Emily D. Dolan

The effect of pre-transplant distress on immune reconstitution among adult autologous hematopoietic cell transplantation patients

Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2-14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.

Optimism and depression: a new look at social support as a mediator among women at risk for breast cancer

Breast cancer risk is a chronic stressor associated with depression. Optimism is associated with lower levels of depression among breast cancer survivors. However, to our knowledge, no studies have explored the relationship between optimism and depression among women at risk for breast cancer. We hypothesized that women at risk for breast cancer who have higher levels of optimism would report lower levels of depression and that social support would mediate this relationship.

Cognitive Behavioral Stress Management for Healthy Women at Risk for Breast Cancer: a Novel Application of a Proven Intervention

BackgroundWomen at risk for breast cancer report elevated psychological distress, which has been adversely associated with cancer-relevant behaviors and biology.PurposeThe present study sought to examine the effects of a 10-week cognitive behavioral stress management (CBSM) group intervention on distress among women with a family history of breast cancer.MethodsParticipants were randomly assigned to CBSM (N = 82) or a wait-list comparison group (N = 76). Baseline to postintervention effects of CBSM on depressive symptoms and perceived stress were examined using hierarchical regression.ResultsCBSM participants reported significantly lower posttreatment depressive symptoms (β = −0.17, p < 0.05) and perceived stress (β = −0.23, p < 0.05) than wait-list comparison participants. Additionally, greater relaxation practice predicted lower distress.ConclusionsGroup-based CBSM intervention is feasible and can reduce psychological distress among women with a family history of breast cancer. The present findings represent an encouraging avenue for the future application of CBSM. (Clinicaltrials.gov number NCT00121160)

Perceived breast cancer risk and breast cancer worry among women with a family history of breast cancer: a new perspective on coping as a mediator

Dear Editor,IntroductionWomen with a family history of breast cancer (FH+) haveelevated cancer worry [1]. Objective breast cancer riskcontributes to reports of cancer worry among FH+women; however, perceived breast cancer risk, which isoften overestimated, is a stronger predictor of breastcancer worry [2]. Lazarus and Folkman’s paradigm is ahelpful model to understand how individuals appraisetheir vulnerability to breast cancer (perceived risk) [3].The original framework focused on three major con-structs: cognitive appraisal, coping, and daily stress.Primary cognitive appraisal of experienced and antici-pated stressors may result in specific types of coping pro-cesses, which in turn may influence emotional reactions tostressors [3]. With regard to breast cancer, overestimatedcognitive appraisal or perceived risk of breast cancermay result in specific types of coping, which areassociated with unnecessarily high levels of cancerworry. To date, no research has tested the theoreticalmediation framework posed by Lazarus and Folkmanin the context of cognitive appraisal of breast cancerrisk, coping, and breast cancer worry [3]. The currentstudy addressed this gap and tested the hypothesis thatincreased perceived breast cancer risk was associatedwith breast cancer worry because of decreased engagedor increased disengaged coping.MethodsProcedures

Perceived breast cancer risk and breast cancer worry among women with a family history of breast cancer

Dear Editor,IntroductionWomen with a family history of breast cancer (FH+) haveelevated cancer worry [1]. Objective breast cancer riskcontributes to reports of cancer worry among FH+women; however, perceived breast cancer risk, which isoften overestimated, is a stronger predictor of breastcancer worry [2]. Lazarus and Folkman’s paradigm is ahelpful model to understand how individuals appraisetheir vulnerability to breast cancer (perceived risk) [3].The original framework focused on three major con-structs: cognitive appraisal, coping, and daily stress.Primary cognitive appraisal of experienced and antici-pated stressors may result in specific types of coping pro-cesses, which in turn may influence emotional reactions tostressors [3]. With regard to breast cancer, overestimatedcognitive appraisal or perceived risk of breast cancermay result in specific types of coping, which areassociated with unnecessarily high levels of cancerworry. To date, no research has tested the theoreticalmediation framework posed by Lazarus and Folkmanin the context of cognitive appraisal of breast cancerrisk, coping, and breast cancer worry [3]. The currentstudy addressed this gap and tested the hypothesis thatincreased perceived breast cancer risk was associatedwith breast cancer worry because of decreased engagedor increased disengaged coping.MethodsProcedures

Perceived breast cancer risk and breast cancer worry among women with a family history of breast cancer: a new perspective on coping as a mediator: Coping as a mediator of perceived breast cancer risk and breast cancer worry

Dear Editor,IntroductionWomen with a family history of breast cancer (FH+) haveelevated cancer worry [1]. Objective breast cancer riskcontributes to reports of cancer worry among FH+women; however, perceived breast cancer risk, which isoften overestimated, is a stronger predictor of breastcancer worry [2]. Lazarus and Folkman’s paradigm is ahelpful model to understand how individuals appraisetheir vulnerability to breast cancer (perceived risk) [3].The original framework focused on three major con-structs: cognitive appraisal, coping, and daily stress.Primary cognitive appraisal of experienced and antici-pated stressors may result in specific types of coping pro-cesses, which in turn may influence emotional reactions tostressors [3]. With regard to breast cancer, overestimatedcognitive appraisal or perceived risk of breast cancermay result in specific types of coping, which areassociated with unnecessarily high levels of cancerworry. To date, no research has tested the theoreticalmediation framework posed by Lazarus and Folkmanin the context of cognitive appraisal of breast cancerrisk, coping, and breast cancer worry [3]. The currentstudy addressed this gap and tested the hypothesis thatincreased perceived breast cancer risk was associatedwith breast cancer worry because of decreased engagedor increased disengaged coping.MethodsProcedures

Optimism and depression

Breast cancer risk is a chronic stressor associated with depression. Optimism is associated with lower levels of depression among breast cancer survivors. However, to our knowledge, no studies have explored the relationship between optimism and depression among women at risk for breast cancer. We hypothesized that women at risk for breast cancer who have higher levels of optimism would report lower levels of depression and that social support would mediate this relationship.

Optimism and depression: a new look at social support as a mediator among women at risk for breast cancer: Social support mediates optimism and depression

Breast cancer risk is a chronic stressor associated with depression. Optimism is associated with lower levels of depression among breast cancer survivors. However, to our knowledge, no studies have explored the relationship between optimism and depression among women at risk for breast cancer. We hypothesized that women at risk for breast cancer who have higher levels of optimism would report lower levels of depression and that social support would mediate this relationship.

Abstract PR-07: Stress management improves prevention relevant outcomes among women at risk for breast cancer

Many psychosocial intervention studies have focused on treating cancer survivors, but less attention has been focused on those at risk for cancer. Women with a family history of breast cancer can9t control their familial risk for cancer, but there are a number of risk-related factors they can control. These include immune function, body weight, diet, and physical activity. Psychological distress modulates all of these. If psychological distress is associated with poor immune function, poor diet, decreased physical activity, and increased BMI, reducing psychological distress should be associated with improved immune function, improved diet, increased physical activity, and lower BMI. We randomized 104 women (mean age 43 (SD=10.7), 87% white, mean education 17 years (SD 2.3)) with a family history of breast cancer who were also reporting elevated levels of distress to receive a cognitive behavioral stress management (CBSM) intervention or wait list control. CBSM women reported decreased distress, improved antibody response to Hepatitis A vaccine, decreased fat consumption, increased fiber consumption, increased leisure time physical activity, and a slight decrease in BMI over the 7 month course of the study that was significant when compared to the increased BMI among the waitlist control group women (all p9s Citation Information: Cancer Prev Res 2011;4(10 Suppl):PR-07.