Psychological therapy alleviates adverse biobehavioral effects in young adult testicular cancer survivors

Reviewed by Emily Henderson, B.Sc.Oct 6 2021

Psychological therapy reduces the adverse biobehavioral effects of testicular cancer in young adult survivors, according to a pilot study led by the University of California, Irvine. Biobehavior is the interaction of biological processes and behavior. Researchers' findings, published in the American Journal of Men's Health, show that Goal-focused Emotion-regulation Therapy, developed specifically to enhance the quality of life for these patients, reduced the stress hormone cortisol and the proinflammatory cell protein cytokine IL-1ra that triggers fatigue, pain and other side effects.

Testicular is the most prevalent non-skin cancer among males in late adolescence and early adulthood, so there is significant need for increased attention to these survivors. They face both psychological and physical impacts, including body image disruption, social relationship difficulty, fertility and sexual distress, anxiety, depression and fear of cancer recurrence. It is particularly challenging because men, especially young men, tend not to seek professional help for stress."

Michael A. Hoyt, Ph.D., UCI associate professor of public health and corresponding author

GET is an individually delivered intervention focused on preventing short- and long-term adverse effects of cancer by developing coping skills (such as realizing that some life goals are now challenged and setting realistic ones) and learning to regulate emotional responses.

Many of the negative physical and psychosocial effects operate in part via proinflammatory and physiological stress pathways. Basic research indicates that proinflammatory cytokines can cause the central nervous system to generate or exacerbate behavioral and physical changes after cancer, including fatigue, pain sensitivity, and mood and cognition problems. The hypothalamic-pituitary-adrenal axis is the central regulatory system for controlling the release of cortisol. The activation of stress hormones is linked to a variety of health complications, such as fatigue and cognitive dysfunction, and may also contribute to cancer progression over time.

The pilot study involved 44 men aged 18 to 39 who had testicular cancer and underwent chemotherapy during the previous two years. Participants were randomized to receive either GET therapy or individualized supportive therapy over eight weeks. Saliva and blood samples were collected before and after the interventions. Those receiving GET had significantly lower salivary cortisol and substantially lower plasma levels of IL-1ra compared to the control group.

"The results of this randomized control trial comparing the two therapies indicate that GET might work to mitigate cancer-relevant proinflammatory and stress-related processes in this young adult survivor group," Hoyt said. "These preliminary findings are promising, but a larger scale trial is needed to determine overall efficacy and impact."