EFFECTS OF PSYCHOLOGICAL TREATMENT ON CANCER SURVIVAL

心理治疗对癌症生存的影响

• 批准号: 3387037
• 负责人: David Spiegel
• 金额: $ 23.81万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1990
• 资助国家: 美国
• 起止时间: 1990-08-01 至 1995-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3387037
• 关键词: anxiety; behavioral medicine; body physical activity; breast neoplasms; cancer rehabilitation mental health service; cortisol; delayed hypersensitivity; depression; diet; family structure /dynamics; group therapy; human morbidity; human mortality; human population study; human subject; hypnosis; interview; metastasis; neoplasm /cancer classification /staging; neoplasm /cancer therapy; pain; personality tests; psychological stressor; questionnaires; repression; social adjustment; terminal patient care; therapy compliance

Prior work by our group (Spiegel, et al, 1989) has provided evidence that participation of metastatic breast cancer patients in group treatment prolongs survival time am average of eighteen months. This difference is clinically as well as statistically significant. This intervention is proposed as a model system for examining psychosocial effects on the progression of a terminal illness. The prognosis and course of metastatic breast cancer and HIV/AIDS are rather similar. Both are almost uniformly fatal, but have a staged and predictable course, usually 2-3 years from diagnosis of breast metastases or AIDS to death. There are four specific aims of the study. We propose to examine: (1) The medical effects of psychosocial treatment for patients with metastatic carcinoma. We predict enhanced survival time among the patients randomized to group support. (2) The medical basis of prolonged survival in cancer patients. We will test the hypothesis that as a result of decreased anxiety, depression and pain, patients who participate in group treatment increase exercise, improve their diet, and undertake more vigorous medical treatment, thereby, enhancing survival. In addition, we will study other physiological mechanisms of delayed disease progression, including the stress hormone cortisol and in vivo immune measure, delayed hypersensitivity. Treatment effects could also be mediated via reduced cortisol or enhanced immune function. Changes in these measures would be relevant to an HIV/AIDS population. (3) psychosocial effects of group treatment. We plan to study the effects of participation in the group on mood disturbance using specific measures of anxiety and depression, pain, and family environment. We predict reduced anxiety, depression, and pain in the treatment group. (4) The predictive power of personality variables, especially repression of emotion, mood, and family environment, in determining survival time. The design of the study involves the recruitment of a well-defined sample of 100 metastatic breast cancer patients. These patients will be matched to assure comparability of medical condition and randomized to a year of group treatment or to routine oncological care. This study will provide an empirical basis for fundamentally altering the structure of standard oncological care for metastatic breast cancer, and, as a model for other patients with progressive terminal illnesses, such as AIDS. Those factors that are found to be determinative of increased survival time will provide a rationale for designing new treatment programs. These studies will determine whether psychosocial support should be added to the standard treatment regimen because of proven medical as well as psychological benefit.

我们小组之前的工作（Spiegel 等人，1989）已经提供了证据： 转移性乳腺癌患者参与团体治疗的情况 平均存活时间延长十八个月。 这个区别是 具有临床意义和统计学意义。 这种干预是 提出作为一个模型系统来检查社会心理影响 绝症的进展。 转移的预后和病程 乳腺癌和艾滋病毒/艾滋病非常相似。 两者几乎一致 致命，但有一个阶段性且可预测的病程，通常为 2-3 年 诊断为乳腺转移或艾滋病致死。 该研究有四个具体目标。 我们建议审查：（1） 心理社会治疗对转移性患者的医疗效果 癌。 我们预测患者的生存时间会延长 随机分配到小组支持。 （二）延长生存的医学基础 在癌症患者中。 我们将检验以下假设： 参与团体的患者焦虑、抑郁和疼痛减少 治疗增加锻炼，改善饮食，并进行更多 积极的医疗治疗，从而提高生存率。 此外，我们 将研究延迟疾病进展的其他生理机制， 包括应激激素皮质醇和体内免疫措施，延迟 超敏反应。 治疗效果也可以通过减少 皮质醇或增强免疫功能。 这些措施的改变将是 与艾滋病毒/艾滋病人群相关。 (3)群体心理社会效应 治疗。 我们计划研究参加该小组的影响 使用特定措施测量焦虑和抑郁、疼痛、 和家庭环境。 我们预计焦虑、抑郁和疼痛会减少 在治疗组中。 (4)性格的预测力 变量，尤其是情绪、情绪和家庭环境的压抑， 在确定生存时间时。 研究的设计涉及招募明确的样本 100 名转移性乳腺癌患者。 这些患者将被匹配 以确保医疗状况的可比性并随机分配到一年 团体治疗或常规肿瘤护理。 这项研究将提供 从根本上改变标准结构的经验基础 转移性乳腺癌的肿瘤护理，并作为其他癌症的典范 患有进行性绝症的患者，例如艾滋病。 那些因素 被发现对延长生存时间具有决定性作用 设计新治疗方案的基本原理。 这些研究将 确定是否应将心理社会支持添加到标准中 治疗方案因经证实的医学和心理 益处。