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The
number of deaths per year across the world from hepatocellular carcinoma
(HCC) exceeds 250,000 and it is the leading cause of death from cancer
in eastern Asia and sub-Sahara Africa and the sixth leading cause of cancer
death worldwide. Risk factors for HCC include primarily hepatitis
B (HBV) and C (HCV), and to a lesser extent alcohol abuse and exposure
to certain toxins. Extensive research has demonstrated that the relationship
between hepatitis B infection and the progression to HCC is mediated by
the immune system dysfunction. In the east (e.g., Africa and Asia),
several factors affecting immune system functioning are easily identified
(e.g., TB, malaria, HIV, malnutrition), however in the west (e.g., U.S.
and Europe), factors contributing to immune suppression are less apparent.
A substantial literature also exists regarding the relationship between
psychosocial factors such as stress, health behaviors, and psychiatric
morbidity, and neuroendocrine and immune system dysfunction and disease
progression in patients with cancer. However, the role of these factors
in the progression of HBV-HCC has not been explored. An understanding
of the relationship between the virology, immunology, and behavior in the
recurrence of HCC may provide alternative methods for secondary prevention
of HCC (e.g., behavioral) until a vaccine and/or pharmacological treatments
are developed, feasible, and affordable. The study design will be
prospective. Twenty-four patients diagnosed with HBV-HCC will serve
as participants. Disease progression will be assessed by intra-hepatic
(primary HCC) or extra-hepatic (metastatic) tumor growth. A battery
of instruments will be administered including a measure of stress, health-related
behaviors, and psychiatric morbidity. Neuroendocrine and immune parameters
will be measured and serve as mediators between the psychosocial variables
and disease progression. Based on previous research, "buffers" such
as coping, social support, and personality traits will be assessed as possible
predictors of stress, health behaviors, and psychiatric morbidity as well
as mediating factors between the psychosocial variables and neuroendocrine
and immune functioning. The results of the proposed pilot study will
provide data to allow a sample size estimation, determine which neuroendocrine
and immune markers are the best |
