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Telles R, Zimmerman MB, Thaker PH, Slavich GM, Ramirez ES, Zia S, Goodheart MJ, Cole SW, Sood AK, Lutgendorf SK. Rural-urban disparities in psychosocial functioning in epithelial ovarian cancer patients. Gynecol Oncol 2024; 184:139-145. [PMID: 38309031 PMCID: PMC11179980 DOI: 10.1016/j.ygyno.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Although rural residence has been related to health disparities in cancer patients, little is known about how rural residence impacts mental health and quality of life (QOL) in ovarian cancer patients over time. This prospective longitudinal study investigated mental health and QOL of ovarian cancer patients in the first-year post-diagnosis. METHOD Women with suspected ovarian cancer completed psychosocial surveys pre-surgery, at 6 months and one-year; clinical data were obtained from medical records. Histologically confirmed high grade epithelial ovarian cancer patients were eligible. Rural/urban residence was categorized from patient counties using the USDA Rural-Urban Continuum Codes. Linear mixed effects models examined differences in psychosocial measures over time, adjusting for covariates. RESULTS Although disparities were not observed at study entry for any psychosocial variable (all p-values >0.22), urban patients showed greater improvement in total distress over the year following diagnosis than rural patients (p = 0.025) and were significantly less distressed at one year (p = 0.03). Urban patients had a more consistent QOL improvement than their rural counterparts (p = 0.006). There were no differences in the course of depressive symptoms over the year (p = 0.17). Social support of urban patients at 12 months was significantly higher than that of rural patients (p = 0.04). CONCLUSION Rural patients reported less improvement in psychological functioning in the year following diagnosis than their urban counterparts. Clinicians should be aware of rurality as a potential risk factor for ongoing distress. Future studies should examine causes of these health disparities and potential long-term inequities and develop interventions to address these issues.
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Affiliation(s)
- Rachel Telles
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - M Bridget Zimmerman
- Department of Preventive Medicine and Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, Saint Louis, MO, USA
| | - George M Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Edgardo S Ramirez
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Sharaf Zia
- Institute of Clinical and Translational Sciences, University of Iowa Hospital & Clinics, Iowa City, IA, USA
| | - Michael J Goodheart
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Steven W Cole
- Division of Hematology-Oncology, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Anil K Sood
- Departments of Gynecologic Oncology, Cancer Biology and Center for RNA Interference and Noncoding RNA, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Susan K Lutgendorf
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA.
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Pan D, Diaz JL, Weidman K, Graham J, Goyal P, Rajan M, Lau J, Pinheiro L, Rachid L, Simmons W, Schenck EJ, Safford MM, Lief L. Social Networks as a Key Health Determinant in Acute Illness Recovery: A Lesson from the COVID-19 Pandemic. Am J Med 2024:S0002-9343(24)00236-5. [PMID: 38677397 DOI: 10.1016/j.amjmed.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The COVID-19 pandemic highlighted the importance of considering social determinants of health in health outcomes. Within this spectrum of determinants, social networks garnered attention as the pandemic highlighted the negative effects of social isolation in the context of social distancing measures. Postpandemic, examining the role social networks play in COVID-19 recovery can help guide patient care and shape future health policies. This study aimed to investigate the relationship between social networks and self-rated health change, as well as physical function, in patients recovering from COVID-19 pneumonia. METHODS This was a retrospective cohort study utilizing clinical data from 2 New York City hospitals and a 9-month follow-up survey of COVID-19 pneumonia survivors. We evaluated a composite Social Network Score from the 6-item Lubben Social Network Scale and its association with 2 outcomes: 1) self-rated health change and 2) physical function. RESULTS A total of 208 patients were included in this study. A 1-point increase in the Social Network Score was associated with greater odds of both same or improved self-rated health change (odds ratio [OR] 1.07, 95% CI 1.02-1.12, P = .01), as well as unimpaired physical function (OR 1.08, 95% CI 1.03-1.14, P < .01). CONCLUSION This study emphasized the importance of social networks as a social determinant of health among patients recovering from COVID-19 hospitalization. Targeted interventions to enhance social networks may benefit not only COVID-19 patients but also individuals recovering from other acute illnesses.
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Affiliation(s)
- Di Pan
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, N.Y..
| | - Jihui L Diaz
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Penn
| | - Karissa Weidman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
| | - Julia Graham
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Mangala Rajan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Jennifer Lau
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Laura Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Leena Rachid
- Stritch School of Medicine at Loyola University Chicago, Maywood, Ill
| | - Will Simmons
- Department of Population Health Sciences, Weill Cornell Medical College, New York, N.Y
| | - Edward J Schenck
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Lindsay Lief
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, N.Y
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Lutgendorf SK, Telles RM, Whitney B, Thaker PH, Slavich GM, Goodheart MJ, Penedo FJ, Noble AE, Cole SW, Sood AK, Corn BW. The biology of hope: Inflammatory and neuroendocrine profiles in ovarian cancer patients. Brain Behav Immun 2024; 116:362-369. [PMID: 38081436 PMCID: PMC11219272 DOI: 10.1016/j.bbi.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 01/01/2024] Open
Abstract
INTRODUCTION Although the concept of hope is highly relevant for cancer patients, little is known about its association with cancer-relevant biomarkers. Here we examined how hope was related to diurnal cortisol and interleukin-6 (IL-6), a pro-inflammatory cytokine previously associated with tumor biology and survival in ovarian cancer. Secondly, we examined whether hope and hopelessness are distinctly associated with these biomarkers. METHOD Participants were 292 high-grade ovarian cancer patients who completed surveys and provided saliva samples 4x/daily for 3 days pre-surgery to assess diurnal cortisol. Blood (pre-surgery) and ascites were assessed for IL-6. Hope and hopelessness were assessed using standardized survey items from established scales (Center for Epidemiological Studies Depression Scale; Profile of Mood States, Functional Assessment of Cancer Therapy). Two hopeless items were z-scored and combined into a composite for analysis. Regression models related these variables to nocturnal cortisol, cortisol slope, plasma and ascites IL-6, adjusting for cancer stage, BMI, age, and depression. RESULTS Greater hope was significantly related to a steeper cortisol slope, β = -0.193, p = 0.046, and lower night cortisol, β = -0.227, p = 0.018, plasma IL-6, β = -0.142, p = 0.033, and ascites IL-6, β = -0.290, p = 0.002. Secondary analyses including both hope and hopelessness showed similar patterns, with distinct relationships of hope with significantly lower nocturnal cortisol β = -0.233,p = 0.017 and ascites IL-6, β = -0.282,p = 0.003, and between hopelessness and a flatter cortisol slope, β = 0.211, p = 0.031. CONCLUSIONS These data suggest a biological signature of hope associated with less inflammation and more normalized diurnal cortisol in ovarian cancer. These findings have potential clinical utility but need replication with more diverse samples and validated assessments of hope.
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Affiliation(s)
- Susan K Lutgendorf
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, United States; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, United States; Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, United States.
| | - Rachel M Telles
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Brendan Whitney
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, United States
| | - Michael J Goodheart
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, United States; Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, United States
| | - Frank J Penedo
- Departments of Psychology and Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Alyssa E Noble
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Steven W Cole
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, United States; Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Anil K Sood
- Departments of Gynecologic Oncology, Cancer Biology and Center for RNA Interference and Noncoding RNA, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Benjamin W Corn
- Shaare Zedek Medical Center, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
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Fei L, Bozza B, Melani G, Righi L, Santarelli G, Boy OB, Benedetti D, Falone A, Flaccomio D, Giuranno G, Martelli M, Merola P, Moretti S, Ndoci E, Pecoraro V, Siviglia S, Berni A, Fanelli A, Giovagnini E, Morettini A, Nozzoli C, Para O, Rostagno C, Tozzetti C. SSRIs in the course of COVID-19 pneumonia: Evidence of effectiveness of antidepressants on acute inflammation. A retrospective study. Hum Psychopharmacol 2024; 39:e2887. [PMID: 38059650 DOI: 10.1002/hup.2887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Relationships between inflammation and mood have been observed in terms of pro-inflammatory effects induced by depressive conditions and, in parallel, by an antidepressant-induced favorable effect on the recovery of inflammatory states. Selective serotonin reuptake inhibitor (SSRI) drugs were hypothesized to improve the prognosis of COVID-19 pneumonia, a typical acute inflammation, in terms of decreased mortality rate and pro-inflammatory cytokine serum levels. METHODS The medical records of COVID-19 pneumonia inpatients at Careggi University Hospital (Florence) were analyzed for prognosis and Interleukin 6 (IL-6) after admission for over a period of 22 months. Medical records of patients treated at admission and not discontinued until discharge with an SSRI or with vortioxetine were identified. Two groups, one treated with antidepressants, the other not treated, were evaluated according to the mentioned parameters. Multiple linear regression and logistic regression were performed. RESULTS The entire sample composed of 1236 records (recovered patients 77.1%, deceased patients 22.9%). The treated group (n = 107) had a better prognosis than the untreated group in spite of age and comorbidity both being greater than in the untreated group. Correspondingly, IL-6 levels in the treated group were significantly lower (p < 0.01) than the levels in the untreated group, in every comparison. CONCLUSIONS Outcomes of this study support the hypothesis of the favorable influence of some antidepressants on the prognosis of COVID-19, possibly mediated by IL-6 modulation. Reduction in acute inflammation induced by the action of antidepressants was confirmed.
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Affiliation(s)
- Leonardo Fei
- Careggi University Hospital (IT), Chair of Psycho-Oncology, Florence, Italy
| | - Bernardo Bozza
- School of Psychiatry, University of Florence (IT), Florence, Italy
| | - Giulia Melani
- School of Psychiatry, University of Florence (IT), Florence, Italy
| | | | | | | | - Davide Benedetti
- School of Psychiatry, University of Florence (IT), Florence, Italy
| | - Andrea Falone
- School of Psychiatry, University of Florence (IT), Florence, Italy
| | - Dario Flaccomio
- School of Psychiatry, University of Florence (IT), Florence, Italy
| | | | - Michela Martelli
- School of Psychiatry, University of Florence (IT), Florence, Italy
| | - Pierpaolo Merola
- School of Psychiatry, University of Florence (IT), Florence, Italy
| | | | - Endrit Ndoci
- School of Psychiatry, University of Florence (IT), Florence, Italy
| | | | - Serena Siviglia
- School of Psychiatry, University of Florence (IT), Florence, Italy
| | - Andrea Berni
- Careggi University Hospital (IT), Florence, Italy
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Edes AN, Brown JL, Edwards KL. Evaluating individual biomarkers for predicting health risks in zoo-housed chimpanzees (Pan troglodytes) and bonobos (Pan paniscus). Am J Primatol 2023; 85:e23457. [PMID: 36537335 DOI: 10.1002/ajp.23457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Although biomarkers are often used for predicting morbidity and mortality in humans, similar data are lacking in our closest relatives. This study analyzed 16 biomarkers in zoo-housed chimpanzees and bonobos from serum samples collected during both routine and nonroutine veterinary immobilizations. Generalized linear and generalized linear mixed models were used to determine the efficacy of each biomarker to predict all-cause morbidity, defined as the presence of at least one chronic condition, or cardiac disease as a subset of all-cause morbidity. Cox proportional hazards models were used to examine associations between biomarkers and mortality risk from any cause. Analyses were conducted using two data sets for each species, one with all values retained (chimpanzees: n = 148; bonobos: n = 33) and the other from samples collected during routine immobilizations only (chimpanzees: n = 95; bonobos: n = 23). Consistent results across both data sets in chimpanzees included associations of higher cortisol with all-cause morbidity risk, lower creatinine with cardiac disease risk, and higher creatinine with mortality risk, and in bonobos were increased cardiac disease risk with higher cortisol and lower dehydroepiandrosterone-sulfate, fructosamine, and triglycerides. However, there were some inconsistencies between data sets, such as tumor necrosis factor-α predicting mortality risk positively in chimpanzees when all values were retained, but negatively for routine values only. Despite the close evolutionary relationships between chimpanzees and bonobos, the only result observed in both species was a negative association between albumin and mortality risk in the all values retained data sets. Thus, data suggest some biomarkers may be useful predictors of future health outcomes, although a better understanding of both individual and species variation in biomarkers and their contribution to health risks is needed.
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Affiliation(s)
- Ashley N Edes
- Department of Reproductive and Behavioral Sciences, Saint Louis Zoo, Saint Louis, Missouri, USA.,Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, Virginia, USA
| | - Janine L Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, Virginia, USA
| | - Katie L Edwards
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, Virginia, USA.,Conservation Science and Policy, North of England Zoological Society, Chester Zoo, Upton by Chester, UK
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Panjwani AA, Aguiar S, Gascon B, Brooks DG, Li M. Biomarker opportunities in the treatment of cancer-related depression. Trends Mol Med 2022; 28:1050-1069. [PMID: 36371336 DOI: 10.1016/j.molmed.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022]
Abstract
Depression comorbid with cancer is common and associated with a host of negative health outcomes. The inflammatory basis of depression is a growing area of research in cancer, focused on how stressors transduce into inflammation and contribute to the emergence of depression. In this review, we synthesize inflammatory biomarker associations with both depression and the currently available pharmacotherapies and psychotherapies in cancer, underscoring the need for expanding research on anti-inflammatory agents with antidepressant effects. Modulation of inflammatory neuroimmune pathways can slow tumor progression and reduce metastases. Biomarkers associated with depression in cancer may help with diagnosis and treatment monitoring, as well as inform research on novel drug targets to potentially improve cancer survival.
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Affiliation(s)
- Aliza A Panjwani
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Stefan Aguiar
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Bryan Gascon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David G Brooks
- Princess Margaret Research Institute, Toronto, ON, Canada; Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Princess Margaret Research Institute, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Edes AN, Zimmerman D, Jourdan B, Brown JL, Edwards KL. Value Ranges and Clinical Comparisons of Serum DHEA-S, IL-6, and TNF-α in Western Lowland Gorillas. Animals (Basel) 2022; 12:ani12192705. [PMID: 36230446 PMCID: PMC9559573 DOI: 10.3390/ani12192705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/12/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
Simple Summary Biomarkers are molecules found in the body that can indicate current physiological functioning and are frequently used to monitor health and diagnose disease. These biomarkers, such as hormones and immune markers, can provide valuable information on the health and welfare of animals. Knowledge on the normal levels of these biomarkers in various species is a crucial step for monitoring health and understanding disease. In this paper, we report assays and value ranges of biomarkers rarely measured in western lowland gorillas in human care. We also compare concentrations of each biomarker between clinical and non-clinical samples. The levels of the two immune biomarkers were higher in clinical samples, but the levels of the neuroendocrine biomarker were not significantly different between clinical and non-clinical samples. These data contribute toward eventually establishing reference ranges for these biomarkers and help improve our understanding of health and welfare in zoo-housed animals. Abstract Physiological data can provide valuable information about the health and welfare of animals. Unfortunately, few validated assays and a lack of information on species-typical levels of circulating biomarkers for wildlife make the measurement, interpretation, and practical application of such data difficult. We validated commercially available kits and calculated reference intervals (herein called “value ranges”) for dehydroepiandrosterone-sulfate (DHEA-S), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) in a sample of zoo-housed western lowland gorillas due to the roles these biomarkers play in stress and immune responses. For each biomarker, we present species-specific value ranges for a sample of gorillas in human care (n = 57). DHEA-S did not vary significantly by sex or age, while IL-6 was higher in males and older gorillas and TNF-α was higher in females but not associated with age. We also compared non-clinical with clinical samples (n = 21) to explore whether these biomarkers reflect changes in health status. There was no significant difference between clinical and non-clinical samples for DHEA-S, but both IL-6 and TNF-α were significantly higher in gorillas showing clinical symptoms or prior to death. Additional work is needed to improve our understanding of normal versus clinical variation in these biomarkers, and we encourage continued efforts to identify and validate additional biomarkers that can be used to inform assessments of health and welfare in wildlife.
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Affiliation(s)
- Ashley N. Edes
- Department of Reproductive and Behavioral Sciences, Saint Louis Zoo, St. Louis, MO 63110, USA
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA 22630, USA
- Correspondence:
| | - Dawn Zimmerman
- Veterinary Initiative for Endangered Wildlife, Bozeman, MT 59715, USA
- Smithsonian Global Health Program, National Zoological Park, Smithsonian Institution, Washington, DC 20008, USA
| | - Balbine Jourdan
- Veterinary Teaching Hospital, University of Illinois College of Veterinary Medicine, Urbana, IL 61802, USA
| | - Janine L. Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA 22630, USA
| | - Katie L. Edwards
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA 22630, USA
- North of England Zoological Society, Chester Zoo, Caughall Road, Upton-by-Chester CH2 1LH, UK
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Wang C, Shen Y, Ni J, Hu W, Yang Y. Effect of chronic stress on tumorigenesis and development. Cell Mol Life Sci 2022; 79:485. [PMID: 35974132 PMCID: PMC11071880 DOI: 10.1007/s00018-022-04455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
Chronic stress activates the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis to aggravates tumorigenesis and development. Although the importance of SNS and HPA in maintaining homeostasis has already attracted much attention, there is still a lot remained unknown about the molecular mechanisms by which chronic stress influence the occurrence and development of tumor. While some researches have already concluded the mechanisms underlying the effect of chronic stress on tumor, complicated processes of tumor progression resulted in effects of chronic stress on various stages of tumor remains elusive. In this reviews we concluded recent research progresses of chronic stress and its effects on premalignancy, tumorigenesis and tumor development, we comprehensively summarized the molecular mechanisms in between. And we highlight the available treatments and potential therapies for stressed patients with tumor.
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Affiliation(s)
- Chen Wang
- State Key Laboratory of Natural Medicines, Center for New Drug Safety Evaluation and Research, China Pharmaceutical University, No. 639 Long Mian Avenue, Jiangning District, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Yumeng Shen
- State Key Laboratory of Natural Medicines, Center for New Drug Safety Evaluation and Research, China Pharmaceutical University, No. 639 Long Mian Avenue, Jiangning District, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Jiaping Ni
- State Key Laboratory of Natural Medicines, Center for New Drug Safety Evaluation and Research, China Pharmaceutical University, No. 639 Long Mian Avenue, Jiangning District, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Weiwei Hu
- State Key Laboratory of Natural Medicines, Center for New Drug Safety Evaluation and Research, China Pharmaceutical University, No. 639 Long Mian Avenue, Jiangning District, Nanjing, 211198, Jiangsu, People's Republic of China.
- Lingang Laboratory, Shanghai, 200032, People's Republic of China.
| | - Yong Yang
- State Key Laboratory of Natural Medicines, Center for New Drug Safety Evaluation and Research, China Pharmaceutical University, No. 639 Long Mian Avenue, Jiangning District, Nanjing, 211198, Jiangsu, People's Republic of China.
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Current strategies to improve erectile function in patients undergoing radical prostatectomy - postoperative scenario. Urol Oncol 2022; 40:87-94. [DOI: 10.1016/j.urolonc.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022]
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Kim Y, Chung ML, Lee H. Caregivers of patients with cancer: perceived stress, quality of life and immune function. BMJ Support Palliat Care 2022:bmjspcare-2021-003205. [PMID: 35210302 DOI: 10.1136/bmjspcare-2021-003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the mediating effect of quality of life (QoL) on the relationship between perceived stress and immune function in Korean family caregivers of patients with cancer. METHODS In this cross-sectional study, 89 family caregivers of patients with cancer completed perceived stress and QoL questionnaires. Immune function was assessed using two proinflammatory biomarkers, IL-6 and tumour necrosis factor-alpha (TNF-α). Multiple parallel mediator regression was conducted using four mediators (burden, lifestyle disruption, positive adaptation and financial concern) representing the subscales of QoL related to caregiving. RESULTS Psychological (indirect effect (ab)=-0.52, 95% CI -1.25 to -0.01) and physical (ab=-0.44, 95% CI -1.07 to -0.05) stress had a significant indirect effect on IL-6 levels attributed to lifestyle disruption associated with caregiving. Psychological (ab=-0.97, 95% CI -2.37 to -0.11) and physical (ab=-1.10, 95% CI -2.87 to -0.08) stress also had a significant indirect effect on TNF-α as a result of financial concerns owing to caregiving. Other indirect effects of psychological/physical stress on inflammation were not significant. CONCLUSION This study demonstrated that the effects of perceived psychological and physical stress on IL-6 and TNF-α levels were mediated by the caregiver's QoL, especially lifestyle disruption and financial concerns. Stress management and improvement of caregivers' QoL related to lifestyle disruption and financial issues should be considered to reduce the negative effects of caregiving on immune function.
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Affiliation(s)
- Yoonjoo Kim
- Department of Nursing, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyangkyu Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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Chang A, Sloan EK, Antoni MH, Knight JM, Telles R, Lutgendorf SK. Biobehavioral Pathways and Cancer Progression: Insights for Improving Well-Being and Cancer Outcomes. Integr Cancer Ther 2022; 21:15347354221096081. [PMID: 35579197 PMCID: PMC9118395 DOI: 10.1177/15347354221096081] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.
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Affiliation(s)
- Aeson Chang
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia
| | - Erica K Sloan
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia.,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.,Peter MacCallum Cancer Centre, Division of Surgery, Melbourne, VIC, Australia
| | - Michael H Antoni
- Departments of Psychology, Psychiatry, and Behavioral Sciences, and Cancer Control Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Jennifer M Knight
- Department of Psychiatry and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Telles
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Susan K Lutgendorf
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
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12
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Amer H, Kartikasari AER, Plebanski M. Elevated Interleukin-6 Levels in the Circulation and Peritoneal Fluid of Patients with Ovarian Cancer as a Potential Diagnostic Biomarker: A Systematic Review and Meta-Analysis. J Pers Med 2021; 11:1335. [PMID: 34945807 PMCID: PMC8704427 DOI: 10.3390/jpm11121335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 01/21/2023] Open
Abstract
Ovarian cancer (OC) is one of the most lethal cancers, largely due to a late diagnosis. This study aimed to provide a comprehensive meta-analysis on the diagnostic performance of IL6 in the blood and ascites separately for advanced and early-stage OC. We included 37 studies with 6948 participants detecting serum or plasma IL6. The plasma/serum IL6 mean level in the late-stage OC was 23.88 pg/mL (95% CI: 13.84-41.23), and the early-stage OC was 16.67 pg/mL (95% CI: 510.06-27.61), significantly higher than the healthy controls at 3.96 pg/mL (95% CI: 2.02-7.73), but not significantly higher than those found in the controls with benign growths in the ovary, which was 9.63 pg/mL (95% CI: 4.16-22.26). To evaluate IL6 in ascites as a diagnostic marker, we included 26 studies with 1590 participants. The mean level of ascitic IL6 in the late-stage OC was 3676.93 pg/mL (95% CI: 1891.7-7146.7), and the early-stage OC was 1519.21 pg/mL (95% CI: 604.6-3817.7), significantly higher than the benign controls at 247.33 pg/mL (95% CI: 96.2-636.0). There was no significant correlation between the levels of circulating and ascitic IL6. When pooling all OC stages for analysis, we found that serum/plasma IL6 provided 76.7% sensitivity (95% CI: 0.71-0.92) and 72% specificity (95% CI: 0.64-0.79). Ascitic IL6 provided higher sensitivity at 84% (95% CI: 0.710-0.919) and specificity at 74% (95% CI: 0.646-0.826). This study highlights the utility of ascitic IL6 for early detection of OC.
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13
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Eckerling A, Ricon-Becker I, Sorski L, Sandbank E, Ben-Eliyahu S. Stress and cancer: mechanisms, significance and future directions. Nat Rev Cancer 2021; 21:767-785. [PMID: 34508247 DOI: 10.1038/s41568-021-00395-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/08/2023]
Abstract
The notion that stress and cancer are interlinked has dominated lay discourse for decades. More recent animal studies indicate that stress can substantially facilitate cancer progression through modulating most hallmarks of cancer, and molecular and systemic mechanisms mediating these effects have been elucidated. However, available clinical evidence for such deleterious effects is inconsistent, as epidemiological and stress-reducing clinical interventions have yielded mixed effects on cancer mortality. In this Review, we describe and discuss specific mediating mechanisms identified by preclinical research, and parallel clinical findings. We explain the discrepancy between preclinical and clinical outcomes, through pointing to experimental strengths leveraged by animal studies and through discussing methodological and conceptual obstacles that prevent clinical studies from reflecting the impacts of stress. We suggest approaches to circumvent such obstacles, based on targeting critical phases of cancer progression that are more likely to be stress-sensitive; pharmacologically limiting adrenergic-inflammatory responses triggered by medical procedures; and focusing on more vulnerable populations, employing personalized pharmacological and psychosocial approaches. Recent clinical trials support our hypothesis that psychological and/or pharmacological inhibition of excess adrenergic and/or inflammatory stress signalling, especially alongside cancer treatments, could save lives.
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Affiliation(s)
- Anabel Eckerling
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Itay Ricon-Becker
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Liat Sorski
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Elad Sandbank
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shamgar Ben-Eliyahu
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
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14
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Roy V, Ruel S, Ivers H, Savard MH, Gouin JP, Caplette-Gingras A, Lemieux J, Couture F, Savard J. Stress-buffering effect of social support on immunity and infectious risk during chemotherapy for breast cancer. Brain Behav Immun Health 2021; 10:100186. [PMID: 34589722 PMCID: PMC8474492 DOI: 10.1016/j.bbih.2020.100186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 10/31/2022] Open
Abstract
Objective This study investigated the stress-buffering effect of social support on immune function and infectious risk in women with breast cancer, during and after chemotherapy. Method Data were collected from 50 women with breast cancer before and after their chemotherapy, as well as three months later. Stress was measured by daily hassles related to cancer and social support by marital status (MS) and perceived support from friends (Ps-fr). Blood was collected to measure innate immune markers (i.e., T cells, NK cells and neutrophils). Infections were evaluated using a semi-structured interview. Moderation, mediation and moderated mediation models were computed to test the hypotheses. Results Higher stress at baseline was found to significantly predict a higher occurrence of infections during chemotherapy, but not three months later. The relationship between stress and infections was not significantly explained by any of the immune markers. The interaction between stress and social support was tested using MS alone and combined with Ps-fr. A protective effect of social support on the deleterious effect of stress on infectious risk was found. Single patients reporting lower Ps-fr showed the strongest association between stress and infections, while the weakest association was found in patients in a committed relationship with a higher level of Ps-fr. Conclusions Women experiencing more stress before the beginning of chemotherapy would appear to be at a higher risk of developing infections during their treatment. Results of this study also suggest that this effect could be buffered by the presence of a romantic partner and by higher Ps-fr.
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Affiliation(s)
- Véronique Roy
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada.,Université Laval Cancer Research Center, Québec, QC, Canada.,School of Psychology, Université Laval, Québec, QC, Canada
| | - Sophie Ruel
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada.,Université Laval Cancer Research Center, Québec, QC, Canada.,School of Psychology, Université Laval, Québec, QC, Canada
| | - Hans Ivers
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada.,Université Laval Cancer Research Center, Québec, QC, Canada.,School of Psychology, Université Laval, Québec, QC, Canada
| | - Marie-Hélène Savard
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada.,Université Laval Cancer Research Center, Québec, QC, Canada.,School of Psychology, Université Laval, Québec, QC, Canada
| | | | - Aude Caplette-Gingras
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada.,Centre des Maladies du sein, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Julie Lemieux
- Centre Hospitalier Universitaire de Québec - Université Laval, Québec, QC, Canada.,Université Laval, Québec, QC, Canada
| | - Félix Couture
- Université Laval Cancer Research Center, Québec, QC, Canada.,Centre Hospitalier Universitaire de Québec - Université Laval, Québec, QC, Canada
| | - Josée Savard
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada.,Université Laval Cancer Research Center, Québec, QC, Canada.,School of Psychology, Université Laval, Québec, QC, Canada
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15
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Edes AN, Brand CM. Age, sex, and inflammatory markers predict chronic conditions, cardiac disease, and mortality among captive western lowland gorillas (Gorilla gorilla gorilla). Primates 2021; 62:931-943. [PMID: 34460009 DOI: 10.1007/s10329-021-00942-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/12/2021] [Indexed: 01/22/2023]
Abstract
In humans, inflammatory markers predict health risks. As great apes experience many similar conditions, measuring inflammation may provide valuable health information. We examined four serum inflammatory markers in zoo-housed gorillas (n = 48): albumin, CRP, IL-6, and TNF-α. We first analyzed age- and sex-associated patterns, then used multimodel inference to evaluate models with age, sex, and inflammatory markers as predictors of all-cause morbidity, cardiac disease, and mortality. Older gorillas had lower albumin and higher IL-6, and males had higher albumin, lower CRP, and lower TNF-α. All-cause morbidity was best predicted by age, sex, and TNF-α, but the second model containing only age and sex was equivalent. Cardiac disease was best predicted by TNF-α alongside age and sex, with lower levels associated with increased risk. When outliers were removed, the model with TNF-α was second to the model containing only age and sex. Finally, mortality risk was best predicted by the model with only age and sex. Other models containing individual inflammatory markers were within top model sets for each health outcome. Our results indicate that age and sex are robust for predicting all-cause morbidity and mortality risk in gorillas; while models which include individual inflammatory markers also predict risk, they may not improve predictions over age and sex alone. However, given the prevalence of cardiac disease in great apes, these results suggest that TNF-α warrants further investigation. With their potential to provide valuable health information, data on inflammatory markers may contribute to the care and management of gorillas in human care.
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Affiliation(s)
- Ashley N Edes
- Center for Species Survival, Smithsonian Conservation Biology Institution, Front Royal, VA, USA.
- Department of Anthropology, The Ohio State University, Columbus, OH, USA.
- Department of Reproductive and Behavioral Sciences, Saint Louis Zoo, Saint Louis, MO, USA.
| | - Colin M Brand
- Department of Anthropology, University of Oregon, Eugene, OR, USA
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16
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Hufnagel DH, Khabele D, Yull FE, Hull PC, Schildkraut J, Crispens MA, Beeghly-Fadiel A. Increasing Area Deprivation Index negatively impacts ovarian cancer survival. Cancer Epidemiol 2021; 74:102013. [PMID: 34438316 DOI: 10.1016/j.canep.2021.102013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While individual-level measures of socioeconomic status have been well-studied in relation to ovarian cancer survival, no studies to date have examined both state and national-level Area Deprivation Indices (ADIs), which incorporate neighborhood affluence and resources. METHODS We abstracted clinical data from medical records for ovarian cancer cases from the Vanderbilt University Medical Center and obtained ADIs from the Neighborhood Atlas®. Associations with clinical characteristics were assessed with Spearman correlations and Kruskal-Wallis tests; associations with progression-free survival (PFS) and overall survival (OS) were assessed with Cox proportional-hazards regression. RESULTS Among 184 cases, state and national ADIs were highly correlated, but not related to any cancer characteristics. In multivariable adjusted regression models, both were significantly associated with OS; each decile increase in state or national ADI corresponded to a 9 % or 10 % greater risk of death, respectively. CONCLUSIONS Increasing area-level deprivation may negatively impact ovarian cancer survival.
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Affiliation(s)
- Demetra H Hufnagel
- Vanderbilt University School of Medicine, Nashville, TN 37240, USA; Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Dineo Khabele
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Fiona E Yull
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37212, USA; Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Pamela C Hull
- Division of Population Science and Community Impact, University of Kentucky, Markey Cancer Center, Lexington, KY 40536, USA
| | - Joellen Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Marta A Crispens
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Alicia Beeghly-Fadiel
- Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
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17
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Cuneo MG, Szeto A, Schrepf A, Thaker PH, Goodheart M, Cole SW, Sood AK, McCabe PM, Mendez AJ, Lutgendorf SK. Positive Psychosocial Factors and Oxytocin in the Ovarian Tumor Microenvironment. Psychosom Med 2021; 83:417-422. [PMID: 34080583 PMCID: PMC8175871 DOI: 10.1097/psy.0000000000000935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Clinical ovarian cancer research shows relationships between psychosocial factors and disease-promoting aspects of the stress response (e.g., norepinephrine and cortisol). However, little is known about how psychosocial factors might relate to beneficial hormones in the ovarian tumor microenvironment. Here we examine relationships between psychosocial factors and tumor-associated oxytocin, a hormone linked to survival and antitumor processes in ovarian cancer. METHODS Patients with ovarian cancer (n = 96) completed assessments of positive psychosocial factors (social support, positive affect, and purpose in life) and distress (perceived stress and depression) at the time of surgery. Levels of oxytocin and interleukin (IL) 6 in ascites fluid were obtained during surgery and analyzed by enzyme-linked immunosorbent assay. Multiple regression analyses adjusting a priori for patient age and disease stage examined associations between psychosocial factors and ascites oxytocin. IL-6 was used as a covariate in secondary analyses to examine the potentially confounding effects of inflammation in these relationships. RESULTS Higher levels of positive affect (β = 0.22, p = .034), purpose in life (β = 0.31, p = .021), and social nurturance (β = 0.24, p = .024) were all related to higher levels of tumor-associated oxytocin at the time of surgery. In contrast, we found no effects for distress or social attachment. Relationships between oxytocin, purpose in life, and social nurturance were independent of IL-6, whereas positive affect was no longer significant with IL-6 in the model. CONCLUSIONS Tumor-associated oxytocin may be a previously uninvestigated link in the relationship between psychosocial factors and health in ovarian cancer. Future studies should examine causal mechanisms of relationships observed in this study.
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Affiliation(s)
| | | | - Andrew Schrepf
- Department of Psychological & Brain Sciences,
University of Iowa
| | - Premal H. Thaker
- Division of Gynecologic Oncology, Department of Obstetrics
and Gynecology, Washington University School of Medicine
| | - Michael Goodheart
- Holden Comprehensive Cancer Center, University of
Iowa
- Division of Gynecologic Oncology, Department of Obstetrics
and Gynecology, University of Iowa
| | - Steve W. Cole
- Department of Medicine, Division of Hematology/Oncology and
Molecular Biology Institute, David Geffen School of Medicine, University of
California, Los Angeles
| | - Anil K. Sood
- Departments of Gynecologic Oncology, Cancer Biology and
Center for RNA Interference and Noncoding RNA, University of Texas M.D. Anderson
Cancer Center
| | | | - Armando J. Mendez
- Diabetes Research Institute, Division of Endocrinology,
Diabetes and Metabolism, Department of Medicine, Miller School of Medicine,
University of Miami
| | - Susan K. Lutgendorf
- Department of Psychological & Brain Sciences,
University of Iowa
- Holden Comprehensive Cancer Center, University of
Iowa
- Division of Gynecologic Oncology, Department of Obstetrics
and Gynecology, University of Iowa
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18
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Iftikhar A, Islam M, Shepherd S, Jones S, Ellis I. Cancer and Stress: Does It Make a Difference to the Patient When These Two Challenges Collide? Cancers (Basel) 2021; 13:cancers13020163. [PMID: 33418900 PMCID: PMC7825104 DOI: 10.3390/cancers13020163] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Head and neck cancers are the sixth most common cancer in the world. The burden of the disease has remained challenging over recent years despite the advances in treatments of other malignancies. The very use of the word malignancy brings about a stress response in almost all adult patients. Being told you have a tumour is not a word anyone wants to hear. We have embarked on a study which will investigate the effect of stress pathways on head and neck cancer patients and which signalling pathways may be involved. In the future, this will allow clinicians to better manage patients with head and neck cancer and reduce the patients’ stress so that this does not add to their tumour burden. Abstract A single head and neck Cancer (HNC) is a globally growing challenge associated with significant morbidity and mortality. The diagnosis itself can affect the patients profoundly let alone the complex and disfiguring treatment. The highly important functions of structures of the head and neck such as mastication, speech, aesthetics, identity and social interactions make a cancer diagnosis in this region even more psychologically traumatic. The emotional distress engendered as a result of functional and social disruption is certain to negatively affect health-related quality of life (HRQoL). The key biological responses to stressful events are moderated through the combined action of two systems, the hypothalamus–pituitary–adrenal axis (HPA) which releases glucocorticoids and the sympathetic nervous system (SNS) which releases catecholamines. In acute stress, these hormones help the body to regain homeostasis; however, in chronic stress their increased levels and activation of their receptors may aid in the progression of cancer. Despite ample evidence on the existence of stress in patients diagnosed with HNC, studies looking at the effect of stress on the progression of disease are scarce, compared to other cancers. This review summarises the challenges associated with HNC that make it stressful and describes how stress signalling aids in the progression of cancer. Growing evidence on the relationship between stress and HNC makes it paramount to focus future research towards a better understanding of stress and its effect on head and neck cancer.
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19
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COVID-19 threatens maternal mental health and infant development: possible paths from stress and isolation to adverse outcomes and a call for research and practice. Child Psychiatry Hum Dev 2021; 52:200-204. [PMID: 33619672 PMCID: PMC7899198 DOI: 10.1007/s10578-021-01140-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic exposed mothers to stress and social isolation during the pre- and post-natal periods. The deleterious effects of stress on both pregnant women and their infants are well documented, with research suggesting that effects are exacerbated by reduced social support. In this brief report, we summarize evidence linking stress and social isolation to negative outcomes for mothers and infants and present a conceptual model featuring inflammation as a driving mechanism. There is strong evidence that the coronavirus pandemic will affect mothers and infants through immune pathways that, in previous research, have been shown to link stress and social isolation during the pre- and post-natal periods with deficits in maternal mental health and infant well-being and development across developmental stages. We close with recommendations for novel research, policy changes, and integrated clinical care that can address these biological threats to infants and mothers while leveraging the anti-inflammatory effects of social support.
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20
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Hoogland AI, Jim HSL, Gonzalez BD, Small BJ, Gilvary D, Breen EC, Bower JE, Fishman M, Zachariah B, Jacobsen PB. Systemic inflammation and symptomatology in patients with prostate cancer treated with androgen deprivation therapy: Preliminary findings. Cancer 2020; 127:1476-1482. [PMID: 33378113 DOI: 10.1002/cncr.33397] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/29/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Increases in fatigue, depressive symptomatology, and cognitive impairment are common after the initiation of androgen deprivation therapy (ADT) for prostate cancer. To date, no studies have examined the potential role of inflammation in the development of these symptoms in ADT recipients. The goal of the current study was to examine circulating markers of inflammation as potential mediators of change in fatigue, depressive symptomatology, and cognitive impairment related to the receipt of ADT. METHODS Patients treated with ADT for prostate cancer (ADT+; n = 47) were assessed around the time of the initiation of ADT and 6 and 12 months later. An age- and education-matched group of men without a history of cancer (CA-; n = 82) was assessed at comparable time points. Fatigue, depressive symptomatology, and cognitive impairment were assessed with the Fatigue Symptom Inventory, the Center for Epidemiological Studies Depression Scale, and a battery of neuropsychological tests, respectively. Circulating markers of inflammation included interleukin 1 receptor antagonist (IL-1RA), interleukin 6 (IL-6), soluble tumor necrosis factor receptor II (sTNF-RII), and C-reactive protein (CRP). RESULTS Fatigue, depressive symptomatology, and serum IL-6 increased significantly over time in the ADT+ group versus the CA- group; rates of cognitive impairment also changed significantly between the groups. No significant changes in IL-1RA, sTNF-RII, or CRP over time were detected. Treatment-related increases in IL-6 were associated with worsening fatigue but not depressive symptomatology or cognitive impairment. CONCLUSIONS Results of this preliminary study suggest that increases in circulating IL-6, perhaps due to testosterone inhibition, may play a role in fatigue secondary to receipt of ADT. Additional research is needed to determine whether interventions to reduce circulating inflammation improve fatigue in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Babu Zachariah
- James A. Haley Veterans Affairs' Medical Center, Tampa, Florida
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21
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Zhou Q, Ding W, Qian Z, Jiang G, Sun C, Xu K. Chronic Unpredictable Mild Stress Accelerates the Growth of Bladder Cancer in a Xenograft Mouse Model. Psychol Res Behav Manag 2020; 13:1289-1297. [PMID: 33380846 PMCID: PMC7767701 DOI: 10.2147/prbm.s288983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/10/2020] [Indexed: 01/17/2023] Open
Abstract
Objective Chronic psychological stress is common in patients with bladder cancer. An increasing number of evidence demonstrated that psychiatric disorder leads to worse prognostic outcomes in bladder cancer. This study was to investigate the effects of chronic psychological stress on the growth of bladder cancer and its potential mechanisms. Methods A xenograft mouse model was established by subcutaneously implanting the human bladder cancer cell line T24 into nude mice. All of the tumor-bearing mice (N=20) were randomly separated into two groups. Mice in the control group were subjected to normal feeding conditions, while in another group, a chronic unpredictable mild stress (CUMS) model was established, in which mice were exposed to various types of stressors. Various analyses were performed on parameters including the tumor volume, tumor weight, expression of Caspase-3 and VEGF, proportion of Ki-67 positive cells (Ki-67 index), microvessel density (MVD) and serum concentrations of epinephrine and cortisol. Results In the CUMS group, the growth of transplanted tumors was distinctly accelerated, with the weight of removed tumors at the end of experiment increased by 34.07% compared to that of the control. Serum levels of epinephrine and cortisol determined by ELISA were significantly increased by CUMS. Immunohistochemistry and Western blot analysis showed that the expression of Caspase-3 was downregulated, whereas the expression of VEGF was upregulated in the CUMS group. Meanwhile, CUMS could increase the Ki-67 index and MVD. Conclusion Our research supports the hypothesis that CUMS could affect the growth of bladder cancer in nude mice, indicating that the intervention of chronic psychological stress may be a possible therapeutic strategy for bladder cancer.
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Affiliation(s)
- Qidong Zhou
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Weihong Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhiyu Qian
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Guangliang Jiang
- Department of Urology, Ruijin Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Chuanyu Sun
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ke Xu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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22
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Lutgendorf SK, Penedo F, Goodheart MJ, Dahmoush L, Arevalo JMG, Thaker PH, Slavich GM, Sood AK, Cole SW. Epithelial-mesenchymal transition polarization in ovarian carcinomas from patients with high social isolation. Cancer 2020; 126:4407-4413. [PMID: 32691853 DOI: 10.1002/cncr.33060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Social isolation has shown robust associations with clinical outcomes in the general population and in patients with cancer. In patients with ovarian cancer, social isolation has been found to be related to decreased survival and multiple biomarkers supporting tumor progression. However, to the authors' knowledge, little is known regarding the relationship between social isolation and the molecular characteristics of ovarian tumors. Herein, the authors have used genome-wide transcriptional profiling to quantify associations between social isolation and epithelial-mesenchymal transition (EMT) polarization in ovarian tumors and transcriptome-driven, promoter-based bioinformatics analyses to identify gene regulatory pathways that may potentially underlie these changes. METHODS Tumor was sampled during primary surgical resection and immediately frozen in liquid nitrogen. After RNA extraction, microarray analysis of the transcriptome was performed and samples were analyzed to assess associations between EMT-related gene transcripts and social isolation (as indicated by a Social Provisions Scale Attachment subscale score <15). Convergent validation was provided by a promoter-based bioinformatic analysis of transcription factor activity. RESULTS Primary analyses of 99 women demonstrated a lower average expression of gene transcripts previously associated with epithelial differentiation in women with high social isolation (-0.143 ± 0.048 log2 mRNA abundance; P = .004), but no difference in mesenchymal differentiation as a function of social isolation (+0.007 ± 0.0064 log2 mRNA abundance; P = .900). Upregulated activity was shown for 3 of the 4 targeted EMT-related transcription factors, including GATA4 (P = .014); SMAD2, SMAD3, and/or SMAD4 (P < .001); and TWIST1 (P < .001). Analyses of SNAIL2/SLUG activity indicated a directional trend toward increased activity that did not reach statistical significance (P = .123). CONCLUSIONS The findings of the current study demonstrated differential EMT polarization and EMT-related transcription factor activity according to social isolation, a known socioenvironmental risk factor. LAY SUMMARY Social isolation has shown robust associations with clinical outcomes in the general population and in patients with cancer. Herein, the authors examined the relationship between social isolation and the molecular characteristics of ovarian tumors. The authors investigated the epithelial-mesenchymal transition (EMT), a process whereby tumor cells lose epithelial characteristics and become more embryonic (mesenchymal), thereby enhancing invasiveness. Primary analyses demonstrated lower expression of genes previously associated with epithelial differentiation and increased activity of specific EMT-related transcription factors in individuals with high social isolation, indicating increased EMT polarization in these patients. These findings extend the understanding of how socioenvironmental factors may modulate tumor growth.
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Affiliation(s)
- Susan K Lutgendorf
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.,Department of Urology, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Frank Penedo
- Department of Psychology, University of Miami, Miami, Florida.,Sylvester Cancer Center, University of Miami, Miami, Florida
| | - Michael J Goodheart
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Laila Dahmoush
- Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Jesusa M G Arevalo
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Center for RNA Interference and Noncoding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steve W Cole
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Cousins Center for Psychoneuroimmunology, University of California at Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California
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23
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Lamboy-Caraballo R, Ortiz-Sanchez C, Acevedo-Santiago A, Matta J, N.A. Monteiro A, N. Armaiz-Pena G. Norepinephrine-Induced DNA Damage in Ovarian Cancer Cells. Int J Mol Sci 2020; 21:ijms21062250. [PMID: 32213975 PMCID: PMC7139728 DOI: 10.3390/ijms21062250] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 12/17/2022] Open
Abstract
Multiple studies have shown that psychological distress in epithelial ovarian cancer (EOC) patients is associated with worse quality of life and poor treatment adherence. This may influence chemotherapy response and prognosis. Moreover, although stress hormones can reduce cisplatin efficacy in EOC treatment, their effect on the integrity of DNA remains poorly understood. In this study, we investigated whether norepinephrine and epinephrine can induce DNA damage and modulate cisplatin-induced DNA damage in three EOC cell lines. Our data show that norepinephrine and epinephrine exposure led to increased nuclear γ-H2AX foci formation in EOC cells, a marker of double-strand DNA breaks. We further characterized norepinephrine-induced DNA damage by subjecting EOC cells to alkaline and neutral comet assays. Norepinephrine exposure caused DNA double-strand breaks, but not single-strand breaks. Interestingly, pre-treatment with propranolol abrogated norepinephrine-induced DNA damage indicating that its effects may be mediated by β-adrenergic receptors. Lastly, we determined the effects of norepinephrine on cisplatin-induced DNA damage. Our data suggest that norepinephrine reduced cisplatin-induced DNA damage in EOC cells and that this effect may be mediated independently of β-adrenergic receptors. Taken together, these results suggest that stress hormones can affect DNA integrity and modulate cisplatin resistance in EOC cells.
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Affiliation(s)
- Rocio Lamboy-Caraballo
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA; (R.L.-C.); (J.M.)
| | | | | | - Jaime Matta
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA; (R.L.-C.); (J.M.)
- Division of Cancer Biology, Ponce Research Institute, Ponce, PR 00716, USA;
| | - Alvaro N.A. Monteiro
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Guillermo N. Armaiz-Pena
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR 00716, USA; (R.L.-C.); (J.M.)
- Division of Cancer Biology, Ponce Research Institute, Ponce, PR 00716, USA;
- Division of Women’s Health, Ponce Research Institute, Ponce, PR 00716, USA
- Correspondence:
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24
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Kadambi S, Soto-Perez-de-Celis E, Garg T, Loh KP, Krok-Schoen JL, Battisti NML, Moffat GT, Gil-Jr LA, Mohile S, Hsu T. Social support for older adults with cancer: Young International Society of Geriatric Oncology review paper. J Geriatr Oncol 2020; 11:217-224. [PMID: 31628066 PMCID: PMC7384244 DOI: 10.1016/j.jgo.2019.09.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/04/2019] [Accepted: 09/05/2019] [Indexed: 12/20/2022]
Abstract
Older adults with cancer have increasing needs in physical, cognitive, and emotional domains, and they can experience decline in all domains with the diagnosis and treatment of cancer. Social support plays a key role in supporting these patients, mitigating negative effects of diagnosis and treatment of cancer, and improving cancer outcomes. We review the importance of social support in older adults with cancer, describe the different components of social support and how they are measured, discuss current interventions that are available to improve social support in older adults, and describe burdens on caregivers. We also highlight Dr. Arti Hurria's contributions to recognizing the integral role of social support to caring for older adults with cancer.
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Affiliation(s)
- Sindhuja Kadambi
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Tullika Garg
- Department of Urology, Department of Epidemiology & Health Services Research, Geisinger, Danville, PA, USA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica L Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | | | - Luiz A Gil-Jr
- Division of Geriatrics, Department of Internal Medicine, Instituto do Câncer do Estado de São Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Supriya Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Tina Hsu
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
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25
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Peres LC, Sinha S, Townsend MK, Fridley BL, Karlan BY, Lutgendorf SK, Shinn E, Sood AK, Tworoger SS. Predictors of survival trajectories among women with epithelial ovarian cancer. Gynecol Oncol 2020; 156:459-466. [PMID: 31839342 PMCID: PMC7771334 DOI: 10.1016/j.ygyno.2019.12.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although ovarian cancer is a deadly disease, approximately a third of women survive ≥9 years after diagnosis. The factors associated with achieving long-term survival are not well understood. In this study, data from the Surveillance, Epidemiology, and End Results (SEER) program were used to determine predictors of survival trajectories among women with epithelial ovarian cancer and across histotype (high-grade serous carcinoma (HGSC) and non-HGSC). METHODS Data on 35,868 women diagnosed with epithelial ovarian cancer in 2004-2016 were extracted from SEER. Extended Cox proportional hazards regression was used to estimate overall and histotype-specific associations between patient and tumor characteristics and all-cause mortality within each survival time (t) interval (t < 3, 3 ≤ t < 6, 6 ≤ t < 9, and 9 ≤ t < 13 years). RESULTS Age at diagnosis, marital status, race/ethnicity, stage, and surgery were more strongly associated with mortality in the short-term survival period, and these associations waned with increasing survival time. Exceptions to this pattern were age >70 years at diagnosis, where a high risk of mortality was observed in both the t < 3 and t ≥ 9 year time periods, and non-Hispanic Asian/Pacific Islanders, where a more pronounced inverse association with mortality was observed in t ≥ 9 years after diagnosis. Similar associations were observed for HGSC, although the waning effect was not apparent for most characteristics. Mortality associations for non-HGSC were more pronounced for stage and race/ethnicity, primarily for non-Hispanic Asian/Pacific Islanders. CONCLUSIONS Most patient and tumor characteristics were more strongly associated with mortality in the years following diagnosis, but have declining impact with increasing survival time. Given this waning effect, it is critical to identify factors impacting risk of mortality as ovarian cancer patients advance through the survival trajectory.
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Affiliation(s)
- Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America.
| | - Sweta Sinha
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
| | - Mary K Townsend
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
| | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
| | - Beth Y Karlan
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Susan K Lutgendorf
- Departments of Psychological and Brain Sciences and Obstetrics and Gynecology, University of Iowa, Iowa City, IA, United States of America
| | - Eileen Shinn
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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26
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Hasselmo K, Mehl MR, Tackman AM, Carey AL, Wertheimer AM, Stowe RP, Sbarra DA. Objectively Measured Social Integration Is Associated With an Immune Risk Phenotype Following Marital Separation. Ann Behav Med 2019. [PMID: 29538627 DOI: 10.1093/abm/kax034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Close relationships play an integral role in human development, and robust evidence links marital separation and divorce to poor health outcomes. Social integration may play a key role in this association. In many ways, the study of marital separation and divorce provides an ideal model system for a more complete understanding of the association between life stress and physical health. Purpose The current study investigated associations among objectively measured social integration, psychological distress, and biomarkers of immune health in recently separated adults (N = 49). Methods We collected four measures of immune functioning-interleukin-6, C-reactive protein, and antibody titers to latent cytomegalovirus and Epstein-Barr virus-that were combined to yield a viral-Immune Risk Profile. To assess how variability in social integration is associated with immunological correlates following the end of a marriage, we incorporated observational ecological momentary assessment data using a novel methodology (the Electronically Activated Recorder). Results We found that objectively measured social behaviors are associated with concurrent viral-Immune Risk Profile scores over and above the effects of psychological distress and that psychological distress may be linked to biomarkers of immune health through social integration. Conclusions This research expands current knowledge of biomarkers of immune health after divorce and separation and includes a new methodology for objective measures of social engagement.
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Affiliation(s)
- Karen Hasselmo
- Department of Psychology, University of Arizona, East University Boulevard, Tucson, AZ, USA
| | - Matthias R Mehl
- Department of Psychology, University of Arizona, East University Boulevard, Tucson, AZ, USA
| | - Allison M Tackman
- Department of Psychology, University of Arizona, East University Boulevard, Tucson, AZ, USA
| | - Angela L Carey
- Department of Psychology, University of Arizona, East University Boulevard, Tucson, AZ, USA
| | - Anne M Wertheimer
- Department of Medicine, Division of Geriatrics, General Internal Medicine and Palliative Medicine and University of Arizona Center on Aging, University of Arizona, Tucson, AZ, USA
| | | | - David A Sbarra
- Department of Psychology, University of Arizona, East University Boulevard, Tucson, AZ, USA
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27
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Leschak CJ, Eisenberger NI. Two Distinct Immune Pathways Linking Social Relationships With Health: Inflammatory and Antiviral Processes. Psychosom Med 2019; 81:711-719. [PMID: 31600173 PMCID: PMC7025456 DOI: 10.1097/psy.0000000000000685] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Social relationships can both influence and be influenced by immune processes. Past work implicates two distinct pathways along which this interaction may occur: inflammatory processes and antiviral processes. This article reviews how social behavior is modulated by these two immune processes and how such processes may in turn regulate social behavior. METHODS This narrative review outlines existing work on social behavior and both inflammatory and antiviral processes. We propose an evolutionary framework that aims to integrate these findings. Specifically, social isolation has evolutionarily increased the likelihood of wounding and therefore increased the need for inflammation, which works to promote healing. Conversely, broader social networks provide protection from physical threats but also lead to increased pathogen exposure, necessitating a more robust antiviral response. RESULTS This review highlights that social adversity, such as social exclusion or loneliness, is associated with increased inflammation, whereas social contact is associated with increased antiviral immunity. Furthermore, increased inflammation leads to sensitivity to social stimuli, presumably to avoid hostile conspecifics and approach allies who may provide care while vulnerable. Individuals with inadequate antiviral immunity engage in behaviors that minimize pathogen exposure, such as reduced affiliative behavior. CONCLUSIONS This review suggests that adverse social experiences (social isolation, perceived social threat) may induce inflammatory responses while suppressing antiviral immunity, whereas positive experiences of social connection may reduce inflammation and bolster antiviral responses. Although acutely elevated inflammation would be adaptive under conditions where wounding is likely, chronic inflammation related to continued social adversity may have detrimental health consequences.
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Affiliation(s)
- Carrianne J Leschak
- From the Department of Psychology, University of California Los Angeles, Los Angeles, California
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28
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Kacel EL, Kirsch JL, Sannes TS, Patidar S, Postupack R, Jensen S, Wong S, Garey S, Dodd S, Ulfig CM, McCrae CS, Robinson ME, Castagno J, Schultz GS, Pereira DB. Interleukin-6 and body mass index, tobacco use, and sleep in gynecologic cancers. Health Psychol 2019; 38:866-877. [PMID: 31368718 DOI: 10.1037/hea0000775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Elevated body mass index (BMI), tobacco use, and sleep disturbance are common health concerns among women with gynecologic cancers. The extent to which these factors are associated with systemic inflammation in gynecologic cancers is unknown. This is a significant literature gap given that (a) chronic, systemic inflammation may mediate relationships between behavioral health factors and cancer outcomes; and (b) elevated BMI, tobacco use, and sleep disturbances can be modified via behavioral interventions. This study examined Interleukin-6 (IL-6) relations with BMI, tobacco use history, and sleep disturbances in patients undergoing surgery for suspected gynecologic cancer. METHOD Participants were 100 women (M age = 58.42 years, SD = 10.62 years) undergoing surgery for suspected gynecologic cancer. Smoking history was determined by participant self-report. Sleep quality/disturbance was assessed via the Pittsburgh Sleep Quality Index. BMI was abstracted from electronic health records. Presurgical serum IL-6 concentrations were determined using Enzyme-Linked Immunosorbent Assay. RESULTS Controlling for the cancer type and stage, regression analyses revealed higher BMI, β = 0.258, p = .007, and former/current smoking status, β = 0.181, p = .046, were associated with higher IL-6. IL-6 did not differ between former and current smokers, β = 0.008, p = .927. Global sleep quality, sleep latency, and sleep efficiency were not associated with IL-6. CONCLUSIONS Higher BMI and any history of tobacco use predicted higher IL-6 among women undergoing surgery for suspected gynecologic cancers. Cognitive-behavioral interventions targeting primary and secondary obesity and tobacco use prevention may reduce systemic inflammation and optimize cancer outcomes in this population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Shan Wong
- Department of Clinical and Health Psychology
| | | | - Stacy Dodd
- Department of Clinical and Health Psychology
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29
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Cheng L, Meiser B. The relationship between psychosocial factors and biomarkers in cancer patients: A systematic review of the literature. Eur J Oncol Nurs 2019; 41:88-96. [DOI: 10.1016/j.ejon.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 02/06/2023]
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30
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Edes AN, Wolfe BA, Crews DE. The first multi-zoo application of an allostatic load index to western lowland gorillas (Gorilla gorilla gorilla). Gen Comp Endocrinol 2018; 266:135-149. [PMID: 29746855 DOI: 10.1016/j.ygcen.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 04/26/2018] [Accepted: 05/06/2018] [Indexed: 01/23/2023]
Abstract
Vertebrate stress responses are highly adaptive biological functions, maximizing survival probability in life-threatening situations. However, experiencing repeated and/or chronic stressors can generate physiological dysregulation and lead to disease. Because stress responses are multi-systemic and involve a wide range of physiological functions, identifying responses to stressors is best accomplished using integrated biomarker models. Allostatic load, defined as the physiological dysregulation that accumulates over the lifespan due to stressful experiences, is one such model. Allostatic load is measured using allostatic load indices, which are composites of biomarkers from multiple somatic systems. Previously, we reported the use of a 7-biomarker allostatic load index (albumin, CRH, cortisol, DHEA-S, glucose, IL-6, TNF-α) in western lowland gorillas housed at a single zoo. Herein, this index is expanded to examine allostatic load responses to lifetime stressors in gorillas from two additional zoos (n = 63) as well as two pooled samples. The index was created using quartile cut-points for each biomarker. Significant associations were observed between multiple predictor variables and allostatic load, including sex, age, number of stressful events (anesthetic events, zoo transfers, agonistic interactions with wounding, pregnancies), and rearing history (mother-reared, nursery-reared, wild-caught). Additionally, allostatic load was associated with indicators of morbidity (creatinine, cholesterol, triglycerides), age at death, and mortality risk. These results are consistent with those reported in human allostatic load research, suggesting allostatic load indices have potential as an investigative and clinical tool for gorillas and other great apes.
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Affiliation(s)
- Ashley N Edes
- Department of Anthropology, 174 West 18th Ave., The Ohio State University, Columbus, OH 43210, United States.
| | - Barbara A Wolfe
- Department of Veterinary Preventive Medicine, 1920 Coffey Rd., The Ohio State University, Columbus, OH 43210, United States
| | - Douglas E Crews
- Department of Anthropology, 174 West 18th Ave., The Ohio State University, Columbus, OH 43210, United States; College of Public Health, 1841 Neil Ave., Columbus, OH 43210, United States
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31
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Jaremka LM, Lebed O, Sunami N. Threats to Belonging, Immune Function, and Eating Behavior: an Examination of Sex and Gender Differences. Curr Psychiatry Rep 2018; 20:71. [PMID: 30094481 DOI: 10.1007/s11920-018-0939-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW The first goal of this review is to discuss the evidence linking belonging threats to immune function and food intake. The second goal is to evaluate whether the links among belonging threats, immune function, and eating behavior differ based on gender. RECENT FINDINGS Threats to belonging are linked to elevated herpesvirus antibody titers, dysregulated appetite-relevant hormones, and increased food consumption. Furthermore, these relationships are largely consistent for both men and women. Threats to belonging are also linked to elevated inflammation. However, some studies showed that these effects were stronger among women, others demonstrated that they were stronger among men, and others determined that the links were consistent for men and women. Understanding why belonging threats are inconsistently linked to inflammation across men and women is an important next step. We conclude the review with four concrete recommendations for researchers studying belonging threats, immune function, and eating behavior.
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Affiliation(s)
- Lisa M Jaremka
- Department of Psychological and Brain Sciences, University of Delaware, 212 Wolf Hall, Newark, DE, 19716, USA.
| | - Olga Lebed
- Department of Psychological and Brain Sciences, University of Delaware, 212 Wolf Hall, Newark, DE, 19716, USA
| | - Naoyuki Sunami
- Department of Psychological and Brain Sciences, University of Delaware, 212 Wolf Hall, Newark, DE, 19716, USA
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32
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Bower JE, Shiao SL, Sullivan P, Lamkin DM, Atienza R, Mercado F, Arevalo J, Asher A, Ganz PA, Cole SW. Prometastatic Molecular Profiles in Breast Tumors From Socially Isolated Women. JNCI Cancer Spectr 2018; 2:pky029. [PMID: 30057973 PMCID: PMC6054021 DOI: 10.1093/jncics/pky029] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/15/2018] [Accepted: 06/01/2018] [Indexed: 01/07/2023] Open
Abstract
Background Social isolation is associated with accelerated breast cancer progression and increased disease recurrence and mortality, but the underlying biological mechanisms remain poorly understood. In preclinical models, beta-adrenergic signaling from fight-or-flight stress responses can stimulate prometastatic processes in the tumor microenvironment including upregulation of M2 macrophages, epithelial–mesenchymal transition (EMT), and lymphovascular invasion. This study examines whether the same pathways are upregulated in breast tumors from socially isolated cancer patients. Methods EMT and M1/M2 macrophage gene expression programs were analyzed by genome-wide transcriptional profiling, and lymphatic and vascular density were assessed by immunohistochemistry in primary tumors from 56 early-stage breast cancer patients who were part of the UCLA RISE study. Social isolation was quantified by the Social Provisions Scale, and disease characteristics were assessed by medical record review. General linear models were used to quantify differential gene expression across risk factor groups. Linear regression models were used to examine associations between social isolation and lymphovascular invasion. Results Tumors from socially isolated patients showed upregulated expression of genes involved in EMT (average score difference = +0.080 log2 mRNA abundance ± 0.034 standard error) and M2 macrophage polarization (+0.033 ± 0.014) as well as increased density of lymphatic vessels (β= –.29) but no difference in blood vessel density. TELiS promoter–based bioinformatics analyses indicated activation of CREB family transcription factors that mediate the gene-regulatory effects of β-adrenergic signaling (log2 fold-difference in promoter binding site prevalence: mean ± standard error = +0.49 ± 0.19). Conclusions Primary breast tumors from socially isolated patients show multiple prometastatic molecular alterations, providing a plausible biological pathway through which poor social support may accelerate breast cancer progression and defining new targets for intervention.
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Affiliation(s)
- Julienne E Bower
- Department of Psychology.,Department of Psychiatry and Biobehavioral Sciences.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA
| | - Stephen L Shiao
- Department of Radiation Oncology.,Department of Biomedical Sciences
| | | | - Donald M Lamkin
- Department of Psychiatry and Biobehavioral Sciences.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA
| | | | | | | | - Arash Asher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Patricia A Ganz
- School of Medicine.,School of Public Health, UCLA, Los Angeles, CA.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA
| | - Steve W Cole
- Department of Psychiatry and Biobehavioral Sciences.,Department of Medicine.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA
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33
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Idahl A, Hermansson A, Lalos A. Social support and ovarian cancer incidence - A Swedish prospective population-based study. Gynecol Oncol 2018; 149:324-328. [PMID: 29555331 DOI: 10.1016/j.ygyno.2018.03.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/01/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Low social support is associated with worse prognosis for epithelial ovarian cancer (EOC) patients. However, few studies have explored the relation between low social support and incidence of EOC. The aim of this prospective nested case-control study was to examine whether self-perceived low social support was associated with the incidence of EOC. METHODS The Swedish Cancer Registry was used to identify participants in the Västerbotten Intervention Programme (VIP) comprising 58,000 women, who later developed EOC. Each case was matched to four cancer free controls. The VIP uses the Social Support questionnaire, a modified version of the validated questionnaire "The Interview Schedule for Social Interaction" (ISSI) measuring quantitative (AVSI) and qualitative (AVAT) aspects of social support. RESULTS The risk of EOC in relation to AVSI and AVAT was similar between the 239 cases and the 941 controls after adjustment for educational level, smoking, BMI, Cambridge Physical Activity Index and age (aOR 0.85, 95% CI 0.72-1.01 and aOR 0.54, 95% CI 0.16-1.81). Lagtime was found to have no impact. A decreased risk of serous ovarian cancer was seen in women with fewer persons available for informal socializing (aOR 0.75, 95% CI 0.59-0.95). Adjusted analyses showed non-significant odds ratios below 1.0 in the vast majority of histotypes. CONCLUSIONS A general trend towards a decreased risk of ovarian cancer associated with low AVSI and AVAT was identified. Solely the serous subtype was significantly associated with low scores of AVSI. Prospective pathophysiological and epidemiological studies regarding social support are needed.
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Affiliation(s)
- Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE-901 87 Umeå, Sweden.
| | - Andrea Hermansson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE-901 87 Umeå, Sweden.
| | - Ann Lalos
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE-901 87 Umeå, Sweden.
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Lutgendorf SK, Thaker PH, Arevalo JM, Goodheart MJ, Slavich GM, Sood AK, Cole SW. Biobehavioral modulation of the exosome transcriptome in ovarian carcinoma. Cancer 2018; 124:580-586. [PMID: 29112229 PMCID: PMC5780197 DOI: 10.1002/cncr.31078] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/29/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Social factors in the patient macroenvironment have been shown to influence molecular events in the tumor microenvironment and thereby influence cancer progression. However, biomarkers providing a window into the longitudinal effects of biobehavioral factors on tumor biology over time are lacking. Exosome analysis is a novel strategy for in vivo monitoring of dynamic changes in tumor cells. This study examined exosomal profiles from patients with low or high levels of social support for epithelial-mesenchymal transition (EMT) polarization and gene expression related to inflammation and β-adrenergic signaling. METHODS Exosomes were isolated from plasma sampled from a series of 40 women before primary surgical resection of advanced-stage, high-grade ovarian carcinoma. Samples were selected for analysis on the basis of extremes of low and high levels of social support. After exosomal isolation and RNA extraction, a microarray analysis of the transcriptome was performed. RESULTS Primary analyses identified significant upregulation of 67 mesenchymal-characteristic gene transcripts and downregulation of 63 epithelial-characteristic transcripts in patients with low social support; this demonstrated increased EMT polarization (P = .0002). Secondary analyses using promoter sequence bioinformatics supported a priori hypotheses linking low social support to 1) increased activity of cyclic adenosine monophosphate response element binding protein (CREB)/activating transcription factor (ATF) family transcription factors that mediate the β-adrenergic response to catecholamines via the cyclic adenosine monophosphate/protein kinase A signaling pathway (mean fold change for CREB: 2.24 ± 0.65; P = .0019; mean fold change for ATF: 2.00 ± 0.55; P = .0049) and 2) increased activity of the proinflammatory nuclear factor κB/Rel family of transcription factors (mean fold change: 2.10 ± 0.70; P = .0109). CONCLUSIONS These findings suggest the possibility of leveraging exosomes as a noninvasive assessment of biobehavioral factors to help to direct personalized treatment approaches. Cancer 2018;124:580-6. © 2017 American Cancer Society.
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Affiliation(s)
- Susan K. Lutgendorf
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA
- Department of Urology, University of Iowa, Iowa City, IA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
| | - Premal H. Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
| | - Jesusa M. Arevalo
- Division of Hematology/Oncology, David Geffen School of Medicine, and the Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA
| | - Michael J. Goodheart
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA
| | - George M. Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Anil K. Sood
- Departments of Gynecologic Oncology and Cancer Biology, University of Texas, MD Anderson Cancer Center, Houston, TX
- Center for RNA Interference and Noncoding RNA, University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Steve W. Cole
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
- Division of Hematology/Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA
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Spencer-Hwang R, Torres X, Valladares J, Pasco-Rubio M, Dougherty M, Kim W. Adverse Childhood Experiences among a Community of Resilient Centenarians and Seniors: Implications for a Chronic Disease Prevention Framework. Perm J 2018; 22:17-146. [PMID: 29702049 PMCID: PMC5922855 DOI: 10.7812/tpp/17-146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Research has linked adverse childhood experiences (ACEs) with chronic disease in adults and diminished life span. Adverse biological embedding of ACEs potentially occurs through inflammatory mechanisms; inflammatory marker alterations are identified as candidate biomarkers for mediating health consequences. Lifestyle practices of residents of California's Loma Linda Blue Zone, one of five worldwide longevity hotspots, may provide insight into inflammation remediation and chronic disease prevention. Little research has been done on centenarians' early-life experiences or on ACEs in a longevity community. OBJECTIVE To interview centenarians and seniors in this region regarding their childhood experiences to inform chronic disease prevention frameworks. DESIGN Qualitative study of Loma Linda Blue Zone community members. Childhood exposures and practices were assessed using focus groups and semistructured key informant interviews, with open-ended questions on general hardships and ACEs and supplemented with lifestyle and resiliency factor questions. Data were audiorecorded and transcribed. Integrative grounded theory methods guided coding and theming. MAIN OUTCOME MEASURES Exposure to ACEs and practice of resiliency factors. RESULTS Participants (7 centenarians and 29 seniors) reported exposure to multiple ACEs (domains: Economic deprivation, family dysfunction, and community violence). Community members reported practicing resiliency factors, each with anti-inflammatory properties suggesting mitigation of ACE-related toxic stress. CONCLUSION This is one of the first studies of its kind to identify a community of resilient members despite their tremendous burden of ACEs. Embedding the identified resiliency factors into chronic disease prevention frameworks has potential for mitigating systemic inflammation, alleviating chronic disease burden, and promoting a culture of health.
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Affiliation(s)
- Rhonda Spencer-Hwang
- Associate Professor at the Center for Community Resilience in the School of Public Health at Loma Linda University in CA.
| | - Xochitl Torres
- Research Associate at the Center for Community Resilience in the School of Public Health at Loma Linda University in CA.
| | - Johanny Valladares
- Research Associate at the Center for Community Resilience in the School of Public Health at Loma Linda University in CA.
| | - Marco Pasco-Rubio
- Research Associate at the Center for Community Resilience in the School of Public Health at Loma Linda University in CA.
| | - Molly Dougherty
- Research Assistant at the Center for Community Resilience in the School of Public Health at Loma Linda University in CA.
| | - Wonha Kim
- Assistant Professor of Pediatrics and Preventive Medicine at the Loma Linda University School of Medicine and Director of the Health Policy and Leadership Institute at Loma Linda University in CA.
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Zhang J, Gan L, Wu Z, Yan S, Liu X, Guo W. The influence of marital status on the stage at diagnosis, treatment, and survival of adult patients with gastric cancer: a population-based study. Oncotarget 2017; 8:22385-22405. [PMID: 26894860 PMCID: PMC5410231 DOI: 10.18632/oncotarget.7399] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 12/20/2022] Open
Abstract
Background & Aims Marital status was reported as a prognostic factor in many cancers. However, its role in gastric cancer (GC) hasn't been thoroughly explored. In this study, we aimed to investigate the effect of marital status on survival, stage, treatment, and survival in subgroups. Methods We used the Surveillance, Epidemiology and End Results (SEER) database and identified 16910 GC patients. These patients were categorized into married (58.44%) and unmarred (41.56%) groups. Pearson chi-square, Wilcoxon-Mann-Whitney, Log-rank, multivariate Cox regression, univariate and multivariate binomial or multinomial logistic regression analysis were used in our analysis. Subgroup analyses of married versus unmarried patients were summarized in a forest plot. Results Married patients had better 5-year overall survival (OS) (32.09% VS 24.61%, P<0.001) and 5-year cancer-caused special survival (CSS) (37.74% VS 32.79%, P<0.001) than unmarried ones. Then we studied several underlying mechanisms. Firstly, married patients weren't in earlier stage at diagnosis (P=0.159). Secondly, married patients were more likely to receive surgery (P < 0.001) or radiotherapy (P < 0.001) compared with the unmarried. Thirdly, in subgroup analyses, married patients still had survival advantage in subgroups with stage II-IV and no radiotherapy. Conclusions These results showed that marital status was an independently prognostic factor for both OS and CSS in GC patients. Undertreatment and lack of social support in unmarried patients were potential explanations. With the knowledge of heterogeneous effects of marriage in subgroups, we can target unmarried patients with better social support, especially who are diagnosed at late stage and undergo no treatment.
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Affiliation(s)
- Jieyun Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Lu Gan
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Zhenhua Wu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Shican Yan
- Department of Surgery, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Xiyu Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Weijian Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
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Bortolato B, Hyphantis TN, Valpione S, Perini G, Maes M, Morris G, Kubera M, Köhler CA, Fernandes BS, Stubbs B, Pavlidis N, Carvalho AF. Depression in cancer: The many biobehavioral pathways driving tumor progression. Cancer Treat Rev 2016; 52:58-70. [PMID: 27894012 DOI: 10.1016/j.ctrv.2016.11.004] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/15/2016] [Accepted: 11/05/2016] [Indexed: 12/11/2022]
Abstract
Major Depressive Disorder (MDD) is common among cancer patients, with prevalence rates up to four-times higher than the general population. Depression confers worse outcomes, including non-adherence to treatment and increased mortality in the oncology setting. Advances in the understanding of neurobiological underpinnings of depression have revealed shared biobehavioral mechanisms may contribute to cancer progression. Moreover, psychosocial stressors in cancer promote: (1) inflammation and oxidative/nitrosative stress; (2) a decreased immunosurveillance; and (3) a dysfunctional activation of the autonomic nervous system and of the hypothalamic-pituitaryadrenal axis. Consequently, the prompt recognition of depression among patients with cancer who may benefit of treatment strategies targeting depressive symptoms, cognitive dysfunction, fatigue and sleep disturbances, is a public health priority. Moreover, behavioral strategies aiming at reducing psychological distress and depressive symptoms, including addressing unhealthy diet and life-style choices, as well as physical inactivity and sleep dysfunction, may represent important strategies not only to treat depression, but also to improve wider cancer-related outcomes. Herein, we provide a comprehensive review of the intertwined biobehavioral pathways linking depression to cancer progression. In addition, the clinical implications of these findings are critically reviewed.
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Affiliation(s)
| | - Thomas N Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Sara Valpione
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Medical Oncology, The Christie NHS Trust, Manchester, United Kingdom
| | - Giulia Perini
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Michael Maes
- IMPACT Strategic Research Centre, Deakin University, School of Medicine and Barwon Health, Geelong, VIC, Australia; Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Faculty of Medicine, State University of Londrina, Londrina, Brazil; Department of Psychiatry, Medical University Plovdiv, Plovdiv, Bulgaria; Revitalis, Waalre, The Netherlands
| | - Gerwyn Morris
- Tir Na Nog, Bryn Road Seaside 87, Llanelli SA152LW, Wales, UK
| | - Marta Kubera
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, Polish Academy of Science, Krakow, Poland
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Fortaleza, CE, Brazil
| | - Brisa S Fernandes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, and Barwon Health, Geelong, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London Box SE5 8AF, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford CM1 1SQ, United Kingdom
| | - Nicholas Pavlidis
- Department of Medical Oncology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina 45110, Greece
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Fortaleza, CE, Brazil.
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38
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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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McHugh Power J, Carney S, Hannigan C, Brennan S, Wolfe H, Lynch M, Kee F, Lawlor B. Systemic inflammatory markers and sources of social support among older adults in the Memory Research Unit cohort. J Health Psychol 2016; 24:397-406. [PMID: 27815328 DOI: 10.1177/1359105316676331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Potential associations between systemic inflammation and social support received by a sample of 120 older adults were examined here. Inflammatory markers, cognitive function, social support and psychosocial wellbeing were evaluated. A structural equation modelling approach was used to analyse the data. The model was a good fit χ1082=256.13 , p < 0.001; comparative fit index = 0.973; Tucker-Lewis Index = 0.962; root mean square error of approximation = 0.021; standardised root mean-square residual = 0.074). Chemokine levels were associated with increased age ( β = 0.276), receipt of less social support from friends ( β = -0.256) and body mass index ( β = -0.256). Results are discussed in relation to social signal transduction theory.
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Affiliation(s)
- Joanna McHugh Power
- 1 Trinity College, University of Dublin, Republic of Ireland.,2 Queen's University Belfast, UK
| | - Sile Carney
- 1 Trinity College, University of Dublin, Republic of Ireland
| | | | - Sabina Brennan
- 1 Trinity College, University of Dublin, Republic of Ireland
| | - Hannah Wolfe
- 1 Trinity College, University of Dublin, Republic of Ireland
| | - Marina Lynch
- 1 Trinity College, University of Dublin, Republic of Ireland
| | | | - Brian Lawlor
- 1 Trinity College, University of Dublin, Republic of Ireland
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40
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Stonnington CM, Darby B, Santucci A, Mulligan P, Pathuis P, Cuc A, Hentz JG, Zhang N, Mulligan D, Sood A. A resilience intervention involving mindfulness training for transplant patients and their caregivers. Clin Transplant 2016; 30:1466-1472. [DOI: 10.1111/ctr.12841] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | | | | | - Andrea Cuc
- Department of Psychiatry and Psychology; Mayo Clinic; Scottsdale AZ USA
| | | | - Nan Zhang
- Department of Biostatistics; Mayo Clinic; Scottsdale AZ USA
| | - David Mulligan
- Section of Transplantation and Immunology; Department of Surgery; Yale-New Haven Hospital Transplantation Center; Yale School of Medicine; New Haven CT USA
| | - Amit Sood
- Department of Internal Medicine; Mayo Clinic; Rochester MN USA
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Nagaraja AS, Dorniak PL, Sadaoui NC, Kang Y, Lin T, Armaiz-Pena G, Wu SY, Rupaimoole R, Allen JK, Gharpure KM, Pradeep S, Zand B, Previs RA, Hansen JM, Ivan C, Rodriguez-Aguayo C, Yang P, Lopez-Berestein G, Lutgendorf SK, Cole SW, Sood AK. Sustained adrenergic signaling leads to increased metastasis in ovarian cancer via increased PGE2 synthesis. Oncogene 2016; 35:2390-7. [PMID: 26257064 PMCID: PMC4749473 DOI: 10.1038/onc.2015.302] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/24/2015] [Accepted: 06/29/2015] [Indexed: 12/17/2022]
Abstract
Adrenergic stimulation adversely affects tumor growth and metastasis, but the underlying mechanisms are not well understood. Here, we uncovered a novel mechanism by which catecholamines induce inflammation by increasing prostaglandin E2 (PGE2) levels in ovarian cancer cells. Metabolic changes in tumors isolated from patients with depression and mice subjected to restraint stress showed elevated PGE2 levels. Increased metabolites, PTGS2 and PTGES protein levels were found in Skov3-ip1 and HeyA8 cells treated with norepinephrine (NE), and these changes were shown to be mediated by ADRB2 receptor signaling. Silencing PTGS2 resulted in significantly decreased migration and invasion in ovarian cancer cells in the presence of NE and decreased tumor burden and metastasis in restraint stress orthotopic models. In human ovarian cancer samples, concurrent increased ADRB2, PTGS2 and PTGES expression was associated with reduced overall and progression-free patient survival. In conclusion, increased adrenergic stimulation results in increased PGE2 synthesis via ADRB2-Nf-kB-PTGS2 axis, which drives tumor growth and metastasis.
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Affiliation(s)
- Archana S. Nagaraja
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Piotr L. Dorniak
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Nouara C. Sadaoui
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Yu Kang
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Tan Lin
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Guillermo Armaiz-Pena
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Sherry Y. Wu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Rajesha Rupaimoole
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Julie K. Allen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Kshipra M. Gharpure
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Sunila Pradeep
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Behrouz Zand
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Rebecca A. Previs
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Jean M. Hansen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Cristina Ivan
- Center for RNAi and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Cristian Rodriguez-Aguayo
- Center for RNAi and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Peiying Yang
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Gabriel Lopez-Berestein
- Center for RNAi and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Susan K. Lutgendorf
- Department of Psychology, Obstetrics and Gynecology, and Urology and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242
| | - Steve W. Cole
- Department of Medicine and Jonsson Comprehensive Cancer Center, University of California, Los Angeles School of Medicine, UCLA Molecular Biology Institute, and Norman Cousins Center, Los Angeles, CA 90095
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
- Center for RNAi and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
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Poole EM, Kubzansky LD, Sood AK, Okereke OI, Tworoger SS. A prospective study of phobic anxiety, risk of ovarian cancer, and survival among patients. Cancer Causes Control 2016; 27:661-8. [PMID: 27023470 DOI: 10.1007/s10552-016-0739-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE In ovarian cancer patients and mouse models, psychosocial stress is associated with higher circulating markers of angiogenesis and cell migration, impaired immune response, and increasing tumor burden and aggressiveness. In the Nurses' Health Studies (NHS/NHSII), we assessed whether phobic anxiety, a marker of chronic distress, was associated with risk of incident ovarian cancer as well as survival among ovarian cancer patients. METHODS We used Cox proportional hazards regression to model the relative risks (RRs) and 95 % confidence intervals (CI) of ovarian cancer incidence and survival by categories of the Crown-Crisp phobic anxiety index (CCI). RESULTS We identified 779 cases of ovarian cancer during 2,497,892 person-years of follow-up. For baseline CCI (NHS: 1988; NHSII: 1993), we observed a statistically nonsignificant increased risk of epithelial ovarian cancer (RR for CCI ≥ 4 vs. 0 or 1: 1.14; 95 % CI 0.96-1.36). However, when we updated CCI (NHS: 2004; NHSII: 2005), the associations were attenuated. Pre-diagnosis CCI was not associated with ovarian cancer survival (RR for ≥4 vs. 0 or 1: 1.00; 95 % CI 0.77-1.31); results were similar for post-diagnosis CCI. CONCLUSIONS Distress, as measured by phobic anxiety symptoms, was not associated with ovarian cancer risk, although we cannot rule out a modest association. Future research should explore the role of phobic anxiety and other forms of psychological distress and ovarian cancer risk and survival.
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Affiliation(s)
- Elizabeth M Poole
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, 3rd Floor, Boston, MA, 02115, USA.
| | | | | | - Olivia I Okereke
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, 3rd Floor, Boston, MA, 02115, USA.,Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Shelley S Tworoger
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, 3rd Floor, Boston, MA, 02115, USA.,Harvard TH Chan School of Public Health, Boston, MA, USA
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Muscatell KA, Eisenberger NI, Dutcher JM, Cole SW, Bower JE. Links between inflammation, amygdala reactivity, and social support in breast cancer survivors. Brain Behav Immun 2016; 53:34-38. [PMID: 26384778 PMCID: PMC5784760 DOI: 10.1016/j.bbi.2015.09.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/27/2015] [Accepted: 09/14/2015] [Indexed: 12/19/2022] Open
Abstract
Psychosocial stress can affect inflammatory processes that have important consequences for cancer outcomes and the behavioral side effects of cancer treatment. To date, however, little is known about the upstream neural processes that may link psychosocial stressors and inflammation in cancer patients and survivors. To address this issue, 15 women who had been diagnosed with early-stage breast cancer and completed cancer treatment and 15 age- and ethnicity-matched women with no cancer history were recruited for a neuroimaging study. Participants provided a blood sample for levels of circulating inflammatory markers (CRP and IL-6), underwent an fMRI scan in which they completed a threat reactivity task designed to elicit activity in the amygdala, and reported their levels of perceived social attachment/support. There were no significant differences between cancer survivors and controls in levels of CRP or IL-6, in amygdala reactivity to the socially threatening images, or in levels of perceived social support. However, results showed a strong, positive correlation between CRP concentration and left amygdala reactivity in the survivor group that was not apparent in controls. Higher levels of social support in the survivor group were also associated with reduced amygdala reactivity and CRP. These data suggest the possibility of a stronger "neural-immune pipeline" among breast cancer survivors, such that peripheral inflammation is more strongly associated with neural activity in threat-related brain regions.
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Affiliation(s)
- Keely A. Muscatell
- Robert Wood Johnson Foundation Health and Society Scholars Program, University of California, San Francisco/University of California, Berkeley, United States,Department of Psychology, UC Berkeley, United States,Corresponding authors at: UC Berkeley Department of Psychology, 4143 Tolman Hall MC 5050, Berkeley, CA 94720-5050, United States (K.A. Muscatell). UCLA Department of Psychology, 1285 Franz Hall Box 951563, Los Angeles, CA 90095-1563, United States (J.E. Bower). (K.A. Muscatell), (J.E. Bower)
| | | | - Janine M. Dutcher
- Department of Psychology, University of California, Los Angeles, United States
| | - Steven W. Cole
- Department of Psychiatry and Biobehavioral Sciences, UCLA, United States,Cousins Center for Psychoneuroimmunology, UCLA, United States,Division of Hematology-Oncology, Department of Medicine, UCLA School of Medicine, United States
| | - Julienne E. Bower
- Department of Psychology, University of California, Los Angeles, United States,Department of Psychiatry and Biobehavioral Sciences, UCLA, United States,Cousins Center for Psychoneuroimmunology, UCLA, United States,Corresponding authors at: UC Berkeley Department of Psychology, 4143 Tolman Hall MC 5050, Berkeley, CA 94720-5050, United States (K.A. Muscatell). UCLA Department of Psychology, 1285 Franz Hall Box 951563, Los Angeles, CA 90095-1563, United States (J.E. Bower). (K.A. Muscatell), (J.E. Bower)
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44
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Xiao C, Beitler JJ, Higgins KA, Conneely K, Dwivedi B, Felger J, Wommack EC, Shin DM, Saba NF, Ong LY, Kowalski J, Bruner DW, Miller AH. Fatigue is associated with inflammation in patients with head and neck cancer before and after intensity-modulated radiation therapy. Brain Behav Immun 2016; 52:145-152. [PMID: 26515035 PMCID: PMC4867228 DOI: 10.1016/j.bbi.2015.10.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/01/2015] [Accepted: 10/26/2015] [Indexed: 12/19/2022] Open
Abstract
Patients with head and neck cancer (HNC) receiving intensity-modulated radiation therapy (IMRT) have particularly high rates of fatigue, and pre- and post-radiotherapy fatigue are prognostic factors for pathologic tumor responses and poor survival. Although inflammation has been proposed as one of the potential mechanisms of fatigue in cancer patients, findings have not been consistent, and there is a dearth of longitudinal studies. Accordingly, we conducted a prospective study in 46 HNC patients pre- and one-month post-IMRT. Fatigue was measured by the Multidimensional Fatigue Inventory (MFI)-20 at both time points along with the assessment of peripheral blood inflammatory markers including interleukin (IL)-6, soluble tumor necrosis factor receptor 2, and C-reactive protein (CRP) and gene expression. Generalized estimating equations were used to examine the association between inflammatory markers and fatigue. Gene enrichment analysis using MetaCore software was performed using up-regulated genes that were significantly associated with IMRT and fatigue. Significant associations between fatigue and IL-6 as well as CRP, which were independent of time, were observed. In addition the change in fatigue from pre- to post-IMRT was positively associated with the change in IL-6 and CRP. Analysis of up-regulated gene transcripts as a function of IMRT and fatigue revealed overrepresentation of transcripts related to the defense response and nuclear factor kappa B. In conclusion, our findings support the hypotheses that inflammation is associated with fatigue over time in HNC patients. Future studies on how inflammation contributes to fatigue as well as strategies targeting inflammation to reduce fatigue are warranted.
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Affiliation(s)
- Canhua Xiao
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta 30322, United States
| | - Jonathan J Beitler
- School of Medicine, Emory University, 1520 Clifton Road NE, Atlanta 30322, United States
| | - Kristin A Higgins
- School of Medicine, Emory University, 1520 Clifton Road NE, Atlanta 30322, United States
| | - Karen Conneely
- Department of Human Genetics, School of Medicine, Emory University, 615 Michael Street, Atlanta, GA 30322, United States
| | - Bhakti Dwivedi
- Biostatistics and Bioinformatics Shared Resource, 1365-B Clifton Road, Atlanta, GA 30322, United States
| | - Jennifer Felger
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 1365-B Clifton Road, Atlanta, GA 30322, United States
| | - Evanthia C Wommack
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 1365-B Clifton Road, Atlanta, GA 30322, United States
| | - Dong M Shin
- School of Medicine, Emory University, 1520 Clifton Road NE, Atlanta 30322, United States
| | - Nabil F Saba
- School of Medicine, Emory University, 1520 Clifton Road NE, Atlanta 30322, United States
| | - Luke Yeeloo Ong
- Emory University, 201 Dowman Dr, Atlanta, GA 30322, United States
| | - Jeanne Kowalski
- Biostatistics and Bioinformatics Shared Resource, 1365-B Clifton Road, Atlanta, GA 30322, United States
| | - Deborah W Bruner
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta 30322, United States
| | - Andrew H Miller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 1365-B Clifton Road, Atlanta, GA 30322, United States
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45
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Price MA, Butow PN, Bell ML, deFazio A, Friedlander M, Fardell JE, Protani MM, Webb PM. Helplessness/hopelessness, minimization and optimism predict survival in women with invasive ovarian cancer: a role for targeted support during initial treatment decision-making? Support Care Cancer 2016; 24:2627-34. [PMID: 26732767 DOI: 10.1007/s00520-015-3070-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/21/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE Women with advanced ovarian cancer generally have a poor prognosis but there is significant variability in survival despite similar disease characteristics and treatment regimens. The aim of this study was to determine whether psychosocial factors predict survival in women with ovarian cancer, controlling for potential confounders. METHODS The sample comprised 798 women with invasive ovarian cancer recruited into the Australian Ovarian Cancer Study and a subsequent quality of life study. Validated measures of depression, optimism, minimization, helplessness/hopelessness, and social support were completed 3-6 monthly for up to 2 years. Four hundred nineteen women (52.5 %) died over the follow-up period. Associations between time-varying psychosocial variables and survival were tested using adjusted Cox proportional hazard models. RESULTS There was a significant interaction of psychosocial variables measured prior to first progression and overall survival, with higher optimism (adjusted hazard ratio per 1 standard deviation (HR) = 0.80, 95 % confidence interval (CI) 0.65-0.97), higher minimization (HR = 0.79, CI 0.66-0.94), and lower helplessness/hopelessness (HR = 1.40, CI 1.15-1.71) associated with longer survival. After disease progression, these variables were not associated with survival (optimism HR = 1.10, CI 0.95-1.27; minimization HR = 1.12, CI 0.95-1.31; and helplessness/hopelessness HR = 0.86, CI 0.74-1.00). Depression and social support were not associated with survival. CONCLUSIONS In women with invasive ovarian cancer, psychosocial variables prior to disease progression appear to impact on overall survival, suggesting a preventive rather than modifying role. Addressing psychosocial responses to cancer and their potential impact on treatment decision-making early in the disease trajectory may benefit survival and quality of life.
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Affiliation(s)
- Melanie A Price
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia. .,Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia.
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.,Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia
| | - Melanie L Bell
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia.,Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Anna deFazio
- Department of Gynaecological Oncology, Westmead Hospital and Westmead Institute for Cancer Research, The University of Sydney at Westmead Millennium Institute, Westmead, Australia
| | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia
| | - Joanna E Fardell
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, Australia
| | - Melinda M Protani
- Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Penelope M Webb
- Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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46
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Prescott LS, Dickens AS, Guerra SL, Tanha JM, Phillips DG, Patel KT, Umberson KM, Lozano MA, Lowe KB, Brown AJ, Taylor JS, Soliman PT, Garcia EA, Levenback CF, Bodurka DC. Fighting cancer together: Development and implementation of shared medical appointments to standardize and improve chemotherapy education. Gynecol Oncol 2016; 140:114-9. [PMID: 26549108 PMCID: PMC4698218 DOI: 10.1016/j.ygyno.2015.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Shared medical appointments offer a novel approach to improve efficiency and quality of care consistent with the goals of the Institute of Medicine. Our objective was to develop and implement a shared medical appointment for gynecologic cancer patients initiating chemotherapy. METHODS We first assessed the level of interest in shared medical appointments among our patients and providers through qualitative interviews. Both patients and providers identified pre-chemotherapy as an optimal area to pilot shared medical appointments. We subsequently created a multidisciplinary team comprised of physicians, advanced practice providers, nurses, pharmacists, administrators, health education specialists and members of the Quality Improvement Department to establish a Shared Medical Appointment and Readiness Teaching (SMART) program for all gynecologic oncology patients initiating chemotherapy with platinum- and/or taxane-based regimens. We developed a standardized chemotherapy education presentation and provided patients with a tool kit that consisted of chemotherapy drug education, a guide to managing side effects, advance directives, and center contact information. RESULTS From May 9, 2014 to June 26, 2015, 144 patients participated in 51 SMART visits. The majority of patients had ovarian cancer and were treated with carboplatin/paclitaxel. Surveyed patients reported being highly satisfied with the group visit and would recommend shared medical appointments to other patients. CONCLUSIONS This model of care provides patient education within a framework of social support that empowers patients. Shared medical appointments for oncology patients initiating chemotherapy are both feasible and well accepted.
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Affiliation(s)
- Lauren S Prescott
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Andrea S Dickens
- Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sandra L Guerra
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jila M Tanha
- The Learning Center, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Desiree G Phillips
- Patient Education, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Katherine T Patel
- Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Katie M Umberson
- Clinical Operations, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Miguel A Lozano
- Performance Improvement, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kathryn B Lowe
- Department of Supportive Medicine, Memorial Hermann Healthcare System, Houston, TX, United States
| | - Alaina J Brown
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jolyn S Taylor
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pamela T Soliman
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth A Garcia
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Charles F Levenback
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Diane C Bodurka
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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47
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Watts S, Prescott P, Mason J, McLeod N, Lewith G. Depression and anxiety in ovarian cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open 2015; 5:e007618. [PMID: 26621509 PMCID: PMC4679843 DOI: 10.1136/bmjopen-2015-007618] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To systematically review the literature pertaining to the prevalence of depression and anxiety in patients with ovarian cancer as a function of treatment stage. DESIGN Systematic review and meta-analysis. PARTICIPANTS 3623 patients with ovarian cancer from primary research investigations. PRIMARY OUTCOME MEASURE The prevalence of depression and anxiety in patients with ovarian cancer as a function of treatment stage. RESULTS We identified 24 full journal articles that met the inclusion criteria for entry into the meta-analysis resulting in a pooled sample size of 3623 patients. The meta-analysis of prevalence rates identified pretreatment, on-treatment and post-treatment depression prevalences of 25.34% (CI 22.79% to 28.07%), 22.99% (CI 19.85% to 26.46%) and 12.71% (CI 10.14% to 15.79%), respectively. Pretreatment, on-treatment and post-treatment anxiety prevalences were 19.12% (CI 17.11% to 21.30%), 26.23% (CI 22.30% to 30.56%) and 27.09% (CI 23.10% to 31.49%). CONCLUSIONS Our findings suggest that the prevalence of depression and anxiety in women with ovarian cancer, across the treatment spectrum, is significantly greater than in the healthy female population. With the growing emphasis on improving the management of survivorship and quality of life, we conclude that further research is warranted to ensure psychological distress in ovarian cancer is not underdiagnosed and undertreated.
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Affiliation(s)
- Sam Watts
- Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Philip Prescott
- Department of Mathematics, University of Southampton, Southampton, UK
| | - Jessica Mason
- Department of Urology, Royal Shrewsbury Hospitals NHS Trust, Shrewsbury, UK
| | - Natalie McLeod
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - George Lewith
- Faculty of Medicine, Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
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48
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Hill EM. Quality of life and mental health among women with ovarian cancer: examining the role of emotional and instrumental social support seeking. PSYCHOL HEALTH MED 2015; 21:551-61. [PMID: 26549407 DOI: 10.1080/13548506.2015.1109674] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of the present study was to examine the role of emotional and instrumental social support seeking in the quality of life (QOL) and mental health of women with ovarian cancer. Participants were recruited through the Pennsylvania Cancer Registry, and one hundred women took part in a mail questionnaire that collected information on their demographics, medical status, social support seeking, QOL and mental health including anxiety, depression and stress. Hierarchical linear regression analyses were conducted to assess the influence of emotional and instrumental social support seeking on QOL and mental health. After controlling for remission status, greater emotional social support seeking was predictive of higher overall QOL, social/family QOL, functional QOL and lower depression scores. Instrumental social support seeking was not significant in the models. The results illustrate that social support seeking as a coping mechanism is an important consideration in the QOL and mental health of women with ovarian cancer. Future studies should examine the psychological and behavioral mediators of the relationship to further understand the QOL and mental health of women with ovarian cancer.
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Affiliation(s)
- Erin M Hill
- a Department of Psychology , West Chester University , West Chester , PA , USA
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49
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Martino J, Pegg J, Frates EP. The Connection Prescription: Using the Power of Social Interactions and the Deep Desire for Connectedness to Empower Health and Wellness. Am J Lifestyle Med 2015; 11:466-475. [PMID: 30202372 DOI: 10.1177/1559827615608788] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/27/2015] [Accepted: 09/08/2015] [Indexed: 11/15/2022] Open
Abstract
Social connection is a pillar of lifestyle medicine. Humans are wired to connect, and this connection affects our health. From psychological theories to recent research, there is significant evidence that social support and feeling connected can help people maintain a healthy body mass index, control blood sugars, improve cancer survival, decrease cardiovascular mortality, decrease depressive symptoms, mitigate posttraumatic stress disorder symptoms, and improve overall mental health. The opposite of connection, social isolation, has a negative effect on health and can increase depressive symptoms as well as mortality. Counseling patients on increasing social connections, prescribing connection, and inquiring about quantity and quality of social interactions at routine visits are ways that lifestyle medicine specialists can use connection to help patients to add not only years to their life but also health and well-being to those years.
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Affiliation(s)
- Jessica Martino
- Tufts University School of Nutrition, Boston, Massachusetts (JM).,Hofstra University, Long Island, New York (JP).,Harvard Medical School, Charlestown, Massachusetts (EPF)
| | - Jennifer Pegg
- Tufts University School of Nutrition, Boston, Massachusetts (JM).,Hofstra University, Long Island, New York (JP).,Harvard Medical School, Charlestown, Massachusetts (EPF)
| | - Elizabeth Pegg Frates
- Tufts University School of Nutrition, Boston, Massachusetts (JM).,Hofstra University, Long Island, New York (JP).,Harvard Medical School, Charlestown, Massachusetts (EPF)
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50
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Schrepf A, Lutgendorf SK, Pyter LM. Pre-treatment effects of peripheral tumors on brain and behavior: neuroinflammatory mechanisms in humans and rodents. Brain Behav Immun 2015; 49:1-17. [PMID: 25958011 PMCID: PMC4567396 DOI: 10.1016/j.bbi.2015.04.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 12/12/2022] Open
Abstract
Cancer patients suffer high levels of affective and cognitive disturbances, which have been attributed to diagnosis-related distress, impairment of quality of life, and side effects of primary treatment. An inflammatory microenvironment is also a feature of the vast majority of solid tumors. However, the ability of tumor-associated biological processes to affect the central nervous system (CNS) has only recently been explored in the context of symptoms of depression and cognitive disturbances. In this review, we summarize the burgeoning evidence from rodent cancer models that solid tumors alter neurobiological pathways and subsequent behavioral processes with relevance to affective and cognitive disturbances reported in human cancer populations. We consider, in parallel, the evidence from human clinical cancer research demonstrating that affective and cognitive disturbances are common in some malignancies prior to diagnosis and treatment. We further consider the underlying neurobiological pathways, including altered neuroinflammation, tryptophan metabolism, prostaglandin synthesis and associated neuroanatomical changes, that are most strongly implicated in the rodent literature and supported by analogous evidence from human cancer populations. We focus on the implications of these findings for behavioral researchers and clinicians, with particular emphasis on methodological issues and areas of future research.
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Affiliation(s)
- Andrew Schrepf
- Department of Psychology, University of Iowa, Iowa City, IA 52242, USA
| | - Susan K Lutgendorf
- Department of Psychology, University of Iowa, Iowa City, IA 52242, USA; Departments of Urology and Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA
| | - Leah M Pyter
- Institute for Behavioral Medicine Research, Departments of Psychiatry and Behavioral Health and Neuroscience, Ohio State University, Columbus, OH 43210, USA.
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