Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA.
Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA; Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA.
Psychoneuroendocrinology. 2020 Aug;118:104708. doi: 10.1016/j.psyneuen.2020.104708. Epub 2020 May 19.
Breast cancer survivors with elevated inflammation have a greater risk for cancer recurrence, premature mortality, and comorbid disease development. The psychological stress survivors experience when confronted with a breast cancer diagnosis and cancer treatment can heighten inflammation. Identifying factors that reduce stress and inflammation could lead to improvements in survivors' long-term health. Accordingly, this study examined the health-enhancing effects of romantic relationships-a key health determinant-on breast cancer survivors' stress and inflammation.
Breast cancer survivors (n = 139, stages 0-IIIC) completed a baseline visit before treatment and two follow-up visits 6 and 18 months after treatment ended. Women completed self-report questionnaires assessing their romantic relationship satisfaction and perceived stress, and they provided a blood sample for serum markers of inflammation at each visit. The longitudinal design allowed for examination within and between survivors. We conducted multilevel mediation analyses to assess how changes in survivors' relationship satisfaction were related to changes in stress and inflammation from visit to visit (i.e., within-person effects), as well as how the average effects of relationship satisfaction were associated with average stress and inflammation levels throughout the study (i.e., between-person effects).
At the within-person level, at visits in which survivors were more satisfied with their relationships, they also perceived less stress, which in turn was related to lower than their own average levels of serum C-reactive protein and proinflammatory cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-1β). At the between-person level, survivors who had greater relationship satisfaction throughout the study had lower perceived stress, which was linked to lower levels of inflammation.
Breast cancer survivors in satisfying romantic relationships felt less stressed and in turn had lower inflammation throughout cancer treatment. This study illustrates the utility of a within-person approach to not only consider the average effects of relationship satisfaction, but also how changes in their own relationship satisfaction impact stress and inflammation over time. Our findings demonstrate important psychological and immunological pathways through which satisfying relationships may promote breast cancer survivors' long-term health.
炎症水平升高的乳腺癌幸存者癌症复发、过早死亡和合并疾病发展的风险更高。当面临乳腺癌诊断和癌症治疗时，幸存者经历的心理压力会加剧炎症。确定可降低压力和炎症的因素可能会改善幸存者的长期健康状况。因此，本研究探讨了浪漫关系（关键健康决定因素之一）对乳腺癌幸存者压力和炎症的健康促进作用。
在治疗前，139 名（0-IIIC 期）乳腺癌幸存者完成了基线访问，并在治疗结束后 6 个月和 18 个月进行了两次随访。女性完成了评估她们的浪漫关系满意度和感知压力的自我报告问卷，并在每次访问时提供了用于炎症血清标志物检测的血液样本。纵向设计允许对幸存者进行内部和之间的检查。我们进行了多层次中介分析，以评估幸存者的关系满意度变化如何与从一次访问到另一次访问的压力和炎症变化相关（即，个体内效应），以及关系满意度的平均效应如何与整个研究过程中的平均压力和炎症水平相关（即，个体间效应）。
在个体内水平上，在幸存者对关系更满意的访问中，他们也感知到较少的压力，这反过来又与血清 C 反应蛋白和促炎细胞因子（肿瘤坏死因子-α、白细胞介素-6 和白细胞介素-1β）的水平低于自己的平均水平有关。在个体间水平上，在整个研究过程中关系满意度较高的幸存者感知到的压力较低，这与炎症水平较低有关。
处于满意浪漫关系中的乳腺癌幸存者感到压力较小，在整个癌症治疗过程中炎症水平也较低。本研究说明了个体内方法的实用性，不仅要考虑关系满意度的平均效应，还要考虑他们自己的关系满意度变化如何随时间影响压力和炎症。我们的研究结果表明，满足关系可能通过重要的心理和免疫途径促进乳腺癌幸存者的长期健康。
