Dr. Antoni's lab has shown to date that greater depression levels in the post-surgical period are associated with elevations in circulating pro-inflammatory cytokines and also predict shorter overall survival at 11yr follow-up. He also showed that breast cancer patients assigned to a 10-wk CBSM intervention show during the first year of treatment improved psychological functioning (less depressed mood, anxiety, and social disruption; and better quality of life); less symptoms during treatment (less fatigue and sleep problems), decreased serum cortisol levels, improved cellular immune function and decreased leukocyte pro-inflammatory gene expression. These patients also show less depression and better quality of life, and greater overall survival and disease free survival over an 11-yr median follow-up. His lab also showed, in another NCI R01-funded trial, that breast cancer patients assigned to briefer (5 wk) relaxation training or cognitive behavioral therapy in the weeks after surgery show decreases in negative mood and cancer-specific intrusive thoughts, and decreases in inflammatory signaling in circulating leukocytes. This cohort is now being followed for long-term health effects.
With Dr. Frank Penedo, Dr. Antoni also showed similar improvements with CBSM intervention in quality of life and urinary symptoms in men with prostate cancer; and reduced stress and decreased odds of persisting cervical dysplasia in HIV+HPV+ low ethnic minority income women. He then extended this work with SCCC collaborators using community-based participatory research (CBPR) methods to reach African American breast cancer survivors (Proj CARE), and monolingual Hispanic prostate cancer patients living in Dade and Broward county in NCI R01 randomized trials. The work to date has resulted in the development and dissemination of empirically-validated treatment manuals published by Oxford press and the American Psychological Association for use in patients with breast cancer, prostate cancer and HIV/AIDS, which are in use at major facilities across the country.
In one ongoing trial, along with multi-PI Bonnie Blomberg in the UM/SCCC Tumor Biology program, funded from a Bankhead-Coley Florida Department of Health grant, his lab is testing whether delivering group CBSM via electronic tablets (eHealth) into patients' homes can improve older breast cancer patients' responses to the Influenza Vaccine and how this relates to changes in stress factors, B-cell function and systemic inflammatory indicators. They are now following this cohort for longer-term effects on cancer-accelerated aging using measures of immune senescence and mental and physical health outcomes. In a second ongoing trial (NCI-funded), Dr. Antoni and Dr. Frank Penedo (Cancer Control program), are testing if a linguistic and cultural translation of CBSM decreases urinary symptoms, inflammatory signaling and quality of life in a multi-site trial of monolingual Hispanic prostate cancer patients.
Dr. Antoni's lab has also collaborated with other investigators at Moffit Cancer Center (Drs. Cathy Meade, Paul Jacobsen) on trials to develop and test technology-assisted stress reduction platforms (DVD and Telehealth) in order to improve quality of life and side effects during chemotherapy. He recently completed a trial of an on-line stepped collaborative care intervention for cancer patients and caregivers, with researchers at the University of Pittsburgh (Dr. Jennifer Steel). Demonstrating that these psychosocial interventions are effective in underserved populations (ethnic/racial minorities, older patients) is key to the catchment area of SCCC.
Dr. Antoni and Dr. Neha Goel, a surgical oncologist, are now studying the effects of neighborhood disadvantage and perceived neighborhood stress on neuroendocrine biomarkers, leukocyte inflammatory gene expression, aggressive tumor biology and disease outcomes in a diverse cohort of breast cancer patients representing our catchment. They seek to identify modifiable stress factors that could be targeted with interventions such as CBSM. Going forward, Dr. Antoni's lab will apply stress management and the use of remote technology (eHealth, mHealth, virtual humans) in other understudied cancer patients including those who face major challenges in attending clinic-based intervention to expand cancer care to the home and the community. Most recently Dr. Antoni and Dr. Penedo worked with digital health care partners to develop a mobile app version of CBSM and recently completed a national trial demonstrating its efficacy in a diverse sample of cancer survivors.