Congress Abstracts 2004

41

EFFECT OF A COUNSELING-EDUCATION INTERVENTION ON PSYCHOLOGICAL AND IMMUNE MEASURES IN WOMEN AT HIGH RISK FOR BREAST CANCER. Janet Bagley, RN, MS, OCN^®, University of Washington School of Nursing, Seattle, WA, and Betty Gallucci, PhD, University of Washington, Seattle, WA.

The nurse’s role here is developing an understanding of relationships between physiological and psychological variables in a high-risk population.

Approximately 1,975,000 women are living with breast cancer in the United States. First-degree relatives of these women have a 2–3 fold increased risk of breast cancer. This exploratory study examined the relationship between psychological and immune measures in high-risk women and evaluated the effect of a counseling-education intervention.

The stress response model was used in this pre-post within subject comparative experimental design.

Methods: 19 women at high risk for breast cancer were randomly assigned to an immediate (n = 10) or a delayed intervention group (n = 9). Psychological self-report, hormonal, and immune measures were obtained at baseline and after the immediate group completed four two-hour monthly sessions (time 2). Psychological measures included Cancer Worry Scale, Impact of Events Scale (IES), Brief Symptom Inventory (BSI) anxiety subscale, and Profile of Mood States. Biologic measures were urinary catecholamine and cortisol, NK cell cytotoxicity, and lymphocyte CD69 and HLA-DR activation antigens after IL-2 incubation.

Nonparametric tests were used to assess correlations, differences between groups, and differences within the immediate intervention group.
In the immediate intervention group, all four self-report measures were lower at time 2, with anxiety-BSI (z = -2, p = 0.045) significantly decreased. There were no significant differences in hormonal or immune measures. The between group comparison at time 2 showed significant differences in the total IES (u = 20.5, p = .043) and anxiety-BSI (u = 17, p = .022). With regard to the relationship between psychological and immune variables, cancer worry was highly correlated with CD69 (rs = .61, p = .014), total IES was moderately correlated with CD69 (rs = .48, p = .048) but marginally significant with HLA-DR (rs = .44, p = .069). Urinary cortisol was significantly and highly correlated with NK HLA-DR (rs = .61, p =. 023) and marginally significant with NK CD69 (rs = -.50, p = .085). A counseling-education intervention benefited high-risk women in terms of self-reported measures. Some psychological measures correlated strongly with the lymphocyte activation antigens. Larger studies are needed to determine if an education counseling intervention will change hormonal and immune responses in women at high risk for breast cancer.