Stress management, leukocyte transcriptional changes and breast cancer recurrence in a randomized trial: An exploratory analysis
Open accessAbstract
Purpose Cognitive behavioral stress management (CBSM) is an empirically-validated group-based psychosocial intervention. CBSM is related to decreased self-reported indicators of psychological adversity during breast cancer treatment and greater disease-free survival (DFS) vs. a control condition. This study examined relationships between CBSM, DFS, and a potential biobehavioral pathway linking these variables in breast cancer patients through a gene expression composite representing the leukocyte conserved transcriptional response to adversity (CTRA).Design Women with stage 0-IIIb breast cancer completed questionnaires and provided blood samples post-surgery. Participants were randomized to 10-week group-based CBSM or a psychoeducation control group and followed at 6 months, 12 months, and median 11 years. In total, 51 participants provided blood data for longitudinal analyses (CBSM n=28; Control n=23). Mixed model analyses examined CBSM effects on 6-12 month changes in CTRA expression (53 indicator genes representing pro-inflammatory, anti-viral and antibody production signaling). Cox regression models assessed the relationship between 6 and 12 month changes in CTRA expression and 11-year DFS.Results Patients randomized to CBSM showed attenuated 6-12 month change in CTRA gene expression, whereas patients randomized to control showed increased CTRA expression (p=0.014). Average DFS was 5.92 years (SD=3.90). Greater 6-12 month CTRA increases predicted shorter 11-year DFS controlling for covariates (p=0.007).Conclusions CBSM attenuated CTRA gene expression during the initial year of breast cancer treatment. In turn, greater increases in CTRA gene expression predicted shorter long-term DFS. These findings identify a biobehavioral oncology pathway to examine in future work.
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Patients randomized to the CBSM condition showed attenuated 6-12 month change in CTRA gene expression, whereas the control group showed increased CTRA gene expression.
“The authors found that patients randomized to the CBSM condition showed both improved psychological symptoms (i.e. cancer-associated intrusive thoughts, interviewed rated anxiety symptoms and negative affect) and attenuated 6–12 month change in CTRA gene expression, whereas the control group showed increased CTRA gene expression.”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [24]
Greater 6-12-month CTRA increases predicted shorter 11-year DFS.
“Greater 6–12-month CTRA increases predicted shorter 11-year DFS.”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [24]
Patients randomized to the CBSM condition showed improved psychological symptoms (i.e. cancer-associated intrusive thoughts, interviewed rated anxiety symptoms and negative affect).
“The authors found that patients randomized to the CBSM condition showed both improved psychological symptoms (i.e. cancer-associated intrusive thoughts, interviewed rated anxiety symptoms and negative affect) and attenuated 6–12 month change in CTRA gene expression, whereas the control group showed increased CTRA gene expression.”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [24]
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- Authors
- Antoni, M. H., Bouchard, L. C., Jacobs, J. M., Lechner, S. C., Jutagir, D. R., Gudenkauf, L. M., Carver, C. S., Lutgendorf, S., Cole, S. W., Lippman, M., & Blomberg, B. B.
- Affiliations
- University of Miami (US)
- Massachusetts General Hospital (US)
- University of Iowa (US)
- Corresponding author
- Antoni, Michael H.
- ORCID
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 74
- Pages
- 269-277
- ISSN
- 0306-4530 (ISSN-L)
- PMC
- PMC5159236
- OpenAlex
- W2521208781
- Cited by
- 89
- References
- 48
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 10 · 2023: 9 · 2022: 14 · 2021: 12 · 2020: 7 · 2019: 15 · 2018: 5 · 2017: 3
- FWCI
- 6.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute
- National Institutes of Health (HHSN261200800001E)
- NCI (R01CA064710)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- cognitive-behavioral stress management, breast cancer, disease-free survival, leukocyte gene expression, conserved transcriptional response to adversity, psychosocial interventions, inflammation, psychoeducation, breast cancer recurrence
- MeSH terms
- Adult, Breast Neoplasms, Female, Follow-Up Studies, Humans, Leukocytes, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Stress, Psychological, Transcription, Genetic, Cognitive Behavioral Therapy, Disease-Free Survival
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