Psychosocial Telephone Counseling for Survivors of Cervical Cancer: Results of a Randomized Biobehavioral Trial

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Abstract

Cervical cancer survivors often face quality-of-life (QOL) disruptions that persist years after treatment has ended. A large number of studies have demonstrated that psychosocial interventions have positive effects on psychosocial functioning and QOL of patients with cancer. It has been well documented that psychosocial telephone counseling (PTC) improves QOL in cancer survivors. Previous studies have suggested that psychosocial intervention may impact clinical outcomes in cancer patients by promoting antitumor immunity via modulation of the stress response.

The aim of this randomized controlled trial was to examine the effect of a PTC intervention in survivors of cervical cancer on patient-reported outcomes of QOL, depression, anxiety, and gynecologic concerns, as well as associations in stress-related biomarkers. A total of 204 survivors of cervical cancer who were 9 or more and less than 30 months from diagnosis were randomized to PTC or usual care. The PTC intervention included 5 weekly sessions and a 1-month booster. Changes in patient-reported outcomes and immune stress biomarkers (cytokines, interleukins) between study arms were compared at baseline and 4 and 9 months after enrollment using multivariable analysis of variance for repeated measures.

Mean age of participants was 43 years; 40% were Hispanic, and 51% were non-Hispanic white. After adjusting for age and baseline scores, patients in the PTC group had significantly improved scores for depression and gynecologic and cancer-specific concerns at 4 months compared with participants in the usual care group (all comparisons P < 0.05). Differences in gynecologic and cancer-specific concerns persisted at 9 months (P < 0.05). Longitudinal change in overall QOL and anxiety was not significantly different at either 4 or 9 months. Significantly greater improvement in QOL occurred in participants with decreasing interleukin 4 (IL-4), IL-5, IL-10, and IL-13 than those with increasing cytokine levels.

These findings demonstrate that PTC provides benefits for depression and QOL cancer-specific and gynecologic concerns in a multiethnic underserved population of cervical cancer survivors. The association between decreasing T-helper type 2 cytokines and counterregulatory cytokines with improved QOL is consistent with a potential biobehavioral pathway relevant to cancer survivorship.

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