Telephone Counseling Boosts Spirits-and Immune Indicators-for Cervical Cancer Survivors

Christina Izzo
Published: Monday, May 11, 2015
Dr. Lari Wenzel

Lari Wenzel, PhD

Psychosocial telephone counseling intervention benefits mood and quality of life for cervical cancer survivors, including cancer-specific and gynecologic concerns, according to a recent study.1

“What our work has determined over the years preceding this trial was that women with cervical cancer in particular are one of the most distressed group of cancer survivors—if not the most—in the United States,” lead author Lari Wenzel, PhD, associate director for Population Science and Cancer Control at the Irvine Chao Family Comprehensive Cancer Center at the University of California, Irvine, said in a recent telephone interview with OncologyLive. “Also, this is a group who may not get the amount or type of supportive care services that could be beneficial.”

Edward L. Nelson, MD, FACP

Edward L. Nelson, MD, FACP

Many patients with cervical cancer are often young and underserved minorities, said Wenzel, who also is a professor of Medicine and Public Health at the UCI School of Medicine. Survivors of the disease often face quality-of-life disruptions that can linger for long periods of time after treatment has ended, such as sexual and childbearing functioning concerns.

Wenzel said the idea of testing a telephone counseling intervention made sense in this situation because these patients are “a group that don’t avail themselves of typical services such as a support group at a hospital or elsewhere.”

For the study, 204 patients who were ≥9 months and <30 months from diagnosis were randomized to receive the telephone counseling service or usual care.

The psychological telephone counseling intervention included five weekly sessions and a 1-month booster. Patients reported outcomes at baseline and at 4 months and 9 months after enrollment.

The participants in the telephone-counseling group received a 5-minute pre-call to schedule the first session, which took up to 60 minutes. The rest of the sessions ranged from 20 minutes to 60 minutes and included topics on managing stress and emotions, health and wellness, managing relationships and sexuality concerns, and communicating with the healthcare team.

After each session, the counselor would prepare a summary letter of the session along with “homework” assignments to help the patient overcome stresses or concerns that they had talked with the counselor about.

Wenzel said one of the benefits of this strategy was that even though the counselors talked about general themes around areas that cancer survivors find important, the homework assignments allowed the treatment to be tailored for each individual.

A Potential Biobehavioral Pathway

The study also examined whether there was an association between quality of life and biomarkers. Interestingly, the study found a correlation between the improvement in patient-reported outcomes and a decrease in both T-helper type 2 (TH-2) and counter-regulatory cytokines.

“We know that in individuals that experience chronic psychological stress, their immune system tends to shift a bit, its ‘immunological stance,’ to try to make more antibodies to keep the body from getting an infection rather than having an immune system that is ready and primed to fight the infection once it arrives. We call that a T-helper type 2 or TH-2, response,” study author Edward L. Nelson, MD, FACP, chief of the Division of Hematology/Oncology and an associate professor at the University of California, Irvine, said in an interview. “So under chronic psychological stress, the amount of TH-2 is much higher than it is when you don’t have that chronic psychological stress. TH-1 and TH-2 can be thought of as being on opposite sides of a seesaw. TH-1 responses are thought to be best for fighting cancers and virus infections. If you have a whole bunch of TH-2, you have less TH-1.”

The study found that women who had improvement in the quality of life and a decrease in their stress level also saw a decrease in TH-2. “This study reinforces a paradigm that connects the psychological state to downstream effects on the neuroendocrine and immune systems—the immune system in particular,” he said. “If you’re going to ask the immune system to behave in the way that you would like it to behave, to fight off cancer, especially with some of our other now novel immunotherapeutic strategies, you would like it to be tuned up in a way that makes it most likely that it is going to be effective.”

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