Cancer patients accentuate the positive

People undergoing treatment for cancer or other life-threatening diseases sometimes report an improved ability to cope with daily affairs, a greater sense of purpose in life, increased spirituality, closer ties to loved ones, or other gratifying changes.

A pilot study now suggests that such personal growth, at least in female breast cancer patients who completed a stint of group therapy, accompanies marked declines in the stress hormone cortisol. Intriguingly, no such stress-hormone drop occurred in the women who cited the lowest amount of emotional turmoil, say psychologist Dean G. Cruess of the University of Miami in Coral Gables and his colleagues.

“Psychosocial interventions might influence immune functioning in cancer patients by fostering [psychological] growth and modulating cortisol levels,” says Miami psychologist Charles S. Carver, one of the study’s coauthors.

Other data indicate that extended exposure to high cortisol levels can undermine the immune system’s disease-fighting capacity, Carver notes.

Cruess’ group obtained blood samples from 34 women diagnosed with early-stage breast cancer. Participants, who averaged 46 years old and exhibited comparable blood cortisol concentrations, were recruited to the psychology study within 8 weeks of surgery to remove cancerous lumps or one or both breasts. Most of the women were white, were married or in a stable relationship, and had attended college.

Volunteers completed questionnaires on perceived benefits from having breast cancer and on emotional distress in the past week. Benefits included having a greater acceptance of daily events and a deeper sense of purpose in life. Distress consisted of feelings of anxiety, depression, and intense anger.

The 24 women who then completed 10 weeks of group therapy had lower cortisol levels at that point than did the rest, who had been randomly assigned to a waiting list. Group therapy focused on both stress-control methods and relaxation training.

Cortisol levels dipped furthest in women reporting the most cancer-related benefits, the scientists report in the May/June Psychosomatic Medicine.

The sharpest cortisol declines occurred in women who entered the study with pessimistic views of their lives and then reported psychological growth after group therapy, Carver says.

“These findings make sense,” comments psychiatrist David Spiegel of Stanford University Medical Center. “Finding meaning in adversity increases the ability to control stress responses.” However, psychological growth during group therapy can include periods of heightened distress as patients, with the encouragement of the group, confront their fears, Spiegel says.

Cruess’ group plans to examine distress more closely in a larger sample of breast cancer patients, including some with more advanced cancers.