| Objectives:In developed countries, the highest incidence of woman's cancer is breast cancer. In the past twenty years, the incidence of breast cancer in china increased significantly, which became the highest incidence of woman's cancer in some cities, and the age of breast cancer patients tended to become young. Adults who undergo chronic stress, such as the diagnosis and surgical treatment of breast cancer, often experience negative psychologic responses, especially for the breast cancer patients whose negative psychologic responses were stronger than the other because of the serious impact of surgery on female sexuality. The stress may affect the immune system, possibly reducing the ability of individuals with cancer to resist disease progression and metastatic spread. The research on psychoneuroimmunology of breast cancer in developed countries was more. However, this kind of research was less in our country, especially the pre-post operative emotional and immune change of breast cancer patients and the impact of social support, coping style, personality on it. The purpose of the study was to understand the pre-post operative emotional and immune change of breast cancer patients, to analyze the impact of social support,coping style, personality on the pre-post operative emotional and immune change of breast cancer patients, to discuss the relationship between emotion and immunity, to find out the main psychosocial factors effecting the pre-post operative emotion and immunity, thus to provide theoretical and practical basis for clinical psychological intervention of breast cancer patients during pre-post operation. The research could also facilitate personal psychological care, and then improve the nurses' quality of psychological care and the patients' quality of life.Subjects and Methods:By convenient sampling method, seventy-six patients at five hospitals in Guangzhou were investigated, who were surgically treated for the first time, had not yet begun adjuvant treatment, whose age was from eighteen to sixty-five and Karnofsky Performance scores were more than sixty. Emotional and immunological data were collected two or three days before surgery and seven days more or less after surgery, and at the same time of investigating emotion before surgery the participants' psychosocial characteristic were assessed. Emotional data was assessed with Profile of Mood States-short form(POMS-SF). Perceived Social Support Scale(PSSS), Dealing with Illness-Coping Inventory(DWI-CI), and Eysenck Personality Questionnaire(EPQ) were used to measure participants' psychosocial characteristic. Blood was draw to understand the participants' immunological function. LDH release assay was used to measure NK cell activity, ELISA was used to measure IFN-y level, and MTT was used to measure proliferative response of peripheral blood lymphocytes to plant lectins. Statistical analyses methods included Descriptive statistic, Paired Mests, Repeated-measures ANOVA, One-way ANOVA, Scheffe-tests, Pearson correlation, Multiple stepwise regression. The software SPSS for Windows, release 10.0 for personal computers was used for statistical anaactivity.Results:1. Pre-post operative emotional changes and the impact of psychosocial factors on it The pre-post differences of emotion. All kinds of emotion became worse one week after surgery compared to before surgery (P<0.05).Impact of social support on emotion. The lower the social support was, the higher the negative emotion scores was, such as: depression-dejection, fatigue-inertia, confusion-bewilderment, and the negative emotion scores increased after surgery(P<0.05). The higher the social support was, the lower the negative emotion scores was, and the negative emotion would not increase after surgery. The impact of the external and internal family support on depression-dejection was both significant after surgery(external family support: F=6.272, P=0.003; internal family support: F=6.886, P<0.002). The impact of the external family support on the negative emotion was stronger than the internal family support.Impact of coping style on emotion. Those with high level of the active-behavior coping had lower scores of anger-hostility, vigor and preoperative confusion-bewilderment than those with low level(P<0.05), and their confusion-bewilderment would not change after surgery. For the patients with middle or lower level of active-cognitive coping, the depression-dejection and the total mood disturbance(TMD) scores became higher after surgery(P<0.05), but for the patients with higher level of active-cognitive coping, the depression-dejection and TMD scores were maintained the same level after surgery as before surgery. For the patients with higher level of avoidance coping, the scores of TMD, tension-anxiety, depression-dejection, confusion-bewilderment all were higher than those with lower level of avoidance coping(P<0.05). However, the negative emotion scores of those with higher level of avoidance coping would not change significantly after surgery,but the negative emotion scores of those with middle or lower level of avoidance coping would become higher after surgery(P<0.05).Impact of personality on emotion. Those with higher level of psychoticisim had higher scores of fatigue-inertia. The tension-anxiety and vigor-activity scores of those with higher level of psychoticisim would not change significantly compared to those with middle or lower level of psychoticisim. The more the extrovistion was, the higher the tension-anxiety scores was(P<0.05). The more the neuroticism was, the higher the negative emotion scores was, such as: depression-dejection, tension-anxiety, fatigue-inertia, confusion-bewilderment(P<0.05). Neuroticism's impact on tension-anxiety was significant before surgery(F=7.460, P=0.001) but not significant after surgery. Those with higher lie had lower scores of anger-hostility, lower scores of fatigue-inertia before surgery, and higher scores of vigor-activity after surgery.Multiple stepwise regression of the influence factors of emotion before or after surgery. Before surgery, factors entering into the regression equation of impacting TMD were avoidance coping, peasant, diagnose time, tumour stages and fee sources, which could explain 36.6% of the total variance, and avoidance coping's contribution rate to the total variance was the highest, arrived at 12.6%. Avoidance coping and diagnose time was statistically significant positively correlated with preoperative TMD. After surgery, factors entering into the regression equation of impacting TMD were preoperative TMD, diagnose time, social support, lie, office clerk, income state and peasant, which could explain 74.7% of the total variance, and preoperative TMD's contribution rate to the total variance was the highest, arrived at 39.9%. Preoperative TMD, diagnose time, lie and office clerk were statistically significant positively correlated with postoperative TMD.2. Pre-post operative immunological changes and the impact of psychosocial factors on itThe pre-post differences of immunity. The NK cell activity and IFN-y level became worse one week after surgery compared to before surgery(P<0.05). Proliferative response of peripheral blood lymphocytes to plant lectins didn't change significantly.Impact of social support on immunity. The higher the external family support was, the higher the NK cell activity was(P<0.05).Impact of coping style on immunity. The higher the active-behavior coping was, the higher NK cell activity and IFN-y level were after surgery(P<0.05).Impact of personality on immunity. Extrovistion-introvision and neuroticism had significantly impact on immunity. The more the extrovistion was, the better the NK cell activity was. The more the neuroticism was, the worse the NK cell activity, IFN-y level and proliferative response of peripheral blood lymphocytes to plant lectins(P<0.05).Correlation between emotion and immunity. Before surgery, the emotion and immunity's correlation was not significantly, but some preoperative emotion had impact on postoperative immunity. After surgery, the emotion had correlation with the NK cell activity, but had not correlation with the other two immunological data. Depression-dejection after surgery correlated significantly and most tightly with the NK cell activity(r =-0.463). The other emotion factors correlated with it significantly and from most to least tightly in order were: postoperative tension-anxiety(r =-0.401), postoperative TMD(r =-0.362), preoperative depression-dejection(r =-0.352), preoperative TMD(r =-0.351). No matter before or after surgery depression-dejection always were statistically significant negatively correlated with the NK cell activity.Multiple stepwise regression of the influence factors of immunity before or after surgery. Before surgery, factors entering into the regression equation of impacting NK cell activity were extrovistion-introvision, social support and neuroticism, which could explain 51.8% of the total variance. After surgery, factors entering into the regression equation of impacting NK cell activity were preoperative NK cell activity, active behavior and neuroticism, which could explain 92.1% of the total variance. In all of the factors entering into regression equation after surgery the preoperative NK cell activity's contribution rate to the total variance was the highest, arrived at 90.2% oBefore surgery, factor entering into the regression equation of impacting IFN-y level was neuroticism, which could explain 20.4% of the total variance. After surgery, factors entering into the regression equation of impacting IFN-y level were preoperative IFN-y level, which could explain88.9% of the total variance.Before surgery, factors entering into the regression equation of impacting proliferative response of peripheral blood lymphocytes to plant lectins were neuroticism and avoidance coping, which could explain 54.6% of the total variance. After surgery, factors entering into the regression equation of impacting proliferative response of peripheral blood lymphocytes to plant lectins were preoperative proliferative response of peripheral blood lymphocytes to plant lectins and preoperative TMD, which could explain 86.2% of the total variance. In all of the factors entering into regression equation after surgery the preoperative proliferative response of peripheral blood lymphocytes to plant lectins' contribution rate to the total variance was the highest, arrived at 84.1 %?Conclusion:1. The emotion and immunity became worse statistically significant one week after surgery compared to before surgery.2. Different level of social support, coping style and personality had different impact on pre-post operative emotion and immunity. In generally, those with higher level of social support, active-behavior, active-cognitive, extrovistion and lower level of avoidance, neuroticism had better emotion or immunity. Otherwise, the emotion and immunity would worse. Some psychosocial factors had different impact at different time.3. Emotion and immunity had correlation with each other. Compared to other immunity, the NK cell activity after surgery correlated with emotion significantly. Depression-dejection and tension-anxiety after surgery correlated significantly and most tightly with the NK cell activity after surgery. Before surgery, the correlation between emotion and immunity was not significantly, but some preoperative emotion had impact on postoperative immunity.4. The influence factors of emotion and immunity were different before or after surgery. For emotion, before surgery, avoidance coping, diagnose time was statistically significant positively correlated with TMD, but peasant, tumour stages and fee sources were statistically significant negatively correlated with TMD; after surgery, pre TMD, diagnose time, lie and office clerk were statistically significant positively correlated with TMD, but social support, income state and peasant were statistically significant negatively correlated with TMD. For immunity, before surgery, those with higher level of extrovistion, lower level of neuroticism, higher level of social support and lower level of avoidance had better immune function; after surgery, those with lower level of neuroticism, higher level of active-behavior and lower level of TMD preoperative had better immune function. Especially after surgery, the psychosocial factors still had impact on immune function when immune function before surgery was entered in multiple regression equations.5. The psychosocial factors' impact on pre-post operative emotion and immunity is complicated, not only had main effect, but also had interactive effect with the time of pre-post operation, and the influence factors were different before or after surgery, together with different psychological response of different patients. Thus, in order to get better treatment effect, it's necessary to give psychological intervention according to the impact characteristic of psychosocial factors and personal differences in psychosocial factors,... |
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