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Barr J, Walz A, Restaino AC, Amit M, Barclay SM, Vichaya EG, Spanos WC, Dantzer R, Talbot S, Vermeer PD. Tumor-infiltrating nerves functionally alter brain circuits and modulate behavior in a mouse model of head-and-neck cancer. eLife 2024; 13:RP97916. [PMID: 39302290 DOI: 10.7554/elife.97916] [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] [Indexed: 09/22/2024] Open
Abstract
Cancer patients often experience changes in mental health, prompting an exploration into whether nerves infiltrating tumors contribute to these alterations by impacting brain functions. Using a mouse model for head and neck cancer and neuronal tracing, we show that tumor-infiltrating nerves connect to distinct brain areas. The activation of this neuronal circuitry altered behaviors (decreased nest-building, increased latency to eat a cookie, and reduced wheel running). Tumor-infiltrating nociceptor neurons exhibited heightened calcium activity and brain regions receiving these neural projections showed elevated Fos as well as increased calcium responses compared to non-tumor-bearing counterparts. The genetic elimination of nociceptor neurons decreased brain Fos expression and mitigated the behavioral alterations induced by the presence of the tumor. While analgesic treatment restored nesting and cookie test behaviors, it did not fully restore voluntary wheel running indicating that pain is not the exclusive driver of such behavioral shifts. Unraveling the interaction between the tumor, infiltrating nerves, and the brain is pivotal to developing targeted interventions to alleviate the mental health burdens associated with cancer.
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Affiliation(s)
- Jeffrey Barr
- Sanford Research, Cancer Biology and Immunotherapies Group, Sioux Falls, Sioux Falls, United States
| | - Austin Walz
- Sanford Research, Cancer Biology and Immunotherapies Group, Sioux Falls, Sioux Falls, United States
| | - Anthony C Restaino
- Sanford Research, Cancer Biology and Immunotherapies Group, Sioux Falls, Sioux Falls, United States
- University of South Dakota, Sanford School of Medicine, Vermillion, United States
| | - Moran Amit
- University of Texas, MD Anderson Cancer Center, Houston, United States
| | - Sarah M Barclay
- Sanford Research, Cancer Biology and Immunotherapies Group, Sioux Falls, Sioux Falls, United States
| | - Elisabeth G Vichaya
- Baylor University, Department of Psychology and Neuroscience, Waco, United States
| | - William C Spanos
- Sanford Research, Cancer Biology and Immunotherapies Group, Sioux Falls, Sioux Falls, United States
- University of South Dakota, Sanford School of Medicine, Vermillion, United States
| | - Robert Dantzer
- University of Texas, MD Anderson Cancer Center, Houston, United States
| | - Sebastien Talbot
- Queen's University, Department of Biomedical and Molecular Sciences, Kingston, Canada
| | - Paola D Vermeer
- Sanford Research, Cancer Biology and Immunotherapies Group, Sioux Falls, Sioux Falls, United States
- University of South Dakota, Sanford School of Medicine, Vermillion, United States
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Barr J, Walz A, Restaino AC, Amit M, Barclay SM, Vichaya EG, Spanos WC, Dantzer R, Talbot S, Vermeer PD. Tumor-infiltrating nerves functionally alter brain circuits and modulate behavior in a male mouse model of head-and-neck cancer. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.10.18.562990. [PMID: 37905135 PMCID: PMC10614955 DOI: 10.1101/2023.10.18.562990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Cancer patients often experience changes in mental health, prompting an exploration into whether nerves infiltrating tumors contribute to these alterations by impacting brain functions. Using a male mouse model for head and neck cancer, we utilized neuronal tracing techniques and show that tumor-infiltrating nerves indeed connect to distinct brain areas via the ipsilateral trigeminal ganglion. The activation of this neuronal circuitry led to behavioral alterations represented by decreased nest-building, increased latency to eat a cookie, and reduced wheel running. Tumor-infiltrating nociceptor neurons exhibited heightened activity, as indicated by increased calcium mobilization. Correspondingly, the specific brain regions receiving these neural projections showed elevated cFos and delta FosB expression in tumor-bearing mice, alongside markedly intensified calcium responses compared to non-tumor-bearing counterparts. The genetic elimination of nociceptor neurons in tumor-bearing mice led to decreased brain Fos expression and mitigated the behavioral alterations induced by the presence of the tumor. While analgesic treatment successfully restored behaviors involving oral movements to normalcy in tumor-bearing mice, it did not have a similar therapeutic effect on voluntary wheel running. This discrepancy points towards an intricate relationship, where pain is not the exclusive driver of such behavioral shifts. Unraveling the interaction between the tumor, infiltrating nerves, and the brain is pivotal to developing targeted interventions to alleviate the mental health burdens associated with cancer.
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Smith SM, Teer A, Tolamatl Ariceaga E, Billman E, Benedict C, Goyal A, Pang EM, Pecos-Duarte C, Lewinsohn R, Smith M, Boynton H, Montes S, Rivera E, Ramirez D, Schapira L. A qualitative study of childhood cancer families' post-treatment needs and the impact of a community-based organization in a rural, socioeconomically disadvantaged, majority Hispanic/Latino region. Pediatr Blood Cancer 2024; 71:e30798. [PMID: 38053230 DOI: 10.1002/pbc.30798] [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: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Individual- and population-level socioeconomic disadvantages contribute to unequal outcomes among childhood cancer survivors. Reducing health disparities requires understanding experiences of survivors from historically marginalized communities, including those with non-English language preference. PROCEDURE We partnered with a community-based organization (CBO) serving families of children with cancer in a rural region in California with low socioeconomic status and majority Hispanic/Latino (H/L) residents. We interviewed English- and Spanish-speaking adolescent/young adult (AYA) childhood cancer survivors (≥15 years old, ≥5 years from diagnosis), parents, and CBO staff to evaluate post-treatment needs and impact of CBO support. Data were analyzed qualitatively using applied thematic analysis. Themes were refined through team discussions with our community partners. RESULTS Twelve AYAs (11 H/L, 11 bilingual), 11 parents (eight H/L, seven non-English preferred), and seven CBO staff (five H/L, five bilingual) participated. AYAs (five female, seven male) were of median (min-max) age 20 (16-32) and 9 (5-19) years post diagnosis; parents (nine female, two male) were age 48 (40-60) and 14 (6-23) years post child's diagnosis. Themes included challenges navigating healthcare, communication barriers among the parent-AYA-clinician triad, and lasting effects of childhood cancer on family dynamics and mental health. Subthemes illustrated that language and rurality may contribute to health disparities. CBO support impacted families by serving as a safety-net, fostering community, and facilitating H/L families' communication. CONCLUSIONS Childhood cancer has long-lasting effects on families, and those with non-English language preference face additional burdens. Community-based support buffers some of the negative effects of childhood cancer and may reduce disparities.
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Affiliation(s)
- Stephanie M Smith
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anmol Teer
- UC Berkeley School of Public Health, Berkeley, California, USA
| | | | - Elle Billman
- Stanford University School of Medicine, Stanford, California, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anju Goyal
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Emily M Pang
- Stanford University School of Medicine, Stanford, California, USA
| | - Caroline Pecos-Duarte
- Stanford University School of Medicine, Stanford, California, USA
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rebecca Lewinsohn
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mary Smith
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Heidi Boynton
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Sandy Montes
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Esmeralda Rivera
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Daniela Ramirez
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford, California, USA
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Palo Alto, California, USA
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Smith SM, Schapira L. Racism and health among cancer survivors. Cancer 2023; 129:2941-2943. [PMID: 37489767 DOI: 10.1002/cncr.34963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Dedicated efforts are needed to measure the impact of racism and discrimination on the health of cancer survivors and simultaneously to develop tools and resources to mitigate adverse health effects. Interventions to improve mental health outcomes for cancer survivors, with special emphasis on those at increased risk because of social and structural factors, should begin now.
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Affiliation(s)
- Stephanie M Smith
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lidia Schapira
- Division of Medical Oncology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Stanford Cancer Institute, Stanford, California, USA
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Dovey Z, Horowitz A, Waingankar N. The influence of lifestyle changes (diet, exercise and stress reduction) on prostate cancer tumour biology and patient outcomes: A systematic review. BJUI COMPASS 2023; 4:385-416. [PMID: 37334023 PMCID: PMC10268595 DOI: 10.1002/bco2.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 06/20/2023] Open
Abstract
Background The mostly indolent natural history of prostate cancer (PCa) provides an opportunity for men to explore the benefits of lifestyle interventions. Current evidence suggests appropriate changes in lifestyle including diet, physical activity (PA) and stress reduction with or without dietary supplements may improve both disease outcomes and patient's mental health. Objective This article aims to review the current evidence on the benefits of all lifestyle programmes for PCa patients including those aimed at reducing obesity and stress, explore their affect on tumour biology and highlight any biomarkers that have clinical utility. Evidence acquisition Evidence was obtained from PubMed and Web of Science using keywords for each section on the affects of lifestyle interventions on (a) mental health, (b) disease outcomes and (c) biomarkers in PCa patients. PRISMA guidelines were used to gather the evidence for these three sections (15, 44 and 16 publications, respectively). Evidence synthesis For lifestyle studies focused on mental health, 10/15 demonstrated a positive influence, although for those programmes focused on PA it was 7/8. Similarly for oncological outcomes, 26/44 studies demonstrated a positive influence, although when PA was included or the primary focus, it was 11/13. Complete blood count (CBC)-derived inflammatory biomarkers show promise, as do inflammatory cytokines; however, a deeper understanding of their molecular biology in relation to PCa oncogenesis is required (16 studies reviewed). Conclusions Making PCa-specific recommendations on lifestyle interventions is difficult on the current evidence. Nevertheless, notwithstanding the heterogeneity of patient populations and interventions, the evidence that dietary changes and PA may improve both mental health and oncological outcomes is compelling, especially for moderate to vigorous PA. The results for dietary supplements are inconsistent, and although some biomarkers show promise, significantly more research is required before they have clinical utility.
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Affiliation(s)
- Zach Dovey
- Mount Sinai Health System, Department of UrologyIcahn Medical SchoolNew YorkNew YorkUSA
| | - Amir Horowitz
- Icahn School of MedicineThe Mount Sinai HospitalNew YorkNew YorkUSA
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Tsai MH, Bevel MS, Andrzejak SE. Racial/Ethnic Disparity in the Relationship of Mental and Physical Health With Colorectal Cancer Screening Utilization Among Breast and Prostate Cancer Survivors. JCO Oncol Pract 2023; 19:e714-e724. [PMID: 36800561 DOI: 10.1200/op.22.00718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
PURPOSE We examined colorectal cancer (CRC) screening utilization among non-Hispanic White, non-Hispanic Black (NHB), non-Hispanic other (NHO)/Hispanic cancer survivors. We also determined whether experiencing poor physical and/or mental health affects CRC screening utilization in breast and prostate cancers across different racial/ethnic groups. METHODS Data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3,023 eligible treatment-utilizing cancer survivors with complete treatment were used. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. RESULTS Among 3,023 eligible survivors, 67.7% of NHO/Hispanic survivors demonstrated lower CRC screening use compared with non-Hispanic White (82%) and NHB (89%) survivors (P < .001). In multivariable analysis, having frequent (14-30 days) poor mental health was associated with lower odds of receiving CRC screening among NHB (odds ratio [OR], 0.32; 95% CI, 0.11 to 0.95) and NHO/Hispanic (OR, 0.39; 95% CI, 0.18 to 0.81) survivors. Similar results in physical health were also found in NHB (OR, 0.34; 95% CI, 0.13 to 0.91) and NHO/Hispanic (OR, 0.22; 95% CI, 0.05 to 0.91) groups. Among those experienced both frequent poor mental and physical health, NHB/NHO/Hispanic were less likely to be screened for CRC (OR, 0.05; 95% CI, 0.02 to 0.10). CONCLUSION NHO/Hispanic survivors demonstrated lower CRC screening use. Frequent poor mental and/or physical health was strongly associated with lower CRC screening use among NHB and NHO/Hispanic survivors. Our study suggests that cancer survivorship care considering mental and physical health status may improve adherence to CRC screening recommendation (for secondary cancer prevention) for NHB, NHO, and Hispanic survivors.
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Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.,Georgia Prevention Institute, Augusta University, Augusta, GA
| | - Malcolm S Bevel
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Sydney E Andrzejak
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
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Pettit T, Proffit E, Reid J, Dobinson H, Waugh V, Sue L, Vincent T, McMillan S, Hemmaway C, Kilpatrick K, Wilding E, Watson H, Ballantine K. "I Don't Have to be Sick to Still Be Worthy": The Barriers Experienced by Adolescent and Young Adult Cancer Survivors in New Zealand. J Adolesc Young Adult Oncol 2022. [PMID: 35917507 DOI: 10.1089/jayao.2022.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To identify the spectrum and nature of survivorship barriers experienced by New Zealand's adolescent and young adult (AYA) cancer survivor population. In addition, we explore associations between survivorship barriers and sociodemographic characteristics, cancer type, and day-to-day happiness following the end of treatment. Methodology: Participants were recruited for the online survey from AYA cancer service patient databases. Eligibility criteria included: aged 12-24 years at diagnosis, diagnosed between 2010 and 2019, and completed treatment at least one year prior. The analysis focused on 11 barriers (domains, issues, or concerns) which respondents may have faced during survivorship. Results: Two hundred and eighteen AYA survivors participated in the study. The mean number of impactful survivorship barriers was 2.5 (standard deviation 1.7), with 13 respondents (6.0%) reporting no barriers of concern and 31 (14.2%) reporting 5 or more. A higher number of impactful barriers was associated with lower day-to-day happiness (r = -0.34, p ≤ 0.001). The most commonly identified impactful survivorship barriers were mental health (50.0% of respondents), physical health (43.1%), thinking and memory (33.0%), education and work (27.1%), social life (26.1%), and fertility (22.5%). Subgroup analysis identified significant differences according to gender, age at diagnosis, tumor group, ethnicity, and time since diagnosis. Poor access to health care and unmet needs were common themes. Positive impacts, particularly with regards to family relationships, were also identified. Conclusion: These results will inform initiatives to improve AYA survivorship care in New Zealand. Gaps in service delivery and funding will need to be overcome by utilizing innovative strategies and broad sector engagement.
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Affiliation(s)
- Tristan Pettit
- Children's Haematology Oncology Centre, Waipapa Hospital, Christchurch, New Zealand
| | - Ellyn Proffit
- Midland AYA Cancer Services, Waikato Hospital, Hamilton, New Zealand
| | - Julia Reid
- Department of Paediatrics and Child Health, Wellington Regional Hospital, Wellington, New Zealand
| | - Hazel Dobinson
- Department of Paediatrics and Child Health, Wellington Regional Hospital, Wellington, New Zealand
| | - Val Waugh
- Southern Blood & Cancer Service, Dunedin Hospital, Dunedin, New Zealand
| | - Louise Sue
- Canterbury AYA Cancer Services, Waipapa Hospital, Christchurch, New Zealand
| | - Tracey Vincent
- Auckland & Northland AYA Cancer Services, Auckland City Hospital, Auckland, New Zealand
| | - Simone McMillan
- Auckland & Northland AYA Cancer Services, Auckland City Hospital, Auckland, New Zealand
| | - Claire Hemmaway
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Kate Kilpatrick
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Eleanor Wilding
- Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Heidi Watson
- AYA Cancer Network Aotearoa, Auckland, New Zealand
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Ji X, Hu X, Brock KE, Mertens AC, Cummings JR, Effinger KE. Early Posttherapy Opioid Prescription, Potential Misuse, and Substance Use Disorder Among Pediatric Cancer Survivors. J Natl Cancer Inst 2022; 114:895-906. [PMID: 35262708 PMCID: PMC9194632 DOI: 10.1093/jnci/djac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/22/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric cancer survivors often have pain, which may be managed with opioids. We examined the prevalence of opioid prescriptions, potential misuse, and substance use disorders (SUDs) among pediatric cancer survivors during the first year posttherapy. METHODS Using MarketScan Commercial Database, we identified 8969 survivors (aged 21 years or younger at diagnosis) who completed cancer therapy in 2009-2018 and remained continuously enrolled for at least 1 year posttherapy and 44 845 age-, sex-, and region-matched enrollees without cancer as a comparison group. Outcomes included opioid prescriptions, any indicator of potential prescription opioid misuse, and SUDs within 1 year posttherapy. Outcomes were compared between survivors and noncancer peers in bivariate and adjusted analyses, stratified by off-therapy age (children: 0-11 years; adolescents: 12-17 years; young adults: 18-28 years). All statistical tests were 2-sided. RESULTS A higher proportion of survivors than noncancer peers filled opioid prescriptions (children: 12.7% vs 2.0%; adolescents: 22.9% vs 7.7%; young adults: 26.0% vs 11.9%). In models adjusting for sociodemographic factors and health status, survivors remained 74.4%-404.8% more likely than noncancer peer to fill opioid prescriptions (P < .001). The prevalence of potential misuse or SUDs was low, with 1.4% of child, 4.7% of adolescent, and 9.4% of young adult survivors fulfilling at least 1 criterion; however, it was higher than noncancer peers (0.1%, 1.4%, and 4.3%, respectively). In adjusted models, the likelihood of potential misuse among survivors remained at least 2 times higher than that among noncancer peers (P < .001), and the difference in SUDs became nonstatistically significant. CONCLUSION Statistically significantly higher rates of opioid prescriptions and potential misuse were found among pediatric cancer survivors within 1 year posttherapy as compared with peers without cancer.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Xin Hu
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Katharine E Brock
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Janet R Cummings
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Karen E Effinger
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
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