Goal-Focused Emotion-Regulation Therapy for Young Adult Testicular Cancer Survivors

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Psychological therapy may reduce adverse biobehavioral effects of testicular cancer in young adult survivors, according to a pilot study published by Hoyt et al in the American Journal of Men’s Health. Biobehavior is the interaction of biologic processes and behavior. The recently published findings showed that goal-focused emotion-regulation therapy—developed specifically to enhance quality of life for these patients—reduced the stress hormone cortisol and the proinflammatory cell protein cytokine IL-1ra, which trigger fatigue, pain, and other side effects.

“Testicular is the most prevalent nonskin cancer among males in late adolescence and early adulthood, so there is significant need for increased attention to these survivors,” said corresponding study author Michael A. Hoyt, PhD, Associate Professor of Public Health at the University of California Irvine. “They face both psychological and physical impacts, including body image disruption, social relationship difficulty, fertility and sexual distress, anxiety, depression, and fear of cancer recurrence. It is particularly challenging because men—especially young men—tend not to seek professional help for stress.”

Goal-Focused Emotion-Regulation Therapy

Goal-focused emotion-regulation therapy is an individually delivered intervention focused on preventing short- and long-term adverse effects of cancer by developing coping skills (such as realizing that some life goals are now challenged and setting realistic ones) and learning to regulate emotional responses.

Many of the negative physical and psychosocial effects operate in part via proinflammatory and physiologic stress pathways. Basic research indicates that proinflammatory cytokines can cause the central nervous system to generate or exacerbate behavioral and physical changes after cancer, including fatigue, pain sensitivity, and mood and cognition problems. The hypothalamic-pituitary-adrenal axis is the central regulatory system for controlling the release of cortisol. The activation of stress hormones is linked to a variety of health complications, such as fatigue and cognitive dysfunction, and may also contribute to cancer progression over time.

Study Findings

The pilot study involved 44 men aged 18 to 39 years who had testicular cancer and received chemotherapy during the previous 2 years. Participants were randomly assigned to receive either goal-focused emotion-regulation therapy or individualized supportive therapy over 8 weeks. Saliva and blood samples were collected before and after the interventions.

Those men who received goal-focused emotion-regulation therapy had significantly lower salivary cortisol and substantially lower plasma levels of IL-1ra compared to the control group.

“The results of this randomized control trial comparing the two therapies indicate that goal-focused emotion-regulation therapy might work to mitigate cancer-relevant proinflammatory and stress-related processes in this young adult survivor group,” Dr. Hoyt said. “These preliminary findings are promising, but a larger-scale trial is needed to determine overall efficacy and impact.”

Disclosure: This work was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.