Penedo Frank J, Fox Rina S, Walsh Emily A, Yanez Betina, Miller Gregory E, Oswald Laura B, Estabrook Ryne, Chatterton Robert T, Mohr David C, Begale Mark J, Flury Sarah C, Perry Kent, Kundu Shilajit D, Moreno Patricia I
Department of Psychology, University of Miami, United States; Department of Medicine, University of Miami Miller School of Medicine, United States.
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States.
Brain Behav Immun. 2021 Jul;95:168-177. doi: 10.1016/j.bbi.2021.03.014. Epub 2021 Mar 15.
Cognitive behavioral stress management (CBSM) improves quality of life and mitigates stress biology in patients with early-stage cancer, including men with localized prostate cancer. However, treatments for advanced prostate cancer like androgen deprivation therapy (ADT) can lead to significant symptom burden that may be further exacerbated by stress-induced inflammation and cortisol dysregulation. The aim of this study was to examine the effects of CBSM (versus an active health promotion control) on circulating inflammatory markers and cortisol in men with advanced prostate cancer.
Men with stage III or IV prostate cancer (N = 192) who had undergone ADT within the last year were randomized to CBSM or health promotion. Both interventions were 10 weeks, group-based, and delivered online. Venous blood was drawn at baseline, 6 months, and 12 months to measure circulating levels of CRP, IL-6, IL-8, IL-10, and TNF-α. Saliva samples were collected at awakening, 30 min after awakening, evening, and night for two consecutive days at baseline, 6-months, and 12-months to measure diurnal cortisol slopes.
Mixed modeling analyses demonstrated that changes in inflammatory markers and cortisol did not differ by intervention. Men in both CBSM and health promotion showed decreases in IL-10, IL-8, and TNF-α from baseline to 6 months (β = -3.85--5.04, p's = 0.004-<0.001). However, these markers generally demonstrated a rebound increase from 6 to 12 months (β = 1.91-4.06, p's = 0.06-<0.001). Men in health promotion also demonstrated a flatter diurnal cortisol slope versus men in CBSM at 6 months (β = -2.27, p = .023), but not at 12 months. There were no intervention effects on CRP, IL-6, or overall cortisol output.
Contrary to hypotheses, CBSM did not lead to changes in the circulating inflammatory markers and cortisol relative to health promotion. CBSM may be associated with healthy diurnal cortisol rhythm because of its focus on cognitive behavioral approaches to stress management. More research is needed to understand the impact of CBSM and health promotion on biomarkers among men with advanced prostate cancer.
认知行为压力管理（CBSM）可改善早期癌症患者的生活质量并减轻压力生物学反应，包括局限性前列腺癌男性患者。然而，像雄激素剥夺疗法（ADT）这样的晚期前列腺癌治疗方法会导致显著的症状负担，而压力诱导的炎症和皮质醇失调可能会进一步加剧这种负担。本研究的目的是检验CBSM（与积极健康促进对照相比）对晚期前列腺癌男性患者循环炎症标志物和皮质醇的影响。
过去一年内接受过ADT的III期或IV期前列腺癌男性患者（N = 192）被随机分为CBSM组或健康促进组。两种干预措施均为期10周，基于小组，通过在线方式进行。在基线、6个月和12个月时采集静脉血，以测量CRP、IL-6、IL-8、IL-10和TNF-α的循环水平。在基线、6个月和12个月时，连续两天在觉醒时、觉醒后30分钟、晚上和夜间采集唾液样本，以测量昼夜皮质醇斜率。
混合模型分析表明，炎症标志物和皮质醇的变化在不同干预措施之间没有差异。CBSM组和健康促进组的男性患者从基线到6个月时，IL-10、IL-8和TNF-α均有所下降（β = -3.85--5.04，p值 = 0.004-<0.001）。然而，这些标志物在6至12个月时通常出现反弹增加（β = 1.91-4.06，p值 = 0.06-<0.001）。在6个月时，健康促进组男性患者的昼夜皮质醇斜率比CBSM组男性患者更平缓（β = -2.27，p = 0.023），但在12个月时并非如此。对CRP、IL-6或总体皮质醇输出没有干预效果。
与假设相反，与健康促进相比，CBSM并未导致循环炎症标志物和皮质醇发生变化。CBSM可能因其专注于压力管理的认知行为方法而与健康的昼夜皮质醇节律相关。需要更多研究来了解CBSM和健康促进对晚期前列腺癌男性患者生物标志物的影响。
