Stress management training for breast cancer surgery patients.

OBJECTIVE: This study evaluated the psychological effects of a pre-surgical stress management training (SMT) in cancer patients. METHODS: Stress management training comprised four sessions in total: on 5 days and 1 day pre-surgery and on 2 days and 1 month post-surgery. Patients also received audio CDs with relaxation and coping skills exercises. Patients were randomly assigned to the SMT (N = 34) or a regular care condition (N = 36). Depression, anxiety, quality of life, perception of control, fatigue, pain, sleep problems, and surgery-related somatic symptoms were measured at Day 6 and Day 1 pre-surgery, and Day 2, 5, 30 and 90 post-surgery. RESULTS: Depression and fatigue decreased in the intervention group and increased in the control group, leading to significant group differences at Day 2 (fatigue) and Day 5 post-surgery (fatigue and depression). It also appeared that surgery-related symptoms had increased more in the control group 3 months post-surgery than in the SMT group. No intervention effects were observed for anxiety, pain, and sleep problems. CONCLUSION: The use of a short psychological intervention is effective in reducing depression and fatigue in the post-surgical period, although the effects are of short duration.

Breast cancer surgery-induced immunomodulation.

BACKGROUND AND OBJECTIVES: Surgical procedures can cause tumor cells to disseminate into the circulatory system. Although this spread of metastatic cells will be limited by immune activity, immunosuppression tends to be the main effect resulting from surgery. The objective of this study is to assess hormonal and immunological changes induced by breast cancer surgery. METHODS: Endocrine and immune responses to surgery were determined in 27 breast cancer patients. Blood samples were taken at 6 days and 1 day before surgery and 2 hr, 1 day, and 5 days after surgery. Changes in endocrine function, number of leucocytes and their subpopulations, enumerative immune expression, functional activity, and cytokine levels were determined. RESULTS: Breast cancer surgery induces a pro-inflammatory response and leucocytosis. Immunosuppression is indicated by decreased HLA-DR expression, decreased NKCA, and a Th2 response. A delayed Th1 response was also found 5 days after surgery. As no cortisol level change was observed, this hormone can be excluded as the mediator of surgery-related immunomodulation in breast cancer. CONCLUSION: Although breast cancer surgery is classified as minor surgery the surgical procedure produces substantial immunomodulation.