Mothers with breast cancer and their adult daughters: The relationship between mothers' reaction to breast cancer and their daughters' emotional and neuroimmune status

Objectives: The objectives of this study were to assess the associations between psychologic distress of patients with breast cancer and of their adult daughters; and to assess the associations between mothers' psychologic distress and daughters' psychologic distress, stress hormone levels, natural cytotoxic activity (NCA), and Th1 cytokine secretion. Methods: Eighty mothers with breast cancer and 80 adult daughters participated in the study. They completed the Symptom Check List (SCL-90R) questionnaire. In addition, daughters completed a set of questions on their health status and habits and on the effects of their mothers' disease on their own lives. Thirty milliliters of heparinized venous blood and a first early-morning urine sample were collected from daughters between 8:00 and 9:00 AM. Spontaneous and interleukin-2 (IL-2)-induced NCA, in vitro IL-2 and IL-12 secretion, and levels of plasma cortisol and urinary catecholamines were tested in daughters. Forty-seven healthy women, age- and education-matched to daughters, completed the psychologic, immunologic, and hormonal tests, and served as a control group. Results: Psychologic distress of mothers and daughters was highly correlated. However, mothers experienced a higher level of distress than daughters. Mothers with advanced disease and their daughters were more distressed than mothers with primary disease and their daughters. Daughters' distress was also related to their subjective caregiving burden and the frequency of meetings with mothers. Higher distressed daughters had lower IL-2-induced NCA and decreased in vitro IL-2 and IL-12 secretion. Norepinephrine secretion level mediated the relationship between daughters' level of distress and their immune functions. Cortisol mediated only the relationship between daughters' distress and IL-2 secretion. Conclusions: This initial study shows that the psychologic distress of mothers with breast cancer and that of their adult daughters are similar. Stress hormone secretions and immune functions of daughters are related to both their own and their mothers' psychologic distress.