Wird mit onkologischen Erkrankungen vor dem Hintergrund psychoneuroimmunologischer Erkenntnisse aktuell angemessen umgegangen?

Zusammenfassung

Die Psychoneuroimmunologie (PNI) untersucht die Wechselwirkungen zwischen Psyche, neuroendokrinem und Immunsystem. Sie trägt damit zur empirischen Fundierung der bio-psycho-sozialen Modellkonzeption George Engels entscheidend bei. Krankheit wird in diesem Modell als Folge eines komplexen, wechselseitigen Zusammenspiels biologischer, psychologischer und sozialer Faktoren beschrieben, wobei psychologische und soziale Faktoren als höher komplexe Einflussfaktoren verstanden werden. Aus Sicht der PNI stellt sich daher die Frage, inwiefern sich multiple Stressbelastungen, die im Rahmen einer Krebserkrankung unweigerlich auftreten, ungünstig auf den weiteren Krankheitsprozess auswirken und welche psycho-immunologischen Wirkpfade diesen Zusammenhang vermitteln.

Bisherige PNI-Studien zeigen, dass stressassoziierte, psychosoziale Belastungsfaktoren (z.B. Hoffnungslosigkeit, Mangel an sozialer Unterstützung) einen prognostisch ungünstigen Einfluss auf das immunassoziierte Krebsgeschehen (z.B. Krebsüberwachung, Tumorwachstum) haben. Hierbei sind Cortisol und Katecholamine (Adrenalin, Nor-adrenalin) als wesentliche Stressmediatoren anzusehen. Erste PNI-Ergebnisse liegen auch zu psychologischen Positivfaktoren (z.B. positiver Affekt, soziale Unterstützung) mit einer günstigen Beeinflussung immunologischer Prozesse bei Krebs vor. Darüber hinaus sprechen Interventionsstudien für eine entzündungsreduzierende Wirkung von unterschiedlichen psychosozialen Interventionen (z.B. kognitiv-behaviorale, achtsamkeitsbasierte Ansätze) bei onkologischen Patienten, auch wenn sich die Datenlage in diesem Bereich bisher noch als inkonsistent erweist. Um solchen inkonsistenten Ergebnissen der PNI-Forschung in Zukunft methodisch besser begegnen zu können, wird für einen einzelfallbasierten, biopsychosozialen Forschungszugang plädiert, der auf Zeitreihenanalyse und qualitativer Interviewmethodik basiert.

Die PNI liefert, wie in dieser Arbeit dargestellt, eine klare empirische Evidenz zur komplexen Verflechtung zwischen psychosozialen Prozessen und biologisch-krebsassoziierten Vorgängen. Diese Tatsache gilt es in der Diagnostik und Behandlung von onkologischen Patienten zwingend zu berücksichtigen.

Summary

Psychoneuroimmunology (PNI) deals with the complex interactions between psychological, neuroendocrinological and immunological factors. In this respect, PNI provides empirical support for the theoretical assumptions of George Engel’s biopsychosocial model. The biopsychosocial model attributes disease outcome to the complex interac-tion of biological, psychological and social factors and, moreover, suggests that social factors superordinate biological ones. PNI investigates whether the multiple stressors inevitably associated with cancer have a negative impact on the course of the disease and which psycho-immunological pathways mediate this connection.

Recent PNI studies demonstrate that stress and psychosocial risk factors (e.g. hopelessness, lack of social support) negatively interfere with tumor progression (immune surveillance, tumor growth). These effects are mediated primarily by neuroendocrine mechanisms (cortisol, catecholamines). Some evidence also suggests that positive psychological factors (e.g. positive effect, social support) favorably influence cancer outcomes. Furthermore, psychotherapeutic evidence in cancer patients shows the inflammation-lowering effects of cognitive-behavioral and mindfulness-based stress reduction interventions. As PNI research in oncology has yielded inconsistent findings, an alternative biopsychosocial methodology based on single-case studies, time series analyses and qualitative interview methods has been developed.

This (mini-)review outlines the complex interactions between psychosocial factors and cancer-associated biological processes. Such evidence needs to be considered in diagnostics and treatment of oncological patients.

Schlüsselwörter

Psychoneuroimmunologie - Psychoonkologie - Stress - Immunsystem - bio-psycho-sozial

Key words

psychoneuroimm unology - psycho-oncology - stress - immune system - bio-psycho-social

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