychology, 24, 288-296. http://dx.doi.org/10.1037/0278-6133.24.3.288
Gooch, J. L., Lee, A. V., & Yee, D. (1998). Interleukin 4 inhibits growth and induces apoptosis in human breast cancer cells. Cancer Research, 58, 4199-4205.
Härtl, K., Engel, J., Herschbach, P., Reinecker, H., Sommer, H., & Friese, K. (2010). Personality traits and psychosocial stress: Quality of life over 2 years following breast cancer diagnosis and psychological impact factors. Psycho-Oncology, 19, 160-169. http://dx.doi.org/10.1002/pon.1536
Head, J. F., Elliott, R. L., & McCoy, J. L. (1993). Evaluation of lymphocyte immunity in breast cancer patients. Breast Cancer Research and Treatment, 26(1), 77-88. http://dx.doi.org/10.1007/BF00682702
Kang, D. H., Coe, C. L., & McCarthy, D. O. (1996). Academic examinations significantly impact immune responses, but not lung function, in healthy and well-managed asthmatic adolescents. Brain, Behavior, and Immunity, 10, 164-181. http://dx.doi.org/10.1006/brbi.1996.0015
Kang, D. H., Coe, C. L., McCarthy, D. O., & Ershler, W. B. (1997). Immune responses to final exams in healthy and asthmatic adolescents. Nursing Research, 46(1), 12-19. http://dx.doi.org/10.1097/00006199-199701000-00003
Kang, D. H., Rice, M., Park, N. J., Turner-Henson, A., & Downs, C. (2010). Stress and inflammation: A biobehavioral approach for nursing research. Western Journal of Nursing Research, 32, 730-760. http://dx.doi.org/10.1177/0193945909356556
Kang, D. H., Weaver, M. T., Park, N. J., Smith, B., McArdle, T., & Carpenter, J. (2009). Significant impairment in immune recovery after cancer treatment. Nursing Research, 58(2), 105-114. http://dx.doi.org/10.1097/NNR.0b013e31818fcecd
Kang, D. H., Weaver, M. T., Park, N. J., Smith, B., McArdle, T., Landers, K., & Carpenter, J. (2011). Psychological and immune outcomes to an integrated stress management and exercise intervention. Manuscription in preparation.
Kangas, M., Henry, J. L., & Bryant, R. A. (2002). Posttraumatic stress disorder following cancer. A conceptual and empirical review. Clinical Psychology Review, 22, 499-524. http://dx.doi.org/10.1016/S0272-7358(01)00118-0
Kerr, L. R., Hundal, R., Silva, W. A., Emerman, J. T., & Weinberg, J. (2001). Effects of social housing condition on chemotherapeutic efficacy in a Shionogi carcinoma (SC115) mouse tumor model: Influences of temporal factors, tumor size, and tumor growth rate. Psychosomatic Medicine, 63, 973-984.
Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002a). Psychoneuroimmunology and psychosomatic medicine: Back to the future. Psychosomatic Medicine, 64(1), 15-28.
Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002b). Psychoneuroimmunology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology, 70, 537-547. http://dx.doi.org/10.1037/0022-006X.70.3.537
Konjevic, G., & Spuzic, I. (1993). Stage dependence of NK cell activity and its modulation by interleukin 2 in patients with breast cancer. Neoplasma, 40(2), 81-85.
Lissoni, P., Barni, S., Rovelli, F., & Tancini, G. (1991). Lower survival in metastatic cancer patients with reduced interleukin-2 blood concentrations. Preliminary report. Oncology, 48, 125-127. http://dx.doi.org/10.1159/000226910
Llanes-Fernández, L., Arango-Prado Mdel, C., Alcocer-González, J. M., Guerra-Yi, M. E., Franco-Odio, S., Camacho-Rodríguez, R., … Rodríguez-Podilla, C. (2009). Association between the expression of IL-10 and T cell activation proteins loss in early breast cancer patients. Journal of Cancer Research and Clinical Oncology, 135, 255-264. http://dx.doi.org/10.1007/s00432-008-0446-7
Luecken, L. J., & Compas, B. E. (2002). Stress, coping, and immune function in breast cancer. Annals of Behavioral Medicine, 24, 336-344. http://dx.doi.org/10.1207/S15324796ABM2404_10
McGregor, B. A., Antoni, M. H., Boyers, A., Alferi, S. M., Blomberg, B. B., & Carver, C. S. (2004). Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. Journal of Psychosomatic Research, 56, 1-8. http://dx.doi.org/10.1016/S0022-3999(03)00036-9
Palesh, O., Butler, L. D., Koopman, C., Giese-Davis, J., Carlson, R., & Spiegel, D. (2007). Stress history and breast cancer recurrence. Journal of Psychosomatic Research, 63, 233-239. http://dx.doi.org/10.1016/j.jpsychores.2007.05.012
Palmer, S. C., Kagee, A., Coyne, J. C., & DeMichele, A. (2004). Experience of trauma, distress, and post-traumatic stress disorder among breast cancer patients. Psychosomatic Medicine, 66, 258-264. http://dx.doi.org/10.1097/01.psy.0000116755.71033.10
Peters, C., Lötzerich, H., Niemeier, B., Schüle, K., & Uhlenbruck, G. (1994). Influence of a moderate exercise training on natural killer cytotoxicity and personality traits in cancer patients. Anticancer Research, 14(3A), 1033-1036.
Pross, H. F., & Lotzová, E. (1993). Role of natural killer cells in cancer. Natural Immunity, 12(4-5), 279-292.
Reiche, E. M., Nunes, S. O., & Morimoto, H. K. (2004). Stress, depression, the immune system, and cancer. Lancet Oncology, 5, 617-625. http://dx.doi.org/10.1016/S1470-2045(04)01597-9
Robinson, F. P., Mathews, H. L., & Witek-Janusek, L. (2003). Psycho-endocrine-immune response to mindfulness-based stress reduction in individuals infected with the human immunodeficiency virus: A quasi-experimental study. Journal of Alternative and Complementary Medicine, 9, 683-694. http://dx.doi.org/10.1089/107555303322524535
Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130, 601-630. http://dx.doi.org/10.1037/0033-2909.130.4.601
Sephton, S. E., Sapolsky, R. M., Kraemer, H. C., & Spiegel, D. (2000). Diurnal cortisol rhythm as a predictor of breast cancer survival. Journal of the National Cancer Institute, 92, 994-1000. http://dx.doi.org/10.1093/jnci/92.12.994
Sinkovics, J. G., & Horvath, J. C. (2005). Human natural killer cells: A comprehensive review. International Journal of Oncology, 27(1), 5-47.
Su, F., Ouyang, N., Zhu, P., Ouyang, N., Jia, W., Gong, C., … Song, E. (2005). Psychological stress induces chemoresistance in breast cancer by upregulating mdr1. Biochemical and Biophysical Research Communications, 329, 888-897. http://dx.doi.org/10.1016/j.bbrc.2005.02.056
Tabachnick, B. G., & Fidell, L. S. (2000). Using multivariate statistics (4th ed.). Boston, MA: Allyn and Bacon.
Thornton, L. M., Andersen, B. L., Crespin, T. R., & Carson, W. E. (2007). Individual trajectories in stress covary with immunity during recovery from cancer diagnosis and treatments. Brain, Behavior, and Immunity, 21, 185-194. http://dx.doi.org/10.1016/j.bbi.2006.06.007
Toi, M., Bicknell, R., & Harris, A. L. (1992). Inhibition of colon and breast carcinoma cell growth by interleukin-4. Cancer Research, 52, 275-279.
Vicari, A. P., & Trinchieri, G. (2004). Interleukin-10 in viral diseases and cancer: Exiting the labyrinth? Immunological Reviews, 202, 223-236. http://dx.doi.org/10.1111/j.0105-2896.2004.00216.x
Vivier, E., Tomasello, E., Baratin, M., Walzer, T., & Ugolini, S. (2008). Functions of natural killer cells. Nature Immunology, 9, 503-510. http://dx.doi.org/10.1038/ni1582
Von Ah, D., Kang, D. H., & Carpenter, J. S. (2007). Stress, optimism, and social support: Impact on immune responses in breast cancer. Research in Nursing and Health, 30(1), 72-83. http://dx.doi.org/10.1002/nur.20164
Webber, K. H., Tate, D. F., Ward, D. S., & Bowling, J. M. (2010). Motivation and its relationship to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight loss intervention. Journal of Nutrition Education and Behavior, 42, 161-167. http://dx.doi.org/10.1016/j.jneb.2009.03.001
Whiteside, T. L., & Herberman, R. B. (1995). The role of natural killer cells in immune surveillance of cancer. Current Opinion in Immunology, 7, 704-710. http://dx.doi.org/10.1016/0952-7915(95)80080-8
Witek-Janusek, L., Albuquerque, K., Chroniak, K. R., Chroniak, C., Durazo-Arvizu, R., & Mathews, H. L. (2008). Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, Behavior, and Immunity, 22, 969-981. http://dx.doi.org/10.1016/j.bbi.2008.01.012
Yang, H. C., Brothers, B. M., & Andersen, B. L. (2008). Stress and quality of life in breast cancer recurrence: moderation or mediation of coping? Annals of Behavioral Medicine, 35, 188-197.