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Immune, endocrine, and behavioral precursors to breast cancer recurrence: a case-control analysis

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Abstract

Background

A period of tumor growth precedes the clinical detection of breast cancer recurrence. We explore immune, endocrine, and behavioral parameters during this period.

Methods

We conducted a phase III clinical trial in which women with surgically treated stage II/III breast cancer (N = 227) were randomized to receive a psychological intervention or assessment-only and then regularly assessed for 10 years. Patients who recurred (R, n = 48) were matched with patients remaining disease-free (DF, n = 48) on demographic and prognostic characteristics, treatment, and duration of disease-free follow-up. Data at three assessment points, occurring, on average, 17, 11, and 4 months before the recurrence was detected clinically, with equivalent time points for the disease-free group, were examined. Mixed-effects models tested for group differences in immune cell counts and function as well as endocrine and behavioral parameters.

Results

In the 17 months prior to recurrence detection, patients exhibited higher white blood cell count, neutrophil, lymphocyte, and natural killer cell counts, relative to DF patients. R patients also showed higher cortisol, worse physical functioning, fatigue, and quality of life. Follow-up analyses showed patients with local recurrences to differ from those with distant recurrence, with the former exhibiting elevated natural killer cell cytotoxicity, lymphocyte proliferative response, fatigue, pain, and emotional distress (depression, anxiety), and the latter exhibiting higher neutrophil, lymphocyte, and natural killer cell counts.

Conclusion

Patients who would recur showed reliable biobehavioral alterations more than a year prior to their diagnosis. This novel observation may contribute to our understanding of the disease relapse processes.

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Acknowledgments

We thank the participants and the professional and research staff of the Stress and Immunity Cancer Projects. Special thanks to Dr. Hae-Chung Yang for assistance with data analysis. This research was funded by the American Cancer Society (PBR-89, RSGPB-03-248-01-PBP), Longaberger Company-American Cancer Society Grant for Breast Cancer Research (PBR-89A), U.S. Army Medical Research Acquisition Activity Grants (DAMD17-94-J-4165; DAMD17-96-1-6294; DAMD17-97-1-7062), National Institutes of Mental Health (1 R01 MH51487), the National Cancer Institute (K05 CA098133; R01 CA92704), the General Clinical Research Center (M01-RR0034), and The Ohio State University Comprehensive Cancer Center (P30 CA16058).

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Authors and Affiliations

  1. Department of Psychology, Ohio State University, 159 Psychology Building, 1835 Neil Avenue Mall, Columbus, OH, 43210, USA

    Lisa M. Thornton & Barbara L. Andersen

  2. Comprehensive Cancer Center, Ohio State University, N924 Doan Hall 410 W. 10th Avenue, Columbus, OH, 43210, USA

    Barbara L. Andersen & William E. Carson III

Authors
  1. Lisa M. Thornton
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  2. Barbara L. Andersen
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  3. William E. Carson III
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Correspondence to Lisa M. Thornton.

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Thornton, L.M., Andersen, B.L. & Carson, W.E. Immune, endocrine, and behavioral precursors to breast cancer recurrence: a case-control analysis. Cancer Immunol Immunother 57, 1471–1481 (2008). https://doi.org/10.1007/s00262-008-0485-6

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  • DOI: https://doi.org/10.1007/s00262-008-0485-6

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