Champion athletes often attribute victory to a winning attitude. But the power of the mind also may improve the survival of recently diagnosed cancer patients.
Hutch scientists are initiating studies to determine whether facilitated group counseling can influence quality of life of late-stage ovarian cancer patients - and whether it can also minimize medical symptoms and prolong survival.
By studying the impact of state of mind on physical health, Public Health Sciences Division investigators are delving into one of the most intriguing and understudied areas of cancer biology:
What is the interplay between psychology and the immune system? And how can it be measured?
Observational work
"Most work in this area has been observational, although there have been some intervention trials designed to improve quality of life," said Dr. Robyn Andersen, who is leading the study.
"Two research groups have shown some success in increasing survival for cancer patients using psychosocial (psychological and social) intervention, but these studies were small and have not been consistently replicated
Andersen and her colleagues will conduct the first large-scale trial to assess the effect of a psychosocial intervention - consisting of a nine-week group workshop - on quality of life for ovarian-cancer patients.
Collaborating on the inervention design is Dr. Karen Syrjala, director of the Clinical Research Division's Biobehaviorial Sciences group.
A unique contribution of the study, Andersen said, is that blood samples will be taken from participants to measure systematically in the future any effects of the intervention on immune system function
The project is a component of the Hutch's Ovarian Specialized Program of Research Excellence, an $11.5 million study funded by the National Cancer Institute and overseen by principal investigator Dr. Nicole Urban.
Randomized trial
The randomized intervention trial will involve about 300 Puget Sound cancer patients. All of the women will participate in workshops on diet and nutrition, but only half will also receive the counseling intervention, including stress reduction, coping skills and social support.
"The intervention is a friendly, supportive workshop designed to address a variety of problems and issues they may be facing," Andersen said.
Factors including fatigue, stress over facing their own mortality, family changes and concerns about additional treatments they may need to undergo are common concerns among survivors.
"Many of the women are dealing with strong emotional changes," she said. "They may have questions about when is a good time to consult a professional versus what is normal sadness after being diagnosed with advanced cancer."
Ovarian cancer causes more than 14,000 deaths annually in the United States and is the leading cause of gynecological death. At least 75 percent of women diagnosed with ovarian cancer are diagnosed at a late stage, because the disease presents with few early warning signals, and 80 percent of women diagnosed with late-stage ovarian cancer die within five years of diagnosis.
Workshops will start after the study enrollees finish primary chemotherapy treatment.
"Generally, that's a time when patients want to put their cancer experience behind them and get on with their lives but it's also a time when they don't yet feel healthy and normal, " Andersen said.
Psychological effects of the treatment will be evaluated with a standard questionnaire to assess quality of life, supplemented with questions specific to the study. In addition, survivors will be monitored for disease recurrence. Blood samples will be obtained from the women prior to and one year after the intervention.
"Typically, the women we will be working with have a remission period after treatment," Andersen said. "We hope our intervention will extend that period, but what we are doing should help them cope better with their disease if and when they become ill again."
Pyschosocial interventions are thought to improve quality of life by reducing stress and providing patients with problem-solving skills. But it has been less clear how such interventions might improve physical health and lengthen disease-free survival.
"One theory is that psychosocial interventions may prolong survival and lengthen remission by boosting immune function," Andersen said.
The constituents of the immune system that may be responsible for this effect are not known, but candidates include natural killer cells and interleukin-2, both of which are known to have cancer-fighting properties.
Enhanced immunity
Andersen speculates that improved survival could be mediated by an enhanced capability of the immune system to detect and kill malignant cells at the earliest stages of recurrence, when there may only be a handful of cancer cells present.
She is consulting with members of the Clinical Research Division to explore methods for measuring immunological function, a project she hopes to pursue if the results from the intervention study are encouraging.
"We feel confident that we can get a positive quality of life response to our intervention," Andersen said. "And if we do, especially if we extend disease free time and/or survival, it should be relatively easy to get funding for further studies designed to look changes in the immune system over time."
WHO CAN ENROLL IN THE PSYCHOSOCIAL OVARIAN STUDY?
Eligible for the study are women who:
- Are diagnosed with stage III or IV ovarian cancer - stages in which the cancer has spread outside the ovary.
- Live close enough to feel comfortable driving or receiving a ride from a friend or family member to workshop sites in Seattle, Tacoma or Everett.
- Have completed five or six rounds of standard chemotherapy as part of treatment.
