Psychosocial factors and immune parameters during cancer chemotherapy

Cancer patients are exposed to side-effects during chemotherapy, such as nausea and vomiting elicited by drug administration, or in anticipation of treatment. Chemotherapy also results in bone marrow suppression. Psychosocial factors including stress relate to immune parameters in humans and learned immune responses to neutral stimuli have been shown in animals. The aim of this research was to examine anticipatory immune reactions, and the relations between psychosocial factors and immune parameters, in patients treated with cyclic combination chemotherapy for breast or ovarian cancer.

To assess immune changes in anticipation of cancer treatment, blood samples were collected in 73 patients' homes two days before chemotherapy and compared to samples obtained at the hospital prior to chemotherapy course 3, 4, or 5. The numbers of white blood cells increased significantly between blood sampling at home and at the hospital before infusion. No changes were observed in the female hospital staff serving as controls. Patients were characterized by increased numbers of granulocytes, and decreased numbers of lymphocytes. In percentages, increases were observed in granulocytes, while percentages of lymphocytes and monocytes were lower at the hospital. State anxiety levels did not predict changes in white blood cell counts. When a saline infusion mimicked a course of chemotherapy after completion of ordinary treatment in a sample of fully informed patients, elevated leukocyte counts were observed only in patients with high levels of trait anxiety. The observed effects are consistent with an interpretation in terms of associative learning and anticipatory stress.

In 38 breast cancer patients, high social support was associated with significantly higher levels of white blood cells after completed chemotherapy, consonant with the proposition that physical recovery is promoted by social support. Relaxation training has previously been shown to affect health aspects and immune variables in healthy subjects and in cancer patients before chemotherapy. Therefore, 22 ovarian cancer patients were allocated to a relaxation or a control group. The intervention group had significantly higher lymphocyte counts, and a tendency to higher white blood cell counts as compared to the controls. The observed relations are consistent with a concept of neuroendocrine - immune interaction, as reflected in changes in various immune parameters during or after chemotherapy for neoplastic disease.