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 Lippman, Bonnie B. Blomberg

Research output: Contribution to journalArticlepeer-review

24 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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