Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada; Southern Alberta Cancer Research Institute, Health Research Innovation Centre, University of Calgary, Calgary, Alberta, Canada.
Cancer. 2015 Feb 1;121(3):476-84. doi: 10.1002/cncr.29063. Epub 2014 Nov 3.
Group psychosocial interventions including mindfulness-based cancer recovery (MBCR) and supportive-expressive group therapy (SET) can help breast cancer survivors decrease distress and influence cortisol levels. Although telomere length (TL) has been associated with breast cancer prognosis, the impact of these two interventions on TL has not been studied to date.
The objective of the current study was to compare the effects of MBCR and SET with a minimal intervention control condition (a 1-day stress management seminar) on TL in distressed breast cancer survivors in a randomized controlled trial. MBCR focused on training in mindfulness meditation and gentle Hatha yoga whereas SET focused on emotional expression and group support. The primary outcome measure was relative TL, the telomere/single-copy gene ratio, assessed before and after each intervention. Secondary outcomes were self-reported mood and stress symptoms.
Eighty-eight distressed breast cancer survivors with a diagnosis of stage I to III cancer (using the American Joint Committee on Cancer (AJCC) TNM staging system) who had completed treatment at least 3 months prior participated. Using analyses of covariance on a per-protocol sample, there were no differences noted between the MBCR and SET groups with regard to the telomere/single-copy gene ratio, but a trend effect was observed between the combined intervention group and controls (F [1,84], 3.82; P = .054; η(2) = .043); TL in the intervention group was maintained whereas it was found to decrease for control participants. There were no associations noted between changes in TL and changes in mood or stress scores over time.
Psychosocial interventions providing stress reduction and emotional support resulted in trends toward TL maintenance in distressed breast cancer survivors, compared with decreases in usual care.
团体心理社会干预，包括基于正念的癌症康复（MBCR）和支持表达团体治疗（SET），可以帮助乳腺癌幸存者减轻痛苦并影响皮质醇水平。尽管端粒长度（TL）与乳腺癌的预后有关，但迄今为止，尚未研究这两种干预措施对 TL 的影响。
本研究的目的是在一项随机对照试验中，比较 MBCR 和 SET 与最小干预对照组（为期 1 天的应激管理研讨会）对有压力的乳腺癌幸存者 TL 的影响。MBCR 侧重于正念冥想和温和哈他瑜伽的训练，而 SET 则侧重于情绪表达和团体支持。主要结局指标是相对 TL，即端粒/单拷贝基因比值，在每次干预前后进行评估。次要结局指标为自我报告的情绪和压力症状。
共有 88 名有压力的乳腺癌幸存者参与了这项研究，他们被诊断为 I 期至 III 期癌症（使用美国癌症联合委员会（AJCC）TNM 分期系统），并且在至少 3 个月前完成了治疗。在按方案样本上进行协方差分析时，MBCR 和 SET 组之间在端粒/单拷贝基因比值方面没有差异，但在联合干预组和对照组之间观察到趋势效应（F [1,84]，3.82；P =.054；η² =.043）；干预组的 TL 得到维持，而对照组的 TL 则发现下降。TL 的变化与随时间变化的情绪或压力评分之间没有关联。
提供减轻压力和情感支持的心理社会干预措施，与常规护理相比，导致有压力的乳腺癌幸存者 TL 保持稳定的趋势。
