Psychoneuroimmunology: implications for oncology?

Article Abstract:

Psychoneuroimmunology is the study of the interaction between the psychological state, the central nervous system, and the immune system. Some investigators believe that psychoneuroimmunology is relevant for cancer research, and the notions of these investigators may be broadly classed into three hypotheses: the outcome of some cancers can be influenced by psychosocial factors; the activities of the immune system can influence the outcome of some cancers; and at least one aspect of the immune response, the activity of NK or natural killer cells, is affected by psychosocial factors. One of the difficulties of interpreting data from the standpoint of psychoneuroimmunology is that few studies take an interdisciplinary approach. For example, while a study might look at the effect of psychosocial factors on the outcome of breast cancer, it is unlikely to monitor immune function. From a physiological standpoint, certain molecules could conceivably serve as a feedback mechanism between the immune system and the brain. Interleukin-1 increases lymphocyte proliferation, but also elicits brain-mediated effects, such as increased body temperature. At least a dozen peptides thought to be produced only within the nervous system are now known to be produced in immune system cells as well. Numerous studies have shown that psychological factors are associated with survival among some cancer patients, but the interpretation of these studies is severely hampered by the unknown relation between health and the psychological state. Patients with better prognoses and less severe cancer may 'feel better' psychologically, and it should not be surprising that these patients also survive longer. It is impossible to experimentally manipulate psychological factors and the stress imposed upon human cancer patients. Researchers have turned to animal models to demonstrate the influence of psychological factors on cancer, but in animal research psychological factors are generally simple stress. Furthermore, many of the tumors artificially induced in laboratory animals are highly immunogenic, and much more amenable to destruction by the immune system than are the majority of human cancers. While the preliminary results may seem tantalizing, hard facts will be a long time coming. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Models, Central nervous system, Immunity, Immunity (Physiology), Psychodiagnostics, Oncology, Psychoneuroimmunology

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Physiologic and psychobehavioral research in oncology

Article Abstract:

While the interaction of psychologic states and illness have been a matter of debate for centuries, it has only been within the past decade that this field of inquiry has blossomed into an impressive field of research. Pain is one of the most important aspects of disease, and involves the contribution of both physiologic and psychologic factors. There is a tendency among some medical researchers to regard pain as impossible to measure reliably, and therefore sufficient data on the alleviation of pain among cancer patients are sadly lacking. There seems to be an attitude among some clinicians that pain is an unavoidable consequence of advanced cancer, and thus some opportunities for pain relief may be missed. Research has also found that the nausea and vomiting associated with chemotherapy may be strongly affected by the psychologic state of the patient. Pavlovian conditioning may cause the patient to experience nausea in anticipation of chemotherapy, and psychologic factors may also contribute to side effects after chemotherapy is administered. Some psychological research has demonstrated that relaxation techniques and guided imagery may reduce nausea and vomiting in some patients. Another function that is strongly affected by psychological state is sexuality. While many studies have examined the effect of breast cancer on sexuality, sexuality may be affected by the depression, stress, and marital discord that are common in many forms of cancer. One field of research that has achieved increasing support and interest is psychoneuroimmunology, which endeavors to uncover the effects that the psychological state has on the immune system. Although stress can influence immune function in an adverse fashion, it is less clear that developing a "positive mental attitude" achieves results beyond those of stress reduction. Furthermore, it is uncertain whether improvements in immune function, as measured in the laboratory, bear a direct relation to a patient's ability to ward off the effects of cancer. Nevertheless, preliminary evidence suggesting that psychosocial intervention can improve survival time among patients with advanced cancer is tantalizing, and warrants further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer, Psychosomatic research

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Research in cancer pain: what we know and what we need to know

Article Abstract:

The author asks why we don't do a better job controlling cancer pain. Some researchers have estimated that pain can be effectively controlled in about 95 percent of cancer patients, and yet the actual percentage of patients for whom pain is adequately controlled is far less. Research has shown that health care professionals are hesitant to prescribe pain killers, and that there is tremendous variability in what degree of pain control is considered adequate. Patient attitudes toward pain are also a contributing factor in the lack of pain relief. Many cancer patients regard pain as an inevitable consequence of their condition, and thus do not insist upon adequate treatment. Furthermore, some patients feel that if pain killers are used too soon, they may no longer be effective in later stages of the disease, which the patient is likely to anticipate as being even more painful. In addition, patients remain sensitive to the notion that they will be regarded as drug addicts if they are receiving ''too much'' pain medication. Fortunately, almost half the states are now beginning cancer pain initiatives which seek to break down the barriers to adequate cancer pain management. These initiatives seek not only to improve the standards of pain management, but also to sanction pain relief as an integral part of cancer treatment which should be supported by health insurers and other third party payers of medical care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Cancer patients, Cancer pain, Analgesia

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