Peri-operative individually tailored psychological intervention in breast cancer patients improves psychological indices and molecular biomarkers of metastasis in excised tumors.

Perioperative stress and inflammatory signaling can invigorate pro-metastatic molecular processes in patients' tumors, potentially worsening long-term survival. Yet, it is unknown whether pre-operative psychotherapeutic interventions can attenuate such effects. Herein, three weeks before surgery, forty women diagnosed with stage I-III invasive ductal/lobular breast carcinoma were randomized to a 6-week one-on-one psychological intervention (6 meetings with a medical psychologist and bi-weekly phone calls) versus standard nursing-staff-attention. The intervention protocol was individually tailored based on evaluation of patients' emotional, cognitive, physiological, and behavioral stress response-patterns, and also included psychoeducation regarding medical treatments and recruitment of social support. Resected primary tumors were subjected to whole-genome RNA sequencing and bioinformatic analyses, assessing a priori hypothesized cancer-relevant molecular signatures. Self-report questionnaires (BSI-18, Hope-18, MSPSS, and a stress-scale) were collected three (T1) and one (T2) week before surgery, a day before (T3) and after (T4) surgery, and three weeks (T5) and 3-months (T6) following surgery. The intervention reduced distress (GSI), depression, and somatization scores (BSI-18: p < 0.01, p < 0.05, p < 0.05; T5 vs. T1). Additionally, tumors from treated patients (vs. controls) showed: (i) decreased activity of transcription control pathways involved in adrenergic and glucocorticoid signaling (CREB, GR) (p < 0.001), pro-inflammatory signaling (NFkB) (p < 0.01), and pro-malignant signaling (ETS1, STAT and GATA families) (p < 0.001, p < 0.01, p < 0.005); (ii) increased M1 macrophage polarization (p < 0.05), and CD4+ T cell activity (p < 0.01); and an unexpected increase in epithelial-to-mesenchymal-transition (EMT) signature (p < 0.005). This is the first randomized controlled trial to show beneficial effects of a psychological perioperative intervention on tumor pro-metastatic molecular biomarkers.

The Effect of Pre-operative Psychological Interventions on Psychological, Physiological, and Immunological Indices in Oncology Patients: A Scoping Review.

Introduction: The stressful pre-operative period exerts a profound impact on psychological, physiological and immunological outcomes. Oncological surgeries, in particular, elicit significantly higher stress responses than most other surgeries. Managing these responses through psychological interventions may improve long-term outcomes. The purpose of the current research was to review studies that have explored pre-operative psychological interventions in cancer patients in order to map the types of current interventions and provide an initial assessment of whether these interventions improved psychological, physiological, and/or immunological indices as well as long-term cancer outcomes. Methods: A systematic literature search for studies that included pre-operative psychological interventions in oncology patients was conducted, using the databases PubMed and Web of Science. Inclusion criteria included studies pertaining to oncological surgery in adults, study designs that included a clearly defined pre-operative psychological intervention and control group. Results: We found 44 studies, each using one of the following interventions: psychoeducation, cognitive interventions, relaxation techniques, integrated approaches. All the studies reported improved immediate post-operative psychological, physiological, and/or immunological outcomes. Only a few studies addressed long-term cancer outcomes, and only one reported improved survival. Conclusions: Research on pre-operative interventions with cancer patients is missing systematic methods. Studies provide varying results, which makes it difficult to compare them and reach reliable conclusions. There is considerable heterogeneity in the literature regarding the specific intervention used, the timing of intervention, the characteristics of the patients studied and the outcome measures. In order to improve research in this field, including the measurement of long-term outcomes, we suggest some steps that should be taken in further research.

Individual stress response patterns: Preliminary findings and possible implications.

BACKGROUND: Research on stress occupied a central position during the 20th century. As it became evident that stress responses affect a wide range of negative outcomes, various stress management techniques were developed in attempt to reduce the damages. However, the existing interventions are applied for a range of different stress responses, sometimes unsuccessfully. OBJECTIVE: The aim of this study was to examine whether there are specific clusters of stress responses representing interpersonal variation. In other words, do people have dominant clusters reflecting the different aspects of the known stress responses (physiological, emotional, behavioral, and cognitive)? METHODS: The researchers derived a measure of stress responses based on previous scales and used it in two studies in order to examine the hypothesis that stress responses can be grouped into dominant patterns according to the type of response. RESULTS: The results of Study 1 revealed four distinctive response categories: psychological (emotional and cognitive), physiological gastro, physiological muscular, and behavioral. The results of Study 2 revealed five distinctive response categories: emotional, cognitive, physiological gastro, physiological muscular, and behavioral. CONCLUSION: By taking into consideration each person's stress response profile while planning stress management interventions and then offering them a tailored intervention that reduces the intensity of these responses, it might be possible to prevent further complications resulting in a disease (physical or mental).

Illness Narratives Through the Eyes of Parents of Children With End-Stage Renal Disease.

The purpose of the present study was to learn about the experiences of parents of children diagnosed with renal failure at different stages of the disease in order to get closer to the process they carry out as caregivers. Semi-structured interviews were conducted with 12 parents and analyzed using interpretative phenomenological analysis method. Data analysis revealed two axes: spatial and temporal. The present article focuses on the temporal axis comprised of diagnosis, coping, and remission. These phases are discussed according to Frank's illness narratives of chaos, quest, and restitution, representing stages in the sequence people undergo while coping with a disease. However, in the case of incurable diseases, such as end-stage renal disease, when there is no restitution and regression in the medical condition is followed by chaos, we suggest a new narrative structure, the Sisyphean Narrative, to symbolize the recurring nature of struggling with the disease.

"Sparks that became a little light over time": A qualitative investigation of musicking as a means of coping in adults with PTSD.

This article investigates the experience of musicking (the performance of musical activity) among people coping with post-traumatic stress disorder (PTSD). Using qualitative research methods, we conducted semi-structured in-depth interviews with 10 male participants in a music project for people coping with PTSD induced by war and terrorism. The project consists of individual music lessons once a week and a musical enrichment group that meets once a month. Group meetings include workshops and lectures by music professionals and artists, during which participants are exposed to diverse musical content. Following an interpretive phenomenological content analysis, we were able to identify two central themes arising from the interviews: musicking as an intra-subjective experience and musicking as mediator of inter-subjective relationships. A further analysis revealed three superordinate themes: musicking as a secure place, musicking as a dialectic experience, and musicking as a means for identity reconstruction (bridging between past, present, and future). From this we concluded that for our interviewees musicking is a secure place for their wounded self, which allows the reconstruction of a coherent personal narrative while conducting a dialectic encounter with the trauma and its symptoms via nonverbal language. Consequently, we recommend musicking as a therapeutic tool for people coping with war-induced PTSD from both intrapersonal and interpersonal perspectives.

The Experiences of Parents of Children Undergoing Surgery for Congenital Heart Defects: A Holistic Model of Care.

The present article is based on a qualitative study focusing on parents of children born with congenital heart defects (CHDs) and hospitalized in the children's intensive care unit post-surgery. Our aim was to explore parents' subjective experiences as primary caregivers. Ten semi-structured interviews were conducted and analyzed using interpretative phenomenological analysis according to the instructions of Smith and Osborn. Our analysis yielded eight categories which were grouped into four themes and two main superordinate themes: (1) dialectical tension between positive and negative experiences; and (2) fluctuations between the inner and the outer world. The two superordinate themes intersect such that parents report positive as well as negative experiences within both their inner and outer worlds. Based on our analysis, we found that the experience of having a child undergo surgery for a CHD can be regarded as a chaotic period characterized by uncertainty, confusion, and helplessness. It is therefore no surprise that many parents display negative psychological outcomes which extend beyond the period of hospitalization and may also affect their future parenting and coping. However, within this chaotic and stressful situation, parents had occasional supportive experiences which decreased their emotional distress and isolation and helped them throughout this difficult period. We thus conclude that the support offered to parents during the hospitalization period should be increased by trying to minimize their negative experiences and strengthen their inner coping abilities. These changes cannot be implemented without also addressing the needs of the medical staff in their role as caregivers. Therefore, we propose a holistic model of care which supports both parents as caregivers of children undergoing surgery for CHD and the medical staff involved in their care.

Perioperative biobehavioral interventions to prevent cancer recurrence through combined inhibition of ß-adrenergic and cyclooxygenase 2 signaling.

Evidence suggests that excess perioperative activation of the sympathetic nervous system and the consequent release of catecholamines (ie, epinephrine and norepinephrine) in the context of cancer surgery and inflammation may significantly facilitate prometastatic processes. This review first presents biomedical processes that make the perioperative timeframe pivotal in determining long-term cancer outcomes nonproportionally to its short duration (days to weeks). Then, it analyzes the various mechanisms via which the excess release of catecholamines can facilitate the progression of cancer metastases in this context by directly affecting the malignant tissues and by regulating, via indirect pathways, immunological and other mechanisms that affect metastatic progression in the tumor microenvironment and systemically. In addition, this review addresses the need to supplement ß-adrenoreceptor blockade with cyclooxygenase 2 inhibition, especially during surgery and shortly thereafter, because similar mechanisms are simultaneously activated by surgery-induced inflammatory responses. Importantly, this review presents translational and clinical evidence showing that perioperative ß-adrenoreceptor blockade and cyclooxygenase 2 inhibition can reduce the prometastatic process and cancer recurrence, and the clinical feasibility and safety of this approach are demonstrated as well. Lastly, alternative psychophysiological approaches to the use of ß-adrenergic blockers are presented because a substantial portion of patients have medical contraindications to this pharmacological treatment. The adaptation of existing psychophysiological interventions to the perioperative period and principles for constructing new approaches are discussed and exemplified. Overall, pharmacobehavioral interventions, separately or in combination, could transform the perioperative timeframe from being a prominent facilitator of metastatic progression to an opportunity for arresting or eliminating residual disease, potentially improving long-term survival rates in cancer patients.

The effect of acupuncture therapy on pain perception and coping strategies: a preliminary report.

The objective of the present study was to examine the effect of acupuncture on the perception of pain and coping strategies, thus focusing on the psychological aspects of pain. The study was conducted in two complementary and alternative medicine clinics of public hospitals. Forty-one patients scheduled for routine acupuncture therapy because of chronic musculoskeletal pain were recruited for the study to receive eight acupuncture treatments. Twenty-four patients completed the treatment schedule and filled two self-reported questionnaires before and after therapy: (1) Illness Perception Questionnaire-Revised (IPQ-R); and (2) Coping Strategies questionnaire (Brief COPE). A significant improvement was found in the following measures related to pain perception: timeline (chronic versus acute), treatment control, and personal control. Additionally, significant improvement was displayed in three measures related to coping strategies: positive reframing, religion, and venting. The results indicate that acupuncture therapy might be efficient in changing patient's pain perception from chronic to acute and in enhancing their sense of personal and treatment control over their pain. In addition, acupuncture therapy partially improved coping strategies. The present study provides further validation for acupuncture therapy in pain and highlights its possible role in affecting the psychological aspects of pain.