Abstract
Lekander, Mats. Psychosocial Factors and Immune Parameters During CancerChemotherapy. Department of Clinical Neuroscience, Department of Oncology/Pathology,Radiumhemmet, Karolinska Institute and Hospital, Stockholm, Sweden.Cancer patients are exposed to side-effects during chemotherapy, such as nausea and vomitingelicited by drug administration, or in anticipation of treatment. Chemotherapy also results inbone marrow suppression. Psychosocial factors including stress relate to immune parameters inhumans and learned immune responses to neutral stimuli have been shown in animals. The aimof this research was to examine anticipatory immune reactions, and the relations betweenpsychosocial factors and immune parameters, in patients treated with cyclic combinationchemotherapy for breast or ovarian cancer. To assess immune changes in anticipation of cancer treatment, blood samples werecollected in 73 patients' homes two days before chemotherapy and compared to samplesobtained at the hospital prior to chemotherapy course 3, 4, or 5. The numbers of white bloodcells increased significantly between blood sampling at home and at the hospital beforeinfusion. No changes were observed in the female hospital staff serving as controls. Patientswere characterized by increased numbers of granulocytes, and decreased numbers oflymphocytes. In percentages, increases were observed in granulocytes, while percentages oflymphocytes and monocytes were lower at the hospital. State anxiety levels did not predictchanges in white blood cell counts. When a saline infusion mimicked a course of chemotherapyafter completion of ordinary treatment in a sample of fully informed patients, elevated leukocytecounts were observed only in patients with high levels of trait anxiety. The observed effects areconsistent with an interpretation in terms of associative learning and anticipatory stress. In 38 breast cancer patients, high social support was associated with significantly higherlevels of white blood cells after completed chemotherapy, consonant with the proposition thatphysical recovery is promoted by social support. Relaxation training has previously beenshown to affect health aspects and immune variables in healthy subjects and in cancer patientsbefore chemotherapy. Therefore, 22 ovarian cancer patients were allocated to a relaxation or acontrol group. The intervention group had significantly higher lymphocyte counts, and atendency to higher white blood cell counts as compared to the controls. The observed relationsare consistent with a concept of neuroendocrine - immune interaction, as reflected in changes invarious immune parameters during or after chemotherapy for neoplastic disease.Key words: chemotherapy, side-effects, anticipatory symptom, conditioning, anxiety,psychoneuroimmunology, relaxation, social support.ISBN 91-628-1874-0
