Prognostische Relevanz der Selbstwirksamkeitserwartung von Frauen mit Brustkrebs im Frühstadium: Ein biopsychosoziales Mediatormodell

Zusammenfassung

Hintergrund Viele Patientinnen mit frühem Mammakarzinom glauben an eine prognostische Relevanz eigener Initiativen zur Krankheitsbewältigung (Kontrollüberzeugung, Selbstwirksamkeitserwartung SWE). Zur Frage des Zusammenhangs zwischen der Ausprägung der SWE und ihres möglichen Einflusses auf objektive Outcome-Parameter von Brustkrebs gibt es jedoch noch keine prospektiven klinischen Studien.

Fragestellung, Ziel Wie kann man sich die Wirkmechanismen der SWE als Prognosefaktor bei Brustkrebs vorstellen? Entwurf eines entsprechenden biopsychosozialen Mediatormodells.

Methodik Literatur-Review zum prognostischen Einfluss von psychosozialen und Wirtsfaktoren beim frühen Mammakarzinom. Quervergleich existierender Mediatormodelle.

Ergebnisse Auf der Basis neuerer psychoonkologischer, neurophysiologischer, immunologischer, molekularbiologischer und epigenetischer Erkenntnisse lässt sich eine geschlossene Kaskade der Ereignisse, angefangen von Verhaltensänderungen der Patientinnen bis hin zur Wachstumsregulation maligner Zellen bei Brustkrebs postulieren.

Diskussion SWE ist möglicherweise der beste Indikator einer psychobiologischen Konstellation, die sich günstig auf den Verlauf von Brustkrebs auswirken kann. Diese Annahme sollte im Rahmen klinischer Studien überprüft werden. Die entsprechenden wissenschaftlichen Voraussetzungen für solche Studien sind heute gegeben.

ABSTRACT

Background The majority of women with early breast cancer (EBC) believe that the outcome of their disease might be positively affected by self-empowerment and self-efficacy expectations (SEE). However, until today there are no long term studies correlating SEE and prognosis in EBC.

Aim To explain the possible mechanisms of action of SEE as a prognostic factor in EBC. Development of a respective biopsychosocial model.

Methods Review of the literature and of existing mediator models with particular reference to EBC, SEE and prognostic factors of host origin.

Results Recent findings from research in psychooncology, neurophysiology, immunology, molecular biology and epigenetics allow for the description of a closed chain of events starting from SEE to molecular modeling of mechanisms involved in breast cancer growth control.

Discussion It appears that SEE is a useful surrogate parameter to assess patient related factors determining the outcome of EBC. The correlation of SEE with end parameters of tumor therapy should be tested in clinical trials. The knowhow and instruments for such trials are available.

Schlüsselwörter

Prognosefaktoren Mammakarzinom - Patientenkompetenz - Selbstwirksamkeitserwartung - Empowerment-Coaching - biopsychosoziales Mediatormodell Brustkrebs

Key words

Prognostic factors breast cancer - expert patients - self-efficacy expectation - empowerment-coaching - biopsychosocial model breast cancer

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