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.

我们小组的事先工作（Spiegel等，1989）提供了证据表明 转移性乳腺癌患者参与组治疗 延长生存时间的平均为18个月。 这种差异是 临床和统计学意义。 这种干预是 提议作为一种模型系统，以检查对社会心理的影响 绝症的进展。 转移的预后和过程 乳腺癌和艾滋病毒/艾滋病相当相似。 两者几乎均匀 致命，但有一个分阶段和可预测的课程，通常是从2 - 3年开始 诊断乳房转移或死亡的辅助。 该研究有四个具体的目标。 我们建议检查：（1） 心理社会治疗对转移性患者的医学作用 癌。 我们预测患者的生存时间会增加 随机分组支持。 （2）长期生存的医疗基础 在癌症患者中。 我们将检验以下假设 焦虑，抑郁和疼痛减轻，参与组的患者 治疗增加运动，改善饮食并进行更多 从而增强生存的剧烈药物治疗。 另外，我们 将研究延迟疾病进展的其他生理机制， 包括压力激素皮质醇和体内免疫测量，延迟 高敏性。 治疗效果也可以通过减少来介导 皮质醇或增强的免疫功能。 这些措施的变化将是 与艾滋病毒/艾滋病人群有关。 （3）小组的社会心理影响 治疗。 我们计划研究参与小组对 使用特定焦虑和抑郁，疼痛的特定措施的情绪干扰， 和家庭环境。 我们预测焦虑，抑郁和疼痛减轻 在治疗组中。 （4）个性的预测能力 变量，尤其是对情绪，情绪和家庭环境的压制， 在确定生存时间。 该研究的设计涉及招募明确的样本 100例转移性乳腺癌患者。 这些患者将与 确保医疗状况的可比性并随机分配到一年 小组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学护理，并作为其他模型 进行性绝症的患者，例如艾滋病。 这些因素 被认为确定生存时间增加的确定性将提供 设计新治疗计划的理由。 这些研究会 确定是否应将社会心理支持添加到标准中 治疗方案是由于经过证明的医学和心理 益处。