not experiencing distress. For this reason it is important to take multiple measures of stress (self-report, other-report, and physiological), as well as measures of personality and coping behaviors, to determine if patients are prone to suppressing emotions. The role of the immune system and specific immune indices in mediating the effects of stress on breast cancer progression also needs to be examined in greater detail. Although the link between stress and immune changes has been shown repeatedly, the link between stress-related immune activity and disease has not been consistently found, and mediational analyses are needed to determine if stress does affect breast cancer progression through its influence on immune cells.
Finally, although initial findings appear very promising, the efficacy of stress-reducing interventions is still untested and the understanding of mechanisms indulging their effects is still poor. Replication of studies finding less recurrence and lower mortality in patients undergoing interventions and verification of theoretically predicted moderators are necessary before endorsing these interventions. It is unknown what type of patient is most likely to benefit from interventions, whether the effectiveness of these interventions differs depending on patient's stage of disease, and what qualities of the interventions are most beneficial (i.e., content, frequency, and/or length of intevention). However, they provide a plausible and attractive mechanism explaining some of the effects of stress on cancer. Future intervention studies need to address these questions to determine the most effective and economical way to treat breast cancer patients.
Akimoto, M., Ishii, H., Nakajima, Y., Iwasaki, H., Tan, M., Abe, R., & Kasai, M. (1986). Assessment of host immune response in breast cancer patients. Cancer Defection and Prevention, 9, 311–317.
Andersen, B. L. (1992). Psychological interventions for cancer patients to enhance the quality of life. Journal of Consulting and Clinical Psychology, 60, 552–568.
Andersen, B. L. (1994). Surviving cancer. Cancer, 7#, 1484–1495.
Andersen, B. L., Farrar, W. B., Golden-Kreutz, D., Kutz, L. A., MacCallum, R., Courtney, B. E., & Glaser, R. (1998). Stress and immune responses after surgical treatment for regional breast cancer. Journal of the National Cancer Institute, 90, 30–36.
Anisman, H., & Sklar, L. S. (1979). Catecholamine depletion in mice upon reexposure to stress: Mediation of the escape deficits produced by inescapable shock. Journal of Comparative and Physiological Psychology, 93, 610–625.
Bachen, E. A., Manuck, S. B., Marsland, A. L., Cohen, S., Malkoff, S. B., Muldoon, M. F., & Rabin, B. S. (b1992). Lymphocyte subset and cellular immune responses to a brief experimental stressor. Psychosomatic Medicine, 54, 673–679.
Baltrusch, H. J., Stangel, W., & Titze, I. (1991). Stress, cancer and immunity. New developments in biopsychosocial and psychoneuroimmunologic research. Acta Neurologica,
M. D., & Melisaratos, N. (1979).
Behavioral Medicine, 5–14.
13, R., Morton, 3 15–327.
Barraclough, J., Pinder, P., Cruddas, M., Osmond, C., Taylor, I., & Perry, M. (1992). Life events and breast cancer prognosis. British Medical Journal, 304, 1078–1081.
Becker, H. (1979). Psychodynamic aspects of breast cancer: Differences in younger and older patients. Psychotherapy and Psychosomatics, 32, 287–296.
Ben-Eliyahu, S., Yirmiya, R., Liebeskind, J. C., Taylor, A. N., &
Gale, R. P. (1991). Stress increases metastatic spread of a mammary tumor in rats: Evidence for mediation by the immune system. Brain, Behavior, and Immunity, 5, 193–205.
Blanc, G., Herve, D., Simon, H., Lisoprawski, A., Glowinski, J., & Tassin, J. P. (1980). Response to stress of mesocortico-frontal dopaminergic neurones in rats after long-term isolation. Nature, 284,265267.
Brown, G. W. (1981). Life events, psychiatric disorder and physical illness. Journal of Psychosomatic Research, 25, 461–473.
Buddeberg, C., Wolf, C., Sieber, M., Riehl-Emde, A., Bergant, A., Steiner, R., Landolt-Ritter, C., & Richter, D. (1991). Coping strategies and course of disease of breast cancer patients. Psychotherapy and Psychosomatics, 5.5, 15 l–1 57.
Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., Ketcham, A. S., Moffat, Jr., F. L., &Clark, K. C. (1993). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65, 375–390.
Cassileth, B. R., Lusk, E. J., Miller, D. S., Brown, L. L., & Miller, C. (1985). Psychosocial correlates of survival in advanced malignant disease? New England Journal of Medicine, 312, 155 l–1 555.
Cooper, C. L., Cooper, R. D., & Faragher, E. B. (1986a). Psychosocial stress as a precursor to breast cancer: A review. Current Psychological Research & Reviews, 5, 268–280.
Cooper, C. L., Cooper, R. D., & Faragher, E. B. (1986b). A prospective study of the relationship between breast cancer and life events, type A behaviour, social support and coping skills. Stress Medicine, 2, 27 l–277.
Cooper, C. L., Cooper, R., & Faragher, E. B. (1989). Incidence and perception of psychosocial stress: The relationship with breast cancer. Psychological Medicine, 19,415–422.
Cooper, C. L., & Faragher, E. B. (1993). Psychosocial stress and breast cancer: The inter-relationship between stress events, coping strategies and personality. Psychological Medicine, 23, 653–662.
Dean, C., & Surtees, P. G. (1989). Do psychological factors predict survival in breast cancer? Journal of Psychosomatic Research, 33,561.569.
Derogatis, L. R., Abeloff, Psychological coping mechanisms and survival time in metastatic breast cancer. Journal of the American Medical Association, 242, 1504–1508.
Edwards, J. R., Cooper, C. L., Pearl, S. G., de Paredes, E. S., O'Leary, T., &Wilhelm, M. C. (1990). The relationship between psychosocial factors and breast cancer: Some unexpected results.
Fawzy, F. I., Cousins, N., Fawzy, N. W., Kemeny, M. E., Elashoff, R., & Morton, D. (1990). A structured psychiatric intervention for cancer patients: I. Changes over time in methods of coping and affective disturbance. Archives of General Psychiatry, 47, 720–725.
Fawzy, F. I., Fawzy, N. W., Hyun, C. S., Elashoff, R., Guthrie, D., Fahey, J. L., & Morton, D. L. (1993). Malignant melanoma: Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Archives of General Psychiatry, 50, 681–689.
Fawzy, F. I., Kemeny, M. E., Fawzy, N. W., Elashoff, D., Cousins, N., & Fahey, J. L. (1990). A structured psychiatric intervention for cancer patients: II. Changes over time in immunological measures. Archives of General Psychiatry, 47, 729735.