Stress management, leukocyte transcriptional changes and breast cancer recurrence in a randomized trial: An exploratory analysis

Michael H Antoni, Laura C. Bouchard, Jamie M. Jacobs, Suzanne C Lechner, Devika R. Jutagir, Lisa M. Gudenkauf, Charles S Carver, Susan Lutgendorf, Steven W. Cole, Marc E Lippman, Bonnie B Blomberg

Research output: Contribution to journalArticle

21 Scopus citations


Purpose Cognitive behavioral stress management (CBSM) is an empirically-validated group-based psychosocial intervention. CBSM is related to decreased self-reported indicators of psychological adversity during breast cancer treatment and greater disease-free survival (DFS) vs. a control condition. This study examined relationships between CBSM, DFS, and a potential biobehavioral pathway linking these variables in breast cancer patients through a gene expression composite representing the leukocyte conserved transcriptional response to adversity (CTRA). Design Women with stage 0-IIIb breast cancer completed questionnaires and provided blood samples post-surgery. Participants were randomized to 10-week group-based CBSM or a psychoeducation control group and followed at 6 months, 12 months, and median 11 years. In total, 51 participants provided blood data for longitudinal analyses (CBSM n = 28; Control n = 23). Mixed model analyses examined CBSM effects on 6–12 month changes in CTRA expression (53 indicator genes representing pro-inflammatory, anti-viral and antibody production signaling). Cox regression models assessed the relationship between 6 and 12 month changes in CTRA expression and 11-year DFS. Results Patients randomized to CBSM showed attenuated 6–12 month change in CTRA gene expression, whereas patients randomized to control showed increased CTRA expression (p = 0.014). Average DFS was 5.92 years (SD = 3.90). Greater 6–12 month CTRA increases predicted shorter 11-year DFS controlling for covariates (p = 0.007). Conclusions CBSM attenuated CTRA gene expression during the initial year of breast cancer treatment. In turn, greater increases in CTRA gene expression predicted shorter long-term DFS. These findings identify a biobehavioral oncology pathway to examine in future work.

Original languageEnglish (US)
Pages (from-to)269-277
Number of pages9
StatePublished - Dec 1 2016


  • Breast cancer recurrence
  • Cognitive behavioral stress management
  • Conserved transcriptional response to adversity
  • Disease-free survival
  • Leukocyte gene expression

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Endocrine and Autonomic Systems
  • Psychiatry and Mental health
  • Biological Psychiatry

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