UCI-led study finds psychological therapy reduces biobehavioral impact of testicular cancer

GET intervention lowered stress-related biomarkers

Michael Hoyt

Psychological therapy reduces the adverse biobehavioral effects of testicular cancer in young adult survivors, according to a pilot study led by the University of California, Irvine. Biobehavior is the interaction of biological processes and behavior. Researchers’ findings, published in the American Journal of Men’s Health, show that Goal-focused Emotion-regulation Therapy, developed specifically to enhance the quality of life for these patients, reduced the stress hormone cortisol and the proinflammatory cell protein cytokine IL-1ra that triggers fatigue, pain and other side effects.

“Testicular is the most prevalent non-skin cancer among males in late adolescence and early adulthood, so there is significant need for increased attention to these survivors,” said Michael A. Hoyt, Ph.D., UCI associate professor of public health and corresponding author. “They face both psychological and physical impacts, including body image disruption, social relationship difficulty, fertility and sexual distress, anxiety, depression and fear of cancer recurrence. It is particularly challenging because men, especially young men, tend not to seek professional help for stress.”

GET is an individually delivered intervention focused on preventing short- and long-term adverse effects of cancer by developing coping skills (such as realizing that some life goals are now challenged and setting realistic ones) and learning to regulate emotional responses.

Many of the negative physical and psychosocial effects operate in part via proinflammatory and physiological stress pathways. Basic research indicates that proinflammatory cytokines can cause the central nervous system to generate or exacerbate behavioral and physical changes after cancer, including fatigue, pain sensitivity, and mood and cognition problems. The hypothalamic-pituitary-adrenal axis is the central regulatory system for controlling the release of cortisol. The activation of stress hormones is linked to a variety of health complications, such as fatigue and cognitive dysfunction, and may also contribute to cancer progression over time.

The pilot study involved 44 men aged 18 to 39 who had testicular cancer and underwent chemotherapy during the previous two years. Participants were randomized to receive either GET therapy or individualized supportive therapy over eight weeks. Saliva and blood samples were collected before and after the interventions. Those receiving GET had significantly lower salivary cortisol and substantially lower plasma levels of IL-1ra compared to the control group.

“The results of this randomized control trial comparing the two therapies indicate that GET might work to mitigate cancer-relevant proinflammatory and stress-related processes in this young adult survivor group,” Hoyt said. “These preliminary findings are promising, but a larger scale trial is needed to determine overall efficacy and impact.”

The study team also included Ashley W. Wang, Ph.D., assistant professor of psychology, Soochow University, Taiwan; Elizabeth C. Breen, Ph.D., professor emerita, Cousins Center for Psychoneuroimmunology, UCLA; and Christian J. Nelson, Ph.D., chief attending psychologist, Memorial Sloan Kettering Cancer Center.

This work was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grants UL1TR00457 and UL1TR001414.


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