COLUMBUS, Ohio – A satisfying intimate relationship may help diminish chemotherapy-related cognitive problems experienced by patients with breast cancer, a new study suggests.
General social support was also protective, but the association was less robust and lasting than a satisfying intimate partnership, which was characterized by fewer declines in both objective measures of cognitive setbacks and patient self-reports of subtle changes such as forgetting grocery list items and being unable to multitask.
The findings suggest that couples therapy aimed at enhancing relationship quality could be a helpful option for partnered patients undergoing chemo, researchers said.
The team also found that blood levels of the hormone oxytocin , an important player in social bonding, decreased significantly over the course of chemotherapy treatment, which may hint at a biological mechanism that could one day be targeted to reduce chemo's side effects.
"There are a lot of cancer treatments, but there are very few treatments for the behavioral side effects of cancer. So we need to understand how they're happening in order to create useful interventions for the side effects," said senior author Leah Pyter , director of the Institute for Behavioral Medicine Research at The Ohio State University and associate professor of psychiatry and behavioral health in the College of Medicine.
"Before this study, we didn't understand that bolstering the intimate partnership before the patient undergoes chemo might attenuate their cognitive side effects."
The research was published recently in the journal Psychoneuroendocrinology .
The 48 participating women with breast cancer were part of a larger study examining links between chemo-induced disruption of the gut microbiome, inflammation and cognitive decline.
Participants completed objective tests assessing verbal learning, word association, visual attention and short-term memory. Separately, they reported on changes to their concentration, memory, word retrieval and mental clarity and how any declines affected their quality of life. These measures were taken before, during and after chemo treatment.
Decreases in mental fitness did not meet the clinical definition of cognitive impairment, but several changes were considered clinically meaningful.
"It was nice to be able to test these patients before they had chemo and then again after, because people can be affected by chemo and still be within normal ranges – but for them, it's not normal," Pyter said.
For this study, first author Melina Seng , then a master's student and now a senior research technician in Pyter's lab, followed up with the partnered patients to assess their intimate relationship satisfaction and how much social support from friends and family they received during chemo treatment.
Statistical analysis revealed associations between changes in cognitive scores and social factors, finding that the more satisfied the patients were in their relationship, the more protected they were from cognitive changes over the course of chemotherapy.
"There was less decline in cognitive function for those who had a good amount of social support, but there were more associations and more enduring associations between protected cognition and the highly satisfying relationship than just with general social support," Pyter said. "We interpreted that as an indication that the most important social relationship is that intimate partnership.
"There's group therapy for chemo patients, which is social support, and this study would suggest that while that therapy might be beneficial, marital or partner therapy used in other medical contexts to improve the quality of the relationship might also be a good approach for patients receiving chemo."
While Seng hoped to find associations between oxytocin levels, cognitive function and social support, no clear connections could be detected. The results did show, however, that the hormone and its receptor were affected by chemo.
In particular, the level of oxytocin circulating in the blood decreased significantly during chemo and returned to baseline levels after treatment, suggesting that chemotherapy could be affecting the hypothalamus region of the brain, where oxytocin is made.
"Oxytocin is well-known to play roles in social interactions and has been called the 'love' hormone, but it does so many other things," Seng said. "To our knowledge, no one has ever studied oxytocin and chemotherapy before, so the fact that we saw a very strong decrease in oxytocin from pre-chemotherapy to during chemotherapy is very interesting and is something that should be investigated further."
Both Pyter and Seng noted that with increased breast cancer survivorship comes an urgent need to address lingering side effects of treatment.
"Chemotherapy is one of the best treatments we have for cancer and for other diseases beyond cancer. It affects a lot of people and is very effective," Pyter said. "We have more survivors, which is fantastic. Our research is focused on issues that are less well-studied, trying to make sure that survivors' quality of life is as high as possible."
This work was supported by the National Center for Advancing Translational Sciences and The Ohio State University Wexner Medical Center .
Additional co-authors, all from Ohio State, were Seth Adarkwah Yiadom, Lauren Otto-Dobos, Sagar Sardesai, Nicole Williams, Margaret Gatti-Mays, Daniel Stover, Preeti Sudheendra, Erica Dawson, Robert Wesolowski, Baldwin Way, Erica Glasper and Rebecca Andridge.
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