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Weitz MV, Bloch JR, Birati Y, Rundio A, Fisher K, Byrne S, Guerra L. The Relationship Between Yoga Practice Dosage and Perceived Stress, Anxiety, and Self-reported Health Among Breast Cancer Survivors Who Practice Yoga. Holist Nurs Pract 2023; 37:347-355. [PMID: 37851351 DOI: 10.1097/hnp.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The aim of this anonymous online study was to explore the yoga practice of breast cancer survivors to determine if yoga dosage (frequency and duration of practice) was related to stress, anxiety, and self-reported health in female survivors. Participants were recruited from online breast cancer support groups during a 3-month period (June-September 2019). Demographic information, stage and treatment of breast cancer, and frequency of yoga participation, including a home yoga practice were reported. Measures include the Perceived Stress Scale, State-Trait Anxiety Inventory, and self-reported health. Cumulative yoga dosage was calculated. Thirty-five women participated (mean age = 55 years) and were divided into low and high yoga dosage groups based on the sample distribution. Low dosage of yoga was operationally defined as a cumulative dosage that fell within the lowest quartile (≤25%). Findings indicated no difference between the low-dosage group compared with the high-dosage group for perceived stress and self-reported health; but the high dosage yoga group had lower state anxiety scores (P < .05). All participants reported good self-reported health. These findings contribute to our knowledge of the psychosocial aspects of breast cancer survivorship and raise questions for further research quantifying the therapeutic dosing of yoga practice.
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Affiliation(s)
- M Velma Weitz
- M Velma Weitz Wellness Practice, Philadelphia, Pennsylvania (Dr Weitz); Graduate Nursing Department, College of Nursing and Health Professions, Drexel University (Drs Bloch, Rundio, and Fisher); Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University Safed, Isreal (Dr Birati); and Department of Nursing & Public Health, School of Nursing and Health Science, The College of New Jersey (Dr Byrne). Dr Guerra, is in private practice at Bala Cynwyd, Pennsylvania
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Goel N, Hernandez AE, Ream M, Clarke ES, Blomberg BB, Cole S, Antoni MH. Effects of neighborhood disadvantage on cortisol and interviewer-rated anxiety symptoms in breast cancer patients initiating treatment. Breast Cancer Res Treat 2023; 202:203-211. [PMID: 37561280 PMCID: PMC11250915 DOI: 10.1007/s10549-023-07050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/13/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Shorter breast cancer (BC) survival outcomes persist by neighborhood disadvantage independent of patient, tumor, and treatment characteristics. This suggests unaccounted mechanisms by which neighborhood disadvantage "gets under the skin" to impact BC survival outcomes. Here, we evaluate the relationship between neighborhood disadvantage and clinical and neuroendocrine markers of stress in BC patients. METHODS Women with stage 0-III BC were enrolled 2-10 weeks post-surgery and before initiating adjuvant treatment in a study examining stress and stress management processes. Women provided an afternoon-evening (PM) serum cortisol sample and were administered the Hamilton Anxiety Rating Scale (HAM-A). Home addresses were used to determine the Area Deprivation Index (ADI), a validated measure of neighborhood disadvantage. Multiple regression assessed the relationship between ADI and PM serum cortisol and the presence of elevated HAM-A symptoms. RESULTS Our sample (n = 225) was predominately middle-aged (M = 50.4 years; range 23-70 years), non-Hispanic White (64.3%), with stage I (38.1%), or II (38.6%) disease. The majority (n = 175) lived in advantaged neighborhoods (ADI 1-3). After controlling for age, stage, and surgery type, women from high ADI (4-10) (vs low ADI) neighborhoods had higher PM cortisol levels (β = 0.19, 95% CI [0.24, 5.00], p = 0.031) and were nearly two times as likely to report the presence of elevated anxiety symptoms (OR = 1.96, 95% CI [1.00, 3.86], p = 0.050). CONCLUSION Neighborhood disadvantage is significantly associated with higher levels of PM cortisol and elevated anxiety symptoms suggesting stress pathways could potentially contribute to relationships between neighborhood disadvantage and BC survival.
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Affiliation(s)
- Neha Goel
- Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Suite 410, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Alexandra E Hernandez
- Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Suite 410, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Molly Ream
- Department of Psychology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Estefany Saez Clarke
- Department of Psychology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie B Blomberg
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Microbiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steve Cole
- Department of Psychiatry/Biobehavioral Sciences and Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael H Antoni
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Miami Miller School of Medicine, Miami, FL, USA
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53
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Lempesis IG, Georgakopoulou VE, Papalexis P, Chrousos GP, Spandidos DA. Role of stress in the pathogenesis of cancer (Review). Int J Oncol 2023; 63:124. [PMID: 37711028 PMCID: PMC10552722 DOI: 10.3892/ijo.2023.5572] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
Stress is a state of disrupted homeostasis, triggered by intrinsic or extrinsic factors, the stressors, which are counteracted by various physiological and behavioural adaptive responses. Stress has been linked to cancer development and incidence for decades; however, epidemiological studies and clinical trials have yielded contradictory results. The present review discusses the effects of stress on cancer development and the various underlying mechanisms. Animal studies have revealed a clear link between stress and cancer progression, revealing molecular, cellular and endocrine processes that are implicated in these effects. Thus, stress hormones, their receptor systems and their intracellular molecular pathways mediate the effects of stress on cancer initiation, progression and the development of metastases. The mechanisms linking stress and cancer progression can either be indirect, mediated by changes in the cancer microenvironment or immune system dysregulation, or direct, through the binding of neuroendocrine stress‑related signalling molecules to cancer cell receptors. Stress affects numerous anti‑ and pro‑cancer immune system components, including host resistance to metastasis, tumour retention and/or immune suppression. Chronic psychological stress through the elevation of catecholamine levels may increase cancer cell death resistance. On the whole, stress is linked to cancer development and incidence, with psychological stressors playing a crucial role. Animal studies have revealed a better link than human ones, with stress‑related hormones influencing tumour development, migration, invasion and cell proliferation. Randomized controlled trials are required to further evaluate the long‑term cancer outcomes of stress and its management.
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Affiliation(s)
- Ioannis G. Lempesis
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vasiliki Epameinondas Georgakopoulou
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Georgios P. Chrousos
- Clinical, Translational and Experimental Surgery Research Centre, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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54
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Yang J, Jiang W. A meta-analysis of the association between post-traumatic stress disorder and cancer risk. Front Psychiatry 2023; 14:1281606. [PMID: 37965365 PMCID: PMC10642749 DOI: 10.3389/fpsyt.2023.1281606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
Background Several studies have investigated the link between post-traumatic stress disorder (PTSD) and cancer risk but reported mixed results. The objective of our study was to investigate the association between PTSD and cancer risk. Methods Studies published in English about the relationship between PTSD and cancer incidence were systematically searched. We performed a meta-analysis to estimate the relative risks (RR) and 95% confidence intervals (CI) for cancer incidence. Result A total of 3,129 articles were screened. Finally, 8 articles and 11 studies were included in the meta-analysis. We found that PTSD was not associated with cancer risk compared with controls. For site-specific cancer, our results showed that women with PTSD were associated with higher risk of ovarian cancer than controls. However, PTSD was not associated with the risk of gastrointestinal cancer, breast cancer and lung cancer. Conclusion These analyzes based on studies published in English suggest that PTSD is associated with ovarian cancer risk, although the evidence base is very limited. Future studies are needed to investigate the mechanisms that PTSD diagnosis influenced cancer incidence depending on types of cancer.
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Affiliation(s)
- Juanjuan Yang
- Department of Health Management, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Wei Jiang
- Department of Oncology, The Second Affiliated Hospital of Xi’ an Jiaotong University, Xi’an, Shaanxi, China
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Cohen M, Shamay Y, Czamanski-Cohen J, Shulman K, Keren Rosenberg S, Abu-Amna M, Turgeman I, Merkin Livshits L, Birenboim R, Dines M, Bar-Sela G. Linkage between Psychological Factors and Response to Immune Checkpoint Inhibitor Therapy: A Preliminary Study. Cells 2023; 12:2471. [PMID: 37887315 PMCID: PMC10605722 DOI: 10.3390/cells12202471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Substantial evidence has accumulated showing that psychological distress affects immune regulation, the response to cancer treatment, and survival. The effect of psychological parameters on the effectiveness of immune checkpoint inhibitor (ICI) treatment has not yet been studied. This preliminary study aimed to (a) examine the associations between psychological factors and responses to ICI treatment and (b) assess the associations between psychological factors and blood measures of sPD-1, sCTLA-4, and cytokines that may alter the effect of ICI treatment. The participants were 62 individuals with advanced cancer, aged 18 years or older, who were candidates for ICI treatment as a new line of treatment. The participants answered questionnaires and provided blood samples and medical data prior to the start of ICI treatment and 3 months after. Perceived health status was positively associated with better responses to ICI treatment. In the subsample of participants with biomarkers, worse health-related quality of life was associated with higher IL-6 and sCTLA-4; emotional distress and sleep difficulties were associated with higher sCTLA-4; and better perceived health was associated with lower IL-6 and TNFα. sPD-1 was not associated with psychological measures. This preliminary study found for the first time that some psychological measures could be linked to responses to cancer treatment, possibly via pro-inflammatory cytokines and sCTLA-4.
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Affiliation(s)
- Miri Cohen
- School of Social Work, University of Haifa, Haifa 3498838, Israel;
| | - Yosi Shamay
- Biomedical Engineering, Technion—Israel Institute of Technology, Haifa 3109601, Israel;
| | - Johanna Czamanski-Cohen
- Emili Sagol Creative Arts Therapies Research Center, School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel; (J.C.-C.); (M.D.)
| | - Katerina Shulman
- Carmel Medical Center, Haifa 3436212, Israel; (K.S.); (L.M.L.)
- Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
- Lin Medical Center, Haifa 6688304, Israel;
| | | | - Mahmoud Abu-Amna
- Cancer Center, Emek Medical Center, Afula 1834111, Israel; (M.A.-A.); (I.T.)
| | - Ilit Turgeman
- Cancer Center, Emek Medical Center, Afula 1834111, Israel; (M.A.-A.); (I.T.)
| | - Ludmila Merkin Livshits
- Carmel Medical Center, Haifa 3436212, Israel; (K.S.); (L.M.L.)
- Lin Medical Center, Haifa 6688304, Israel;
| | | | - Monica Dines
- Emili Sagol Creative Arts Therapies Research Center, School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel; (J.C.-C.); (M.D.)
| | - Gil Bar-Sela
- Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
- Cancer Center, Emek Medical Center, Afula 1834111, Israel; (M.A.-A.); (I.T.)
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56
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Cui B, He B, Huang Y, Wang C, Luo H, Lu J, Su K, Zhang X, Luo Y, Zhao Z, Yang Y, Zhang Y, An F, Wang H, Lam EWF, Kelley KW, Wang L, Liu Q, Peng F. Pyrroline-5-carboxylate reductase 1 reprograms proline metabolism to drive breast cancer stemness under psychological stress. Cell Death Dis 2023; 14:682. [PMID: 37845207 PMCID: PMC10579265 DOI: 10.1038/s41419-023-06200-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
Cancer stem-like cells (CSCs) contribute to cancer metastasis, drug resistance and tumor relapse, yet how amino acid metabolism promotes CSC maintenance remains exclusive. Here, we identify that proline synthetase PYCR1 is critical for breast cancer stemness and tumor growth. Mechanistically, PYCR1-synthesized proline activates cGMP-PKG signaling to enhance cancer stem-like traits. Importantly, cGMP-PKG signaling mediates psychological stress-induced cancer stem-like phenotypes and tumorigenesis. Ablation of PYCR1 markedly reverses psychological stress-induced proline synthesis, cGMP-PKG signaling activation and cancer progression. Clinically, PYCR1 and cGMP-PKG signaling components are highly expressed in breast tumor specimens, conferring poor survival in breast cancer patients. Targeting proline metabolism or cGMP-PKG signaling pathway provides a potential therapeutic strategy for breast patients undergoing psychological stress. Collectively, our findings unveil that PYCR1-enhanced proline synthesis displays a critical role in maintaining breast cancer stemness.
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Affiliation(s)
- Bai Cui
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Bin He
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yanping Huang
- Department of Oncology, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cenxin Wang
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Huandong Luo
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Jinxin Lu
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Keyu Su
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Xiaoyu Zhang
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Yuanyuan Luo
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China
| | - Zhuoran Zhao
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Yuqing Yang
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Yunkun Zhang
- Department of Pathology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Fan An
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Hong Wang
- Department of Orthopaedics, The Central Hospital of Dalian University of Technology, Dalian, China
| | - Eric W-F Lam
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Keith W Kelley
- Department of Pathology, College of Medicine and Department of Animal Sciences, College of ACES, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ling Wang
- Department of Oncology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Quentin Liu
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China.
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China.
| | - Fei Peng
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China.
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Oliveira MEC, Torres GSV, Franklin RG, Gomes KAL, Nóbrega WFS, Fernandes TP, Santos NA. Cognitive impairments associated with chemotherapy in women with breast cancer: a meta-analysis and meta-regression. Braz J Med Biol Res 2023; 56:e12947. [PMID: 37851791 PMCID: PMC10578133 DOI: 10.1590/1414-431x2023e12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/19/2023] [Indexed: 10/20/2023] Open
Abstract
Chemotherapy is one of the most widely used treatments for breast cancer (BC). However, there is evidence of side effects like cognitive changes related to the chemotherapy treatment. The aim of the study was not only to summarize the existing evidence on the relationship between chemotherapy and cognitive performance in women with BC but also to identify additional consequences and aspects associated with these impairments. We conducted a systematic review with meta-analysis and meta-regression to present updated information on the matter. We retrieved data from the databases PubMed, Web of Science, PsycINFO, CINAHL, and Scopus. Twenty studies comprising over 2,500 women were examined and the results indicated that chemotherapy can compromise cognition in women with BC (-1.10 OR [95%CI: -1.81 to -0.74], P<0.01), with working memory (-0.49 OR [95%CI: -0.85 to -0.13], P=0.03) being the most affected among the domains. Furthermore, additional data indicated that cognitive impairment is most likely amid women with BC having a lower education level (Q=4.85, P=0.02). Our results suggested that chemotherapy affects cognitive functions in women with BC, and certain characteristics can worsen the deterioration. A comprehensive study of women with breast cancer and existing predictors contributes to optimized personal journeys, elevated life prospects, and advanced care that can also aid prognosis and therapeutic approaches.
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Affiliation(s)
- M E C Oliveira
- Departamento de Psicologia, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - G S V Torres
- Departamento de Psicologia, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - R G Franklin
- Departamento de Psicologia, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - K A L Gomes
- Departamento de Psicologia, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - W F S Nóbrega
- Departamento de Odontologia, Universidade Estadual da Paraíba, Campina Grande, PB, Brasil
| | - T P Fernandes
- Departamento de Psicologia, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - N A Santos
- Departamento de Psicologia, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
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Chapman B, Grunfeld EA, Derakshan N. Quality of working life can protect against cognitive and emotional vulnerability in women living with metastatic breast cancer: a cross-sectional study. J Cancer Surviv 2023; 17:1295-1308. [PMID: 35038120 PMCID: PMC8761843 DOI: 10.1007/s11764-022-01169-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/10/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Research focusing on the cognitive and emotional health of women with metastatic breast cancer (MBC) is limited. The focal aim of the current study was to explore how quality of working life was related to global health, perceived cognitive function, anxiety and depression. To this end, women's experience of employers after MBC diagnosis and its relationship to quality of working life was also explored. METHODS Women living with MBC (N = 88) completed online questionnaires assessing their global health status, perceived cognitive and emotional vulnerability and their experience of employers following diagnosis. Women working at the time of the study also reported on their quality of working life. RESULTS Women's experience of employers after MBC diagnosis was positively related to their quality of working life. Importantly, greater quality of working life met with better perceived cognitive function and global health, as well as lower levels of depression in working women. CONCLUSIONS Our study is the first to establish the role of quality of working life in protecting against levels of cognitive vulnerability and emotional vulnerability to depression in women with MBC. We also highlight the importance of having a positive experience with employers. Our findings suggest that educational programmes can be provided to employers to enhance their understanding and awareness of the needs of women with MBC. IMPLICATIONS FOR CANCER SURVIVORS Women with MBC may benefit from employers accessing educational (or support) programmes that can increase their awareness of the treatment-related sequelae and needs of women with MBC in the workplace.
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Affiliation(s)
- Bethany Chapman
- Department of Psychological Sciences, The BRiC Centre (Birkbeck Centre for Building Resilience in Breast Cancer), Birkbeck University of London, Malet Street, London, WC1E 7HX, UK.
| | - Elizabeth A Grunfeld
- Department of Psychological Sciences, The BRiC Centre (Birkbeck Centre for Building Resilience in Breast Cancer), Birkbeck University of London, Malet Street, London, WC1E 7HX, UK
| | - Nazanin Derakshan
- Department of Psychological Sciences, The BRiC Centre (Birkbeck Centre for Building Resilience in Breast Cancer), Birkbeck University of London, Malet Street, London, WC1E 7HX, UK
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Wong SSS, Liu TW, Ng SSM. Performance of physical, cardiovascular, and psychological functions in middle-aged women with and without breast cancer. Eur J Oncol Nurs 2023; 66:102399. [PMID: 37689046 DOI: 10.1016/j.ejon.2023.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/08/2023] [Accepted: 07/15/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE To compare the physical performance, including upper-limb motor and cardiovascular functions, and psychological functions, including anxiety and depression, sleep, and fatigue, between women with and without breast cancer. METHODS Thirty-two women with breast cancer and 32 healthy counterparts were recruited for the study. Upper-limb muscle strength, shoulder range of motion, and upper-limb function were assessed using a handheld dynamometer, a goniometer, and the short form of the Disabilities of Arm-Shoulder-Hand Questionnaire, respectively. Exercise endurance and cardiovascular functions were assessed using the 6-min walk test and blood pressure and heart rate variability, respectively. The Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Quality Index, and the Fatigue Assessment Scale were used to assess the symptoms of anxiety and depression, sleep quality, and fatigue, respectively. RESULTS Breast cancer participants' body-weight-adjusted upper-limb strength of both the affected and unaffected sides (0.11-0.14) was only 61.1-77.8% of those of the healthy participants (0.18). Their shoulder mobility of the affected side (flexion: 161.64°; abduction: 157.01°) were 94.2% (flexion) and 92.5% (abduction) of those of the healthy participants (flexion: 171.56°; abduction: 169.68°), respectively. Breast cancer participants had higher quickDASH mean score (19.53), HADS-A mean score (6.78), HADS-D mean score (4.72), global PSQI mean score (7.22) and FAS mean score (25.97) as well as shorter mean distance covered by 6 MWT (496.66 m) than those of the healthy participants. CONCLUSIONS Rehabilitative interventions, such as mind-body interventions and exercise training, target physical fitness and promote the psychological health of women with breast cancer are necessary.
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Affiliation(s)
- Sarah Suet Shan Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (SAR), China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong (SAR), China
| | - Tai Wa Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong (SAR), China
| | - Shamay Sheung Mei Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (SAR), China; Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (SAR), China.
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Vafaei Z, Najafian J, Shekarchizadeh M, Mohammadifard N, Mostafavi S, Roohafza H, Darakhshandeh A, Khosravifarsani M, Ashraf F, Sharif M, Emami MH, Javanmard SH, Hassannejad R, Maracy MR, Sarrafzadegan N. Perceived stress, anxiety, and depression in women with breast cancer: CIBC study. J Cancer Res Ther 2023; 19:1893-1898. [PMID: 38376294 DOI: 10.4103/jcrt.jcrt_2205_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/02/2022] [Indexed: 02/21/2024]
Abstract
BACKGROUND Many breast cancer (BC) patients experience psychological reactions and may have psychiatric morbidities, especially anxiety and depressive disorders. The aim of this study was to evaluate perceived stress and factors affecting this stress in women with BC in Isfahan. MATERIAL AND METHODS This analytical cross-sectional study was carried out among 197 females with BC who were newly diagnosed and referred to Isfahan Cardio-Oncology Clinic. Stress was measured by the Perceived Stress Scale Standard questionnaire. Generalized linear models (GLMs) with gamma distribution and Log Link Function were used for data analyzing. RESULTS The mean age of the patients was 48.9 ± 10.9 years, and mean perceived stress in patients was 42.8 ± 16.5. The GLMs with Gamma distribution and Log Link Function showed interaction between anxiety and surgical type and also between depression and surgical type. Patients perceived stress with anxiety*nonsurgery were significantly 2.5% higher than normal anxiety and none surgery (P = 0.004), and patients with depression*lumpectomy had significantly 2% higher stress score compared to normal depression and nonsurgery (P =0.003). CONCLUSIONS Early detection of anxiety and depression can contribute to managing the stress. Coordination between psychologists and oncologists in care and treatment of these patients is important for pursuing treatment and following the recommendations of doctors and ultimately affect the morbidity and survival in BC patients.
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Affiliation(s)
- Zamaneh Vafaei
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Najafian
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masood Shekarchizadeh
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samaneh Mostafavi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Darakhshandeh
- Department of Medical Oncology- Hematology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Farzaneh Ashraf
- Cardio-Oncolog Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Mehran Sharif
- Department of Internal Medicine, School of Medicine Cancer Prevention Research Center Seyyed AlShohada Hospital Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hassan Emami
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | - Razieh Hassannejad
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemilogy and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Carlson LE, Ismaila N, Addington EL, Asher GN, Atreya C, Balneaves LG, Bradt J, Fuller-Shavel N, Goodman J, Hoffman CJ, Huston A, Mehta A, Paller CJ, Richardson K, Seely D, Siwik CJ, Temel JS, Rowland JH. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2023; 41:4562-4591. [PMID: 37582238 DOI: 10.1200/jco.23.00857] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/13/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations. RESULTS The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline. RECOMMENDATIONS Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment. DISCUSSION Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Gary N Asher
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Chloe Atreya
- University of California San Francisco, San Francisco, CA
| | | | - Joke Bradt
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA
| | | | | | | | - Alissa Huston
- University of Rochester Medical Center, Rochester, NY
| | | | - Channing J Paller
- Sidney Kimmel Comprehensive Cancer Center, John Hopkins University, Baltimore, MD
| | | | - Dugald Seely
- University of Ottawa, Ottawa, ON, Canada
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Chelsea J Siwik
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Malgaroli M, Szuhany KL, Riley G, Miron CD, Park JH, Rosenthal J, Chachoua A, Meyers M, Simon NM. Heterogeneity of posttraumatic stress, depression, and fear of cancer recurrence in breast cancer survivors: a latent class analysis. J Cancer Surviv 2023; 17:1510-1521. [PMID: 35224684 PMCID: PMC10037701 DOI: 10.1007/s11764-022-01195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/19/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Breast cancer survivors may demonstrate elevated psychological distress, which can also hinder adherence to survivorship care plans. Our goal was to study heterogeneity of behavioral health and functioning in breast cancer survivors, and identify both risk and protective factors to improve targets for wellness interventions. METHODS Breast cancer survivors (n = 187) consented to complete self-reported psychological measures and to access their medical records. Latent class analysis (LCA) was used to classify heterogeneous subpopulations based on levels of depression, post-traumatic stress, fear of cancer recurrence, cancer-related pain, and fatigue. Multinomial logistic regression and auxiliary analysis in a 3-step modeling conditional approach was used to identify characteristics of the group based on demographics, treatment history and characteristics, and current medication prescriptions. RESULTS Three subpopulations of breast cancer survivors were identified from the LCA: a modal Resilient group (48.2%, n = 90), a Moderate Symptoms group (34%, n = 65), and an Elevated Symptoms group (n = 17%, n = 32) with clinically-relevant impairment. Results from the logistic regression indicated that individuals in the Elevated Symptoms group were less likely to have a family history of breast cancer; they were more likely to be closer to time of diagnosis and younger, have received chemotherapy and psychotropic prescriptions, and have higher BMI. Survivors in the Elevated Symptoms group were also less likely to be prescribed estrogen inhibitors than the Moderate Symptoms group. CONCLUSIONS This study identified subgroups of breast cancer survivors based on behavioral, psychological, and treatment-related characteristics, with implications for targeted monitoring and survivorship care plans. IMPLICATIONS FOR CANCER SURVIVORS Results showed the majority of cancer survivors were resilient, with minimal psychological distress. Results also suggest the importance of paying special attention to younger patients getting chemotherapy, especially those without a family history of breast cancer.
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Affiliation(s)
- Matteo Malgaroli
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA.
| | - Kristin L Szuhany
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Gabriella Riley
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Carly D Miron
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Jae Hyung Park
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY, 10010, USA
| | - Jane Rosenthal
- Perlmutter Cancer Center, NYU Grossman School of Medicine, 160 E 34th St, New York, NY, 10016, USA
| | - Abraham Chachoua
- Perlmutter Cancer Center, NYU Grossman School of Medicine, 160 E 34th St, New York, NY, 10016, USA
| | - Marleen Meyers
- Perlmutter Cancer Center, NYU Grossman School of Medicine, 160 E 34th St, New York, NY, 10016, USA
| | - Naomi M Simon
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
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63
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Dong J, Guo J. Effects of Comprehensive Noise Reduction Management Combined with Reality Therapy on Anxiety and Depression in Hospitalised Patients with Breast Cancer. Noise Health 2023; 25:211-219. [PMID: 38358236 PMCID: PMC10849016 DOI: 10.4103/nah.nah_37_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 02/16/2024] Open
Abstract
Objective This study was conducted to explore the effects of comprehensive noise reduction management combined with reality therapy on anxiety and depression in hospitalised patients with breast cancer. Methods The medical records of 166 inpatients with breast cancer in Tongji Hospital affiliated with Tongji Medical College of Huazhong University of Science and Technology from March 2020 to March 2022 were retrospectively analysed. According to different intervention methods, these patients were divided into group A (n = 58, receiving conventional intervention), group B (n = 55, receiving conventional intervention combined with reality therapy) and group C (n = 53, receiving conventional intervention combined with comprehensive noise reduction management and reality therapy intervention). Patients' anxiety and depression, quality of life and satisfaction degree in the three groups were compared. Results Before the intervention, the scores of the Hospital Anxiety and Depression Scale (HADS) and Short-From-36 Health Survey (SF-36) scale did not significantly differ amongst the three groups (P > 0.05). After the intervention, we observed a difference in the pairwise comparison of HADS scores amongst the three groups, in which group C had the lowest score and group A had the highest HADS score (P < 0.001). We also noted a difference in the pairwise comparison of SF-36 scores amongst the three groups, in which group C had the highest SF-36 score and group A had the lowest SF-36 score (P < 0.001). The pairwise comparison of satisfaction revealed a difference amongst the three groups, in which group C had the highest satisfaction (92.45%, 94.34% and 94.34%), and group A had the lowest satisfaction (74.14%, 74.14% and 75.86%; P < 0.05). Conclusion Comprehensive noise reduction management combined with reality therapy can effectively relieve the negative emotions of inpatients with breast cancer, as well as improve their survival state of patients. It is suggested that it be included in the clinical intervention system for breast cancer.
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Affiliation(s)
- Jie Dong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, Hubei, China
| | - Juan Guo
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, Hubei, China
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Pan J, Zhang L, Wang X, Li L, Yang C, Wang Z, Su K, Hu X, Zhang Y, Ren G, Jiang J, Li P, Huang J. Chronic stress induces pulmonary epithelial cells to produce acetylcholine that remodels lung pre-metastatic niche of breast cancer by enhancing NETosis. J Exp Clin Cancer Res 2023; 42:255. [PMID: 37773152 PMCID: PMC10540414 DOI: 10.1186/s13046-023-02836-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Chronic stress promotes most hallmarks of cancer through impacting the malignant tissues, their microenvironment, immunity, lymphatic flow, etc. Existing studies mainly focused on the roles of stress-induced activation of systemic sympathetic nervous system and other stress-induced hormones, the organ specificity of chronic stress in shaping the pre-metastatic niche remains largely unknown. This study investigated the role of chronic stress in remodeling lung pre-metastatic niche of breast cancer. METHODS Breast cancer mouse models with chronic stress were constructed by restraint or unpredictable stress. Expressions of tyrosine hydroxylase, vesicular acetylcholine transporter (VAChT), EpCAM and NETosis were examined by immunofluorescence and confocal microscopy. mRNA and protein levels of choline acetyltransferase (ChAT), VAChT, and peptidylarginine deiminase 4 were detected by qRT-PCR and Western blotting, respectively. Immune cell subsets were analyzed by flow cytometry. Acetylcholine (ACh) and chemokines were detected by ELISA and multi chemokine array, respectively. ChAT in lung tissues from patients was examined by immunohistochemistry. RESULTS Breast cancer-bearing mice suffered chronic stress metastasized earlier and showed more severe lung metastasis than did mice in control group. VAChT, ChAT and ChAT+ epithelial cells were increased significantly in lung of model mice undergone chronic stress. ACh and chemokines especially CXCL2 in lung culture supernatants from model mice with chronic stress were profoundly increased. Chronic stress remodeled lung immune cell subsets with striking increase of neutrophils, enhanced NETosis in lung and promoted NETotic neutrophils to capture cancer cells. ACh treatment resulted in enhanced NETosis of neutrophils. The expression of ChAT in lung tissues from breast cancer patients with lung metastasis was significantly higher than that in patients with non-tumor pulmonary diseases. CONCLUSIONS Chronic stress promotes production of CXCL2 that recruits neutrophils into lung, and induces pulmonary epithelial cells to produce ACh that enhances NETosis of neutrophils. Our findings demonstrate for the first time that chronic stress induced epithelial cell derived ACh plays a key role in remodeling lung pre-metastatic niche of breast cancer.
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Affiliation(s)
- Jun Pan
- Department of Breast Surgery, Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, P.R. China
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Leyi Zhang
- Department of Breast Surgery, Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, P.R. China
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Xiaomei Wang
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Department of Pathology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Lili Li
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Department of Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Chenghui Yang
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Department of Breast Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P.R. China
| | - Zhen Wang
- Department of Breast Surgery, Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, P.R. China
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Ke Su
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Xiaoxiao Hu
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Yi Zhang
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Guohong Ren
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Jiahuan Jiang
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Peng Li
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China
| | - Jian Huang
- Department of Breast Surgery, Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, P.R. China.
- Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China.
- Cancer Institute, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P.R. China.
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Wei Q, Chen C, Zhu J, Mei B, Liu X. Influence of low-dose esketamine on postoperative depressive symptoms in patients with breast cancer (EASE): study protocol for a randomised controlled trial. BMJ Open 2023; 13:e075767. [PMID: 37748853 PMCID: PMC10533742 DOI: 10.1136/bmjopen-2023-075767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/01/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Depressive symptoms have surfaced as the principal mental health concern among patients with breast cancer, with surgical interventions potentially exacerbating these symptoms and adversely influencing clinical outcomes. This study protocol is designed to investigate the efficacy of low-dose esketamine administered perioperatively on depressive symptoms in patients with breast cancer. It also aims to illuminate the potential neurobiological underpinnings of this effect. METHODS AND ANALYSIS This research represents a single-centre, prospective, randomised, double-blind, placebo-controlled study. The trial anticipates enrolling 108 female patients exhibiting mild-to-severe depressive symptoms who are slated for radical mastectomy. Through stratified randomisation, eligible patients will be systematically assigned to either the esketamine group (0.25 mg/kg) or placebo group (0.9% saline) in a 1:1 ratio. The primary outcome is the response rate at the third postoperative day. Secondary outcomes encompass the remission rate, depression-related scores, depression severity and safety-related endpoints. Tertiary (exploratory) outcomes involve alterations in brain-derived neurotrophic factor and resting-state functional brain connectivity. ETHICS AND DISSEMINATION The Clinical Trial Ethics Committee at The First Affiliated Hospital of Anhui Medical University has conferred ethical approvals for this trial (approval number: PJ2023-05-25). Results from this trial will be disseminated in peer-reviewed journals and presented at professional symposiums. TRIAL REGISTRATION NUMBER Chinese Clinical Trials Registry (ChiCTR2300071062).
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Affiliation(s)
- Qingfeng Wei
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cen Chen
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiajia Zhu
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Bin Mei
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuesheng Liu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China
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66
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Chen G. Molecular basis of breast cancer with comorbid depression and the mechanistic insights of Xiaoyaosan in treating breast cancer-associated depression. Medicine (Baltimore) 2023; 102:e35157. [PMID: 37747031 PMCID: PMC10519572 DOI: 10.1097/md.0000000000035157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Depression and breast cancer (BC) have been found to have a shared genetic basis, multiple loci of effect, and a presumed causal relationship. The treatment of BC combined with depression poses significant challenges. This study aims to use bioinformatics and network pharmacology to explore the molecular basis of BC combined with depression and to elucidate the potential mechanisms of Xiaoyaosan (XYS) in treating this disease. The molecular background of BC complicated with depression was discovered via data mining and bioinformatics. The molecular mechanism of XYS in the treatment of BC with depression was investigated by network pharmacology. The binding affinity between targets and active compounds was evaluated by molecular docking. The impact of XYS on the gene and protein expression of matrix metallopeptidase 9 (MMP9) in microglial cells was assessed using RT-quantitative PCR and western blot analysis, respectively. Differential expression analysis was conducted to identify genes associated with BC, revealing that 2958 genes were involved, with 277 of these genes also being related to depression. XYS was found to contain 173 active compounds and 342 targets, with 44 of these targets being involved in regulating the progression of BC and depression. Enrichment analysis was performed to identify pathways associated with these targets, revealing that they were related to cell proliferation, catalytic activity, cell communication, and interleukin-18 signaling and LXR/RXR activation. Network analysis was conducted to identify key targets of Xiaoyaosan in treating BC combined with depression, with EGF, interleukin 6, epidermal growth factor receptor, and peroxisome proliferator activated receptor gamma being identified as important targets. Molecular docking was also performed to assess the binding affinity between key targets and active compounds, with puerarin showing the strongest affinity for MMP9. In microglial cells, XYS significantly enhances the gene and protein expression of MMP9. This study elucidated the pharmacological mechanism of co-treatment for BC patients complicated with depression and the pharmacological mechanism of XYS against BC plus depression.
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Affiliation(s)
- Gang Chen
- Department of Breast Surgery, Hangzhou Fuyang Women and Children Hospital, Hangzhou, China
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Sun W, Shen J, Sun R, Zhou D, Li H. Establishment and Validation of a Predictive Model for Post-Treatment Anxiety Based on Patient Attributes and Pre-Treatment Anxiety Scores. Psychol Res Behav Manag 2023; 16:3883-3894. [PMID: 37745270 PMCID: PMC10517682 DOI: 10.2147/prbm.s425055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
Objective In this study, we aim to establish and evaluate a predictive model for post-treatment anxiety state based on basic patient attributes and pre-treatment SAS scores, with the expectation that this model will guide clinical precision intervention. Methods Data were collected from 606 patients with breast cancer who underwent surgery at our hospital between January 1, 2015 and December 30, 2018 and 144 newly diagnosed patients with breast cancer who were admitted between June 1, 2019 and December 30, 2019, for a total of 750 patients with breast cancer. The relationship between SAS_A scores and prognosis was verified by analyzing patient baseline characteristics, follow-up data, pre-treatment self-rating anxiety scale (SAS) scores, and SAS_A scores in follow-up period after the end of treatment. A risk prediction model was developed in view of the SAS_A scores, which was then screened, validated, and simplified by scoring, with a nomogram plotted. Results The SAS_A score can be utilized to differentiate prognosis. In K-M analysis, the high SAS_A score group had a significantly poorer progression-free survival rate than the low score group, p-value < 0.0001. Through model feature selection and clinical analysis, all variables were finally incorporated to establish a predictive model with a ROC AUC of 0.721 (0.637-0.805) for the validation set and external data, and an AUC of 0.810 (0.719-0.902) for external data, demonstrating good predictive performance. Calibration curves and probability distribution maps were constructed. DCA and CIC analyses demonstrated that model intervention could boost clinical benefits more effectively than intervention for all patients. Conclusion Using a predictive model to guide clinical management for anxiety in breast cancer patients is feasible, but additional research is required.
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Affiliation(s)
- Wenwen Sun
- Department of Breast Surgery, the First People’s Hospital of Lianyungang, the Affiliated Hospital of XuZhou Medical University, LianYunGang, Jiangsu, 222002, People’s Republic of China
| | - Jun Shen
- Department of Breast Surgery, the First People’s Hospital of Lianyungang, the Affiliated Hospital of XuZhou Medical University, LianYunGang, Jiangsu, 222002, People’s Republic of China
| | - Ru Sun
- Department of Breast Surgery, the First People’s Hospital of Lianyungang, the Affiliated Hospital of XuZhou Medical University, LianYunGang, Jiangsu, 222002, People’s Republic of China
| | - Dan Zhou
- Department of Breast Surgery, the First People’s Hospital of Lianyungang, the Affiliated Hospital of XuZhou Medical University, LianYunGang, Jiangsu, 222002, People’s Republic of China
| | - Haihong Li
- Department of Nursing, the First People’s Hospital of Lianyungang, The Affiliated Hospital of XuZhou Medical University, LianYunGang, Jiangsu, 222002, People’s Republic of China
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Zhan D, Wang X, Zheng Y, Wang S, Yang B, Pan B, Wang N, Wang Z. Integrative dissection of 5-hydroxytryptamine receptors-related signature in the prognosis and immune microenvironment of breast cancer. Front Oncol 2023; 13:1147189. [PMID: 37795441 PMCID: PMC10546427 DOI: 10.3389/fonc.2023.1147189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/14/2023] [Indexed: 10/06/2023] Open
Abstract
Background Depression increases the risk of breast cancer recurrence and metastasis. However, there lacks potential biomarkers for predicting prognosis in breast cancer. 5-hydroxytryptamine (5-HT) plays a key role in the pathogenesis and treatment of depression. In this study, we developed a prognostic signature based on 5-HT receptors (5-HTRs) and elucidated its potential immune regulatory mechanisms for breast cancer prognosis. Methods Oncomine, GEPIA, UALCAN, cBioPortal, Kaplan-Meier plotter, and TIMER were used to analyze differential expression, prognostic value, genetic alteration, and immune cell infiltration of HTRs in breast cancer patients. The model training and validation assays were based on the analyses of GSE1456 and GSE86166. A risk signature was established by univariate and multivariate Cox regression analyses. The transwell assay was utilized to verify the effect of the 5-HTRs expression on breast cancer invasion. Effects of HTR2A/2B inhibitor on CD8+ T cell proliferation and infiltration as well as apoptosis of 4T1 cells in the tumor microenvironment were detected by flow cytometry and TUNEL assay. Zebrafish and mouse breast cancer xenografts were used to determine the effect of HTR2A/2B inhibitor on breast cancer metastasis. Results The expression levels of HTR1A, HTR1B, HTR2A, HTR2B, HTR2C, HTR4, and HTR7 were significantly downregulated in highly malignant breast cancer types. 5-HTRs were significantly associated with recurrence-free survival (RFS) in breast cancer patients. The genetic alteration of HTR1D, HTR3A, HTR3B, and HTR6 in breast cancer patients was significantly associated with shorter overall survival (OS). Finally, HTR2A and HTR2B were determined to construct the risk signature. The expression of HTR2A/2B was positively correlated with the infiltration of immune cells such as CD8+ T cells and macrophages. Furthermore, inhibition of HTR2A expression could suppress CD8+ T cell proliferation and enhance invasion and metastasis of breast cancer cells in both zebrafish and mice model. Conclusions The HTR2A/2B risk signature not only highlights the significance of HTRs in breast cancer prognosis by modulating cancer immune microenvironment, but also provides a novel gene-testing tool for early prevention of depression in breast cancer patients and lead to an improved prognosis and quality of life.
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Affiliation(s)
- Dandan Zhan
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuan Wang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yifeng Zheng
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shengqi Wang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
| | - Bowen Yang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Bo Pan
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Neng Wang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Integrative Medicine Research Center, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhiyu Wang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
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Bird MJ, Li G, MacNeil A, Jiang Y, de Groh M, Fuller-Thomson E. Pandemic-Induced Depression Among Older Adults with a History of Cancer During the COVID-19 Pandemic: Findings from the Canadian Longitudinal Study on Aging. Cancer Manag Res 2023; 15:937-955. [PMID: 37700810 PMCID: PMC10493151 DOI: 10.2147/cmar.s421675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose The objectives of this study were to identify the prevalence of, and factors associated with, incident and recurrent depression in a sample of older adults with a history of cancer during the COVID-19 pandemic. Materials and Methods Data were drawn from four waves of the Canadian Longitudinal Study on Aging Comprehensive Cohort (n=2486 with cancer). The outcome of interest was a positive screen for depression based on the CES-D-10 during the autumn of 2020. Results Among older adults with cancer and no pre-pandemic history of depression (n=1765), 1 in 8 developed first onset depression during the pandemic. Among respondents with cancer and a history of depression (n=721), 1 in 2 experienced a recurrence of depression. The risk of both incident and recurrent depression was higher among those who were lonely, those with functional limitations, and those who experienced an increase in family conflict during the pandemic. The risk of incident depression only was higher among older women, those who did not engage in church or religious activities, those who experienced a loss of income during the pandemic, and those who became ill or had a loved one become ill or die during the pandemic. The risk of recurrent depression only was higher among those who felt isolated from others and those whose income did not satisfy their basic needs. Conclusion Health care providers should continue to screen and provide mental health support to their cancer patients and those with a lifetime history of cancer, with consideration for those with the aforementioned vulnerabilities.
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Affiliation(s)
- Meghan J Bird
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
| | - Grace Li
- Department of Sociology, University of Victoria, Victoria, BC, Canada
| | - Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
| | - Ying Jiang
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Margaret de Groh
- Applied Research Division, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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70
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Cui Y, Lu W, Shao T, Zhuo Z, Wang Y, Zhang W. Severe mental illness and the risk of breast cancer: A two-sample, two-step multivariable Mendelian randomization study. PLoS One 2023; 18:e0291006. [PMID: 37656762 PMCID: PMC10473543 DOI: 10.1371/journal.pone.0291006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Based on epidemiological reports, severe mental illness (SMI) and breast cancer (BC) risk are linked positively. However, it is susceptible to clinical confounding factors, such as smoking, alcohol consumption, etc. Here, we performed a two-sample, two-step multivariable Mendelian randomization (MR) research to explore how the SMI etiologically influences BC risk and to quantify mediating effects of known modifiable risk factors. METHODS Data concerning the single nucleotide polymorphism (SNP)-associated with schizophrenia, bipolar disorder (BD), major depressive disorder (MDD), and BC were obtained from two large consortia: the Breast Cancer Association Consortium (BCAC) and the Psychiatric Genomics Consortium (PGC). Then, the correlations of the previous SMI with the BC prevalence and the potential impact of mediators were explored through the two-sample and two-step MR analyses. RESULTS In two-sample MR, schizophrenia increased BC incidence (odds ratio (OR) 1.06, 95% confidence interval (CI) 1.02-1.10, P = 0.001). In subgroup analysis, schizophrenia increased ER+ BC (OR 1.06, 95% CI 1.03-1.10, P = 0.0009) and ER-BC (OR 1.06, 95% CI 1.01-1.11, P = 0.0123) incidences. Neither MDD nor BD elevated the BC risk. In two-step MR, smoking explained 11.29% of the schizophrenia-all BC risk association. CONCLUSIONS Our study indicates that schizophrenia increases susceptibility to breast cancer, with smoking playing a certain mediating role. Therefore, BC screening and smoking should be incorporated into the health management of individuals with schizophrenia.
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Affiliation(s)
- Yongjia Cui
- Oncology Department, China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, China
| | - Wenping Lu
- Oncology Department, China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, China
| | - Tianrui Shao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zhili Zhuo
- Oncology Department, China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, China
| | - Ya’nan Wang
- Oncology Department, China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, China
| | - Weixuan Zhang
- Oncology Department, China Academy of Chinese Medical Sciences Guang’anmen Hospital, Beijing, China
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Xia L, Lai J, Liu X, Kong F, Qiu S, Hu H, Zhu S, Cao J. Epidemiological and survival outcomes of neuroendocrine carcinoma of the breast: a SEER data analysis. Transl Cancer Res 2023; 12:1951-1962. [PMID: 37701099 PMCID: PMC10493786 DOI: 10.21037/tcr-23-368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/01/2023] [Indexed: 09/14/2023]
Abstract
Background Neuroendocrine carcinoma of the breast (NECB) is a rare subtype of breast cancer, comprising only 0.1% to 5% of all breast cancer cases. Despite its rarity, it is important to gain a better understanding of the epidemiological, clinical, and prognostic features of NECB. The purpose of the study was to obtain population-based evaluations of the epidemiological and survival outcomes of NECB. Methods The data of patients with neuroendocrine carcinoma diagnosed and enrolled between 2000 and 2017 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Descriptive statistical analyses were used to assess the distribution and tumor-related characteristics of these patients. Kaplan-Meier curves and univariate and multivariate Cox proportional risk models were used to analyze variables that might be associated with prognosis. Results This study included 7,856 patients with neuroendocrine carcinoma. The median age of the patients was 64 years, and most of them were female, White, and diagnosed at ≥60 years old. The most common pathological type was neoplasm. Survival analysis indicated that there were significant differences in age, marital status, registration location, American Joint Committee on Cancer (AJCC) stage, breast subtype, surgery of primary tumor, and no cancer cause surgery patients with NECB. The results also indicated that treatment with surgery, including surgery of primary tumor, surgery combined with radiation, and no cancer cause surgery, were all effective in improving the prognosis compared with not providing surgical treatment. Conclusions In conclusion, NECB is a very rare lesion for which age, marital status, registration location, and surgery, AJCC stage, breast subtype were found to be independent prognostic factors.
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Affiliation(s)
- Longjie Xia
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
| | - Jianqin Lai
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
| | - Xiangxia Liu
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fanbiao Kong
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of Colorectal and Anal Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- Institute of Minimally Invasive Technology and Applications Guangxi Academy of Medical Science, Nanning, China
| | - Shenghui Qiu
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
| | - Huiqiong Hu
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
| | - Shaoliang Zhu
- Department of Hepatobiliary, Pancreas and Spleen Surgery, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jie Cao
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of General Surgery, Guangzhou First People’s Hospital, Guangzhou, China
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Omari M, Amaadour L, Zarrouq B, Al-Sheikh YA, El Asri A, Kriya S, Nadi S, Benbrahim Z, Mellas N, Rhazi KE, Ragala MEA, Hilaly JE, Giesy JP, Aboul-Soud MAM, Halim K. Evaluation of psychological distress is essential for patients with locally advanced breast cancer prior to neoadjuvant chemotherapy: baseline findings from cohort study. BMC Womens Health 2023; 23:445. [PMID: 37612725 PMCID: PMC10464406 DOI: 10.1186/s12905-023-02571-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND patients with locally advanced breast cancer (LABC) are often treated by neoadjuvant chemotherapy (NACT). This study aims to determine the prevalence of psychological distress and their sociodemographic and clinical factors in patients recently diagnosed with LABC and before NACT. METHODS A total of 209 LABC patients without metastatic localization were recruited between 2021 and 2022 in the oncology hospital at Fez. A structured questionnaire and the Hospital Anxiety and Depression Scale were used. A descriptive analysis and linear model were performed. RESULTS a mean age of participants was 47.43 ± 9.45 years. The prevalence of depression, anxiety and psychological distress among participants was 59.62% (95% CI: 52.61-33.34), 47.85% (95% CI: 40.91-54.85), and 65.07 (95% CI: 58.19-71.52) respectively. Depression was associated to age (< 50 years) (AOR = 2.19; 95% CI = 1.13-4.23) and health insurance (AOR = 3.64; 95% CI: 1.18-11.26). Anxiety was associated to age (< 50) (AOR = 2.21; 95% CI: 1.18-4.13) and right breast cancer (AOA = 2.01; 95% CI: 1.11-3.65). Psychological distress was associated to chronic illness (AOR = 2.78; 95% CI: 1.32-5.85) and lymph node status (AOR = 2.39; 95% CI: 1.26-4.57). CONCLUSIONS Based on the high prevalence of depression and anxiety it appears opportune to treat psychological distress among LABC patient candidates for NACT. Each psychological intervention should take into account sociodemographic and clinical factors found associated in our study. Psychological therapeutic interventions are crucial for LABC patients as early as the time of diagnosis and through subsequent steps in NACT to improve their overall mental health.
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Affiliation(s)
- Majid Omari
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco.
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
| | - Lamiae Amaadour
- Department of Medical Oncology, Hassan II University Hospital, Fez, Morocco
| | - Btissame Zarrouq
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
- Department of Biology and Geology, Teacher's Training College (Ecole Normale Supérieure), Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Yazeed A Al-Sheikh
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Achraf El Asri
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Salima Kriya
- Higher Institute of Nursing Professions and Health Techniques, Fez, Morocco
| | - Sara Nadi
- Higher Institute of Nursing Professions and Health Techniques, Fez, Morocco
| | - Zineb Benbrahim
- Department of Medical Oncology, Hassan II University Hospital, Fez, Morocco
| | - Nawfel Mellas
- Department of Medical Oncology, Hassan II University Hospital, Fez, Morocco
| | - Karima El Rhazi
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Mohammed El Amine Ragala
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Department of Biology and Geology, Teacher's Training College (Ecole Normale Supérieure), Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Jaouad El Hilaly
- Laboratory of Pedagogical and Didactic Engineering of Sciences and Mathematics, Regional Center of Education and Training (CRME F) of Fez, Fez, Morocco
- R.N.E Laboratory, Multidisciplinary Faculty of Taza, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - John P Giesy
- Toxicology Centre, University of Saskatchewan, Saskatoon, SK, S7N 5B3, Canada
- Department of Veterinary Biomedical Sciences, University of Saskatchewan, Saskatoon, SK, S7N 5B4, Canada
- Department of Integrative Biology, Michigan State University, East Lansing, MI, 48824, USA
- Department of Environmental Sciences, Baylor University, Waco, TX, 76706, USA
| | - Mourad A M Aboul-Soud
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Karima Halim
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Department of Human and Social Sciences - Education Sciences, Teachers Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Zhu W, Gao J, Guo J, Wang L, Li W. Anxiety, depression, and sleep quality among breast cancer patients in North China: Mediating roles of hope and medical social support. Support Care Cancer 2023; 31:514. [PMID: 37552286 PMCID: PMC10409667 DOI: 10.1007/s00520-023-07972-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Sleep disorders are highly prevalent among breast cancer patients and have a detrimental impact on their quality of life. This study aims to investigate the serial multiple mediating roles of social support and hope in the relationship between anxiety, depression, and sleep quality in breast cancer patients. METHODS A cross-sectional study was conducted in China from October 2021 to February 2022. A total of 315 breast cancer patients were assessed using self-reported questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Medical Outcomes Study Social Support Survey (MOS-SSS), Herth Hope Index (HHI), and Hospital Anxiety and Depression Scale (HADS). Mediation analysis was performed using the R Statistical Software. RESULTS Sleep quality exhibited a negative correlation with hope and medical social support (P < 0.01), and a positive correlation with anxiety and depression (P < 0.01). Anxiety and depression accounted for 18.8% and 12.8% of the variance in sleep quality, respectively. Bootstrap analyses of the anxiety-medical social support-hope-sleep quality pathway indicated the presence of direct effects [B = 0.331, 95%CI (0.215, 0.493)] and indirect effects of anxiety on sleep quality mediated solely by medical social support [B = 0.054, 95%CI (0.015, 0.108)] and hope [B = 0.041, 95%CI (0.018, 0.073)], as well as combined effects [B = 0.012, 95%CI (0.004, 0.025)]. Similarly, the depression-medical social support-hope-sleep quality pathway revealed direct effects [B = 0.235, 95%CI (0.104, 0.372)] and indirect effects of depression on sleep quality mediated solely by medical social support [B = 0.078, 95%CI (0.016, 0.150)] and hope [B = 0.049, 95%CI (0.018, 0.086)], as well as combined effects [B = 0.017, 95%CI (0.004, 0.034)]. CONCLUSIONS This research validates the hypothesis that medical social support and hope serve as mediators between anxiety, depression, and sleep quality in breast cancer patients. Interventions targeting anxiety, depression, medical social support, and hope have the potential to effectively enhance sleep quality.
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Affiliation(s)
- Wenjuan Zhu
- Breast Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Shanxi Province, Taiyuan, 030032, China
| | - Jinnan Gao
- Breast Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Shanxi Province, Taiyuan, 030032, China
| | - Jun Guo
- Breast Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Shanxi Province, Taiyuan, 030032, China
| | - Linying Wang
- Comprehensive Medical Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Province, Wuhan, 430030, China
| | - Wanling Li
- Nursing Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Shanxi Province, Taiyuan, 030032, China.
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, 430030, People's Republic of China.
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Yang T, Guo Z, Zhu X, Liu X, Guo Y. The interplay of personality traits, anxiety, and depression in Chinese college students: a network analysis. Front Public Health 2023; 11:1204285. [PMID: 37601217 PMCID: PMC10434527 DOI: 10.3389/fpubh.2023.1204285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Anxiety and depression are among the greatest contributors to the global burden of diseases. The close associations of personality traits with anxiety and depression have been widely described. However, the common practice of sum scores in previous studies limits the understanding of the fine-grained connections between different personality traits and anxiety and depression symptoms and cannot explore and compare the risk or protective effects of personality traits on anxiety and depression symptoms. Objective We aimed to determine the fine-grained connections between different personality traits and anxiety and depression symptoms and identify the detrimental or protective effects of different personality traits on anxiety and depression symptoms. Methods A total of 536 college students from China were recruited online, and the average age was 19.98 ± 1.11. The Chinese version of the Ten-Item Personality Inventory, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-9 was used to investigate the personality traits and symptoms of anxiety and depression of participants after they understood the purpose and filling method of the survey and signed the informed consent. The demographic characteristics were summarized, and the scale scores were calculated. The network model of personality traits and symptoms of anxiety and depression was constructed, and bridge expected influence (BEI) was measured to evaluate the effect of personality traits on anxiety and depression. The edge accuracy and BEI stability were estimated, and the BEI difference and the edge weight difference were tested. Results In the network, 29 edges (indicating partial correlations between variables) bridged the personality community and the anxiety and depression community, among which the strongest correlations were extraversion-fatigue, agreeableness-suicidal ideation, conscientiousness-uncontrollable worry, neuroticism-excessive worry, neuroticism-irritability, and openness-feelings of worthlessness. Neuroticism had the highest positive BEI value (0.32), agreeableness had the highest negative BEI value (-0.27), and the BEI values of neuroticism and agreeableness were significantly different from those of most other nodes (p < 0.05). Conclusion There are intricate correlations between personality traits and the symptoms of anxiety and depression in college students. Neuroticism was identified as the most crucial risk trait for depression and anxiety symptoms, while agreeableness was the most central protective trait.
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Affiliation(s)
- Tianqi Yang
- Section of Basic Psychology, Department of Military Medical Psychology, Air Force Medical University, Xi'an, Shaanxi, China
| | - Zhihua Guo
- Section of Military Psychology, Department of Military Medical Psychology, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xia Zhu
- Section of Military Psychology, Department of Military Medical Psychology, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xufeng Liu
- Section of Basic Psychology, Department of Military Medical Psychology, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yaning Guo
- Section of Basic Psychology, Department of Military Medical Psychology, Air Force Medical University, Xi'an, Shaanxi, China
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Niveau N, Beaudoin M, De Cornulier J, New B. The Lexical Association Technique: A randomized controlled trial with breast cancer patients. Appl Psychol Health Well Being 2023; 15:846-864. [PMID: 36320165 DOI: 10.1111/aphw.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Low self-esteem is a vulnerability factor for depressive disorders, and the prevention of psychological disorders is essential in cancer patients. The enhancement of self-esteem in breast cancer patients may therefore be an appropriate clinical target. Previous studies have shown the efficacy of the Lexical Association Technique to enhance self-esteem in healthy subjects. This study aims to test the clinical efficacy and acceptability of the Lexical Association Technique on the self-esteem of cancer patients. A double-blind randomized controlled trial was conducted on 63 breast cancer patients during their radiotherapy treatment. Global self-esteem measures were taken using the Rosenberg Self-Esteem Scale before and after the Lexical Association Technique and 1 month after its end. The results showed a significant improvement in global self-esteem in patients immediately after performing the Lexical Association Technique compared to an active control group. However, the positive effects did not last 1 month. These results confirm the efficacy and suitability of the Lexical Association Technique for cancer patients. Avenues of research are proposed to extend the effects of the technique and increase its transdiagnostic applicability.
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Affiliation(s)
- Noémie Niveau
- Université Savoie Mont-Blanc, Université Grenoble Alpes, LIP/PC2S, Chambéry, France
- Université Savoie Mont-Blanc, Université Grenoble Alpes, CNRS, LPNC, Chambéry, France
| | - Marine Beaudoin
- Université Savoie Mont-Blanc, Université Grenoble Alpes, LIP/PC2S, Chambéry, France
| | - Joanne De Cornulier
- Service de Radiothérapie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Boris New
- Université Savoie Mont-Blanc, Université Grenoble Alpes, CNRS, LPNC, Chambéry, France
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Zhou S, Yu J. Crohn's disease and breast cancer: a literature review of the mechanisms and treatment. Intern Emerg Med 2023; 18:1303-1316. [PMID: 37138170 PMCID: PMC10412481 DOI: 10.1007/s11739-023-03281-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023]
Abstract
This is a literature review describes Crohn's disease (CD) concomitant with breast cancer and summarizes possible common pathogenic mechanisms shared by the two diseases involving the IL-17 and NF-κB signaling pathways. Inflammatory cytokines including TNF-α and Th17 cells in CD patients can induce activation of the ERK1/2, NF-κB and Bcl-2 pathways. Hub genes are involved in the generation of cancer stem cells (CSCs) and are related to inflammatory mediators, including CXCL8, IL1-β and PTGS2, which promote inflammation and breast cancer growth, metastasis, and development. CD activity is highly associated with altered intestinal microbiota processes, including secretion of complex glucose polysaccharides by Ruminococcus gnavus colonies; furthermore, γ-proteobacteria and Clostridium are associated with CD recurrence and active CD, while Ruminococcaceae, Faecococcus and Vibrio desulfuris are associated with CD remission. Intestinal microbiota disorder promotes breast cancer occurrence and development. Bacteroides fragilis can produce toxins that induce breast epithelial hyperplasia and breast cancer growth and metastasis. Gut microbiota regulation can also improve chemotherapy and immunotherapy efficacy in breast cancer treatment. Intestinal inflammation can affects the brain through the brain-gut axis, which activates the hypothalamic‒pituitary‒adrenal (HPA) axis to induce anxiety and depression in patients; these effects can inhibit the antitumor immune responses of the immune system and promote breast cancer occurrence in patients with CD. There are few studies on the treatment of patients with CD concomitant with breast cancer, but published studies show three main strategies: new biological agents combined with breast cancer treatment methods, intestinal fecal bacteria transplantation, and dietary treatment.
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Affiliation(s)
- Sisi Zhou
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China
| | - Jing Yu
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China.
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Tsai TC, Lee GG, Ting A, Antoni MH, Mendez A, Carver CS, Kim Y. Roles of benefit finding in psychological and inflammatory adjustments in persons with colorectal cancer: a prospective analysis on the multidimensionality of benefit finding. Psychol Health 2023:1-19. [PMID: 37488833 PMCID: PMC10805970 DOI: 10.1080/08870446.2023.2238280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/03/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE This study examined the unique associations of different dimensions of the resilience factor, benefit finding, on concurrent and prospective psychological and biological adjustment outcomes over the first year after a colorectal cancer diagnosis. METHODS AND MEASURES Individuals newly diagnosed with colorectal cancer (n = 133, mean age = 56 years old, 59% female, 46% Hispanic) completed questionnaires assessing the multidimensional aspects of benefit finding around 4 months post-diagnosis (T1). Psychological (depressive symptoms and life satisfaction) and biological [C-reactive protein (CRP) and interleukin-10 (IL-10)] adjustments were assessed at T1 and one-year post-diagnosis (T2). RESULTS Structural equation modeling revealed that at T1, greater reprioritization was concurrently related to higher depressive symptoms (p=.020). Lower acceptance, lower empathy, and greater positive self-view predicted higher life satisfaction at T2 (ps<.010). Additionally, lower empathy and greater family valuation predicted higher CRP at T2 (ps<.004), whereas greater positive self-view predicted higher IL-10 at T2 (p=.039). Greater overall benefit finding was associated with lower IL-10 at T1 (p=.013). CONCLUSION Various aspects of benefit finding differentially relate to psychological and inflammatory markers during the first year after diagnosis in persons with colorectal cancer. Interventions designed to specifically enhance positive self-view may promote both the psychological and biological health of individuals with cancer.
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Affiliation(s)
- Thomas C. Tsai
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
| | - Gabriela G. Lee
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
| | - Amanda Ting
- VA Palo Alto Health Care, 3801 Miranda Ave., Palo Alto, CA 94304
| | - Michael H. Antoni
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
| | - Armando Mendez
- University of Miami Miller School of Medicine, 1600 NW 10 Ave., Miami, FL, United States 33136
| | - Charles S. Carver
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
| | - Youngmee Kim
- University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, United States 33146
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Harel K, Czamanski-Cohen J, Cohen M, Weihs KL. Emotional Processing, Coping, and Cancer-Related Sickness Symptoms in Breast Cancer Survivors: Cross- Sectional Secondary Analysis of the REPAT Study. RESEARCH SQUARE 2023:rs.3.rs-3164706. [PMID: 37503214 PMCID: PMC10371152 DOI: 10.21203/rs.3.rs-3164706/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Purpose The study aims to provide a better understanding of the relationship between emotional processing, coping, and cancer-related sickness symptoms. Methods The study used a cross-sectional, secondary analysis of data from 179 Israeli Jewish women who were breast cancer survivors (BCS) 3 to 18 months after completing primary treatment and who participated in a larger randomized controlled trial (REPAT study). Data were collected at baseline. Participants completed questionnaires measuring emotion acceptance, situational approach, avoidance coping, and cancer-related sickness symptoms (depression, fatigue, and pain) and a performance measure of emotional awareness. Hierarchical linear regressions were performed, controlling for background variables. Results Participants experienced significant clinical depression (51.7%), cancer-related fatigue (CRF, 78.8%), pain interference (78%), and pain intensity (66%) levels. There were strong correlations between cancer-related symptoms. After controlling for confounders, emotional processing (acceptance) was negatively associated with depression, and avoidance coping was positively associated with depression, CRF, and pain interference (i.e., higher use of avoidance related to higher cancer-related symptoms; higher acceptance was associated with lower depression). Emotional awareness and coping by approaching emotions were not related to cancer-related symptoms. Conclusions The BCS posttreatment period presents the challenge of dealing with elevated cancer-related symptoms. Regardless, BCS who used high emotional processing levels-especially acceptance of emotion and lower reliance on avoidance to cope-experienced fewer cancer-related symptoms. Implications for Cancer Survivors Professionals should recognize the potential role of emotional processing and avoidant coping relative to cancer-related symptoms and recognize their patterns in posttreatment patients.
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79
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Perry LM, Peipert JD, Kircher SM, Cantoral J, Penedo FJ, Garcia SF. Adverse COVID-19 experiences and health-related quality of life in cancer survivors: indirect effects of COVID-19-related depression and financial burden. J Patient Rep Outcomes 2023; 7:71. [PMID: 37458820 DOI: 10.1186/s41687-023-00601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Cancer survivors are at greater risk for poor health outcomes due to COVID-19. However, the pandemic's impact on patients' health-related quality of life (HRQoL) is not well known. This study hypothesized that cancer survivors' adverse COVID-19 experiences would be associated with worse HRQoL. Further, this association would be moderated by psychosocial resiliency factors (perceived social support, benefits, and ability to manage stress) and mediated by psychosocial risk factors (anxiety, depression; health, financial and social concerns). METHODS 1,043 cancer survivors receiving care at Northwestern Medicine completed a cross-sectional survey on COVID-19 practical and psychosocial concerns from 6/2021 to 3/2022. Participants reported on 21 adverse COVID-19 experiences (e.g., COVID-19 hospitalization, death of family/friends, loss of income, medical delays). The survey assessed 9 psychosocial factors related to COVID-19: anxiety, depression; health care, financial, and social disruptions; health care satisfaction; social support, perceived benefits, and stress management skills. The FACT-G7 assessed HRQoL. Hypotheses were tested in a structural equation model. The number of reported adverse COVID-19 experiences was the primary (observed) independent variable. The dependent variable of HRQoL, and the proposed mediating and moderating factors, were entered as latent variables indicated by their respective survey items. Latent interaction terms between the independent variable and each resiliency factor tested moderation effects. Analyses were adjusted for demographic and COVID-specific variables. RESULTS Participants were, on average, aged 58 years and diagnosed with cancer 4.9 years prior. They were majority female (73.3%), White (89.6%), non-Hispanic/Latino (94.5%), college-educated (81.7%), and vaccinated for COVID-19 (95.5%). An average of 3.8 adverse COVID-19 experiences were reported. Results of structural equation modeling demonstrated that the association between adverse COVID-19 experiences and HRQoL was explained by indirect effects through COVID-19-related depression (β = - 0.10, percentile bootstrap 95% CI - 0.15 to - 0.07) and financial concerns (β = - 0.04, percentile bootstrap 95% CI - 0.07 to - 0.01). Hypotheses testing moderation by resiliency factors were not significant. CONCLUSIONS Adverse COVID-19 experiences were associated with higher depression symptoms and financial concerns about COVID-19, and in turn, worse HRQoL. Oncology clinics should be cognizant of the experience of adverse COVID-19 events when allocating depression and financial support resources.
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Affiliation(s)
- Laura M Perry
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - John D Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sheetal M Kircher
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jackelyn Cantoral
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sofia F Garcia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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80
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Lemij AA, de Glas NA, Derks MGM, Linthorst-Niers EMH, Guicherit OR, van der Pol CC, Lans TE, van Dalen T, Vulink AJE, Merkus JWS, van Gerven L, van den Bos F, Rius Ottenheim N, Liefers GJ, Portielje JEA. Mental health outcomes in older breast cancer survivors: Five-year follow-up from the CLIMB study. Eur J Cancer 2023; 187:87-95. [PMID: 37130464 DOI: 10.1016/j.ejca.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND There is a lack of information on mental health outcomes for the increasing older population. Therefore, the aim of the current study is to assess depressive symptoms, loneliness, and apathy in older patients with breast cancer within the first 5 years after diagnosis. METHODS Women aged ≥70 years with early-stage breast cancer were included. Multivariate linear mixed models were used to assess longitudinal changes in symptoms of depression (according to the 15-item Geriatric Depression Scale), loneliness (according to the De Jong Gierveld Loneliness Scale) and apathy (according to the Starkstein Apathy Scale) over time at 3, 9, 15, 27 and 60 months follow-up. RESULTS In total, 299 patients were included (mean [standard deviation (SD)] age: 75.8 [5.2] years). At 3 months follow-up, shortly after the acute treatment, 10% of patients had significant depressive symptoms, while loneliness and apathy were present in 31% and 41% of all patients, respectively. Depression, loneliness and apathy scores showed no clinically relevant changes over time in the whole cohort. Patients who received adjuvant systemic therapies (i.e. endocrine therapy and/or chemotherapy and/or targeted therapy (trastuzumab)) had similar mental health outcomes as those who did not. However, frail patients had more symptoms (p < 0.001) and were more prone to develop depressive symptoms over time than non-frail patients (p = 0.002). DISCUSSION Depression, loneliness and apathy were frequently observed in older women with breast cancer and did not change over time. Patients who received adjuvant systemic therapies had similar mental health outcomes as those who did not. However, frail patients were at higher risk to experience these symptoms.
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Affiliation(s)
- Annelieke A Lemij
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Nienke A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marloes G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Onno R Guicherit
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | | | - Titia E Lans
- Department of Surgery, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Annelie J E Vulink
- Department of Medical Oncology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Jos W S Merkus
- Department of Surgery, Haga Hospital, The Hague, the Netherlands
| | - Leander van Gerven
- Department of Internal Medicine, LangeLand Hospital, Zoetermeer, the Netherlands
| | - Frederiek van den Bos
- Department of Gerontology & Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
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Åsberg RE, Giskeødegård GF, Raj SX, Karlsen J, Engstrøm M, Salvesen Ø, Nilsen M, Lundgren S, Reidunsdatter RJ. Sexual functioning, sexual enjoyment, and body image in Norwegian breast cancer survivors: a 12-year longitudinal follow-up study and comparison with the general female population. Acta Oncol 2023; 62:719-727. [PMID: 37534752 DOI: 10.1080/0284186x.2023.2238548] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/27/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Given the scarcity of evidence concerning the long-term sexual health of breast cancer (BC) survivors (BC-Pop), we aimed to assess how BC treatments affect short- and long-term sexual functioning, sexual enjoyment, and body image, and compare with aged-matched women in the Norwegian general population (F-GenPop). MATERIAL AND METHODS The 349 patients in BC-Pop treated at Trondheim University Hospital in 2007-2014, were assessed in clinical controls at the hospital; before starting radiotherapy (T1, baseline), immediately after ending radiotherapy (T2), and after 3, 6, and 12 months (T3-T5), and at a long-term follow-up 7-12 years after baseline (T6). Meanwhile, F-GenPop included 2254 age-matched women in the Norwegian general population. The impact of BC treatment on sexual functioning was examined using a Linear Mixed Model. Sexual functioning, sexual enjoyment, and body image were assessed with the EORTC's QLQ-BR23 scales and compared between the populations in the four age groups (30-49, 50-59, 60-69, and 70+ years) using means with 95% confidence intervals and Student t-test. Linear regression, adjusted for age and comorbidity was applied to estimate individual scores. RESULT BC survivors treated with mastectomy had overall lower sexual functioning than patients who had received breast-conserving surgery (p = 0.017). Although BC survivors treated with chemotherapy had lower sexual functioning than those treated without chemotherapy at T1-T5 (p = 0.044), both groups showed the same level of functioning at T6. BC-Pop exhibited significantly poorer sexual functioning (p < 0.001), lower sexual enjoyment (p < 0.05), and better body image (p < 0.001) than F-GenPop in all age groups. CONCLUSION The impact of specific BC treatments on sexual functioning was modest; only mastectomy had a persistent negative influence. Nevertheless, all age groups in BC-Pop displayed significantly poorer sexual functioning than F-GenPop at both 12 months and up to 12 years after treatment.
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Affiliation(s)
- Ragnhild Emilie Åsberg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Guro F Giskeødegård
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
- Department of Breast and Endocrine Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sunil X Raj
- Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jarle Karlsen
- Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Monica Engstrøm
- Department of Breast and Endocrine Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Marianne Nilsen
- Department of Social Work, Faculty of Social and Educational Sciences, NTNU, Trondheim, Norway
| | - Steinar Lundgren
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Dalton SO, Johansen C. Survivorship - the situation room. Acta Oncol 2023; 62:673-675. [PMID: 37605618 DOI: 10.1080/0284186x.2023.2245563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Susanne Oksbjerg Dalton
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Christoffer Johansen
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Oncology, Center for Cancer and Organ Diseases, Late Effect Research Unit (CASTLE), Rigshospitalet, Copenhagen, Denmark
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83
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Liu X, Zhan G. Prevalence, risk factors and prognostic value of anxiety and depression in recurrent glioma patients. PSYCHOL HEALTH MED 2023; 28:2474-2485. [PMID: 37271963 DOI: 10.1080/13548506.2023.2221445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
Anxiety and depression are frequently noticed in glioma patients, while few studies report this issue in recurrent glioma patients. Hence, this study aimed to evaluate the prevalence of anxiety and depression, as well as their risk factors and prognostic value in recurrent glioma patients. Eighty recurrent glioma patients, 40 newly-diagnosed glioma patients, and 40 healthy controls were enrolled in this study. Then, the Hospital Anxiety and Depression Scale for anxiety (HADS-A) and for depression (HADS-D) were used to assess the anxiety and depression status of all subjects. The HADS-A score (8.6 ± 3.3 vs. 7.0 ± 2.9 vs. 4.3 ± 2.5), anxiety rate (58.8% vs. 32.5% vs. 10.0%), HADS-D score (7.9 ± 3.0 vs. 6.9 ± 3.1 vs. 4.0 ± 2.6), and depression rate (45.0% vs. 30.0% vs. 7.5%) were all highest in recurrent glioma patients, followed by newly-diagnosed glioma patients, and were lowest in healthy controls (all P < 0.001). Furthermore, female sex (vs. male sex) was independently correlated with anxiety (odds ratio (OR): 3.042, P = 0.029); meanwhile, higher World Health Organization (WHO) pathological grade was independently correlated with depression (OR: 2.573, P = 0.019) in recurrent glioma patients. Additionally, anxiety was correlated with shortened progression-free survival (PFS) (P = 0.028) and overall survival (OS) (P = 0.047), while depression only had a correlation trend with shortened PFS (without statistical significance) (P = 0.069) and was associated with shortened OS (P = 0.035) in recurrent glioma patients. The prevalence of anxiety and depression is high in recurrent glioma patients, which relates to gender, WHO pathological grade, and estimates worsen survival.
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Affiliation(s)
- Xiumei Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ge Zhan
- Department of General Therapy, The First Specialized Hospital of Harbin, Harbin, China
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84
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Wang Y, Liu S, Zhang Y, Zhu G, Wang H, Xu B, Xie Y, Yang S. Effect of traditional Chinese medicine on postoperative depression of breast cancer: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1019049. [PMID: 37426820 PMCID: PMC10327430 DOI: 10.3389/fphar.2023.1019049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Background: Depression is one of the common complications in patients with postoperative breast cancer (BC). Conventional therapies for postoperative depression of BC always have modest treatment outcomes and undesirable side effects. Clinical practice and many studies have shown that traditional Chinese medicine (TCM) has a good effect on postoperative depression of BC. This meta-analysis aimed to assess the clinical effect of TCM as an add-on treatment for postoperative depression of BC. Methods: A systematic and thorough search was conducted on eight online electronic databases up to 20 July 2022. The control group received conventional therapies, and intervention groups received what control groups received plus TCM treatment. Review Manager 5.4.1 was used for statistical analysis. Results: Nine RCTs involved 789 participants who met the inclusion standards. The results showed the intervention group was better at decreasing the score of the Hamilton rating scale for depression (HAMD) (mean difference, MD = -4.21, 95% CI -5.54 to -2.88) and the self-rating depression scale (SDS) (MD = -12.03, 95% CI -15.94 to -8.13), improving clinical efficacy (RR = 1.25, 95% CI 1.14-1.37), increasing the levels of 5-hydroxytryptamine (5-HT) (MD = 0.27, 95% CI 0.20-0.34), dopamine (DA) (MD = 26.28, 95% CI 24.18-28.77), and norepinephrine (NE) (MD = 11.05, 95% CI 8.07-14.04), and influencing the immune index, including the levels of CD3+ (MD = 15.18, 95% CI 13.61-16.75), CD4+ (MD = 8.37, 95% CI 6.00-10.74), and CD4+/CD8+ (MD = 0.33, 95% CI 0.27-0.39). The level of CD8+ (MD = -4.04, 95% CI -11.98 to 3.99) had no obvious difference between the two groups. Conclusion: The meta-analysis stated that a therapeutic regimen involving TCM could better improve the depression status in postoperative BC.
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85
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Chang YC, Tseng TA, Lin GM, Hu WY, Wang CK, Chang YM. Immediate impact of Mindfulness-Based Cognitive Therapy (MBCT) among women with breast cancer: a systematic review and meta-analysis. BMC Womens Health 2023; 23:331. [PMID: 37349700 PMCID: PMC10288664 DOI: 10.1186/s12905-023-02486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) may have positive physiological and psychological benefits for breast cancer survivors. However, few studies involved a combination of the relevant literatures to confirm the effects. METHODS Our study included randomized controlled trials (RCTs) and non-RCTs comparing interventions of MBCT and control protocols for alleviation of symptoms among breast cancer survivors. We calculated pooled mean differences (MDs), standardized mean differences (SMDs), and 95% confidence intervals (CIs) by using random effects models to estimate summary effect sizes. RESULTS Thirteen trials with 20-245 participants were considered in our studies; for the meta-analysis, 11 of these studies were eligible for assessment. The pooled meta-analysis results revealed that at the end of the MBCT intervention, participants' anxiety (SMD, - 0.70; 95% CI, - 1.26 to - 0.13; I2 = 69%), pain (SMD, - 0.64; 95% CI, - 0.92 to - 0.37; I2 = 0%), and depression (SMD, - 0.65; 95% CI, - 1.14 to - 0.17; I2 = 75%) levels significantly decreased, and their mindfulness (MD, 8.83; 95% CI, 3.88 to 13.78; I2 = 68%) levels significantly increased. CONCLUSION The MBCT may be associated with improved pain, anxiety, depression, and mindfulness. However, the quantitative analysis pointed to an inconclusive result due to moderate to high levels of heterogeneity among indicator of anxiety, depression, and mindfulness. Future work requires more studies to better elucidate the clinical significance of this possible association. The results suggest that MBCT is highly beneficial as an intervention for patients who have received treatment for breast cancer.
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Affiliation(s)
- Yun-Chen Chang
- School of Nursing and Graduate Institute of Nursing, China Medical University, 406, Taichung, Taiwan
- Nursing Department, China Medical University Hospital, Taichung, Taiwan
| | - Tzuhui Angie Tseng
- Department of Environmental and Cultural Resources, National Tsing Hua University, Hsinchu, Taiwan
| | - Gen-Min Lin
- Departments of Medicine, Hualien-Armed Forces General Hospital, Hualien City, Taiwan
- Tri-Service General Hospital, National Defense Medical Center, Taipei City, 100, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine, National Taiwan University, 100, Taipei City, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei City, 100, Taiwan
| | - Chih-Kai Wang
- Cancer Center, China Medical University Hospital, Taichung, 404, Taiwan
| | - Yuh-Ming Chang
- Department of Neurology, Hsinchu Mackay Memorial Hospital, No. 690, Sec. 2, Guangfu Rd., East Dist., Hsinchu City, 30071, Taiwan.
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Wieder R. Awakening of Dormant Breast Cancer Cells in the Bone Marrow. Cancers (Basel) 2023; 15:cancers15113021. [PMID: 37296983 DOI: 10.3390/cancers15113021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Up to 40% of patients with breast cancer (BC) have metastatic cells in the bone marrow (BM) at the initial diagnosis of localized disease. Despite definitive systemic adjuvant therapy, these cells survive in the BM microenvironment, enter a dormant state and recur stochastically for more than 20 years. Once they begin to proliferate, recurrent macrometastases are not curable, and patients generally succumb to their disease. Many potential mechanisms for initiating recurrence have been proposed, but no definitive predictive data have been generated. This manuscript reviews the proposed mechanisms that maintain BC cell dormancy in the BM microenvironment and discusses the data supporting specific mechanisms for recurrence. It addresses the well-described mechanisms of secretory senescence, inflammation, aging, adipogenic BM conversion, autophagy, systemic effects of trauma and surgery, sympathetic signaling, transient angiogenic bursts, hypercoagulable states, osteoclast activation, and epigenetic modifications of dormant cells. This review addresses proposed approaches for either eliminating micrometastases or maintaining a dormant state.
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Affiliation(s)
- Robert Wieder
- Rutgers New Jersey Medical School and the Cancer Institute of New Jersey, 185 South Orange Avenue, MSB F671, Newark, NJ 07103, USA
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Yang J, Zhang S, Jiang W. Impact of Beta Blockers on Breast Cancer Incidence and Prognosis. Clin Breast Cancer 2023:S1526-8209(23)00136-2. [PMID: 37353431 DOI: 10.1016/j.clbc.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 06/25/2023]
Abstract
Several studies have investigated the link between beta blockers (BB) and breast cancer outcomes but have reported mixed results. Our aim was to investigate the relationship between BB and breast cancer outcomes. Literatures investigating the relationship between BB and breast cancer outcomes were searched through PubMed and Embase. A total 43 articles were included by meta-analysis. We found BB increased breast cancer risk (n = 22, RR: 1.169, 95% CI: 1.063-1.285). We also found BB were associated with a lower overall survival (OS, n = 19, RR: 1.125, 95% CI: 1.078-1.173) and a higher recurrence risk (n = 8, RR: 1.130, 95% CI: 1.040-1.227) for breast cancer. Interestingly, subgroup analyses found only selective BB increased breast cancer risk (n = 5, RR: 1.766, 95% CI: 1.148-2.718) and recurrence risk (n = 2, RR: 1.168 -, 95% CI: 1.026-1.328) while only nonselective BB were associated with a lower OS (n = 4, RR: 1.135, 95% CI: 1.073-1.202) for breast cancer. Moreover, we found BB were associated with a significantly lower OS (n = 3, RR: 2.751, 95% CI: 1.213-6.238) and higher recurrence (n = 2, RR: 1.284, 95% CI: 1.102-1.497) only in luminal breast cancer while with a higher PFS (n = 2, RR: 0.585, 95% CI: 0.343-0.997) in Her2+ breast cancer. No significant differences in terms of CSM (n = 19, RR: 1.009, 95% CI: 0.947-1.077), PFS (n = 4, RR: 0.932, 95% CI: 0.616-1.305), and DFS (n = 2, RR: 0.776, 95% CI: 0.512-1.176) were observed. Our results provide evidence of the relationship between BB and breast cancer incidence and prognosis.
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Affiliation(s)
- Juanjuan Yang
- Department of Health Management, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Provice, China
| | - Shuqun Zhang
- Department of Oncology, the Second Affiliated Hospital of Xi' an Jiaotong University, Xi'an, Shaanxi Provice, China
| | - Wei Jiang
- Department of Oncology, the Second Affiliated Hospital of Xi' an Jiaotong University, Xi'an, Shaanxi Provice, China.
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Zheng Y, Wang N, Wang S, Zhang J, Yang B, Wang Z. Chronic psychological stress promotes breast cancer pre-metastatic niche formation by mobilizing splenic MDSCs via TAM/CXCL1 signaling. J Exp Clin Cancer Res 2023; 42:129. [PMID: 37210553 DOI: 10.1186/s13046-023-02696-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Emerging studies have identified chronic psychological stress as an independent risk factor influencing breast cancer growth and metastasis. However, the effects of chronic psychological stress on pre-metastatic niche (PMN) formation and the underlying immunological mechanisms remain largely unknown. METHODS The effects and molecular mechanisms of chronic unpredictable mild stress (CUMS) on modulating tumor-associated macrophages (TAMs) and PMN formation were clarified by multiplex immunofluorescence technique, cytokine array, chromatin immunoprecipitation, the dual-luciferase reporter assay, and breast cancer xenografts. Transwell and CD8+ T cytotoxicity detection were used to analyze the mobilization and function of myeloid-derived suppressor cells (MDSCs). mCherry-labeled tracing strategy and bone marrow transplantation were applied to explore the crucial role of splenic CXCR2+/+ MDSCs facilitating PMN formation under CUMS. RESULTS CUMS significantly promoted breast cancer growth and metastasis, accompanied by TAMs accumulation in the microenvironment. CXCL1 was identified as a crucial chemokine in TAMs facilitating PMN formation in a glucocorticoid receptor (GR)-dependent manner. Interestingly, the spleen index was significantly reduced under CUMS, and splenic MDSCs were validated as a key factor mediating CXCL1-induced PMN formation. The molecular mechanism study revealed that TAM-derived CXCL1 enhanced the proliferation, migration, and anti-CD8+ T cell functions of MDSCs via CXCR2. Moreover, CXCR2 knockout and CXCR2-/-MDSCs transplantation significantly impaired CUMS-mediated MDSC elevation, PMN formation, and breast cancer metastasis. CONCLUSION Our findings shed new light on the association between chronic psychological stress and splenic MDSC mobilization, and suggest that stress-related glucocorticoid elevation can enhance TAM/CXCL1 signaling and subsequently recruit splenic MDSCs to promote PMN formation via CXCR2.
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Affiliation(s)
- Yifeng Zheng
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
- Integrative Research Laboratory of Breast Cancer, Discipline of Integrated Chinese and Western Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Neng Wang
- Integrative Research Laboratory of Breast Cancer, Discipline of Integrated Chinese and Western Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, 510006, China
- The Research Center for Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Shengqi Wang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
- Integrative Research Laboratory of Breast Cancer, Discipline of Integrated Chinese and Western Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Juping Zhang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
- Integrative Research Laboratory of Breast Cancer, Discipline of Integrated Chinese and Western Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Bowen Yang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
- Integrative Research Laboratory of Breast Cancer, Discipline of Integrated Chinese and Western Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Zhiyu Wang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
- Integrative Research Laboratory of Breast Cancer, Discipline of Integrated Chinese and Western Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China.
- Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China.
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, 510006, China.
- The Research Center for Integrative Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China.
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Clift AK, Dodwell D, Lord S, Petrou S, Brady M, Collins GS, Hippisley-Cox J. Development and internal-external validation of statistical and machine learning models for breast cancer prognostication: cohort study. BMJ 2023; 381:e073800. [PMID: 37164379 PMCID: PMC10170264 DOI: 10.1136/bmj-2022-073800] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To develop a clinically useful model that estimates the 10 year risk of breast cancer related mortality in women (self-reported female sex) with breast cancer of any stage, comparing results from regression and machine learning approaches. DESIGN Population based cohort study. SETTING QResearch primary care database in England, with individual level linkage to the national cancer registry, Hospital Episodes Statistics, and national mortality registers. PARTICIPANTS 141 765 women aged 20 years and older with a diagnosis of invasive breast cancer between 1 January 2000 and 31 December 2020. MAIN OUTCOME MEASURES Four model building strategies comprising two regression (Cox proportional hazards and competing risks regression) and two machine learning (XGBoost and an artificial neural network) approaches. Internal-external cross validation was used for model evaluation. Random effects meta-analysis that pooled estimates of discrimination and calibration metrics, calibration plots, and decision curve analysis were used to assess model performance, transportability, and clinical utility. RESULTS During a median 4.16 years (interquartile range 1.76-8.26) of follow-up, 21 688 breast cancer related deaths and 11 454 deaths from other causes occurred. Restricting to 10 years maximum follow-up from breast cancer diagnosis, 20 367 breast cancer related deaths occurred during a total of 688 564.81 person years. The crude breast cancer mortality rate was 295.79 per 10 000 person years (95% confidence interval 291.75 to 299.88). Predictors varied for each regression model, but both Cox and competing risks models included age at diagnosis, body mass index, smoking status, route to diagnosis, hormone receptor status, cancer stage, and grade of breast cancer. The Cox model's random effects meta-analysis pooled estimate for Harrell's C index was the highest of any model at 0.858 (95% confidence interval 0.853 to 0.864, and 95% prediction interval 0.843 to 0.873). It appeared acceptably calibrated on calibration plots. The competing risks regression model had good discrimination: pooled Harrell's C index 0.849 (0.839 to 0.859, and 0.821 to 0.876, and evidence of systematic miscalibration on summary metrics was lacking. The machine learning models had acceptable discrimination overall (Harrell's C index: XGBoost 0.821 (0.813 to 0.828, and 0.805 to 0.837); neural network 0.847 (0.835 to 0.858, and 0.816 to 0.878)), but had more complex patterns of miscalibration and more variable regional and stage specific performance. Decision curve analysis suggested that the Cox and competing risks regression models tested may have higher clinical utility than the two machine learning approaches. CONCLUSION In women with breast cancer of any stage, using the predictors available in this dataset, regression based methods had better and more consistent performance compared with machine learning approaches and may be worthy of further evaluation for potential clinical use, such as for stratified follow-up.
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Affiliation(s)
- Ash Kieran Clift
- Cancer Research UK Oxford Centre, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, Oxford OX2 6GG, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Simon Lord
- Department of Oncology, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, Oxford OX2 6GG, UK
| | - Michael Brady
- Department of Oncology, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, Oxford OX2 6GG, UK
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90
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Xia L, Qiu S, Kong FB, Lai J, Huang H, Hu H, Liu X, Ye Z, Cao J. Epidemiology and Nomogram for Predicting the Cancer-specific Survival of Ovarian Granulosa Cell Tumor: A Seer database study. J Gynecol Obstet Hum Reprod 2023; 52:102601. [PMID: 37156420 DOI: 10.1016/j.jogoh.2023.102601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE ovarian granulosa cell tumor (OGCT) is a kind of infrequent ovarian malignant tumor with limited epidemiological data available. we established a predictive nomograph to verify the clinical prognosis. METHODS 1005 diagnosed with ovarian granulosa cell tumor (OGCT) were extracted from Surveillance, Epidemiology, and End Results (SEER) public database from 2000-2018. Kaplan-Meier analysis was applied to distinguish risk factors, univariate and multivariate Cox analyses were used to determine the independent prognostic factors for cancer-specific survival (CSS) of OGCT patients. The obtained prognostic variables were combined to construct a nomogram model for predicting CSS in OGCT patients. RESULTS Model performance was detected and evaluated with ROC curves and calibration plots. Data collected from 1005 patients were divided into two groups: training cohort(n=703,70%) and validation cohort(n=302,30%). The multivariate Cox model identified five covariates including age, marital status, AJCC stages, surgery and chemotherapy as independent interfering factors of CSS. The nomogram has shown a promising and excellent accuracy in evaluating 3 -, 5 -, 8-year CSS in OGCT patients. In terms of the CSS of the training cohort, the AUC values of the 3 -, 5 -, 8-year ROC curves were 0.819,0.8,0.819, while in terms of the CSS of the validation cohort, the AUC values of the validation cohort were 0.822,0.84,0.823, respectively. All the calibration curves showed pleasant consistency between predicted and actual survival rates. The nomogram model established in the study can improve the veracity of prognosis prediction, thereby improving the accuracy of individualized survival risk assessment, and providing targeted and constructive recommendations for specific treatment options. CONCLUSION Age, advanced clinical stage, widower and without surgery therapy are independent risk factors for poor prognosis and the nomogram we constructed can help clinicians efficiently recognize high-risk OGCT patients to guide targeted therapies and improve their outcomes.
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Affiliation(s)
- Longjie Xia
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, 613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, China.; Department of General Surgery, Guangzhou First People's Hospital, Guangzhou, No. 1 Panfu Road, Yuexiu District, Guangzhou 510180, China
| | - Shenghui Qiu
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, 613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, China.; Department of General Surgery, Guangzhou First People's Hospital, Guangzhou, No. 1 Panfu Road, Yuexiu District, Guangzhou 510180, China
| | - Fan-Biao Kong
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, 613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, China.; Department of Colorectal and Anal Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Nanning, Guangxi Zhuang autonomous region 530021, People's Republic of China.; Institute of Minimally Invasive Technology and Applications Guangxi Academy of Medical Science,6 Taoyuan Road, Nanning, Guangxi Zhuang autonomous region 530021, People's Republic of China
| | - Jianqin Lai
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, 613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, China.; Department of General Surgery, Guangzhou First People's Hospital, Guangzhou, No. 1 Panfu Road, Yuexiu District, Guangzhou 510180, China
| | - Huixian Huang
- Department of Plastic Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Huiqiong Hu
- Department of General Surgery, Guangzhou First People's Hospital, Guangzhou, No. 1 Panfu Road, Yuexiu District, Guangzhou 510180, China
| | - Xiangxia Liu
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN, USA 38138..
| | - Zi Ye
- Department of Emergency, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou 510080, China.
| | - Jie Cao
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Jinan University, 613 West Huangpu Avenue, Tianhe District, Guangzhou 510630, China.; Department of General Surgery, Guangzhou First People's Hospital, Guangzhou, No. 1 Panfu Road, Yuexiu District, Guangzhou 510180, China.
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91
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Rethorst CD, Carmody TJ, Argenbright KE, Mayes TL, Hamann HA, Trivedi MH. Considering depression as a secondary outcome in the optimization of physical activity interventions for breast cancer survivors in the PACES trial: a factorial randomized controlled trial. Int J Behav Nutr Phys Act 2023; 20:47. [PMID: 37081460 PMCID: PMC10120257 DOI: 10.1186/s12966-023-01437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Depressive symptoms result in considerable burden for breast cancer survivors. Increased physical activity may reduce these burdens but existing evidence from physical activity interventions in equivocal. Furthermore, physical activity intervention strategies may differentially impact depressive symptoms, which should be considered in designing and optimizing behavioral interventions for breast cancer survivors. METHODS The Physical Activity for Cancer Survivors (PACES) trial enrolled 336 participants breast cancer survivors, who were 3 months to 10 years post-treatment, and insufficiently active (< 150 min of moderate-to-vigorous physical activity per week). Participants were randomly assigned to a combination of 4 intervention strategies in a full-factorial design: 1) supervised exercise sessions, 2) facility access, 3) Active Living Every Day, and 4) Fitbit self-monitoring. Depressive symptoms were assessed at baseline, mid-intervention (3 months), and post-intervention (6 months) using the Quick Inventory for Depressive Symptoms. Change in depressive symptoms were analyzed using a linear mixed-effects model. RESULTS Results from the linear mixed-effects model indicated that depressive symptoms decreased significantly across the entire study sample over the 6-month intervention (F = 4.09, p = 0.044). A significant ALED x time interaction indicated participants who received the ALED intervention experienced greater reductions in depressive symptoms (F = 5.29, p = 0.022). No other intervention strategy significantly impacted depressive symptoms. CONCLUSIONS The ALED intervention consists of strategies (i.e., goal setting, social support) that may have a beneficial impact on depressive symptoms above and beyond the effect of increased physical activity. Our findings highlight the need to consider secondary outcomes when designing and optimizing physical activity interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03060941. Posted February 23, 2017.
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Affiliation(s)
- Chad D Rethorst
- Institute for Advancing Health Through Agriculture, Texas A&M Agrilife Research, 17360 Coit Road, Dallas, TX, 75252, USA.
| | - Thomas J Carmody
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Keith E Argenbright
- Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, TX Fort Worth, TX, USA
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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92
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Andersen BL, Lacchetti C, Ashing K, Berek JS, Berman BS, Bolte S, Dizon DS, Given B, Nekhlyudov L, Pirl W, Stanton AL, Rowland JH. Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update. J Clin Oncol 2023:JCO2300293. [PMID: 37075262 DOI: 10.1200/jco.23.00293] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors. METHODS A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted. RESULTS The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations. RECOMMENDATIONS It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
| | | | | | | | | | - Sage Bolte
- Inova Health Foundation, Falls Church, VA
| | - Don S Dizon
- Legorreta Cancer Center at Brown University and Lifespan Cancer Institute, Providence, RI
| | | | - Larissa Nekhlyudov
- Brigham and Women's Hospital, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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93
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Avisar A, Cohen M, Aharon A, Katz R, Bar-Sela G. Positive affect and fatigue as predictors of anti-inflammatory IL-10 concentrations among colorectal cancer patients during adjuvant chemotherapy. J Psychosom Res 2023; 167:111162. [PMID: 36796157 DOI: 10.1016/j.jpsychores.2023.111162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVES (1) To examine the relationships of positive and negative affect and symptoms of depression, anxiety, and fatigue at baseline with the anti-inflammatory cytokine IL-10 concentrations in serum at three points in colorectal cancer patients; and (2) to assess the relationship between these factors and disease recurrence or mortality after a median follow-up of 24 months. METHODS In a prospective trial, 92 stage II or III colorectal cancer patients scheduled to receive standard chemotherapy were enrolled. Blood samples were collected prior to start of chemotherapy onset (T0), 3 months later (T1), and upon chemotherapy completion (T2). RESULTS IL-10 concentrations were similar across the time points. Linear mixed-effects model analysis showed that controlling for confounders, higher positive affect and lower fatigue pretreatment (T0) predicted IL-10 concentrations across the time points (estimate = 0.18, SE = 0.08, 95% CI = 0.03, 0.34, p < .04 and estimate = -0.25, SE = 0.12, 95% CI = -0.50, 0.01, p < .04, respectively). Depression at T0 significantly predicted higher disease recurrence and mortality (estimate = 0.17, SE = 0.08, adjusted OR = 1.18, 95% CI = 1.02, 1.38, p = .03). CONCLUSIONS We report on associations not previously assessed between positive affect and fatigue and the anti-inflammatory cytokine IL-10. Results add to previous findings suggesting that positive affect and fatigue could have a role in anti-inflammatory cytokine dysregulation.
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Affiliation(s)
- Adva Avisar
- The Graduate Studies Authority, University of Haifa, Haifa, Israel
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
| | - Anat Aharon
- Hematology Research Laboratory, Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rina Katz
- Clinical Immunology and Tissue Typing Lab, Rambam Health Care Campus, Haifa, Israel
| | - Gil Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Cancer Center, Emek Medical Center, Afula, Israel.
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Grassi L, Caruso R, Riba MB, Lloyd-Williams M, Kissane D, Rodin G, McFarland D, Campos-Ródenas R, Zachariae R, Santini D, Ripamonti CI. Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guideline. ESMO Open 2023; 8:101155. [PMID: 37087199 PMCID: PMC10163167 DOI: 10.1016/j.esmoop.2023.101155] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 03/15/2023] Open
Abstract
•Anxiety and depressive disorders are common in patients with cancer. •A higher prevalence seen in patients with cancer than the general population is often underrecognised. •Psychotherapy, cognitive behavioural therapy and mindfulness-based therapies are effective treatments. •Psychopharmacological treatments have been shown to be effective treatments of anxiety and depressive disorders.
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Affiliation(s)
- L Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - R Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - M B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor; University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, USA
| | - M Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool; Department of Supportive and Palliative Care, Liverpool John Moores University, Liverpool, UK
| | - D Kissane
- Department of Psychiatry, Monash University and Monash Medical Centre, Monash Health, Clayton, Australia
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - D McFarland
- Department of Psychiatry, University of Rochester, Rochester; Wilmont Cancer Institute, University of Rochester Medical Center, Rochester, USA
| | - R Campos-Ródenas
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - R Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - D Santini
- UOC Medical Oncology, AUSL Latina, Sapienza University of Rome, Aprilia
| | - C I Ripamonti
- Oncology-Supportive Care in Cancer, Department of Oncology & Haematology Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Maculaitis MC, Liu X, Berk A, Massa A, Weiss MC, Kurosky SK, Li B, McRoy L. Psychosocial Wellbeing among Patients with Breast Cancer during COVID-19. Curr Oncol 2023; 30:3886-3900. [PMID: 37185407 PMCID: PMC10136618 DOI: 10.3390/curroncol30040294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
The impact of coronavirus disease 2019 (COVID-19) on the wellbeing of breast cancer (BC) patients is not well understood. This study described psychosocial problems among these patients in the United States (US) during the COVID-19 pandemic. Data were collected from BC patients via an online self-report survey between 30 March-6 July 2021 to assess the prevalence of COVID-19 diagnosis history and potential depression, health-related quality of life, COVID-related stress, and financial toxicity. Patients with early-stage (eBC) and metastatic (mBC) disease were compared. Of 669 patients included in the analysis, the prevalence of COVID-19 diagnosis history (10.9% versus 7.7%) and potential depression (33.7% versus 28.3%) were higher in mBC than eBC patients. Patients with eBC (versus mBC) had higher scores on nearly all Functional Assessment of Cancer Therapy-Breast scales (all, p < 0.001). For the Psychological Impact of Cancer subscales measuring negative coping strategies, the emotional distress score was the highest (9.1 ± 1.8) in the overall sample. Comprehensive Score for Financial Toxicity scores were higher in eBC than in mBC patients (24.2 ± 11.3 vs. 21.3 ± 10.2, p < 0.001). Overall, the COVID-19-related stress score was highest for danger/contamination fears (8.2 ± 5.6). In conclusion, impairments to psychosocial wellbeing among patients during the pandemic were observed, particularly financial toxicity and poor mental health and emotional functioning, with greater problems among mBC patients.
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Affiliation(s)
| | | | | | | | - Marisa C Weiss
- Breastcancer.org, Ardmore, PA 19003, USA
- Lankenau Medical Center, Wynnewood, PA 19096, USA
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96
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Xiao X, Huang S, Gan C, Quan X, Xiang Y, Zheng B. Pretreatment Depressive Status Associated with Poor Nutrition and Prognosis in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy. Nutr Cancer 2023; 75:1223-1232. [PMID: 36919535 DOI: 10.1080/01635581.2023.2186265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
The prevalence of pretreatment depression in breast cancer patients and its impact on nutrition and prognosis during neoadjuvant chemotherapy remain unknown. One hundred twenty-one patients with previously untreated breast cancer undergoing neoadjuvant chemotherapy (NAC) were enrolled. Patients completed the Self-rating Depressive symptoms Scale (SDS) before treatment and were divided into two groups (non-depressive group and depressive group). The nutrition risk screening-2002 (NRS-2002), and nutritional and prognostic indicators, including neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI), were collected at baseline (pretreatment) and post-treatment. One- and two-year progression-free survival (PFS) in both groups were also calculated. We found that 38.84% patients experienced pretreatment depressive symptoms. Patients in the depressive group had higher nutritional risk and lower body mass index, potassium, sodium, total cholesterol, total protein, and fasting blood glucose levels than those in pretreatment non-depressive group after NAC (all p < 0.05). And higher NLR (p = 0.039) and lower PNI level (p = 0.0021) after NAC were found in patients with pretreatment depressive status. Multivariable Cox analysis showed pretreatment depressive status (HR: 1.893; 95% CI: 1.047-3.426; p = 0.034) were a significant predictor of PFS. This study provides evidence for early identification of pretreatment depression in patients receiving NAC, which would certainly favor nutrition and survival outcome.
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Affiliation(s)
- Xiaodan Xiao
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Siyin Huang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chengju Gan
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaoli Quan
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yali Xiang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Baojia Zheng
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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Almeida SS, Oliveira MA, Medeiros R, Guerra MP, Pariante CM, Fernandes L. Emotional, inflammatory, and genetic factors of resilience and vulnerability to depression in patients with premenopausal breast cancer: A longitudinal study protocol. PLoS One 2023; 18:e0279344. [PMID: 36787313 PMCID: PMC9928105 DOI: 10.1371/journal.pone.0279344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/06/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Psychosocial stress and depressive disorder have been associated with cancer as putative contributors to worse prognosis. On the other hand, cancer diagnosis is a recognised life event that can contribute to distress and depressive states. Humoral and cellular inflammation can promote depressive disorder by means of decreased monoamine synthesis, glutamate neurotoxicity, neurogenesis and neuroplasticity, dysregulated hypothalamic-pituitary-adrenal axis, and glucocorticoid resistance. This protocol objectives are to observe the interactions between psychosocial variables and biochemical and immunological biomarkers in a longitudinal, prospective design; to identify inflammation-related depression endophenotypes in breast cancer patients and to understand if early diagnosed and treated depression in this population will translate in better inflammation status and better global prognosis. METHODS Prospective observational cohort, composed by 100 consecutive premenopausal patients, diagnosed with non-distant metastatic breast carcinoma and with no history of major psychopathology or other organic illness. The participants will have an in-person assessment in three different moments, along illness treatment and follow-up, with respect to cytometric, immunologic, and psychosocial parameters and will be tested for depression vulnerability and resilience inflammation-related functional genetic polymorphisms. Additionally, at years 5 and 10 post enrollment, patients`medical records will be assessed. As a control cohort, all patients excluded due to psychiatric history or past psychiatric treatments will have their clinical records assessed at years 5 and 10 after admission. All the data will be managed with the SPSS® software. DISCUSSION AND CONCLUSION This study is an original longitudinal cohort of breast cancer premenopausal patients, with a comprehensive approach to psychosocial, clinical, inflammatory, and genetic variables. It expects to provide evidence regarding the links between genetic, cytometric, immunologic, and psychosocial factors, their potential contribution to the pathophysiology of depressive disorder, breast cancer course, progression, and prognosis. It may further contribute with data to better efficacy of the psycho-oncological interventions. TRIAL REGISTRATION National Commission of Data Protection (CNPD) 13413/2017; Ethics Committee of IPOP project code CI-IPOP81/2017.
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Affiliation(s)
- Susana S. Almeida
- Psychiatry Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- Psychiatry and Psychology Service, CUF Porto Hospital, Porto, Portugal
| | - Magda A. Oliveira
- Psychiatry and Psychology Service, CUF Porto Hospital, Porto, Portugal
- Psychology Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) /Porto Comprehensive Cancer Center (Porto.CCC), Research Center-LAB2, Porto, Portugal
- ICBAS, Abel Salazar Institute for the Biomedical Sciences, University of Porto, Porto, Portugal
- Biomedical Research Center (CEBIMED), Faculty of Health Sciences, Fernando Pessoa University (UFP), Porto, Portugal
- Research Department, LPCC- Portuguese League Against Cancer (NRNorte), Porto, Portugal
| | - Marina P. Guerra
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology at University of Porto (CPUP), Porto, Portugal
| | - Carmine M. Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College of London, London, United Kingdom
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- Psychiatry Service, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
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98
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Álvarez-Pardo S, de Paz JA, Romero-Pérez EM, Tánori-Tapia JM, Rendón-Delcid PA, González-Bernal JJ, Fernández-Solana J, Simón-Vicente L, Mielgo-Ayuso J, González-Santos J. Related Factors with Depression and Anxiety in Mastectomized Women Breast Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2881. [PMID: 36833577 PMCID: PMC9956270 DOI: 10.3390/ijerph20042881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Breast cancer (BC) is the most common cancer diagnosis with the highest mortality rate worldwide. The aim of this study was to identify factors related to depression and anxiety in mastectomized women BC survivors. A cross-sectional study was conducted with a sample of 198 women diagnosed with BC aged 30-80 years in Mexico. Depression and anxiety were assessed using the 14-item Hospital Anxiety and Depression Scale (HADS). The results showed that 94.44% and 69.18% of the women scored more than eight points on HADS in the anxiety and depression subscales, respectively; 70.20% and 10.60% were identified as pathological. The following variables were analyzed: age, time elapsed since the start of treatment, received treatment at the time of the evaluation, type of surgery, family history, marital status and employment status. Time elapsed since surgery, having a partner, and employment showed significant results as factors associated to levels of depression and anxiety in these patients. In conclusion, it has been shown that BCSs under 50 years of age receiving some kind of treatment, without family history, without a partner, with a job, with more than secondary education and with more than 5 years since diagnosis could have higher rates of clinical depression. On the other hand, BCSs older than 50 years receiving some kind of treatment, without family history, without a partner, with a job, with more than secondary education and with more than 5 years since diagnosis, could have higher rates of clinical anxiety. In conclusion, the variables studied provide valuable information for the implementation of psychotherapy plans in healthcare systems to reduce the risk of depression and/or anxiety in women with BC who have undergone mastectomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Juan Mielgo-Ayuso
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain
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99
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Rasmussen GHF, Kristiansen M, Arroyo-Morales M, Voigt M, Madeleine P. The Analgesic Effect of Resistance Training after Breast Cancer (ANTRAC): A Randomized Controlled Trial. Med Sci Sports Exerc 2023; 55:167-176. [PMID: 36084228 DOI: 10.1249/mss.0000000000003034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this blinded parallel-arm randomized controlled trial was to investigate the effect of resistance training (RT) on pain, maximal strength, and shoulder function in breast cancer survivors (BCS) with persistent pain after treatment. METHODS Twenty BCS with self-reported pain ≥1.5 yr after treatment were randomized to an experimental group (EXP, n = 10), who performed a supervised progressive total body heavy RT program 2 times per week for 12 wk, or a control group (CON, n = 10), who was instructed to continue their everyday life. Perceived pain intensity, pressure pain threshold (PPT) levels, one-repetition maximum (1RM), and active range of motion were collected pre- and postintervention and at 3 months follow-up. RESULTS There was a significant 11% decrease in peak pain intensity ( P < 0.05) for both groups, a significant 48% increase in 1RM ( P < 0.05), and a significant 35% increase in PPT levels ( P < 0.001) for EXP, but not for CON. For EXP, maximal strength at follow-up was still significantly greater than at preintervention ( P < 0.05), whereas PPT levels had reverted to baseline levels. There was no change in active range of motion ( P < 0.05) and no change in arm circumference ( P < 0.05). CONCLUSIONS RT had a significant effect on 1RM and PPT of BCS with persistent pain after treatment, demonstrating both a functional and analgesic effect of progressive RT in this population. Strength was largely maintained after detraining, whereas PPT levels were not, indicating that the process of RT rather than the gain in strength may be associated with analgesia.
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Affiliation(s)
- Gorm Henrik Fogh Rasmussen
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
| | - Mathias Kristiansen
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
| | | | - Michael Voigt
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
| | - Pascal Madeleine
- Sport Sciences-Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg, DENMARK
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100
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Dragioti E, Radua J, Solmi M, Gosling CJ, Oliver D, Lascialfari F, Ahmed M, Cortese S, Estradé A, Arrondo G, Gouva M, Fornaro M, Batiridou A, Dimou K, Tsartsalis D, Carvalho AF, Shin JI, Berk M, Stringhini S, Correll CU, Fusar-Poli P. Impact of mental disorders on clinical outcomes of physical diseases: an umbrella review assessing population attributable fraction and generalized impact fraction. World Psychiatry 2023; 22:86-104. [PMID: 36640414 PMCID: PMC9840513 DOI: 10.1002/wps.21068] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 01/15/2023] Open
Abstract
Empirical evidence indicates a significant bidirectional association between mental disorders and physical diseases, but the prospective impact of men-tal disorders on clinical outcomes of physical diseases has not been comprehensively outlined. In this PRISMA- and COSMOS-E-compliant umbrella review, we searched PubMed, PsycINFO, Embase, and Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, up to March 15, 2022, to identify systematic reviews with meta-analysis that examined the prospective association between any mental disorder and clinical outcomes of physical diseases. Primary outcomes were disease-specific mortality and all-cause mortality. Secondary outcomes were disease-specific incidence, functioning and/or disability, symptom severity, quality of life, recurrence or progression, major cardiac events, and treatment-related outcomes. Additional inclusion criteria were further applied to primary studies. Random effect models were employed, along with I2 statistic, 95% prediction intervals, small-study effects test, excess significance bias test, and risk of bias (ROBIS) assessment. Associations were classified into five credibility classes of evidence (I to IV and non-significant) according to established criteria, complemented by sensitivity and subgroup analyses to examine the robustness of the main analysis. Statistical analysis was performed using a new package for conducting umbrella reviews (https://metaumbrella.org). Population attributable fraction (PAF) and generalized impact fraction (GIF) were then calculated for class I-III associations. Forty-seven systematic reviews with meta-analysis, encompassing 251 non-overlapping primary studies and reporting 74 associations, were included (68% were at low risk of bias at the ROBIS assessment). Altogether, 43 primary outcomes (disease-specific mortality: n=17; all-cause mortality: n=26) and 31 secondary outcomes were investigated. Although 72% of associations were statistically significant (p<0.05), only two showed convincing (class I) evidence: that between depressive disorders and all-cause mortality in patients with heart failure (hazard ratio, HR=1.44, 95% CI: 1.26-1.65), and that between schizophrenia and cardiovascular mortality in patients with cardiovascular diseases (risk ratio, RR=1.54, 95% CI: 1.36-1.75). Six associations showed highly suggestive (class II) evidence: those between depressive disorders and all-cause mortality in patients with diabetes mellitus (HR=2.84, 95% CI: 2.00-4.03) and with kidney failure (HR=1.41, 95% CI: 1.31-1.51); that between depressive disorders and major cardiac events in patients with myocardial infarction (odds ratio, OR=1.52, 95% CI: 1.36-1.70); that between depressive disorders and dementia in patients with diabetes mellitus (HR=2.11, 95% CI: 1.77-2.52); that between alcohol use disorder and decompensated liver cirrhosis in patients with hepatitis C (RR=3.15, 95% CI: 2.87-3.46); and that between schizophrenia and cancer mortality in patients with cancer (standardized mean ratio, SMR=1.74, 95% CI: 1.41-2.15). Sensitivity/subgroup analyses confirmed these results. The largest PAFs were 30.56% (95% CI: 27.67-33.49) for alcohol use disorder and decompensated liver cirrhosis in patients with hepatitis C, 26.81% (95% CI: 16.61-37.67) for depressive disorders and all-cause mortality in patients with diabetes mellitus, 13.68% (95% CI: 9.87-17.58) for depressive disorders and major cardiac events in patients with myocardial infarction, 11.99% (95% CI: 8.29-15.84) for schizophrenia and cardiovascular mortality in patients with cardiovascular diseases, and 11.59% (95% CI: 9.09-14.14) for depressive disorders and all-cause mortality in patients with kidney failure. The GIFs confirmed the preventive capacity of these associations. This umbrella review demonstrates that mental disorders increase the risk of a poor clinical outcome in several physical diseases. Prevention targeting mental disorders - particularly alcohol use disorders, depressive disorders, and schizophrenia - can reduce the incidence of adverse clinical outcomes in people with physical diseases. These findings can inform clinical practice and trans-speciality preventive approaches cutting across psychiatric and somatic medicine.
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Affiliation(s)
- Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families and Health Professionals, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Imaging of Mood- and Anxiety-Related Disorders Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, University of Barcelona, Barcelona, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Corentin J Gosling
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- DysCo Lab, Paris Nanterre University, Nanterre, France
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Boulogne-Billancourt, France
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Filippo Lascialfari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Muhammad Ahmed
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, and Solent NHS Trust, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gonzalo Arrondo
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Mary Gouva
- Research Laboratory Psychology of Patients, Families and Health Professionals, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Agapi Batiridou
- Research Laboratory Psychology of Patients, Families and Health Professionals, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina Dimou
- Research Laboratory Psychology of Patients, Families and Health Professionals, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | - Andre F Carvalho
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Severance Children's Hospital, Seoul, South Korea
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine and Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Silvia Stringhini
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- University Centre for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
- Department of Health and Community Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
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