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Zimmaro LA, Sephton SE, Siwik CJ, Phillips KM, Rebholz WN, Kraemer HC, Giese-Davis J, Wilson L, Bumpous JM, Cash ED. Depressive symptoms predict head and neck cancer survival: Examining plausible behavioral and biological pathways. Cancer 2018; 124:1053-1060. [PMID: 29355901 DOI: 10.1002/cncr.31109] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/25/2017] [Accepted: 10/10/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Head and neck cancers are associated with high rates of depression, which may increase the risk for poorer immediate and long-term outcomes. Here it was hypothesized that greater depressive symptoms would predict earlier mortality, and behavioral (treatment interruption) and biological (treatment response) mediators were examined. METHODS Patients (n = 134) reported depressive symptomatology at treatment planning. Clinical data were reviewed at the 2-year follow-up. RESULTS Greater depressive symptoms were associated with significantly shorter survival (hazard ratio, 0.868; 95% confidence interval [CI], 0.819-0.921; P < .001), higher rates of chemoradiation interruption (odds ratio, 0.865; 95% CI, 0.774-0.966; P = .010), and poorer treatment response (odds ratio, 0.879; 95% CI, 0.803-0.963; P = .005). The poorer treatment response partially explained the depression-survival relation. Other known prognostic indicators did not challenge these results. CONCLUSIONS Depressive symptoms at the time of treatment planning predict overall 2-year mortality. Effects are partly influenced by the treatment response. Depression screening and intervention may be beneficial. Future studies should examine parallel biological pathways linking depression to cancer survival, including endocrine disruption and inflammation. Cancer 2018;124:1053-60. © 2018 American Cancer Society.
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Affiliation(s)
- Lauren A Zimmaro
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Sandra E Sephton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky.,James Graham Brown Cancer Center, Louisville, Kentucky
| | - Chelsea J Siwik
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Kala M Phillips
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Whitney N Rebholz
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky
| | - Helena C Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California
| | - Janine Giese-Davis
- Alberta Health Services Center Care (Holy Cross Site), Calgary, Alberta, Canada.,Division of Psychosocial Oncology, Department of Oncology, Faculty of Medicine, University of Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Liz Wilson
- James Graham Brown Cancer Center, Louisville, Kentucky.,Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jeffrey M Bumpous
- James Graham Brown Cancer Center, Louisville, Kentucky.,Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky
| | - Elizabeth D Cash
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky.,James Graham Brown Cancer Center, Louisville, Kentucky.,Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky
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102
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Song W, Miao DL, Chen L. Survival rates are higher in married patients with biliary tract cancer: a population-based study. Oncotarget 2018; 9:9531-9539. [PMID: 29507708 PMCID: PMC5823654 DOI: 10.18632/oncotarget.24170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022] Open
Abstract
Marital status has been identified as a prognostic factor in multiple malignancies. In this study, we assessed the prognostic value of marital status in 24,035 patients from the Surveillance, Epidemiology, and End Results database diagnosed with biliary tract cancer (BTC) between 2004 and 2014. Widowed patients were more likely to be women, elderly (> 60 years), have gallbladder cancer, and have localized SEER Stage disease than all other patients. Marital status was identified as an independent prognostic factor in both univariate and multivariate analyses, and cause-specific survival (CSS) rates were higher in married patients than unmarried patients. In addition, CSS rates were higher in ampulla of Vater cancer patients than in gallbladder cancer or cholangiocarcinoma patients. Further analysis revealed that CSS rates were lowest in widowed patients at each TNM stage and for all tumor sites. These results suggest marital status is a prognostic factor for clinical outcomes in patients with BTC, and widowed patients are at greater risk of cancer-specific mortality.
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Affiliation(s)
- Wei Song
- Department of Intervention and Vascular Surgery, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou Cancer Medical Center, Suzhou, China
| | - Dong-Liu Miao
- Department of Intervention and Vascular Surgery, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou Cancer Medical Center, Suzhou, China
| | - Lei Chen
- Department of Intervention and Vascular Surgery, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou Cancer Medical Center, Suzhou, China
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Abstract
The cancer anorexia cachexia syndrome is a systemic metabolic disorder characterized by the catabolism of stored nutrients in skeletal muscle and adipose tissue that is particularly prevalent in nonsmall cell lung cancer (NSCLC). Loss of skeletal muscle results in functional impairments and increased mortality. The aim of the present study was to characterize the changes in systemic metabolism in a genetically engineered mouse model of NSCLC. We show that a portion of these animals develop loss of skeletal muscle, loss of adipose tissue, and increased inflammatory markers mirroring the human cachexia syndrome. Using noncachexic and fasted animals as controls, we report a unique cachexia metabolite phenotype that includes the loss of peroxisome proliferator-activated receptor-α (PPARα) -dependent ketone production by the liver. In this setting, glucocorticoid levels rise and correlate with skeletal muscle degradation and hepatic markers of gluconeogenesis. Restoring ketone production using the PPARα agonist, fenofibrate, prevents the loss of skeletal muscle mass and body weight. These results demonstrate how targeting hepatic metabolism can prevent muscle wasting in lung cancer, and provide evidence for a therapeutic strategy.
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104
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Wu W, Fang D, Shi D, Bian X, Li L. Effects of marital status on survival of hepatocellular carcinoma by race/ethnicity and gender. Cancer Manag Res 2018; 10:23-32. [PMID: 29379317 PMCID: PMC5757210 DOI: 10.2147/cmar.s142019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose It is well demonstrated that being married is associated with a better prognosis in multiple types of cancer. However, whether the protective effect of marital status varied across race/ethnicity and gender in patients with hepatocellular carcinoma remains unclear. Therefore, we aimed to evaluate the roles of race/ethnicity and gender in this relationship. Patients and methods We identified eligible patients from Surveillance, Epidemiology and End Results (SEER) database during 2004–2012. Overall and cancer-specific survival differences across marital status were compared by Kaplan–Meier curves. We also estimated crude hazard ratios (CHRs) and adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) for marital status associated with survival by race/ethnicity and gender in Cox proportional hazard models. Results A total of 12,168 eligible patients diagnosed with hepatocellular carcinoma were included. We observed that married status was an independent protective prognostic factor for overall and cancer-specific survival. In stratified analyses by race/ethnicity, the AHR of overall mortality (unmarried vs married) was highest for Hispanic (AHR =1.25, 95% CI, 1.13–1.39; P<0.001) and lowest for Asian or Pacific Islander (AHR =1.13; 95% CI, 1.00–1.28; P=0.042). Stratified by gender, the AHR was higher in males (AHR =1.27; 95% CI, 1.20–1.33; P<0.001). Conclusion: We demonstrated that married patients obtained better survival advantages. Race/ethnicity and gender could influence the magnitude of associations between marital status and risk of mortality.
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Affiliation(s)
- Wenrui Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
| | - Daiqiong Fang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
| | - Ding Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
| | - Xiaoyuan Bian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
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105
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Shadnia S, Zamani N, Hassanian-Moghaddam H, Shafaroodi H, Padandar M, Rezaeizadeh MH. Prognostic value of cortisol and thyroid function tests in poisoned patients admitted to toxicology ICU. World J Emerg Med 2018; 9:51-55. [PMID: 29290896 DOI: 10.5847/wjem.j.1920-8642.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prognostic value of cortisol and thyroid function tests (TFTs) has previously been evaluated in medical ICUs. We aimed to evaluate prognostic efficacy of cortisol and TFTs in critically ill poisoned patients admitted to toxicology intensive care unit (ICU). METHODS In a prospective study of consecutively enrolled subjects admitted to the toxicology ICU, lab analyses included TFTs (total T3 and T4 as well as TSH) and cortisol levels drawn between 8 am-10 am during period of the first 24 hours post-ingestion/exposure. Simplified Acute Physiology Score II (SAPS II) and Acute Physiology and Chronic Health Evaluation II (APACHE II) were recorded. All scores were compared to detect the best prognostic factor. Type of poisoning was also included. RESULTS In 200 patients evaluated, 129 were male and mean age was 31 years. In general, SAPS II, T4, and cortisol could prognosticate death. After regression analysis, only cortisol had such efficacy (P=0.04; OR=1.06; 95%CI=1.05-1.08; cut-off=42 µg/dL; sensitivity=70%; specificity=82%). Between aluminium phosphide (ALP)- and non ALP-poisoned patients, level of consciousness, mean arterial pressure, and cortisol level could prognosticate death in ALP poisoning (all Ps<0.001 in both uni and multivariate analyses). Median (interquartile range; IQR) GCS was 7 (6, 10) and 15 (8, 15) in non-ALP and ALP-poisoned patients (P<0.003). SAPS II and APACHE II could not prognosticate death at all. CONCLUSION Cortisol best prognosticated outcomes for subjects admitted to the toxicology ICU. Its level is higher in ALP-poisoned patients probably due to the higher stress while they remain conscious till the final stages of toxicity and are aware of deterioration of their clinical condition or may be due to their significantly lower blood pressures.
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Affiliation(s)
- Shahin Shadnia
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran
| | - Nasim Zamani
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Toxicological Research Center, Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran
| | - Hamed Shafaroodi
- Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, Iran
| | - Mina Padandar
- Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), Tehran, Iran
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106
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Bellagambi F, Degano I, Ghimenti S, Lomonaco T, Dini V, Romanelli M, Mastorci F, Gemignani A, Salvo P, Fuoco R, Di Francesco F. Determination of salivary α-amylase and cortisol in psoriatic subjects undergoing the Trier Social Stress Test. Microchem J 2018. [DOI: 10.1016/j.microc.2017.04.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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107
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Kuras YI, Assaf N, Thoma MV, Gianferante D, Hanlin L, Chen X, Fiksdal A, Rohleder N. Blunted Diurnal Cortisol Activity in Healthy Adults with Childhood Adversity. Front Hum Neurosci 2017; 11:574. [PMID: 29234280 PMCID: PMC5712303 DOI: 10.3389/fnhum.2017.00574] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 11/13/2017] [Indexed: 11/16/2022] Open
Abstract
Childhood adversity, such as neglect, or physical, emotional, or sexual abuse, is prevalent in the U.S. and worldwide, and connected to an elevated incidence of disease in adulthood. A pathway in this relationship might be altered hypothalamic-pituitary-adrenal (HPA) axis functioning, as a result of differential hippocampal development in early life. A blunted diurnal cortisol slope is a precursor for many disorders. While studies have focused on HPA reactivity in relation to childhood adversity, there has been markedly less research on basal HPA functioning in those with low-to-moderate adversity. Based on previous research, we hypothesized that adults with low-to-moderate childhood adversity would have altered HPA axis functioning, as evidenced by a blunted diurnal cortisol slope and altered cortisol awakening response (CAR). Healthy adults aged 18–65 (n = 61 adults; 31 males and 30 females) completed the Childhood Trauma Questionnaire. Participants provided at-home saliva samples on two consecutive days at wake-up, and 30 min, 1, 4, 9, and 13 h later; samples were averaged over the 2 days. We found that low-to-moderate childhood adversity predicted lower morning cortisol (β = -0.34, p = 0.007, R2 = 0.21), as well as a blunted cortisol slope (β = 2.97, p = 0.004, R2 = 0.22), but found no association with CAR (β = 0.19, p = 0.14, R2 = 0.12). Overall, we found that in healthy participants, low-to-moderate adversity in childhood is associated with altered basal HPA activity in adulthood. Our findings indicate that even low levels of childhood adversity may predispose individuals to disease associated with HPA dysregulation in later life.
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Affiliation(s)
- Yuliya I Kuras
- Laboratory for Biological Health Psychology, Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Naomi Assaf
- Laboratory for Biological Health Psychology, Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Myriam V Thoma
- Laboratory for Biological Health Psychology, Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Danielle Gianferante
- Laboratory for Biological Health Psychology, Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Luke Hanlin
- Laboratory for Biological Health Psychology, Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Xuejie Chen
- Laboratory for Biological Health Psychology, Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Alexander Fiksdal
- Laboratory for Biological Health Psychology, Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Nicolas Rohleder
- Laboratory for Biological Health Psychology, Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States.,Chair of Health Psychology, Department of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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108
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Nirvani M, Khuu C, Utheim TP, Sand LP, Sehic A. Circadian clock and oral cancer. Mol Clin Oncol 2017; 8:219-226. [PMID: 29435282 PMCID: PMC5774470 DOI: 10.3892/mco.2017.1518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/24/2017] [Indexed: 12/20/2022] Open
Abstract
The circadian clock is comprised of a master component situated in the hypothalamic suprachiasmatic nucleus and subordinate clock genes in almost every cell of the body. The circadian clock genes and their encoded proteins govern the organism to follow the natural signals of time, and adapt to external changes in the environment. The majority of physiological processes in mammals exhibit variable circadian rhythms, which are generated and coordinated by an oscillation in the expression of the clock genes. A number of studies have reported that alteration in the expression level of clock genes is correlated with several pathological conditions, including cancer. However, little is known about the role of clock genes in homeostasis of the oral epithelium and their disturbances in oral carcinogenesis. The present review summarizes the current state of knowledge of the implications of clock genes in oral cancer. It has been demonstrated that the development of oral squamous cell carcinoma undergoes circadian oscillation in relation to tumor volume and proliferation rate. The circadian clock gene period (PER)1 has been associated with oral cancer pathogenesis and it is suggested that changes in the expression of PER1 may exhibit an important role in the development, invasion, and metastasis of oral squamous cell carcinoma. However, its role remains elusive and there is a need for further research in order to understand the underlying mechanisms of the clock genes in oral cancer pathogenesis.
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Affiliation(s)
- Minou Nirvani
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, 0316 Oslo, Norway
| | - Cuong Khuu
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, 0316 Oslo, Norway
| | - Tor Paaske Utheim
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, 0316 Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, 0424 Oslo, Norway
| | - Lars Peter Sand
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, 0316 Oslo, Norway
| | - Amer Sehic
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, 0316 Oslo, Norway
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109
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Siwik C, Hicks A, Phillips K, Rebholz WN, Zimmaro LA, Weissbecker I, Cash E, Sephton SE. Impact of coping strategies on perceived stress, depression, and cortisol profiles among gynecologic cancer patients. J Health Psychol 2017; 25:993-1003. [DOI: 10.1177/1359105317740737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We explored associations between problem-focused, emotional processing, and emotional expression coping strategies and markers of stress including perceived stress, depressive symptoms, and diurnal cortisol profiles among women with gynecologic cancer. Problem-focused coping was associated with less perceived stress, fewer depressive symptoms, and more rhythmic diurnal salivary cortisol profiles. Emotional processing was associated with lower perceived stress and fewer depressive symptoms. Emotional expression was associated with fewer depressive symptoms and elevated diurnal mean and evening cortisol levels. Results point to key differences in coping strategies. In this sample, only problem-focused coping was linked with adaptive differences in both psychological and physiological stress measures.
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Affiliation(s)
| | | | | | | | | | | | | | - Sandra E Sephton
- University of Louisville, USA
- James Graham Brown Cancer Center, USA
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110
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Frugé AD, Cases MG, Howell CR, Tsuruta Y, Smith-Johnston K, Moellering DR, Demark-Wahnefried W. Fingernail and toenail clippings as a non-invasive measure of chronic cortisol levels in adult cancer survivors. Cancer Causes Control 2017; 29:185-191. [PMID: 29170880 DOI: 10.1007/s10552-017-0989-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/21/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer survivors are at greater risk of comorbidities and functional decline due to physiological and psychological stress which can be measured by salivary cortisol. If saliva is used, multiple samples must be collected to accurately quantify long-term stress; however, fingernail (FN) and toenail (TN) clippings offer an opportunity to measure retrospective cortisol levels in a non-invasive manner. METHODS Three sets of FN and TN clippings were collected at 12-month intervals in conjunction with saliva samples from cancer survivors (n = 109) participating in two clinical trials. FN and TN samples were stored at room temperature (RT); a subset underwent additional processing and freezing before analysis. Cortisol levels were determined via enzyme immunoassay, and correlation coefficients were generated to determine overall correspondence of the individual measures. RESULTS Matched RT and frozen samples were highly correlated for TN (r = 0.950, p = 5.44 × 10-37) and FN (r = 0.784, p = 1.05 × 10-10). Correlations between RT FN and TN were statistically significant (r = 0.621, p = 3.61 × 10- 17), as were frozen FN and TN (r = 0.310, p = 0.0283). RT, but not frozen TN and FN correlated with salivary cortisol (r = 0.580, p = 1.65 × 10- 16 and r = 0.287, p = 0.00042 for TN and FN, respectively). CONCLUSIONS FN and TN cortisol levels correlate with salivary cortisol in adult cancer survivors and may offer a less invasive and convenient means for measuring chronic cortisol levels.
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Affiliation(s)
- Andrew D Frugé
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA.
| | | | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yuko Tsuruta
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA
| | - Kelley Smith-Johnston
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA
| | - Douglas R Moellering
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), WTI 102V, 1824 6th Ave S, Birmingham, AL, 35294, USA
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111
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Marital status independently predicts gastric cancer survival after surgical resection--an analysis of the SEER database. Oncotarget 2017; 7:13228-35. [PMID: 26840093 PMCID: PMC4914354 DOI: 10.18632/oncotarget.7107] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/24/2016] [Indexed: 12/24/2022] Open
Abstract
Marital status was found to be an independent prognostic factor for survival in various cancer types, but it hasn't been studied in gastric cancer. The Surveillance, Epidemiology and End Results database was used to compare survival outcomes with marital status. A total of 16,106 eligible patients were identified. Patients in the widowed group had the highest proportion of women, more common site of stomach, more prevalence of elderly patients, higher percentage of adenocarcinoma, and more tumors at localized stage (P < 0.05). Patients in married group had better 5year cause-specific survival (CSS) than those unmarried (P < 0.05). Further analysis showed that widowed patients always presented the lowest CSS compared with that of other groups. Widowed patients had 7.1% reduction in 5-year CSS compared with married patients at Localized stage (77.2% vs 70.1%, P < 0.001), 9.6% reduction at Regional stage (38.2% vs 28.6%, P < 0.001), and 4.7% reduction at Distant stage (13.3% vs 8.6%, P < 0.001). These results showed that unmarried patients were at greater risk of cancer specific mortality. Despite favorable clinicpathological characteristics, widowed patients were at highest risk of death compared with other groups.
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112
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Zoccola PM, Manigault AW, Figueroa WS, Hollenbeck C, Mendlein A, Woody A, Hamilton K, Scanlin M, Johnson RC. Trait Rumination Predicts Elevated Evening Cortisol in Sexual and Gender Minority Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111365. [PMID: 29120379 PMCID: PMC5708004 DOI: 10.3390/ijerph14111365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Abstract
Stress may contribute to illness through the impaired recovery or sustained activity of stress-responsive biological systems. Rumination, or mental rehearsal of past stressors, may alter the body’s stress-responsive systems by amplifying and prolonging exposure to physiological mediators, such as cortisol. The primary aim of the current investigation was to test the extent to which the tendency to ruminate on stress predicts diminished diurnal cortisol recovery (i.e., elevated evening cortisol) in a sample of sexual and gender minority young adults. Participants included 58 lesbian, gay, bisexual, and transgender young adults (Mage = 25.0, SD = 4.1) who completed an initial online survey that assessed trait rumination and current depressed mood. Participants completed daily evening questionnaires and provided salivary cortisol samples at wake, 45 min post-wake, 12 h post-wake, and at bedtime over seven consecutive days. Trait rumination predicted significantly higher cortisol concentrations at bedtime, but was unrelated to other cortisol indices (e.g., morning cortisol, diurnal slope, total output). The association with trait rumination was not accounted for by daily negative affect, and was largely independent of depressed mood. These results have implications for identifying and treating those who may be at risk for impaired diurnal cortisol recovery and associated negative health outcomes.
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Affiliation(s)
- Peggy M Zoccola
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA.
| | - Andrew W Manigault
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA.
| | - Wilson S Figueroa
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA.
| | - Cari Hollenbeck
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA.
- Department of Social and Public Health, Ohio University, Grover Center W324, Athens, OH 45701, USA.
| | - Anna Mendlein
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA.
| | - Alex Woody
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA.
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, 460 Medical Center Drive, Columbus, OH 43210, USA.
| | - Katrina Hamilton
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA.
- Heritage College of Osteopathic Medicine, Ohio University, 35 W. Green Drive, Athens, OH 45701, USA.
| | - Matt Scanlin
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA.
- Department of Social and Public Health, Ohio University, Grover Center W324, Athens, OH 45701, USA.
| | - Ryan C Johnson
- Department of Psychology, Ohio University, 200 Porter Hall, Athens, OH 45701, USA.
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113
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Wang H, Wang L, Kabirov I, Peng L, Chen G, Yang Y, A ZA, Xu W. Impact of marital status on renal cancer patient survival. Oncotarget 2017; 8:70204-70213. [PMID: 29050272 PMCID: PMC5642547 DOI: 10.18632/oncotarget.19600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/12/2017] [Indexed: 12/24/2022] Open
Abstract
Marital status is an independent prognostic factor for various cancer types. The present study used the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute (NCI) to analyze the impact of marital status on renal cancer patient survival outcomes. We identified a total of 62,405 eligible patients (23,800 women and 38,605 men). Overall 5-year renal cancer cause-specific survival (CSS) was 80.3% in the married group, 69.2% in the widowed group, 78.9% in the single group, and 76.5% in the divorced/separated group. The widowed patient group had the highest female/male ratio, more distant metastases, and fewer high-grade (III/IV) tumors. Most widowed patients (90.4%) were elderly (>60 years old). In our study, male renal cancer patients benefited more from marriage than females. We also found that white married patients had better survival outcomes than other white patient groups, but black unmarried and married patients exhibited similar survival outcomes. Our results show that, in general, unmarried patients have higher rates of cancer-specific mortality and highlight the importance of psychological intervention for cancer patients during treatment.
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Affiliation(s)
- Hongzhi Wang
- Department of Urology, The 4th Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Lu Wang
- Department of Urology, The 4th Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Ildar Kabirov
- Department of Urology, The 4th Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Li Peng
- Department of Urology, The 4th Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Guang Chen
- Department of Urology, The 4th Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Yinhui Yang
- Department of Urology, The 4th Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Zamyatnin Andrey A
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, Moscow 119991, Russia
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow 119992, Russia
| | - Wanhai Xu
- Department of Urology, The 4th Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
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Bei B, Seeman TE, Carroll JE, Wiley JF. Sleep and Physiological Dysregulation: A Closer Look at Sleep Intraindividual Variability. Sleep 2017; 40:3885856. [PMID: 28651371 PMCID: PMC5806573 DOI: 10.1093/sleep/zsx109] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Study Objectives Variable daily sleep (ie, higher intraindividual variability; IIV) is associated with negative health consequences, but potential physiological mechanisms are poorly understood. This study examined how the IIV of sleep timing, duration, and quality is associated with physiological dysregulation, with diurnal cortisol trajectories as a proximal outcome and allostatic load (AL) as a multisystem distal outcome. Methods Participants are 436 adults (Mage ± standard deviation = 54.1 ± 11.7, 60.3% women) from the Midlife in the United States study. Sleep was objectively assessed using 7-day actigraphy. Diurnal cortisol was measured via saliva samples (four/day for 4 consecutive days). AL was measured using 23 biomarkers from seven systems (inflammatory, hypothalamic-pituitary-adrenal axis, metabolic glucose and lipid, cardiovascular, parasympathetic, sympathetic) using a validated bifactor model. Linear and quadratic effects of sleep IIV were estimated using a validated Bayesian model. Results Controlling for covariates, more variable sleep timing (p = .04 for risetime, p = .097 for bedtime) and total sleep time (TST; p = .02), but not mean sleep variables, were associated with flatter cortisol diurnal slope. More variable sleep onset latency and wake after sleep onset, later average bedtime, and shorter TST were associated with higher AL adjusting for age and sex (p-values < .05); after controlling for all covariates, however, only later mean bedtime remained significantly associated with higher AL (p = .04). Conclusions In a community sample of adults, more variable sleep patterns were associated with blunted diurnal cortisol trajectories but not with higher multisystem physiological dysregulation. The associations between sleep IIV and overall health are likely complex, including multiple biopsychosocial determinants and require further investigation.
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Affiliation(s)
- Bei Bei
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Centre for Women’s Mental Health, Department of Psychiatry, University of Melbourne, Royal Women’s Hospital, Victoria, Australia
| | - Teresa E Seeman
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Joshua F Wiley
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne,Victoria, Australia
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Cortisol Awakening Response as a Prospective Risk Factor for Depressive Symptoms in Women After Treatment for Breast Cancer. Psychosom Med 2017; 79:763-769. [PMID: 28570439 PMCID: PMC5573620 DOI: 10.1097/psy.0000000000000499] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of the study was to investigate hypothalamic-pituitary-adrenal axis (HPA axis) functioning as a neurobiological risk factor for depressive symptoms in an ongoing longitudinal, observational study of women undergoing treatment and recovery from breast cancer. Many women with breast cancer experience depressive symptoms that interfere with their treatment, recovery, and quality of life. Psychosocial risk factors for depression among patients with cancer and survivors have been identified, yet neurobiological risk factors in this population remain largely unexamined. METHODS Women recently diagnosed with early-stage breast cancer (N = 135) were enrolled before starting neoadjuvant/adjuvant treatment (radiation, chemotherapy, endocrine therapy). At baseline, participants collected saliva samples to measure diurnal HPA axis functioning for 3 days: at waking, 30 minutes after waking, 8 hours after waking, and bedtime. Participants also completed a standardized measure of depressive symptoms (Center for Epidemiological Studies-Depression Scale) at baseline and 6 months after completion of primary treatment. Multivariate regression was used to predict continuous depressive symptoms at 6-month posttreatment from continuous depressive symptoms at baseline, cortisol awakening response (CAR), and other measures of diurnal HPA axis functioning. RESULTS The magnitude of CAR predicted changes in depressive symptoms over time, such that women with a higher CAR showed a greater increase from baseline to 6-month posttreatment (b = 5.67, p = .023). Diurnal slope and total cortisol output were not associated with concurrent depressive symptoms or their change over time. CONCLUSIONS Elevated CAR may be a neurobiological risk factor for increases in depressive symptoms in the months after breast cancer treatment and warrants further investigation.
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Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology 2017; 83:25-41. [PMID: 28578301 PMCID: PMC5568897 DOI: 10.1016/j.psyneuen.2017.05.018] [Citation(s) in RCA: 505] [Impact Index Per Article: 72.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 01/20/2023]
Abstract
Changes in levels of the stress-sensitive hormone cortisol from morning to evening are referred to as diurnal cortisol slopes. Flatter diurnal cortisol slopes have been proposed as a mediator between chronic psychosocial stress and poor mental and physical health outcomes in past theory and research. Surprisingly, neither a systematic nor a meta-analytic review of associations between diurnal cortisol slopes and health has been conducted to date, despite extensive literature on the topic. The current systematic review and meta-analysis examined associations between diurnal cortisol slopes and physical and mental health outcomes. Analyses were based on 179 associations from 80 studies for the time period up to January 31, 2015. Results indicated a significant association between flatter diurnal cortisol slopes and poorer health across all studies (average effect size, r=0.147). Further, flatter diurnal cortisol slopes were associated with poorer health in 10 out of 12 subtypes of emotional and physical health outcomes examined. Among these subtypes, the effect size was largest for immune/inflammation outcomes (r=0.288). Potential moderators of the associations between diurnal cortisol slopes and health outcomes were examined, including type of slope measure and study quality indices. The possible roles of flatter slopes as either a marker or a mechanism for disease etiology are discussed. We argue that flatter diurnal cortisol slopes may both reflect and contribute to stress-related dysregulation of central and peripheral circadian mechanisms, with corresponding downstream effects on multiple aspects of biology, behavior, and health.
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Affiliation(s)
- Emma K. Adam
- School of Education and Social Policy and Institute for Policy Research, Northwestern University, 2120 Campus Drive, Evanston, IL, 60208, USA,Corresponding author: , 847-467-2010
| | - Meghan E. Quinn
- Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, IL 60208, USA and Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood St., Chicago, IL, 60612, USA
| | - Royette Tavernier
- Department of Psychology, Wesleyan University, 207 High Street, Middletown, CT, 06459, USA.
| | - Mollie T. McQuillan
- School of Education and Social Policy and Institute for Policy Research, Northwestern University, 2120 Campus Drive, Evanston, IL, 60208, USA
| | - Katie A. Dahlke
- American Institutes for Research, 1120 E. Diehl Road, Suite 200, Naperville, IL, USA, 60563
| | - Kirsten E. Gilbert
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Parkway, Suite 2100, St. Louis, MO, USA
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Hypothalamic Dysfunction and Multiple Sclerosis: Implications for Fatigue and Weight Dysregulation. Curr Neurol Neurosci Rep 2017; 16:98. [PMID: 27662896 DOI: 10.1007/s11910-016-0700-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Signs and symptoms of multiple sclerosis are usually attributed to demyelinating lesions in the spinal cord or cerebral cortex. The hypothalamus is a region that is often overlooked yet controls many important homeostatic functions, including those that are perturbed in multiple sclerosis. In this review we discuss how hypothalamic dysfunction may contribute to signs and symptoms in people with multiple sclerosis. While dysfunction of the hypothalamic-pituitary-adrenal axis is common in multiple sclerosis, the effects and mechanisms of this dysfunction are not well understood. We discuss three hypothalamic mechanisms of fatigue in multiple sclerosis: (1) general hypothalamic-pituitary-adrenal axis hyperactivity, (2) disordered orexin neurotransmission, (3) abnormal cortisol secretion. We then review potential mechanisms of weight dysregulation caused by hypothalamic dysfunction. Lastly, we propose future studies and therapeutics to better understand and treat hypothalamic dysfunction in multiple sclerosis. Hypothalamic dysfunction appears to be common in multiple sclerosis, yet current studies are underpowered and contradictory. Future studies should contain larger sample sizes and standardize hormone and neuropeptide measurements.
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118
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Bandinelli LP, Levandowski ML, Grassi-Oliveira R. The childhood maltreatment influences on breast cancer patients: A second wave hit model hypothesis for distinct biological and behavioral response. Med Hypotheses 2017; 108:86-93. [PMID: 29055407 DOI: 10.1016/j.mehy.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 12/20/2022]
Abstract
Stress and cancer are two complex situations involving different biological and psychological mechanisms. Their relationship have long been studied, and there is evidence of the impact stress has on both, development and disease progression. Furthermore, early stress has been studied as an important factor associated to this relationship, since its impacts on the immune, endocrine and cognitive development throughout life is already known. Therefore, understanding early stress as a first wave of stress in life is necessary in order to explore a possible second wave hit model. From this perspective, we believe that breast cancer can be understood as a second wave of stress during development and that, in addition to the first wave, can cause important impacts on the response to cancer treatment, such as increased chances of disease progression and distinct behavioral responses. In this article we propose a second wave hit hypothesis applied to breast cancer and its implications on the immune, endocrine and cognitive systems, through mechanisms that involve the HPA axis and subsequent activations of stress responses.
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Affiliation(s)
- Lucas Poitevin Bandinelli
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifical Catholic University of Rio Grande do Sul (PUCRS), RS, Brazil; Post-Graduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (PUCRS), RS, Brazil
| | - Mateus Luz Levandowski
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifical Catholic University of Rio Grande do Sul (PUCRS), RS, Brazil; Post-Graduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (PUCRS), RS, Brazil
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifical Catholic University of Rio Grande do Sul (PUCRS), RS, Brazil; Post-Graduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre (PUCRS), RS, Brazil.
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Carlson LE, Zelinski EL, Speca M, Balneaves LG, Jones JM, Santa Mina D, Wayne PM, Campbell TS, Giese-Davis J, Faris P, Zwicker J, Patel K, Beattie TL, Cole S, Toivonen K, Nation J, Peng P, Thong B, Wong R, Vohra S. Protocol for the MATCH study (Mindfulness and Tai Chi for cancer health): A preference-based multi-site randomized comparative effectiveness trial (CET) of Mindfulness-Based Cancer Recovery (MBCR) vs. Tai Chi/Qigong (TCQ) for cancer survivors. Contemp Clin Trials 2017; 59:64-76. [PMID: 28576734 PMCID: PMC5639905 DOI: 10.1016/j.cct.2017.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE A growing number of cancer survivors suffer high levels of distress, depression and stress, as well as sleep disturbance, pain and fatigue. Two different mind-body interventions helpful for treating these problems are Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ). However, while both interventions show efficacy compared to usual care, they have never been evaluated in the same study or directly compared. This study will be the first to incorporate innovative design features including patient choice while evaluating two interventions to treat distressed cancer survivors. It will also allow for secondary analyses of which program best targets specific symptoms in particular groups of survivors, based on preferences and baseline characteristics. METHODS AND SIGNIFICANCE The design is a preference-based multi-site randomized comparative effectiveness trial. Participants (N=600) with a preference for either MBCR or TCQ will receive their preferred intervention; while those without a preference will be randomized into either intervention. Further, within the preference and non-preference groups, participants will be randomized into immediate intervention or wait-list control. Total mood disturbance on the Profile of mood states (POMS) post-intervention is the primary outcome. Other measures taken pre- and post-intervention and at 6-month follow-up include quality of life, psychological functioning, cancer-related symptoms and physical functioning. Exploratory analyses investigate biomarkers (cortisol, cytokines, blood pressure/Heart Rate Variability, telomere length, gene expression), which may uncover potentially important effects on key biological regulatory and antineoplastic functions. Health economic measures will determine potential savings to the health system.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada.
| | - Erin L Zelinski
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Michael Speca
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Jones
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Janine Giese-Davis
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Peter Faris
- Centre for Advancement of Health, Alberta Health Services, AB, Canada
| | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Kamala Patel
- Department of Immunology, University of Calgary, Calgary, AB, Canada
| | - Tara L Beattie
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Steve Cole
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kirsti Toivonen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jill Nation
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Philip Peng
- Department of Anesthesia, University of Toronto, ON, Canada
| | - Bruce Thong
- Department of Athletics and Recreation, McMaster University, Hamilton, ON, Canada
| | - Raimond Wong
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine and Dentistry, Integrative Health Institute, University of Alberta, Edmonton, AB, Canada
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Currow D, Watts GJ, Johnson M, McDonald CF, Miners JO, Somogyi AA, Denehy L, McCaffrey N, Eckert DJ, McCloud P, Louw S, Lam L, Greene A, Fazekas B, Clark KC, Fong K, Agar MR, Joshi R, Kilbreath S, Ferreira D, Ekström M. A pragmatic, phase III, multisite, double-blind, placebo-controlled, parallel-arm, dose increment randomised trial of regular, low-dose extended-release morphine for chronic breathlessness: Breathlessness, Exertion And Morphine Sulfate (BEAMS) study protocol. BMJ Open 2017; 7:e018100. [PMID: 28716797 PMCID: PMC5726102 DOI: 10.1136/bmjopen-2017-018100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD. METHODS AND ANALYSIS The primary question is what effect regular ER morphine has on worst breathlessness, measured daily on a 0-10 numerical rating scale. Uniquely, the coprimary outcome will use a FitBit to measure habitual physical activity. Secondary questions include safety and, whether upward titration after initial benefit delivers greater net symptom reduction. Substudies include longitudinal driving simulation, sleep, caregiver, health economic and pharmacogenetic studies. Seventeen centres will recruit 171 participants from respiratory and palliative care. The study has five phases including three randomisation phases to increasing doses of ER morphine. All participants will receive placebo or active laxatives as appropriate. Appropriate statistical analysis of primary and secondary outcomes will be used. ETHICS AND DISSEMINATION Ethics approval has been obtained. Results of the study will be submitted for publication in peer-reviewed journals, findings presented at relevant conferences and potentially used to inform registration of ER morphine for chronic breathlessness. TRIAL REGISTRATION NUMBER NCT02720822; Pre-results.
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Affiliation(s)
- David Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Gareth John Watts
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Hull York Medical School, University of Hull, Hull, UK
| | - Christine F McDonald
- Department of Austin Health, Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Australia
| | - John O Miners
- Clinical Pharmacology School of Medicine, Flinders University, Adelaide, Australia
| | - Andrew A Somogyi
- Department of Clinical Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Linda Denehy
- School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nicola McCaffrey
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeRA) Randwick, New South Wales, Australia
| | - Philip McCloud
- MCloud Consulting Group, Belrose, New South Wales, Australia
| | - Sandra Louw
- MCloud Consulting Group, Belrose, New South Wales, Australia
| | - Lawrence Lam
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Aine Greene
- Southern Adelaide Palliative Services, Adelaide, South Australia, Australia
| | - Belinda Fazekas
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Katherine C Clark
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
- School of Medicine and Public Health, The University if Newcastle, Newcastle, New South Wales, Australia
| | - Kwun Fong
- Thoracic Research Centre, The Prince Charles Hospital School of Medicine, University of Queensland, Australia
| | - Meera R Agar
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Faculty of Health, University of Technology Sydney, Sydney, Australia
- Clinical Trials, Ingham Institute of Applied Medical Research, Sydney, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Rohit Joshi
- Department of Medical Oncology, University of Adelaide Lyell MEwin Hospital, Adelaide, Australia
| | - Sharon Kilbreath
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Diana Ferreira
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Magnus Ekström
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
- Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Sweden
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Relationships of salivary cortisol and melatonin rhythms to sleep quality, emotion, and fatigue levels in patients with newly diagnosed lung cancer. Eur J Oncol Nurs 2017; 29:79-84. [PMID: 28720269 DOI: 10.1016/j.ejon.2017.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE After being diagnosed with lung cancer, patients often experience sleep disturbance, anxiety, depression, and fatigue. These symptoms may occur because of changes in neurotransmitter secretion caused by tumors. This study investigated the correlation of cortisol and melatonin rhythms with sleep quality, anxiety, depression, and fatigue levels in patients with newly diagnosed lung cancer. METHOD We conducted a case-control study and recruited 40 patients with newly diagnosed lung cancer and 40 healthy adults. RESULTS The patient group had a lower salivary melatonin level and flatter slope (p < 0.001 and p < 0.001), higher salivary cortisol level and steeper slope (p < 0.001 and p < 0.001), higher sleep disturbance level (p = 0.004), and higher depression level (p < 0.001). The multivariate linear regression analysis indicated that the cortisol slope (p = 0.005) and fatigue score (p = 0.032) predicted the sleep quality score (p = 0.011). CONCLUSION Overall, the patients with newly diagnosed lung cancer had poorer sleep quality, higher depression levels, lower salivary melatonin levels, higher cortisol levels, and flatter melatonin and cortisol slopes than did the controls. The fatigue level and cortisol slope significantly predicted sleep quality. Therefore, the assessment of cortisol and melatonin rhythms and levels could provide crucial information that may be beneficial for managing symptoms in patients with newly diagnosed lung cancer.
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Abstract
Chronotherapeutics aim at treating illnesses according to the endogenous biologic rhythms, which moderate xenobiotic metabolism and cellular drug response. The molecular clocks present in individual cells involve approximately fifteen clock genes interconnected in regulatory feedback loops. They are coordinated by the suprachiasmatic nuclei, a hypothalamic pacemaker, which also adjusts the circadian rhythms to environmental cycles. As a result, many mechanisms of diseases and drug effects are controlled by the circadian timing system. Thus, the tolerability of nearly 500 medications varies by up to fivefold according to circadian scheduling, both in experimental models and/or patients. Moreover, treatment itself disrupted, maintained, or improved the circadian timing system as a function of drug timing. Improved patient outcomes on circadian-based treatments (chronotherapy) have been demonstrated in randomized clinical trials, especially for cancer and inflammatory diseases. However, recent technological advances have highlighted large interpatient differences in circadian functions resulting in significant variability in chronotherapy response. Such findings advocate for the advancement of personalized chronotherapeutics through interdisciplinary systems approaches. Thus, the combination of mathematical, statistical, technological, experimental, and clinical expertise is now shaping the development of dedicated devices and diagnostic and delivery algorithms enabling treatment individualization. In particular, multiscale systems chronopharmacology approaches currently combine mathematical modeling based on cellular and whole-body physiology to preclinical and clinical investigations toward the design of patient-tailored chronotherapies. We review recent systems research works aiming to the individualization of disease treatment, with emphasis on both cancer management and circadian timing system–resetting strategies for improving chronic disease control and patient outcomes.
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Affiliation(s)
- Annabelle Ballesta
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - Pasquale F Innominato
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - Robert Dallmann
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - David A Rand
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - Francis A Lévi
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
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Martínez ME, Unkart JT, Tao L, Kroenke CH, Schwab R, Komenaka I, Gomez SL. Prognostic significance of marital status in breast cancer survival: A population-based study. PLoS One 2017; 12:e0175515. [PMID: 28475579 PMCID: PMC5419505 DOI: 10.1371/journal.pone.0175515] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/27/2017] [Indexed: 01/02/2023] Open
Abstract
Research shows that married cancer patients have lower mortality than unmarried patients but few data exist for breast cancer. We assessed total mortality associated with marital status, with attention to differences by race/ethnicity, tumor subtype, and neighborhood socioeconomic status (nSES). We included, from the population-based California Cancer Registry, women ages 18 and older with invasive breast cancer diagnosed between 2005 and 2012 with follow-up through December 2013. We estimated mortality rate ratios (MRR) and 95% confidence intervals (CI) for total mortality by nSES, race/ethnicity, and tumor subtype. Among 145,564 breast cancer cases, 42.7% were unmarried at the time of diagnosis. In multivariable-adjusted models, the MRR (95% CI) for unmarried compared to married women was 1.28 (1.24-1.32) for total mortality. Significant interactions were observed by race/ethnicity (P<0.001), tumor subtype (P<0.001), and nSES (P = 0.009). Higher MRRs were observed for non-Hispanic whites and Asians/Pacific Islanders than for blacks or Hispanics, and for HR+/HER2+ tumors than other subtypes. Assessment of interactive effect between marital status and nSES showed that unmarried women living in low SES neighborhoods had a higher risk of dying compared with married women in high SES neighborhoods (MRR = 1.60; 95% CI: 1.53-1.67). Unmarried breast cancer patients have higher total mortality than married patients; the association varies by race/ethnicity, tumor subtype, and nSES. Unmarried status should be further evaluated as a breast cancer prognostic factor. Identification of underlying causes of the marital status associations is needed to design interventions that could improve survival for unmarried breast cancer patients.
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Affiliation(s)
- María Elena Martínez
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States of America
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Jonathan T. Unkart
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States of America
- Department of Surgery, University of California, San Diego, La Jolla, CA, United States of America
| | - Li Tao
- Cancer Prevention Institute of California, Fremont, CA, United States of America
| | - Candyce H. Kroenke
- Kaiser Permanente, Division of Research, Oakland, CA, United States of America
| | - Richard Schwab
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States of America
| | - Ian Komenaka
- Maricopa Medical Center, Department of Surgery, Phoenix, AZ, United States of America
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, CA, United States of America
- Stanford Cancer Institute, Palo Alto, CA, United States of America
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Ryan R, Clow A, Spathis A, Smyth N, Barclay S, Fallon M, Booth S. Salivary diurnal cortisol profiles in patients suffering from chronic breathlessness receiving supportive and palliative care services: A cross-sectional study. Psychoneuroendocrinology 2017; 79:134-145. [PMID: 28284169 DOI: 10.1016/j.psyneuen.2017.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/16/2016] [Accepted: 01/24/2017] [Indexed: 02/07/2023]
Abstract
Chronic breathlessness is a common source of psychological and physical stress in patients with advanced or progressive disease, suggesting that hypothalamic-pituitary-adrenal (HPA) axis dysregulation may be prevalent. The aim of this study was to measure the salivary diurnal cortisol profile in patients receiving supportive and palliative care for a range of malignant and non-malignant conditions and to compare the profile of those experiencing moderate-to-severe disability due to breathlessness against that of patients with mild/no breathlessness and that of healthy controls. Saliva samples were collected over two consecutive weekdays at 3, 6, and 12h after awakening in 49 patients with moderate-to-severe breathlessness [Medical Research Council (MRC) dyspnoea grade ≥3], 11 patients with mild/no breathlessness (MRC dyspnoea grade ≤2), and 50 healthy controls. Measures of breathlessness, stress, anxiety, depression, wellbeing and sleep were examined concomitantly. The diurnal cortisol slope (DCS) was calculated for each participant by regressing log-transformed cortisol values against collection time. Mean DCS was compared across groups using ANCOVA. Individual slopes were categorised into one of four categories: consistent declining, consistent flat, consistent ascending and inconsistent. Controlling for age, gender and socioeconomic status, the mean DCS was significantly flatter in patients with moderate-to-severe breathlessness compared to patients with mild/no breathlessness and healthy controls [F (2, 103)=45.64, p<0.001]. Furthermore, there was a higher prevalence of flat and ascending cortisol profiles in patients with moderate-to-severe breathlessness (23.4%) compared to healthy controls (0%). The only variable which correlated significantly with DCS was MRC dyspnoea grade (rs=0.29, p<0.05). These findings suggest that patients with moderate-to-severe breathlessness have evidence of HPA axis dysregulation and that this dysregulation may be related to the functional disability imposed by breathlessness.
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Affiliation(s)
- Richella Ryan
- Cambridge University Hospitals NHS Foundation Trust, Palliative Care Department, Addenbrooke's Hospital, Hill's Road, Cambridge, CB2 0QQ, United Kingdom; Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom.
| | - Angela Clow
- Psychophysiology and Stress Group, University of Westminster, Department of Psychology, 115 New Cavendish Street, London, W1W 6UW, United Kingdom
| | - Anna Spathis
- Cambridge University Hospitals NHS Foundation Trust, Palliative Care Department, Addenbrooke's Hospital, Hill's Road, Cambridge, CB2 0QQ, United Kingdom; Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom
| | - Nina Smyth
- Psychophysiology and Stress Group, University of Westminster, Department of Psychology, 115 New Cavendish Street, London, W1W 6UW, United Kingdom
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom
| | - Marie Fallon
- Edinburgh Cancer Research Centre (IGMM), The University of Edinburgh, Crewe Road South, Edinburgh, EH4 2XR, United Kingdom
| | - Sara Booth
- Cambridge University Hospitals NHS Foundation Trust, Palliative Care Department, Addenbrooke's Hospital, Hill's Road, Cambridge, CB2 0QQ, United Kingdom
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Black DS, Peng C, Sleight AG, Nguyen N, Lenz HJ, Figueiredo JC. Mindfulness practice reduces cortisol blunting during chemotherapy: A randomized controlled study of colorectal cancer patients. Cancer 2017; 123:3088-3096. [PMID: 28387949 DOI: 10.1002/cncr.30698] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/06/2017] [Accepted: 03/04/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this randomized clinical experiment was to test the influence of a mindfulness meditation practice, when delivered during 1 session of active chemotherapy administration, on the acute salivary cortisol response as a marker of neuroendocrine system activity in cancer patients. METHODS A mindfulness, attention-control, or resting exposure was assigned to 57 English- or Spanish-speaking colorectal cancer patients at 1 county oncology clinic and 1 university oncology clinic at the start of chemotherapy. Saliva samples were collected at the start of chemotherapy and at subsequent 20-minute intervals during the first 60 minutes of chemotherapy (4 samples in all). Self-reporting on biobehavioral assessments after chemotherapy included distress, fatigue, and mindfulness. RESULTS An area-under-the-curve analysis (AUC) showed a relative increase in cortisol reactivity in the mindfulness group after adjustments for biological and clinical measures (β = 123.21; P = .03). More than twice as many patients in the mindfulness group versus the controls displayed a cortisol rise from the baseline to 20 minutes (69% vs 34%; P = .02). AUC values were uncorrelated with biobehavioral measure scores, although mindfulness scores were inversely correlated with fatigue (r = -0.46; P < .01) and distress scores (r = -0.54; P < .01). CONCLUSIONS Findings suggest that mindfulness practice during chemotherapy can reduce the blunting of neuroendocrine profiles typically observed in cancer patients. Implications include support for the use of mindfulness practice in integrative oncology. Cancer 2017;123:3088-96. © 2017 American Cancer Society.
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Affiliation(s)
- David S Black
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Cheng Peng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Alix G Sleight
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Nathalie Nguyen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Heinz-Josef Lenz
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Jane C Figueiredo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Chen X, Gianferante D, Hanlin L, Fiksdal A, Breines JG, Thoma MV, Rohleder N. HPA-axis and inflammatory reactivity to acute stress is related with basal HPA-axis activity. Psychoneuroendocrinology 2017; 78:168-176. [PMID: 28209543 PMCID: PMC5375039 DOI: 10.1016/j.psyneuen.2017.01.035] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 01/17/2017] [Accepted: 01/28/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Inflammation is drawing attention as pathway between psychosocial stress and health, and basal HPA axis activity has been suggested to exert a consistent regulatory influence on peripheral inflammation. Here we studied the relationship between basal HPA axis activity and inflammatory and HPA axis acute stress reactivity. METHODS We recruited 48 healthy individuals and collected saliva for diurnal cortisol sampling at 6 points. Participants were previously exposed to the Trier Social Stress Test (TSST) on two consecutive days. Plasma interleukin-6 (IL-6) and salivary cortisol reactivity to acute stress were measured, and their relationships with basal HPA axis activity were analyzed. RESULTS Steeper cortisol awakening response (CAR) linear increase was related with stronger cortisol stress reactivity (γ=0.015; p=0.042) and marginally significantly with greater habituation (γ=0.01; p=0.066). Greater curvilinearity of CAR was related with stronger cortisol reactivity (γ=-0.014; p=0.021) and greater cortisol habituation (γ=-0.011; p=0.006). Steeper daily linear decline was related with significant or marginally significantly stronger cortisol and IL-6 reactivity (cortisol: γ=-0.0004; p=0.06; IL-6: γ=-0.028; p=0.031) and greater habituation (cortisol: γ=-0.002; p=0.009, IL-6: γ=-0.015; p=0.033). Greater curvilinearity of daily decline was related with stronger IL-6 reactivity (γ=0.002; p=0.024) and also greater cortisol and IL-6 habituation (cortisol: γ=0.00009; p=0.03, IL-6: γ=0.001; p=0.024). CONCLUSIONS Patterns of basal HPA axis activity that are related with healthier outcomes were found to be related with stronger initial cortisol and IL-6 reactivity and greater habituation. This is an important step in understanding the long-term health implications of acute stress responsiveness, and future studies should employ longitudinal designs to identify the direction of these relationships.
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Affiliation(s)
- Xuejie Chen
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Danielle Gianferante
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Luke Hanlin
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Alexander Fiksdal
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Juliana G. Breines
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States
| | - Myriam V. Thoma
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States,Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Nicolas Rohleder
- Department of Psychology and Volen National Center for Complex Systems, Brandeis University, Waltham, MA, United States; Chair of Health Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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Herriot H, Wrosch C, Gouin JP, Miller GE. Intra-individual cortisol variability and low-grade inflammation over 10 years in older adults. Psychoneuroendocrinology 2017; 77:141-149. [PMID: 28043038 DOI: 10.1016/j.psyneuen.2016.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/09/2016] [Accepted: 12/18/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study examined the associations between intra-individual variability in, and inter-individual levels of, diurnal cortisol secretion with a marker of low-grade inflammation (i.e., C-Reactive Protein; CRP). Reasoning that greater day-to-day cortisol variability could reflect a dysregulation of the HPA axis, we hypothesized that it would predict higher levels of CRP, above and beyond inter-individual differences in cortisol levels. METHODS A 10-year longitudinal study of 130 older adults examined diurnal cortisol secretion on three different days across each of the 6 waves of data collection and levels of CRP during the last 3 waves. Indicators of mean cortisol levels, short-term cortisol variability, and long-term cortisol variability were analyzed. RESULTS Hierarchical linear modeling showed significant main effects, linking baseline mean cortisol levels, T-ratio=2.25, p=0.03, and long-term cortisol variability, T-ratio=2.63, p=0.01, with higher CRP values six to ten years after study entry. In addition, a two-way interaction demonstrated that short-term variability in cortisol were associated with higher levels of CRP among individuals who secreted relatively high, T-ratio=2.68, p=0.01, but not low, T-ratio=-1.09, p=0.28, baseline levels of cortisol. Finally, a three-way interaction, T-ratio=2.24, p=0.03, suggested that the effect of long-term cortisol variability on CRP became stronger over time among participants who secreted high average levels of cortisol, whereas it became weaker among their counterparts who secreted low average levels of cortisol. CONCLUSION Variability in cortisol secretion across days forecasts low-grade inflammation, and this association is paramount among older adults who secrete high levels of diurnal cortisol.
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Oster H, Challet E, Ott V, Arvat E, de Kloet ER, Dijk DJ, Lightman S, Vgontzas A, Van Cauter E. The Functional and Clinical Significance of the 24-Hour Rhythm of Circulating Glucocorticoids. Endocr Rev 2017; 38:3-45. [PMID: 27749086 PMCID: PMC5563520 DOI: 10.1210/er.2015-1080] [Citation(s) in RCA: 294] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/21/2016] [Indexed: 02/07/2023]
Abstract
Adrenal glucocorticoids are major modulators of multiple functions, including energy metabolism, stress responses, immunity, and cognition. The endogenous secretion of glucocorticoids is normally characterized by a prominent and robust circadian (around 24 hours) oscillation, with a daily peak around the time of the habitual sleep-wake transition and minimal levels in the evening and early part of the night. It has long been recognized that this 24-hour rhythm partly reflects the activity of a master circadian pacemaker located in the suprachiasmatic nucleus of the hypothalamus. In the past decade, secondary circadian clocks based on the same molecular machinery as the central master pacemaker were found in other brain areas as well as in most peripheral tissues, including the adrenal glands. Evidence is rapidly accumulating to indicate that misalignment between central and peripheral clocks has a host of adverse effects. The robust rhythm in circulating glucocorticoid levels has been recognized as a major internal synchronizer of the circadian system. The present review examines the scientific foundation of these novel advances and their implications for health and disease prevention and treatment.
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Affiliation(s)
- Henrik Oster
- Medical Department I (H.O., V.O.), University of Lübeck, 23562 Lübeck, Germany; Institute for Cellular and Integrative Neuroscience (E.C.), Centre National de la Recherche Scientifique (CNRS) UPR 3212, University of Strasbourg, 67084 Strasbourg, France; Division of Endocrinology, Diabetology and Metabolism (E.A.), Department of Internal Medicine, University of Turin, 10043 Turin, Italy; Department of Endocrinology and Metabolic Disease (E.R.d.K.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Surrey Sleep Research Center (D.-J.D.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology (S.L.), University of Bristol, Bristol BS8 1TH, United Kingdom; Sleep Research and Treatment Center (A.V.), Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and Sleep, Metabolism, and Health Center (E.V.C.), Department of Medicine, University of Chicago, Chicago, Illinois 60637
| | - Etienne Challet
- Medical Department I (H.O., V.O.), University of Lübeck, 23562 Lübeck, Germany; Institute for Cellular and Integrative Neuroscience (E.C.), Centre National de la Recherche Scientifique (CNRS) UPR 3212, University of Strasbourg, 67084 Strasbourg, France; Division of Endocrinology, Diabetology and Metabolism (E.A.), Department of Internal Medicine, University of Turin, 10043 Turin, Italy; Department of Endocrinology and Metabolic Disease (E.R.d.K.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Surrey Sleep Research Center (D.-J.D.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology (S.L.), University of Bristol, Bristol BS8 1TH, United Kingdom; Sleep Research and Treatment Center (A.V.), Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and Sleep, Metabolism, and Health Center (E.V.C.), Department of Medicine, University of Chicago, Chicago, Illinois 60637
| | - Volker Ott
- Medical Department I (H.O., V.O.), University of Lübeck, 23562 Lübeck, Germany; Institute for Cellular and Integrative Neuroscience (E.C.), Centre National de la Recherche Scientifique (CNRS) UPR 3212, University of Strasbourg, 67084 Strasbourg, France; Division of Endocrinology, Diabetology and Metabolism (E.A.), Department of Internal Medicine, University of Turin, 10043 Turin, Italy; Department of Endocrinology and Metabolic Disease (E.R.d.K.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Surrey Sleep Research Center (D.-J.D.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology (S.L.), University of Bristol, Bristol BS8 1TH, United Kingdom; Sleep Research and Treatment Center (A.V.), Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and Sleep, Metabolism, and Health Center (E.V.C.), Department of Medicine, University of Chicago, Chicago, Illinois 60637
| | - Emanuela Arvat
- Medical Department I (H.O., V.O.), University of Lübeck, 23562 Lübeck, Germany; Institute for Cellular and Integrative Neuroscience (E.C.), Centre National de la Recherche Scientifique (CNRS) UPR 3212, University of Strasbourg, 67084 Strasbourg, France; Division of Endocrinology, Diabetology and Metabolism (E.A.), Department of Internal Medicine, University of Turin, 10043 Turin, Italy; Department of Endocrinology and Metabolic Disease (E.R.d.K.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Surrey Sleep Research Center (D.-J.D.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology (S.L.), University of Bristol, Bristol BS8 1TH, United Kingdom; Sleep Research and Treatment Center (A.V.), Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and Sleep, Metabolism, and Health Center (E.V.C.), Department of Medicine, University of Chicago, Chicago, Illinois 60637
| | - E Ronald de Kloet
- Medical Department I (H.O., V.O.), University of Lübeck, 23562 Lübeck, Germany; Institute for Cellular and Integrative Neuroscience (E.C.), Centre National de la Recherche Scientifique (CNRS) UPR 3212, University of Strasbourg, 67084 Strasbourg, France; Division of Endocrinology, Diabetology and Metabolism (E.A.), Department of Internal Medicine, University of Turin, 10043 Turin, Italy; Department of Endocrinology and Metabolic Disease (E.R.d.K.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Surrey Sleep Research Center (D.-J.D.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology (S.L.), University of Bristol, Bristol BS8 1TH, United Kingdom; Sleep Research and Treatment Center (A.V.), Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and Sleep, Metabolism, and Health Center (E.V.C.), Department of Medicine, University of Chicago, Chicago, Illinois 60637
| | - Derk-Jan Dijk
- Medical Department I (H.O., V.O.), University of Lübeck, 23562 Lübeck, Germany; Institute for Cellular and Integrative Neuroscience (E.C.), Centre National de la Recherche Scientifique (CNRS) UPR 3212, University of Strasbourg, 67084 Strasbourg, France; Division of Endocrinology, Diabetology and Metabolism (E.A.), Department of Internal Medicine, University of Turin, 10043 Turin, Italy; Department of Endocrinology and Metabolic Disease (E.R.d.K.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Surrey Sleep Research Center (D.-J.D.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology (S.L.), University of Bristol, Bristol BS8 1TH, United Kingdom; Sleep Research and Treatment Center (A.V.), Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and Sleep, Metabolism, and Health Center (E.V.C.), Department of Medicine, University of Chicago, Chicago, Illinois 60637
| | - Stafford Lightman
- Medical Department I (H.O., V.O.), University of Lübeck, 23562 Lübeck, Germany; Institute for Cellular and Integrative Neuroscience (E.C.), Centre National de la Recherche Scientifique (CNRS) UPR 3212, University of Strasbourg, 67084 Strasbourg, France; Division of Endocrinology, Diabetology and Metabolism (E.A.), Department of Internal Medicine, University of Turin, 10043 Turin, Italy; Department of Endocrinology and Metabolic Disease (E.R.d.K.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Surrey Sleep Research Center (D.-J.D.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology (S.L.), University of Bristol, Bristol BS8 1TH, United Kingdom; Sleep Research and Treatment Center (A.V.), Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and Sleep, Metabolism, and Health Center (E.V.C.), Department of Medicine, University of Chicago, Chicago, Illinois 60637
| | - Alexandros Vgontzas
- Medical Department I (H.O., V.O.), University of Lübeck, 23562 Lübeck, Germany; Institute for Cellular and Integrative Neuroscience (E.C.), Centre National de la Recherche Scientifique (CNRS) UPR 3212, University of Strasbourg, 67084 Strasbourg, France; Division of Endocrinology, Diabetology and Metabolism (E.A.), Department of Internal Medicine, University of Turin, 10043 Turin, Italy; Department of Endocrinology and Metabolic Disease (E.R.d.K.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Surrey Sleep Research Center (D.-J.D.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology (S.L.), University of Bristol, Bristol BS8 1TH, United Kingdom; Sleep Research and Treatment Center (A.V.), Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and Sleep, Metabolism, and Health Center (E.V.C.), Department of Medicine, University of Chicago, Chicago, Illinois 60637
| | - Eve Van Cauter
- Medical Department I (H.O., V.O.), University of Lübeck, 23562 Lübeck, Germany; Institute for Cellular and Integrative Neuroscience (E.C.), Centre National de la Recherche Scientifique (CNRS) UPR 3212, University of Strasbourg, 67084 Strasbourg, France; Division of Endocrinology, Diabetology and Metabolism (E.A.), Department of Internal Medicine, University of Turin, 10043 Turin, Italy; Department of Endocrinology and Metabolic Disease (E.R.d.K.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Surrey Sleep Research Center (D.-J.D.), Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XP, United Kingdom; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology (S.L.), University of Bristol, Bristol BS8 1TH, United Kingdom; Sleep Research and Treatment Center (A.V.), Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033; and Sleep, Metabolism, and Health Center (E.V.C.), Department of Medicine, University of Chicago, Chicago, Illinois 60637
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Life Out of Balance: Stress-Related Disorders in Animals and Humans. Comp Med 2017. [DOI: 10.1007/978-3-319-47007-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Use of Salivary Diurnal Cortisol as an Outcome Measure in Randomised Controlled Trials: a Systematic Review. Ann Behav Med 2016; 50:210-36. [PMID: 27007274 PMCID: PMC4823366 DOI: 10.1007/s12160-015-9753-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is associated with diverse adverse health outcomes, making it an important therapeutic target. Measurement of the diurnal rhythm of cortisol secretion provides a window into this system. At present, no guidelines exist for the optimal use of this biomarker within randomised controlled trials (RCTs). Purpose The aim of this study is to describe the ways in which salivary diurnal cortisol has been measured within RCTs of health or behavioural interventions in adults. Methods Six electronic databases (up to May 21, 2015) were systematically searched for RCTs which used salivary diurnal cortisol as an outcome measure to evaluate health or behavioural interventions in adults. A narrative synthesis was undertaken of the findings in relation to salivary cortisol methodology and outcomes. Results From 78 studies that fulfilled the inclusion criteria, 30 included healthy participants (38.5 %), 27 included patients with physical disease (34.6 %) and 21 included patients with psychiatric disease (26.9 %). Psychological therapies were most commonly evaluated (n = 33, 42.3 %). There was substantial heterogeneity across studies in relation to saliva collection protocols and reported cortisol parameters. Only 39 studies (50 %) calculated a rhythm parameter such as the diurnal slope or the cortisol awakening response (CAR). Patterns of change in cortisol parameters were inconsistent both within and across studies and there was low agreement with clinical findings. Conclusions Salivary diurnal cortisol is measured inconsistently across RCTs, which is limiting the interpretation of findings within and across studies. This indicates a need for more validation work, along with consensus guidelines. Electronic supplementary material The online version of this article (doi:10.1007/s12160-015-9753-9) contains supplementary material, which is available to authorized users.
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131
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Chang HY, Li F, Li FS, Zheng CZ, Lei YZ, Wang J. Genetic Polymorphisms of SP-A, SP-B, and SP-D and Risk of Respiratory Distress Syndrome in Preterm Neonates. Med Sci Monit 2016; 22:5091-5100. [PMID: 28011976 PMCID: PMC5207009 DOI: 10.12659/msm.898553] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background We examined selected polymorphisms in 3 pulmonary surfactant-associated proteins (SP) for their influence on serum SP levels and risk of respiratory distress syndrome (RDS) in preterm neonates. Material/Methods Premature infants from a Han population were enrolled, including 100 premature infants with RDS (case group) and 120 premature infants without RDS (control group). SNP genotyping for SP-A (+186A/G and +655C/T), SP-B (−18A/C and 1580C/T), and SP-D (Met11ThrT/C and Ala160ThrG/A) used polymerase chain reaction-restriction fragment length polymorphism. Haplotypes were calculated with Shesis software and serum SP-A/B/D levels were quantified by ELISA. Results Case and control groups exhibited significant differences in genotype and allele frequencies of SP-A (+186A/G, +655C/T) and SP-B (1580C/T). However, no statistically significant differences were observed in the allele and genotype frequencies of SP-B −18A/C, SP-D Met11ThrT/C, and SP-D Ala160ThrG/A. Importantly, serum SP-A and SP-B levels were reduced in RDS patients carrying SP-A (+186A/G, +655C/T) and SP-B (1580C/T) polymorphisms. AA genotype of +186A/G, SP-A level, and CC genotype of 1580C/T were independently correlated with increased RDS risk. Conclusions SP-A (+186A/G) and SP-B (1580C/T) polymorphisms are strongly associated with the risk of RDS in preterm infants. Notably, reduced serum SP-A levels were correlated with a high risk of RDS and may serve as novel biomarkers for RDS detection and monitoring.
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Affiliation(s)
- Hong-Yu Chang
- Department of Pediatrics, The General Hospital of the PLA Rocket Force, Beijing, China (mainland)
| | - Fang Li
- Department of Pediatrics, The General Hospital of the PLA Rocket Force, Beijing, China (mainland)
| | - Feng-Sheng Li
- Central Laboratory, The General Hospital of the PLA Rocket Force, Beijing, China (mainland)
| | - Cheng-Zhong Zheng
- Department of Pediatrics, The 306 Hospital of PLA, Beijing, China (mainland)
| | - Yan-Zhe Lei
- Department of Neonatology, Haidian Maternal and Child Healthcare Hospital, Beijing, China (mainland)
| | - Jing Wang
- Department of Neonatology, Nanjing Tongren Hospital, Nanjing, China (mainland)
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132
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Schwann cells: a new player in the tumor microenvironment. Cancer Immunol Immunother 2016; 66:959-968. [PMID: 27885383 DOI: 10.1007/s00262-016-1929-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/14/2016] [Indexed: 02/07/2023]
Abstract
Cancerous cells must cooperate with the surrounding stroma and non-malignant cells within the microenvironment to support the growth and invasion of the tumor. The nervous system is a component of every organ system of the body, and therefore, is invariably at the front line of the tumor invasion. Due to the complexity of the nervous system physiology, this review separately discusses the contributions of the central and peripheral nervous systems to the tumorigenesis and tumor progression. We further focus the discussion on the evidence that Schwann cells aid in tumor growth and invasion. Schwann cells, a largely unexplored element of the tumor microenvironment, may participate in the creation of tumor-favorable conditions through both bi-directional interaction with cancer cells and the facilitation of the immune-suppressive microenvironment through the mechanism of neural repair and immunomodulation.
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133
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Lutgendorf SK, Andersen BL. Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. ACTA ACUST UNITED AC 2016; 70:186-97. [PMID: 25730724 DOI: 10.1037/a0035730] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the last decade, there have been groundbreaking strides in our understanding of the multiple biological pathways by which psychosocial and behavioral factors can affect cancer progression. It is now clear that biobehavioral factors not only affect cellular immunity but both directly and indirectly modulate fundamental processes in cancer growth, including inflammation, angiogenesis, invasion, and metastasis. There is also an emerging understanding of how psychological and behavioral factors used in interventions can impact these physiological processes. This review outlines our current understanding of the physiological mechanisms by which psychological, social, and behavioral processes can affect cancer progression. The intervention literature is discussed, along with recommendations for future research to move the field of biobehavioral oncology forward.
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134
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The influence of cancer on endocrine, immune, and behavioral stress responses. Physiol Behav 2016; 166:4-13. [DOI: 10.1016/j.physbeh.2015.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/10/2015] [Accepted: 09/30/2015] [Indexed: 12/21/2022]
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135
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Azher S, Azami O, Amato C, McCullough M, Celentano A, Cirillo N. The Non-Conventional Effects of Glucocorticoids in Cancer. J Cell Physiol 2016; 231:2368-73. [PMID: 27115293 DOI: 10.1002/jcp.25408] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 12/26/2022]
Abstract
Synthetic corticosteroids are widely used for the treatment of a variety of diseases, including pre-malignant and malignant conditions. In striking contrast, recent evidence suggests that corticosteroids can bear tumor-promoting effects in solid tumors of epithelial origin. We have recently shown that epithelial tissues, including the mucosa of the oral cavity and the skin, are able to modulate the local concentration of active corticosteroids and to produce steroids de novo. This has important clinical and physiopathological implications, because tissue-specific regulation of glucocorticoids plays a key role in the overall effect of these molecules. In the present review of the current English literature, performed using MEDLINE/PubMed/Ovid databases, we collected published evidence to demonstrate that corticosteroids induce effects that are more complex and controversial than previously acknowledged. Published studies clearly demonstrate that this class of molecules influences pathophysiological processes that are strictly related to malignancy, providing the rationale for further investigation. J. Cell. Physiol. 231: 2368-2373, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Simra Azher
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
| | - Omid Azami
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
| | - Caterina Amato
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
| | - Michael McCullough
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
- Oral Health Cooperative Research Centre (CRC), University of Melbourne, Carlton, Victoria, Australia
| | - Antonio Celentano
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Nicola Cirillo
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
- Oral Health Cooperative Research Centre (CRC), University of Melbourne, Carlton, Victoria, Australia
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136
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Altered diurnal pattern of steroid hormones in relation to various behaviors, external factors and pathologies: A review. Physiol Behav 2016; 164:68-85. [DOI: 10.1016/j.physbeh.2016.05.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 05/20/2016] [Accepted: 05/21/2016] [Indexed: 11/17/2022]
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137
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He XK, Lin ZH, Qian Y, Xia D, Jin P, Sun LM. Marital status and survival in patients with primary liver cancer. Oncotarget 2016; 8:64954-64963. [PMID: 29029403 PMCID: PMC5630303 DOI: 10.18632/oncotarget.11066] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/19/2016] [Indexed: 02/06/2023] Open
Abstract
Background Marital status is viewed as an independent prognostic factor for survival in various cancer types. However, its role in primary liver cancer has yet to be thoroughly explored. Objective To investigate the impact of marital status on survival outcomes among liver cancer patients. Results We finally identified 40,809 eligible liver cancer patients between 2004 and 2012, including 21,939 (53.8%) patients were married at diagnosis and 18,870 (46.2%) were unmarried (including 5,871 divorced/separated, 4,338 widowed and 8,660 single). Married patients enjoyed overall and cause-specific survival outcomes compared with patients who were divorced/separated, widowed, single, respectively. The survival benefit associated with marriage still persisted even after adjusted for known confounders. Widowed individuals were at greater risk of overall and cancer-specific mortality compared to other groups. Similar associations were observed in subgroup analyses according to SEER stage. Materials and Methods We used the Surveillance, Epidemiology and End Results (SEER) database to identify 40,809 patients diagnosed with primary liver cancer between 2004 and 2012. Kaplan-Meier analysis and Cox regression were performed to identify the influence of marital status on overall survival (OS) and liver cancer-specific survival (CSS). Conclusions In primary liver cancer patients, married patients enjoyed survival benefits while widowed persons suffered survival disadvantages in both overall survival and cancer-specific survival.
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Affiliation(s)
- Xing-Kang He
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
| | - Zheng-Hua Lin
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
| | - Yun Qian
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
| | - Daheng Xia
- Current address: Sir Run Run Shaw Hospital, Jianggan, China
| | - Piaopiao Jin
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lei-Min Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
- Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China
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138
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Rebholz WN, Cash E, Zimmaro LA, Bayley-Veloso R, Phillips K, Siwik C, Chagpar AB, Dhabhar FS, Spiegel D, Bell BS, Sephton SE. Distress and quality of life in an ethnically diverse sample awaiting breast cancer surgery. J Health Psychol 2016; 23:1438-1451. [PMID: 27466289 DOI: 10.1177/1359105316659916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor breast cancer-related quality of life is associated with flattened cortisol rhythms and inflammation in breast cancer survivors and women with advanced disease. We explored the associations of cancer-specific distress (Impact of Events Scale), mood (Profile of Mood States), activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient) and cortisol (diurnal slope) circadian rhythms, and inflammation (interleukin-6) with quality of life (Functional Assessment of Cancer Therapy-Breast) among patients awaiting breast cancer surgery ( N = 57). Models were adjusted for differences in age and cancer stage. Distress and mood disturbance were significantly correlated with lower quality of life. Ethnic differences in the relationship between distress and mood disturbance with global quality of life and subscales of quality of life were observed. Actigraphic measures showed that in comparison with non-Hispanic patients, African Americans had significantly poorer activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient). Circadian disruption and inflammation were not associated with quality of life. Physiological dysregulation and associated comorbidities may take time to develop over the course of disease and treatment.
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139
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Zeitzer JM, Nouriani B, Rissling MB, Sledge GW, Kaplan KA, Aasly L, Palesh O, Jo B, Neri E, Dhabhar FS, Spiegel D. Aberrant nocturnal cortisol and disease progression in women with breast cancer. Breast Cancer Res Treat 2016; 158:43-50. [PMID: 27314577 PMCID: PMC4938753 DOI: 10.1007/s10549-016-3864-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
While a relationship between disruption of circadian rhythms and the progression of cancer has been hypothesized in field and epidemiologic studies, it has never been unequivocally demonstrated. We determined the circadian rhythm of cortisol and sleep in women with advanced breast cancer (ABC) under the conditions necessary to allow for the precise measurement of these variables. Women with ABC (n = 97) and age-matched controls (n = 24) took part in a 24-h intensive physiological monitoring study involving polysomnographic sleep measures and high-density plasma sampling. Sleep was scored using both standard clinical metrics and power spectral analysis. Three-harmonic regression analysis and functional data analysis were used to assess the 24-h and sleep-associated patterns of plasma cortisol, respectively. The circadian pattern of plasma cortisol as described by its timing, timing relative to sleep, or amplitude was indistinguishable between women with ABC and age-matched controls (p's > 0.11, t-tests). There was, however, an aberrant spike of cortisol during the sleep of a subset of women, during which there was an eightfold increase in the amount of objectively measured wake time (p < 0.004, Wilcoxon Signed-Rank). This cortisol aberration was associated with cancer progression such that the larger the aberration, the shorter the disease-free interval (time from initial diagnosis to metastasis; r = -0.30, p = 0.004; linear regression). The same aberrant spike was present in a similar percent of women without ABC and associated with concomitant sleep disruption. A greater understanding of this sleep-related cortisol abnormality, possibly a vulnerability trait, is likely important in our understanding of individual variation in the progression of cancer.
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Affiliation(s)
- Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA, 94304, USA.
| | - Bita Nouriani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Michelle B Rissling
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA, 94304, USA
- Durham VA Medical Center, Durham, NC, 27705, USA
| | - George W Sledge
- Department of Medicine/Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Katherine A Kaplan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Linn Aasly
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Columbia University, New York, NY, 10027, USA
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
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140
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Jin JJ, Wang W, Dai FX, Long ZW, Cai H, Liu XW, Zhou Y, Huang H, Wang YN. Marital status and survival in patients with gastric cancer. Cancer Med 2016; 5:1821-9. [PMID: 27264020 PMCID: PMC4898975 DOI: 10.1002/cam4.758] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/30/2016] [Accepted: 04/04/2016] [Indexed: 12/30/2022] Open
Abstract
The objective of this study is to examine the impact of marital status on incidence of metastasis at diagnosis, receipt of surgery, and cause‐specific survival (CSS) in patients with gastric cancer (GC). Research data is extracted from The Surveillance, Epidemiology, and End Results (SEER) database, and 18,196 patients diagnosed with GC from 2004 to 2010 are involved. Effects of marital status on incidence of metastasis at diagnosis, receipt of surgery, and CSS are determined using multivariable logistic regression and multivariable Cox regression models, as appropriate. Single GC patients have a higher incidence of metastasis at diagnosis than married patients, while the differences between divorced/separated patients or widowed patients and married patients are not significant. Among those without distant metastasis, single patients, divorced/separated patients, and widowed patients are much less likely to accept surgery compared with married patients. Finally, in the whole group of 18,196 GC patients, single patients, divorced/separated patients, and widowed patients have shorter CSS compared with married patients, even in each of the TNM stage. Marriage had a protective effect against undertreatment and cause‐specific mortality (CSM) in GC. Spousal support may contribute to higher rate of surgery receipt and better survival in patients with GC.
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Affiliation(s)
- Jie-Jie Jin
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wei Wang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, 226001, China
| | - Fa-Xiang Dai
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, 226001, China
| | - Zi-Wen Long
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Hong Cai
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiao-Wen Liu
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ye Zhou
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Hua Huang
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ya-Nong Wang
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
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141
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Sladek MR, Doane LD, Jewell SL, Luecken LJ. Social support coping style predicts women's cortisol in the laboratory and daily life: the moderating role of social attentional biases. ANXIETY STRESS AND COPING 2016; 30:66-81. [PMID: 27189781 DOI: 10.1080/10615806.2016.1181754] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Social stress and associated coping responses can profoundly influence women's stress physiology and health. Implicit social attentional biases can also influence psychological and physiological stress responses. The purpose of this study was to explore whether a coping style characterized by greater use of social support predicts indices of cortisol activity in laboratory and daily life contexts among female university students. We hypothesized that the relation of this coping style to cortisol activity would be moderated by women's attentional biases. METHODS Seventy-four women (Mage = 19.44, range: 17.8-27.8, 64% White) completed an interpersonal stress task and an attentional bias task in the lab, along with a self-report coping inventory. Participants provided five saliva samples during the lab protocol, followed by three saliva samples per day for three consecutive weekdays. Outcome measures included cortisol response to lab tasks (AUCg), diurnal cortisol slope, diurnal AUCg, and cortisol awakening response (CARi). RESULTS A coping style characterized by greater use of social support predicted lower lab AUCg and lower, flatter average diurnal cortisol slope for women with attentional avoidance compared to women with attentional vigilance (ps < .05). CONCLUSIONS Responding to stress by using social support is linked to lower cortisol responses to social stress and diurnal cortisol activity for women with implicit avoidance of social threat cues.
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Affiliation(s)
- Michael R Sladek
- a Department of Psychology , Arizona State University , Tempe , AZ , USA
| | - Leah D Doane
- a Department of Psychology , Arizona State University , Tempe , AZ , USA
| | - Shannon L Jewell
- a Department of Psychology , Arizona State University , Tempe , AZ , USA
| | - Linda J Luecken
- a Department of Psychology , Arizona State University , Tempe , AZ , USA
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142
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Gomez SL, Hurley S, Canchola AJ, Keegan THM, Cheng I, Murphy JD, Clarke CA, Glaser SL, Martínez ME. Effects of marital status and economic resources on survival after cancer: A population-based study. Cancer 2016; 122:1618-25. [PMID: 27065317 PMCID: PMC5558592 DOI: 10.1002/cncr.29885] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although married cancer patients have more favorable survival than unmarried patients, reasons underlying this association are not fully understood. The authors evaluated the role of economic resources, including health insurance status and neighborhood socioeconomic status (nSES), in a large California cohort. METHODS From the California Cancer Registry, we identified 783,167 cancer patients (386,607 deaths) who were diagnosed during 2000 through 2009 with a first primary, invasive cancer of the 10 most common sites of cancer-related death for each sex and were followed through 2012. Age-stratified and stage-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality associated with marital status, adjusted for cancer site, race/ethnicity, and treatment. RESULTS Compared with married patients, unmarried patients had an elevated risk of mortality that was higher among males (HR, 1.27; 95% CI, 1.26-1.29) than among females (HR, 1.19; 95% CI, 1.18-1.20; Pinteraction < .001). Adjustment for insurance status and nSES reduced the marital status HRs to 1.22 for males and 1.15 for females. There was some evidence of synergistic effects of marital status, insurance, and nSES, with relatively higher risks observed for unmarried status among those who were under-insured and living in high nSES areas compared with those who were under-insured and living in low nSES areas (Pinteraction = 6.8 × 10(-9) among males and 8.2 × 10(-8) among females). CONCLUSIONS The worse survival of unmarried than married cancer patients appears to be minimally explained by differences in economic resources. Cancer 2016;122:1618-25. © 2016 American Cancer Society.
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Affiliation(s)
- Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford, California
| | - Susan Hurley
- Cancer Prevention Institute of California, Fremont, California
| | | | - Theresa H. M. Keegan
- Department of Internal Medicine, Division of Hematology and Oncology, University of California-Davis, Sacramento, California
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, California
- Stanford Cancer Institute, Stanford, California
| | - James D. Murphy
- Moores Cancer Center, University of California-San Diego, La Jolla, California
| | - Christina A. Clarke
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford, California
| | - Sally L. Glaser
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford, California
| | - María Elena Martínez
- Department of Internal Medicine, Division of Hematology and Oncology, University of California-Davis, Sacramento, California
- Moores Cancer Center, University of California-San Diego, La Jolla, California
- Department of Family Medicine and Public Health, University of California-San Diego, La Jolla, California
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143
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MANKARIOUS AMANDA, DAVE FORAM, PADOS GEORGE, TSOLAKIDIS DIMITRIS, GIDRON YORI, PANG YEFEI, THOMAS PETER, HALL MARCIA, KARTERIS EMMANOUIL. The pro-social neurohormone oxytocin reverses the actions of the stress hormone cortisol in human ovarian carcinoma cells in vitro. Int J Oncol 2016; 48:1805-14. [PMID: 26935408 PMCID: PMC4809651 DOI: 10.3892/ijo.2016.3410] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022] Open
Abstract
The journey patients with ovarian cancer travel from non-specific symptoms causing delayed diagnosis through surgery and chemotherapy, culminating in a 5-year survival rate of 43%, must have a profound and detrimental psychological impact on patients. Emerging studies link higher levels of oxytocin (OT) and increased social support, an independent prognostic factor in cancer, with a moderating effect on stress. In contrast, there is a known association of tumour cell proliferation with elevated cortisol (stress hormone) levels. We hypothesise therefore that there is cross-talk between cortisol and oxytocin at a molecular level. Three ovarian cancer cell lines, used as in vitro models, were treated with cortisol at concentrations mimicking physiological stress in vivo in the presence or absence of OT. OT reduced cell proliferation and migration, induced apoptosis and autophagy for all three cell lines, partially reversing the effects of cortisol. Quantitative RT-PCR of tissue taken from ovarian cancer patients revealed that the glucocorticoid receptor (splice variant GR-P) and OT receptor (OTR) were significantly upregulated compared to controls. Tissue microarray revealed that the expression of GRα was lower in the ovarian cancer samples compared to normal tissue. OT is also shown to drive alternative splicing of the GR gene and cortisol-induced OTR expression. OT was able to transactivate GR in the presence of cortisol, thus providing further evidence of cross-talk in vitro. These data provide explanations for why social support might help distressed ovarian cancer patients and help define novel hypotheses regarding potential therapeutic interventions in socially isolated patients.
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Affiliation(s)
- AMANDA MANKARIOUS
- Division of Biosciences, Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, Middlesex UB8 3PH, UK
| | - FORAM DAVE
- Division of Biosciences, Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, Middlesex UB8 3PH, UK
| | - GEORGE PADOS
- University of Thessaloniki Medical School, Thessaloniki, Greece
| | | | - YORI GIDRON
- Free University of Brussels (VUB), Brussels, Belgium
| | - YEFEI PANG
- University of Texas at Austin, Marine Science Institute, Port Aransas, TX 78373, USA
| | - PETER THOMAS
- University of Texas at Austin, Marine Science Institute, Port Aransas, TX 78373, USA
| | - MARCIA HALL
- Division of Biosciences, Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, Middlesex UB8 3PH, UK
- Mount Vernon Cancer Centre, Northwood HA6 2RN, UK
| | - EMMANOUIL KARTERIS
- Division of Biosciences, Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, Middlesex UB8 3PH, UK
- Correspondence to: Dr Emmanouil Karteris, Division of Biosciences, Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK, E-mail:
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144
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Ortiz-Tudela E, Innominato PF, Rol MA, Lévi F, Madrid JA. Relevance of internal time and circadian robustness for cancer patients. BMC Cancer 2016; 16:285. [PMID: 27102330 PMCID: PMC4839139 DOI: 10.1186/s12885-016-2319-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/15/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adequate circadian timing of cancer treatment schedules (chronotherapy) can enhance tolerance and efficacy several-fold in experimental and clinical situations. However, the optimal timing varies according to sex, genetic background and lifestyle. Here, we compute the individual phase of the Circadian Timing System to decipher the internal timing of each patient and find the optimal treatment timing. METHODS Twenty-four patients (11 male; 13 female), aged 36 to 77 years, with advanced or metastatic gastro-intestinal cancer were recruited. Inner wrist surface Temperature, arm Activity and Position (TAP) were recorded every 10 min for 12 days, divided into three 4-day spans before, during and after a course of a set chronotherapy schedule. Pertinent indexes, I < O and a new biomarker, DI (degree of temporal internal order maintenance), were computed for each patient and period. RESULTS Three circadian rhythms and the TAP rhythm grew less stable and more fragmented in response to treatment. Furthermore, large inter- and intra-individual changes were found for T, A, P and TAP patterns, with phase differences of up to 12 hours among patients. A moderate perturbation of temporal internal order was observed, but the administration of fixed chronomodulated chemotherapy partially resynchronized temperature and activity rhythms by the end of the study. CONCLUSIONS The integrated variable TAP, together with the asynchrony among rhythms revealed by the new biomarker DI, would help in the personalization of cancer chronotherapy, taking into account individual circadian phase markers.
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Affiliation(s)
- Elisabet Ortiz-Tudela
- />Chronobiology Laboratory, Department of Physiology, University of Murcia, IMIB-Arrixaca, Murcia, Spain
- />INSERM, UMRS 776 « Biological Rhythms and Cancers », Villejuif, France
- />Warwick Medical School, Cancer Chronotherapy Unit, Coventry, UK
| | - Pasquale F. Innominato
- />INSERM, UMRS 776 « Biological Rhythms and Cancers », Villejuif, France
- />APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse Hospital, Villejuif, France
| | - Maria Angeles Rol
- />Chronobiology Laboratory, Department of Physiology, University of Murcia, IMIB-Arrixaca, Murcia, Spain
- />Chronobiology Laboratory, Department of Physiology, Faculty of Biology, University of Murcia, Campus de Espinardo, Espinardo, Murcia, Zip Code 30100 Spain
| | - Francis Lévi
- />INSERM, UMRS 776 « Biological Rhythms and Cancers », Villejuif, France
- />APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse Hospital, Villejuif, France
- />Warwick Medical School, Cancer Chronotherapy Unit, Coventry, UK
| | - Juan Antonio Madrid
- />Chronobiology Laboratory, Department of Physiology, University of Murcia, IMIB-Arrixaca, Murcia, Spain
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145
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Phipps AI, Bhatti P, Neuhouser ML, Chen C, Crane TE, Kroenke CH, Ochs-Balcom H, Rissling M, Snively BM, Stefanick ML, Treggiari MM, Watson NF. Pre-diagnostic Sleep Duration and Sleep Quality in Relation to Subsequent Cancer Survival. J Clin Sleep Med 2016; 12:495-503. [PMID: 26612513 PMCID: PMC4795275 DOI: 10.5664/jcsm.5674] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/02/2015] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Poor sleep quality and short sleep duration have been associated with elevated risk for several cancer types; however, the relationship between sleep and cancer outcomes has not been well characterized. We assessed the association between pre-diagnostic sleep attributes and subsequent cancer survival within the Women's Health Initiative (WHI). METHODS We identified WHI participants in whom a first primary invasive cancer had been diagnosed during follow-up (n = 21,230). Participants provided information on sleep characteristics at enrollment. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between these pre-diagnostic sleep characteristics and cancer-specific survival for all cancers combined and separately for common cancers. Analyses were adjusted for age, study arm, cancer site, marital status, income, smoking, physical activity, and time to diagnosis. RESULTS No individual pre-diagnostic sleep characteristics were found to be significantly associated with cancer survival in analyses of all cancer sites combined; however, women who reported short sleep duration (≤ 6 h sleep/night) combined with frequent snoring (≥ 5 nights/w experienced significantly poorer cancer-specific survival than those who reported 7-8 h of sleep/night and no snoring (HR = 1.32, 95% CI: 1.14-1.54). Short sleep duration (HR = 1.46, 95% CI: 1.07-1.99) and frequent snoring (HR = 1.34, 95% CI: 0.98-1.85) were each associated with poorer breast cancer survival; those reporting short sleep combined with frequent snoring combined had substantially poorer breast cancer survival than those reporting neither (HR = 2.14, 95% CI: 1.47-3.13). CONCLUSIONS Short sleep duration combined with frequent snoring reported prior to cancer diagnosis may influence subsequent cancer survival, particularly breast cancer survival.
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Affiliation(s)
- Amanda I. Phipps
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Epidemiology Department, School of Public Health, University of Washington, Seattle, WA
| | - Parveen Bhatti
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Epidemiology Department, School of Public Health, University of Washington, Seattle, WA
| | - Marian L. Neuhouser
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chu Chen
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Tracy E. Crane
- Health Promotion Sciences Division, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Candyce H. Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Heather Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | | | - Beverly M. Snively
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, Stanford University, School of Medicine, Palo Alto, CA
| | - Miriam M. Treggiari
- Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR
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146
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Hoyt MA, Bower JE, Irwin MR, Weierich MR, Stanton AL. Sleep quality and depressive symptoms after prostate cancer: The mechanistic role of cortisol. Behav Neurosci 2016; 130:351-6. [PMID: 26820589 DOI: 10.1037/bne0000107] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A substantial portion of men treated for prostate cancer report clinically significant sleep problems and disturbance in sleep quality constitutes significant risk for the development of depressive symptoms in survivors. Dysregulation in biological stress processes underlies the impact of poor sleep on the onset and/or progression of depressive symptoms, yet few studies have sought to identify potential neurobiological mechanisms (e.g., HPA axis activation) underlying this association in PC survivors. The present study examines the relationships between sleep disturbance, depressive symptoms, and indices of diurnal cortisol patterns among men treated for prostate cancer. In total, 66 men (84.8% White; mean age = 65.8 years, SD = 9.04) treated in the prior 2 years for localized prostate cancer were recruited. They completed questionnaires to measure sleep quality and depressive symptoms at study entry (T1) and 4 months later (T2). They also provided 4 saliva samples per day, over 3 days, at T1. Three cortisol indices were computed: diurnal slope, area under the curve (AUCg), and cortisol awakening response (CAR). Analyses indicate that, controlling for body mass index and age, worse sleep quality at T1 was significantly associated with higher levels of depressive symptoms at T2. Significant indirect effects were observed for cortisol slope (indirect effect = -.17, 95% CI [-.61, -.01]) and AUCg (indirect effect = -.14, 95% CI [-.43, -.01]), but not CAR. Results suggest that dysregulation in HPA activity acts as a neurobiological mechanism of the impact of sleep disruption on depressive symptoms in men with prostate cancer. (PsycINFO Database Record
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Affiliation(s)
- Michael A Hoyt
- Department of Psychology, Graduate Center, Hunter College, City University of New York
| | - Julienne E Bower
- Department of Psychology, Cousins Center for Psychoneuroimmunology, Semel Institute, University of California, Los Angeles
| | - Michael R Irwin
- Department of Psychology, Cousins Center for Psychoneuroimmunology, Semel Institute, University of California, Los Angeles
| | - Mariann R Weierich
- Department of Psychology, Graduate Center, Hunter College, City University of New York
| | - Annette L Stanton
- Department of Psychology, Cousins Center for Psychoneuroimmunology, Semel Institute, University of California, Los Angeles
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147
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Li Q, Gan L, Liang L, Li X, Cai S. The influence of marital status on stage at diagnosis and survival of patients with colorectal cancer. Oncotarget 2016; 6:7339-47. [PMID: 25749515 PMCID: PMC4466689 DOI: 10.18632/oncotarget.3129] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/09/2015] [Indexed: 12/11/2022] Open
Abstract
Marital status was found to be an independent prognostic factor for survival in various cancer types, but it hasn’t been fully studied in colorectal cancer (CRC). The Surveillance, Epidemiology and End Results database was used to compare survival outcomes with marital status in each stage. In total, 112, 776 eligible patients were identified. Patients in the widowed group were more frequently elderly women, more common of colon cancer, and more stage I/II in tumor stage (P < 0.001), but the surgery rate was comparable to that for the married group (94.72% VS 94.10%). Married CRC patients had better 5year cause-specific survival (CSS) than those unmarried (P < 0.05). Further analysis showed that widowed patients always presented the lowest CSS compared with that of other’ group. Widowed patients had 5% reduction 5-year CSS compared with married patients at stage I (94.8% vs 89.8%, P < 0.001), 9.4% reduction at stage II (85.9% vs 76.5%, P < 0.001), 16.7% reduction at stage III (70.6% vs 53.9%, P < 0.001) and 6.2% reduction at stage IV(14.4% VS 8.2%, P < 0.001). These results showed that unmarried patients were at greater risk of cancer specific mortality. Despite favorable clinicpathological characteristics, widowed patients were at highest risk of death compared with other groups.
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Affiliation(s)
- Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Lu Gan
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Lei Liang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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148
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Intraindividual Cortisol Variability and Psychological Functioning in Caregivers of Hematopoietic Stem Cell Transplant Patients. Psychosom Med 2016; 78:242-7. [PMID: 26569536 PMCID: PMC4738013 DOI: 10.1097/psy.0000000000000272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Caregiving for allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients carries a significant psychological burden, yet it remains unclear whether Allo-HSCT caregivers demonstrate disruptions to stress systems, such as the hypothalamic-pituitary-adrenal axis. Greater intraindividual cortisol variability (ICV) has been observed in psychiatric disorders; however, there is a knowledge gap evaluating ICV in caregivers. We predicted that greater ICV would be related to poorer mental health in Allo-HSCT caregivers. METHODS Allo-HSCT caregivers (n = 140) collected saliva for 3 consecutive days at 4 time points/d. Psychological variables included sleep quality and a summary composite score of overall mental health. RESULTS Regression analyses demonstrated that greater ICV was significantly related to poorer overall mental health (β = 0.25, p = .009), whereas poorer sleep did not reach significance (β = 0.16, p = .069). No significant relationships emerged for the cortisol area under the curve, diurnal decline, or awakening response. CONCLUSIONS Results extend prior work examining ICV as a unique marker that is possibly more sensitive than other widely applied measures of hypothalamic-pituitary-adrenal axis dysregulation to a distressed population of caregivers.
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149
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Shinn EH, Valentine A, Jethanandani A, Basen-Engquist K, Fellman B, Urbauer D, Atkinson E, Yusuf SW, Lenihan D, Woods ML, Kies MS, Sood AK, Carmack C, Morrison WH, Gillenwater A, Sturgis EM, Garden AS. Depression and Oropharynx Cancer Outcome. Psychosom Med 2016; 78:38-48. [PMID: 26632757 PMCID: PMC4696911 DOI: 10.1097/psy.0000000000000256] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Studies have shown a modest relationship between depression and mortality in patients with cancer. Our study addressed methodological weaknesses in the literature by restricting the sample to patients with one cancer type, adjusting for factors known to affect outcome, and following up patients for a sufficient period. METHODS We prospectively followed patients newly diagnosed with squamous cell oropharyngeal cancer from the start of radiation therapy until death or until date of last clinical visit. All patients were optimally treated with radiation and sometimes chemotherapy. After adjusting for tumor stage, treatment, comorbidities, smoking, excessive alcohol use, and demographic factors, we assessed the effects of baseline self-reported depression on overall survival and recurrence. RESULTS One hundred thirty participants were followed for a median of 5 years. The average age was 56 years, and 83% were male. Eighteen participants died during the study and 15 experienced disease recurrence. Self-reported depression was associated with decreased overall survival duration (hazard ratio = 3.6, 95% confidence interval = 1.2-10.8) and disease recurrence (hazard ratio = 3.8, 95% confidence interval = 1.2-12.2) in multivariate analysis. In addition, smoking was associated with disease recurrence. CONCLUSIONS Patients with oropharyngeal cancer may benefit from depression screening and evidence-based treatments, if appropriate. Future studies are needed to determine whether depression is an independent prognostic factor of outcome and to elucidate biobehavioral mechanisms involved in patients with oropharyngeal cancer.
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Affiliation(s)
- Eileen H. Shinn
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center
| | - Alan Valentine
- Department of Psychiatry, University of Texas M. D. Anderson Cancer Center
| | - Amit Jethanandani
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center
| | - Karen Basen-Engquist
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center
| | - Bryan Fellman
- Department of Biostatistics, University of Texas M. D. Anderson Cancer Center
| | - Diana Urbauer
- Department of Biostatistics, University of Texas M. D. Anderson Cancer Center
| | - Emma Atkinson
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center
| | - Syed Wamique Yusuf
- Department of Cardiology, University of Texas M. D. Anderson Cancer Center
| | - Daniel Lenihan
- Department of Cardiology, Vanderbilt University Medical Center
| | - Myrshia L. Woods
- Department of Cardiology, University of Texas M. D. Anderson Cancer Center
| | - Merrill S. Kies
- Department of Thoracic Medical Oncology, University of Texas M. D. Anderson Cancer Center
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center
| | - Cindy Carmack
- Department of Palliative Care, University of Texas M. D. Anderson Cancer Center
| | - William H. Morrison
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center
| | - Ann Gillenwater
- Department of Head and Neck Cancer Surgery, University of Texas M. D. Anderson Cancer Center
| | - Erich M. Sturgis
- Department of Head and Neck Cancer Surgery, University of Texas M. D. Anderson Cancer Center
| | - Adam S. Garden
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center
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150
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Tomarken AJ, Han G, Corbett BA. Temporal patterns, heterogeneity, and stability of diurnal cortisol rhythms in children with autism spectrum disorder. Psychoneuroendocrinology 2015; 62:217-26. [PMID: 26318632 PMCID: PMC4945957 DOI: 10.1016/j.psyneuen.2015.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
Abstract
The current study used a multifaceted approach to assess whether children with ASD have a distinctive diurnal rhythm of cortisol that differentiates them from typically developing (TD) peers and whether sub-groups of ASD children can be identified with unique diurnal profiles. Salivary cortisol was sampled at four time points during the day (waking, 30-min post-waking, afternoon, and evening) across three days in a sample of 36 children with autism spectrum disorder (ASD) and 27 typically developing (TD) peers. Between-group comparisons on both mean levels and featural components of diurnal cortisol indicated elevated evening cortisol and a dampened linear decline across the day in the ASD group. No differences were evident on the cortisol awakening response (CAR). Group-based trajectory modeling indicated that a subgroup (25%) of ASD children demonstrated an attenuated linear decline while the cortisol trajectory of the second subgroup was indistinguishable from that of the TD group. Intraclass correlations indicated that, when aggregated across days, cortisol measures were generally stable over the interval assessed. There were few significant relations between cortisol measures or sub-groups and measures of stress, temperament, and symptoms. Results encourage follow-up studies to investigate the functional significance, heterogeneity and longer-term stability of diurnal cortisol profiles in children with ASD.
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Affiliation(s)
| | - Gloria Han
- Vanderbilt University, Department of Psychology
| | - Blythe A. Corbett
- Vanderbilt University, Department of Psychology,Vanderbilt University, Department of Psychiatry
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