Objective: The diagnosis of a life-threatening illness in a child is one of the most stressful events imaginable for parents and is associated with increased anxiety and distress. Despite associations between stress and immune function in animal and human models, the immune function in caregivers of children at the time of a child-related potentially traumatic event, like cancer, is not known. Methods: Nineteen parents (11 mothers, 8 fathers), representing six caregiver pairs, provided blood for natural killer (NK) cell count by flow cytometry and function assays [% NK whole blood, absolute NK whole blood, LU20 (lytic unit) peripheral blood mononuclear cells, LU20 NK cells] and completed self-report measures (acute stress) within 2 weeks of learning their child had cancer. The NK cell assay was also completed with a sample of healthy adults, the immune reference group. Results: There were similar levels of NK cell activity between caregivers and the immune reference group. Immune level and psychological outcomes were not associated. LU20 peripheral blood mononuclear cells and LU20 NK cells were each correlated at r = 0.83 between mothers and fathers in the same family. Conclusions: Although based on a small sample, these preliminary results suggest that knowledge about stress responses in parents of children with life-threatening illness may be important and provide novel data regarding the shared impact of stress on immune function within caregiver dyads.
© 2008 S. Karger AG, Basel
- Pediatric cancer
- Natural killer cell
- Immune function
- Acute stress
- Kazak AE, Simms S, Alderfer MA, Rourke MT, Crump T, McClure K, Jones P, Rodriguez A, Boeving CA, Hwang WT, Reilly A: Feasibility and preliminary outcomes from a pilot study of a brief psychological intervention for families of children newly diagnosed with cancer. J Pediatr Psychol 2005;30:644–655.
- Stuber ML, Shemesh E: Post-traumatic stress response to life-threatening illnesses in children and their parents. Child Adolesc Psychiatr Clin N Am 2006;15:597–609.
- Kazak AE, Boeving CA, Alderfer MA, Hwang WT, Reilly A: Posttraumatic stress symptoms during treatment in parents of children with cancer. J Clin Oncol 2005;23:7405–7410.
- American Psychiatric Association: DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 2000.
- Patiño-Fernández AM, Pai A, Alderfer MA, Hwang WT, Reilly A, Kazak AE: Acute stress in parents of children newly diagnosed with cancer. Pediatr Blood Cancer 2008;50:289–292.
- Starkweather AR, Witek-Janusek L, Nockels RP, Peterson J, Mathews HL: Immune function, pain, and psychological stress in patients undergoing spinal surgery. Spine 2006;31:E641–E647.
- Lutgendorf S, Sood AK, Anderson B, McGinn S, Maiseri H, Dao M, Sorosky JI, De Geest K, Ritchie J, Lubaroff D: Social support, psychological distress, and natural killer cell activity in ovarian cancer. J Clin Oncol 2005;23:7105–7113.
- Douglas SD, Camarca M, Xu J, Durako S, Murphy D, Moscicki B, Wilson CM: The relationships between substance abuse, psychological variables, and natural killer cell enumeration and function in HIV-infected and high-risk uninfected adolescents. AIDS Res Hum Retroviruses 2003;19:399–408.
- De Gucht V, Fischler B, Demanet C: Immune dysfunction associated with chronic professional stress in nurses. Psychiatry Res 1999;85:105–111.
- Arranz L, Guayerbas N, De la Fuente M: Impairment of several immune functions in anxious women. J Psychosom Res 2007;62:1–8.
- Kawamura N, Kim Y, Asukai N: Suppression of cellular immunity in men with a past history of posttraumatic stress disorder. Am J Psychiatry 2001;158:484–486.
- Futterman AD, Wellisch DK, Zighelboim J, Luna-Raines M, Weiner H: Psychological and immunological reactions of family members to patients undergoing bone marrow transplantation. Psychosom Med 1996;58:472–480.
- Glaser R: Stress-associated immune dysregulation and its importance for human health: a personal history of psychoneuroimmunology. Brain Behav Immun 2005;19:3–11.
- Kuster PA, Merkle CJ: Caregiving stress, immune function, and health: implications for research with parents of medically fragile children. Issues Compr Pediatr Nurs 2004;27:257–276.
- Bryant RA, Moulds ML, Guthrie RM: Acute Stress Disorder Scale: a self-report measure of acute stress disorder. Psychol Assess 2000;12:61–68.
- Auerbach SM, Kiesler DJ, Wartella J, Rausch S, Ward KR, Ivatury R: Optimism, satisfaction with needs met, interpersonal perceptions of the healthcare team, and emotional distress in patients’ family members during critical care hospitalization. Am J Crit Care 2005;14:202–210.
- Balluffi A, Kassam-Adams N, Kazak A, Tucker M, Dominguez T, Helfaer M: Traumatic stress in parents of children admitted to the pediatric intensive care unit. Pediatr Crit Care Med 2004;5:547–553.
- Werba BE, Hobbie W, Kazak AE, Ittenbach RF, Reilly A, Meadows AT: Classifying the intensity of pediatric cancer treatment protocols: the Intensity of Treatment Rating Scale 2.0 (ITR-2). Pediatr Blood Cancer 2007;48:673–677.
- Douglas SD, Ho WZ, Gettes DR, Cnaan A, Zhao H, Leserman J, Petitto JM, Golden RN, Evans DL: Elevated substance P levels in HIV-infected men. AIDS 2001;15:2043–2045.
- Motzer SA, Jarrett M, Heitkemper MM, Tsuji J: Natural killer cell function and psychological distress in women with and without irritable bowel syndrome. Biol Res Nurs 2002;4:31–42.
- Irwin M, Hauger R, Patterson TL, Semple S, Ziegler M, Grant I: Alzheimer caregiver stress: basal natural killer cell activity, pituitary-adrenal cortical function, and sympathetic tone. Ann Behav Med 1997;19:83–90.
- Segerstrom SC, Miller GE: Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull 2004;130:601–630.
- Dopp JM, Miller GE, Myers HF, Fahey JL: Increased natural killer-cell mobilization and cytotoxicity during marital conflict. Brain Behav Immun 2000;14:10–26.
Dr. Anne E. Kazak
The Children’s Hospital of Philadelphia
34th Street and Civic Center Boulevard, Room 1486, CHOP North
Philadelphia, PA 19104-4399 (USA)
Tel. +1 215 590 2220, Fax +1 215 590 3020, E-Mail firstname.lastname@example.org
Received: October 17, 2007
Accepted: March 12, 2008
Published online: August 5, 2008
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 2, Number of References : 23
Vol. 15, No. 2, Year 2008 (Cover Date: August 2008)
Journal Editor: Savino W. (Rio de Janeiro)
ISSN: 1021–7401 (Print), eISSN: 1423–0216 (Online)
For additional information: http://www.karger.com/NIM
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.