Stress reduction strategies in breast cancer: review of pharmacologic and non-pharmacologic based strategies

Effects of the CALM intervention on cancer-related fatigue and heart rate variability in NSCLC: a randomized trial

OBJECTIVES

To evaluate the effects of CALM intervention on cancer-related fatigue (CRF), quality of life (QOL), and heart rate variability (HRV) in non-small cell lung cancer (NSCLC) patients.

METHODS

A total of 153 NSCLC patients were enrolled in the study. Participants were randomly assigned to the CALM group and usual care (UC) group. Patients in the CALM group were received 6 CALM intervention sessions over a 12-week period and evaluated using CRF, QOL and HRV at baseline (T0) and after 2, 4, and 6 intervention sessions.

RESULTS

The CALM group showed significant differences in total CRF, behavioral/daily life CRF, emotional/affective CRF, sensory/physical CRF, cognitive CRF and QOL before and after CALM intervention sessions (F = 643.47, F = 208.34, F = 354.52, F = 285.69, F = 334.29, F = 245.77, p < 0.001). The CALM group showed significant increases in standard deviation of normal R-R interval (SDNN) and high-frequency power (HF) (z = -4.94, p < 0.001,z = -4.30, p < 0.001). Significant negative correlations were observed between CRF and SDNN, HF and QOL across all participants.

CONCLUSIONS

The CALM intervention had a positive impact on overall physical and mental health, fatigue reduction, quality of life and autonomic dysfunction in NSCLC patients. Heart rate variability may serve as an observational indicator of physical and mental health.

The effectiveness of acupuncture in cancer pain treatment

Introduction

In recent years, pain has been recognized as a primary factor significantly diminishing the quality of life in cancer patients. Recent data have prompted the establishment and increased application of non-pharmacological interventions in pain management, such as acupuncture.

Objectives

This review assesses literature from 2018 to 2023 on the impact of acupuncture on pain management and quality of life in cancer patients, with a particular focus on reducing pain intensity. The effectiveness of acupuncture therapy was compared with the traditional treatment of pain symptoms, with a focus on the patients' quality of life.

Conclusions

Although no conclusive scientific evidence confirms the effectiveness of acupuncture in treating cancer pain symptoms, numerous studies have demonstrated its ability to reduce pain, better control pain, decrease analgesic intake, and significantly improve patients' quality of life. Further research is needed to unequivocally confirm the clinical benefits of acupuncture.

Association between chronic stress-related amygdala metabolic activity and lymph node metastasis in endometrial cancer

Chronic stress's link to endometrial cancer risk and tumor aggressiveness remains unclear. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a well-established technique for evaluating the metabolic activity of the amygdala (AmygA), a crucial brain region involved in the response to chronic stress. We aimed to investigate the association between AmygA and lymph node (LN) metastasis in patients with endometrial cancer. In total, 161 patients with newly diagnosed endometrial cancer who received preoperative 18F-FDG PET/CT were recruited. AmygA was calculated as the ratio of the maximum standardized uptake value (SUVmax) of the amygdala to the mean standardized uptake value (SUVmean) of the temporal lobe. Postmenopausal patients with positive LN metastasis had elevated AmygA levels and systemic inflammation markers, such as spleen and bone marrow SUVmax, compared to those without LN metastasis. Notably, AmygA was independently associated with LN metastasis in postmenopausal patients but not in premenopausal patients. Additionally, the correlation between AmygA and systemic inflammation markers was more pronounced in postmenopausal patients. AmygA is independently associated with LN metastasis status in postmenopausal endometrial cancer patients. Our findings suggest that neurobiological activity related to stress, particularly involving the amygdala, may be associated with tumor aggressiveness in postmenopausal endometrial cancer patients.

Effects of Ashwagandha (Withania Somnifera) on stress and anxiety: A systematic review and meta-analysis

BACKGROUND

Ashwagandha (Withania somnifera) is an adaptogenic herb used to prevent and treat psychosomatic disorders. This systematic review and meta-analysis evaluated the effects and safety of Ashwagandha on psychosomatic functions related to stress and anxiety among patients.

METHODS

A comprehensive search was conducted in MEDLINE, EMBASE, PubMed, PsychINFO, and the Cochrane Library for articles published from January 2000 to January 2022. Randomized controlled trials that examined the effects of Ashwagandha on stress and anxiety were included. Two authors independently extracted all relevant data from the included studies. Both subjective and objective measures of stress and anxiety were assessed as outcome variables.

RESULT

Nine randomized controlled trials involving 558 patients were eligible for this study. The findings of the meta-analysis showed a significant effect of Ashwagandha formulations on the Perceived Stress Scale (PSS) (MD = -4.72, 95 % CI = [-8.45 to -0.99]), Hamilton Anxiety Scale (HAS) (MD = -2.19, 95 % CI = [-3.83 to -0.55]), and serum cortisol levels (MD = -2.58, 95 % CI = [-4.99 to -0.16]) compared to the placebo group. Among the included studies, four reported mild to moderate adverse events.

CONCLUSION

The findings from the included studies indicate that Ashwagandha formulations have beneficial effects on stress and anxiety. The adverse effects associated with Ashwagandha are limited; however, further information is required to determine its safety with long-term administration.

A new clinical prognosis model for breast cancer with ADSS as the hub gene

Background: Breast cancer (BRCA) is the most common malignant tumor and the leading cause of cancer death worldwide. Adenylosuccinate synthetase (ADSS) is highly expressed in BRCA and its subtypes malignant tumors and is associated with poor prognosis. Methods: By applying ROC curve, survival analysis, WGCNA, enrichment analysis, Cox regression model and other methods, this study explores the role of ADSS in BRCA and constructs a scoring model. Results: In this study, the ADSS demonstrated good diagnostic efficacy and high expression in breast cancer tissues. Further exploration of the role of ADSS in BRCA revealed that its significantly related coexpressed genes are clearly involved in biological functions and signaling pathways associated with cell proliferation and differentiation. Additionally, the ADSS-related scoring model showed a significant prognostic impact on clinical characteristics, such as metastasis to lymph nodes, and it was discovered that the ADSS score and related scoring genes may affect the immune microenvironment of BRCA patients, potentially participating in the occurrence of this disease. Conclusion: In summary, our gene expression analysis of ADSS in BRCA generated a clinical scoring model based on the ADSS that may be used to assess prognostic risk and provide potential clinical applications and rational therapeutic targets.

The Construction of Peer Support Among Recently Diagnosed Breast Cancer Patients

BACKGROUND

Breast cancer (BC) and its treatments decrease patients' psychological well-being. Peer support is one form of social support, but little is known about what gives rise to peer support.

OBJECTIVE

The purpose of this study was to examine how peer support is constructed among recently diagnosed BC patients.

METHODS

Eighteen women were randomly picked from 130 women who had received phone calls from a trained peer supporter and were invited to group interviews. In the interviews, patients discussed their cancer, peer support experiences, and social support. The transcribed data were analyzed using Braun and Clarke's thematic analysis approach.

RESULTS

The construction of peer support among newly diagnosed BC patients was complex. It depended on the needs of the patient and the success of interactions. Once they had received a diagnosis, the lives of the patients changed suddenly, and patients dove into the I-we-others consideration and had a need to talk. Interaction with peer supporters gave them a chance to share their stories. At their best, interactions led to belonging, caring, and a sense of security.

CONCLUSIONS

The need to be heard and seen is strong in a patient's changing health situation. Peer support plays an important role in high-standard care and in strengthening patients' self-determination.

IMPLICATIONS FOR PRACTICE

Hospitals should create chances for supportive communication, and the supportive communication should be easily accessible and successful. The training of peer supporters should ensure that they have reflected on their own BC process and know how to consider the needs of newly diagnosed patients.

Quercetin inhibits chronic stress-mediated progression of triple-negative breast cancer by blocking β2-AR/ERK1/2 pathway

Chronic stress-mediated sustained release of neurotransmitters, which ultimately leads to the activation of β2-adrenergic receptor (β2-AR) signaling, is one of the most important reasons for triple-negative breast cancer (TBNC) progression. Quercetin (Que) has been proven to have the advantage of ameliorating stress psychological disorder. Our present study aimed to investigate the effect of Que on tumor growth and metastasis in TNBC xenograft mice undergoing stress, and to explore its underlying mechanisms. We first evaluated the effect of Que on the progression of TNBC in nude mice in vivo. The results showed that, Que could inhibit chronic stress-induced TNBC growth and occurrence of lung metastasis. We subsequently employed epinephrine (E) as a representative of stress hormone to investigate its possible mechanism in vitro. The results showed that, Que could inhibit E-mediated proliferation and migration of TNBC cells by blocking β2-AR/ERK1/2 pathway. In conclusion, our data demonstrated that Que could inhibit chronic stress-induced ERK1/2 activity in TNBC cells, and thereby weakening the potential for TNBC growth and metastasis.

Meditation for the reduction of perioperative anxiety in patients undergoing oncology surgery: A scoping review

Objective

Patients undergoing surgery, particularly patients undergoing surgery for oncology diagnoses, experience anxiety. Surgery remains the primary treatment for many common types of cancer. One promising potential intervention to alleviate anxiety in the preoperative and postoperative period is meditation, an integrative medicine intervention. However, there remains a gap in the literature regarding the effectiveness of meditation to alleviate anxiety during the perioperative time period.

Methods

The scoping review was conducted using the Arksey and O'Malley framework to synthesize the study findings and was reported with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The review included EMBASE, PubMed, Web of Science, CINAHL Plus, Scopus, and Cochrane Review databases from 2013 through 2024. All identified articles were exported to the online systematic review software, Covidence.

Results

A total of 538 initial citations were identified, 415 titles and abstracts were screened, and 83 full-text articles reviewed. Six studies were finally included. The data extracted from the literature included: study purpose, study design, sample size, preoperative or postoperative timeframe, instrument to evaluate anxiety, and conclusions.

Conclusions

For patients undergoing oncology surgery, the perioperative period can be filled with anxiety. Guided, mindfulness, and loving-kindness meditation may be helpful in reducing anxiety, particularly in patients undergoing surgery for breast cancer during the postoperative period. However, the current literature is extremely limited. Future research should expand on the preliminary effectiveness to broader populations and carefully target the highest-risk populations for the ideal time point for interventions.

Perceived social support mediates cancer and living meaningfully intervention effects on quality of life after breast cancer surgery

Aim: To explore the role of perceived social support in enhancing psychological resilience and quality of life in postoperative breast cancer patients.Materials & methods: The Managing Cancer and Living Meaningfully (CALM) intervention was used to improve indicators such as psychological resilience in breast cancer patients, while the role of perceived social support in this was assessed.Results: The intervention group exhibited significant improvements compared with the control group in psychological resilience (F = 9.059, p < 0.01). The analysis showed that increased social support in the control group partly mediated the link between psychological resilience and quality of life.Conclusion: CALM improves overall well-being, indicating that incorporating it into standard care for post-mastectomy patients can positively impact their mental health.

Baicalin reduces chronic stress-induced breast cancer metastasis via directly targeting β2-adrenergic receptor

Recent studies have shown that stress can substantially facilitate breast cancer metastasis, which can be reduced by nonselective β1/β2-adrenergic receptor (β1/β2-AR) blocker. However, several side effects were identified. Thus, it is extremely warranted to explore more effective and better-tolerated β2-AR blocker. Currently, we demonstrated that baicalin (BA), a major bioactive component of Scutellaria baicalensis Georgi, could significantly attenuate stress hormones especially epinephrine (Epi)-induced breast cancer cell migration and invasion in vitro. Mechanistically, we identified that β2-AR was a direct target of BA via the drug affinity responsive target stability (DARTS) combined with mass spectrum assay, and BA photoaffinity probe with pull-down assay, which was further confirmed by a couple of biophysical and biochemical assays. Furthermore, we demonstrated that BA could directly bind to the Phe-193 and Phe-289 of β2-AR, subsequently inhibit cyclic adenosine monophosphate-protein kinase A-focal adhesion kinase (cAMP-PKA-FAK) pathway, and thus impede epithelial-mesenchymal transition (EMT), thereby hindering the metastatic progression of the chronic stress coupled with syngeneic and xenograft in vivo orthotopic and tail vein mouse model. These findings firstly identify BA as a potential β2-AR inhibitor in the treatment of stress-induced breast cancer metastasis.

Health benefits of yoga for cancer survivors: An updated systematic review and meta-analysis

Objective

To evaluate the effects of yoga on health-related outcomes [i.e., physical function, mental health, and overall quality of life (QOL)] of cancer survivors via a systematic review and meta-analysis of randomized controlled trials (RCTs) over the past 5 years across cancer types.

Methods

An updated systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RCTs published from January 1, 2018, to February 23, 2023, were searched in five English databases (PubMed, The Cochrane Library, ISI, PsycINFO, and CINAHL), three Chinese databases (Wan Fang, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database), and three English clinical trials registry platforms (International Clinical Trials Registry Platform, ClinicalTrials.gov, and EU Clinical Trials Register).

Results

A total of 34 RCTs were included in this updated review. Yoga benefited the physical function, mental health, and overall QOL of cancer survivors. The effect size of yoga for most physical and mental health-related outcomes was relatively small, but that for the QOL was generally large. The impact of yoga on the QOL of cancer survivors ranged from moderate to high.

Conclusions

Yoga has health benefits for cancer survivors and could therefore be used as an optional supportive intervention for cancer-related symptom management.

β-Adrenoceptors in Cancer: Old Players and New Perspectives

Distress, or negative stress, is known to considerably increase the incidence of several diseases, including cancer. There is indeed evidence from pre-clinical models that distress causes a catecholaminergic overdrive that, mainly through the activation of β-adrenoceptors (β-ARs), results in cancer cell growth and cancer progression. In addition, clinical studies have evidenced a role of negative stress in cancer progression. Moreover, plenty of data demonstrates that β-blockers have positive effects in reducing the pro-tumorigenic activity of catecholamines, correlating with better outcomes in some type of cancers as evidenced by several clinical trials. Among β-ARs, β2-AR seems to be the main β-AR subtype involved in tumor development and progression. However, there are data indicating that also β1-AR and β3-AR may be involved in certain tumors. In this chapter, we will review current knowledge on the role of the three β-AR isoforms in carcinogenesis as well as in cancer growth and progression, with particular emphasis on recent studies that are opening new avenues in the use of β-ARs as therapeutic targets in treating tumors.

Distinct Co-occurring Morning and Evening Fatigue Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy

BACKGROUND

Patients with gastrointestinal cancers experience diurnal variations in fatigue severity during chemotherapy that decrease their functional status and quality of life.

OBJECTIVES

Study purposes were to identify subgroups of patients with distinct co-occurring morning and evening fatigue profiles and evaluate for differences among these subgroups in demographic, clinical, stress, and symptom characteristics.

METHODS

Patients with gastrointestinal cancers (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. The Lee Fatigue Scale was used to evaluate diurnal variations in fatigue severity. Latent profile analysis was used to identify subgroups of patients with distinct co-occurring morning AND evening fatigue profiles. Differences among the subgroups in demographic, clinical, stress, and symptom characteristics at enrollment were evaluated using parametric and nonparametric analyses.

RESULTS

Two classes were identified, namely: low morning and moderate evening fatigue (ie, Low-Moderate, 60.0%) and high morning and high evening fatigue (ie, Both High, 40.0%). Compared with the Low-Moderate class, the Both High class was significantly younger, female, unmarried, and unemployed and lacked regular exercise. In addition, they had childcare responsibilities, lower annual income, lower functional status, higher comorbidity burden, and self-reported anemia and depression. Patients in the Both High class reported higher levels of anxiety, depressive symptoms, sleep disturbance, pain, and stress, and lower levels of energy and cognitive function.

CONCLUSIONS

Findings provide new insights into the risk factors for higher levels of co-occurring morning and evening fatigue in patients with gastrointestinal cancers.

IMPLICATIONS FOR PRACTICE

Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.

Cortisol as a Target for Treating Mental Disorders: A Promising Avenue for Therapy

Cortisol, commonly known as the "stress hormone," plays a critical role in the body's response to stress. Elevated cortisol levels have been associated with various mental disorders, including anxiety, depression, and post-traumatic stress disorder. Consequently, researchers have explored cortisol modulation as a promising avenue for treating these conditions. However, the availability of research on cortisol as a therapeutic option for mental disorders is limited, and existing studies employ diverse methodologies and outcome measures. This review article aimed to provide insights into different treatment approaches, both pharmacological and non-pharmacological, which can effectively modulate cortisol levels. Pharmacological interventions involve the use of substances, such as somatostatin analogs, dopamine agonists, corticotropin-releasing hormone antagonists, and cortisol synthesis inhibitors. Additionally, non-pharmacological techniques, including cognitivebehavioral therapy, herbs and supplements, transcranial magnetic stimulation, lifestyle changes, and surgery, have been investigated to reduce cortisol levels. The emerging evidence suggests that cortisol modulation could be a promising treatment option for mental disorders. However, more research is needed to fully understand the effectiveness and safety of these therapies.

The effect of Benson relaxation technique on cancer patients: a systematic review

PURPOSE

Although many studies have investigated the effect of this method on cancer patients, no review of the available literature has been done. So, a literature review is conducted to evaluate all published literature on the Benson relaxation technique in cancer patients.

METHODS

A systematic literature search was conducted. A systematic search of online electronic databases including PubMed/MEDLINE, Scopus Web of Science, PsycINFO, and EMBASE was performed using keywords extracted from Medical Subject Headings such as "Benson Relaxation Technique," "Cancer Patients," "Malignancy," and "Neoplasia" from the beginning to April 27, 2023. A total of 810 publications were assessed for relevance by title and abstract. The remaining 31 articles were examined using inclusion criteria for all Persian and English-language publications that evaluate the effectiveness of the Benson relaxation technique on cancer patients. We did not have gray literature in our review. The methodological quality of the included studies was appraised using specific checklists.

RESULTS

Finally, nine studies were included in this systematic review. Studies on breast cancer patients showed improvement in fatigue, nausea, vomiting, pain, shortness of breath, insomnia, anorexia, constipation, diarrhea, treatment side effects, breast symptoms, arm symptoms, worry about hair loss, and scores of hope. Two studies were conducted among cervical cancer patients that showed a decrease in anxiety scores and an improvement in the quality of sleep. Another study on gastric cancer patients showed decreased Chemotherapy-Induced Nausea, Vomiting, and Retching scores.

CONCLUSION

Overall, this systematic review showed that the Benson relaxation method could improve sleep quality, appetite, anxiety, and quality of life. Therefore, using the Benson relaxation technique is suggested to improve health-related outcomes in cancer patients.

Association of serum cortisol and cortisone levels and risk of recurrence after endocrine treatment in breast cancer

Metabolic reprogramming in breast cancer involves changes in steroid hormone synthesis and metabolism. Alterations in estrogen levels in both breast tissue and blood may influence carcinogenesis, breast cancer growth, and response to therapy. Our aim was to examine whether serum steroid hormone concentrations could predict the risk of recurrence and treatment-related fatigue in patients with breast cancer. This study included 66 postmenopausal patients with estrogen receptor-positive breast cancer who underwent surgery, radiotherapy, and adjuvant endocrine treatment. Serum samples were collected at six different time points [before the start of radiotherapy (as baseline), immediately after radiotherapy, and then 3, 6, 12 months, and 7-12 years after radiotherapy]. Serum concentrations of eight steroid hormones (cortisol, cortisone, 17α-hydroxyprogesterone, 17β-estradiol, estrone, androstenedione, testosterone, and progesterone) were measured using a liquid chromatography-tandem mass spectrometry-based method. Breast cancer recurrence was defined as clinically proven relapse/metastatic breast cancer or breast cancer-related death. Fatigue was assessed with the QLQ-C30 questionnaire. Serum steroid hormone concentrations measured before and immediately after radiotherapy differed between relapse and relapse-free patients [(accuracy 68.1%, p  = 0.02, and 63.2%, p  = 0.03, respectively, partial least squares discriminant analysis (PLS-DA)]. Baseline cortisol levels were lower in patients who relapsed than in those who did not (p < 0.05). The Kaplan-Meier analysis showed that patients with high baseline concentrations of cortisol (≥ median) had a significantly lower risk of breast cancer recurrence than patients with low cortisol levels ( Collapse

Key Words

• Breast cancer recurrence
• Cortisol
• Cortisone
• Fatigue
• Steroid hormones

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MESH Headings

• Humans
• Female
• Breast Neoplasms/drug therapy
• Cortisone/analysis
• Hydrocortisone/analysis
• Neoplasm Recurrence, Local
• Steroids
• Recurrence

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Grants

• 2020/FO298770 Stiftelsen Dam
• 2020/3806-4 and 28346 The Liaison Committee for Education, Research and Innovation in Central Norway
• 2020/14-304/2020 Kreftfondet at St. Olavs Hospital
• 2020 and 2021 NTNU ISB småforsk
• 2019 Norwegian National Network for Breast Cancer Research
• NTNU Norwegian University of Science and Technology (incl St. Olavs Hospital - Trondheim University Hospital)

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Affiliation(s)

Feng Wang Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. Department of Breast and Endocrine Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Guro F Giskeødegård Department of Breast and Endocrine Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Sissel Skarra Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Monica J Engstrøm Department of Breast and Endocrine Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway Deprtment of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Lars Hagen Deprtment of Clinical and Molecular Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim, Norway PROMEC Core Facility for Proteomics and Modomics, Norwegian University of Science and Technology, NTNU, and the Central Norway Regional Health Authority Norway, Trondheim, Norway
Jürgen Geisler Deparment of Oncology, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
Tomi S Mikkola Department of Gynecology, Helsinki University Hospital, Helsinki, Finland
Matti J Tikkanen Folkhälsan Research Center, University of Helsinki, Helsinki, Finland Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Julia Debik Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Randi J Reidunsdatter Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
Tone F Bathen Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NTNU, Trondheim, Norway. Department of Breast and Endocrine Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

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A meta-analysis of the association between post-traumatic stress disorder and cancer risk

Background

Several studies have investigated the link between post-traumatic stress disorder (PTSD) and cancer risk but reported mixed results. The objective of our study was to investigate the association between PTSD and cancer risk.

Methods

Studies published in English about the relationship between PTSD and cancer incidence were systematically searched. We performed a meta-analysis to estimate the relative risks (RR) and 95% confidence intervals (CI) for cancer incidence.

Result

A total of 3,129 articles were screened. Finally, 8 articles and 11 studies were included in the meta-analysis. We found that PTSD was not associated with cancer risk compared with controls. For site-specific cancer, our results showed that women with PTSD were associated with higher risk of ovarian cancer than controls. However, PTSD was not associated with the risk of gastrointestinal cancer, breast cancer and lung cancer.

Conclusion

These analyzes based on studies published in English suggest that PTSD is associated with ovarian cancer risk, although the evidence base is very limited. Future studies are needed to investigate the mechanisms that PTSD diagnosis influenced cancer incidence depending on types of cancer.

The relationship between COVID-19, depressive disorder, and anxiety: a bidirectional Mendelian randomization study

Background

Previous clinical studies have found that negative mental states such as depression and anxiety are closely related to COVID-19 infection. We used Mendelian randomization (MR) to explore the relationship between depression, anxiety, and COVID-19 infection.

Methods

Our data were based on publicly available GWAS databases. The COVID-19 samples were obtained from the COVID-19 Host Genetics Initiative (HGI). The depression samples were obtained from the Psychiatric Genomics Consortium (PGC). The anxiety samples were derived from the Finngen database. We used inverse-variance weighting (IVW) as the primary analysis method, with weighted median, MR Egger, and multivariate MRI adjustment.

Results

There was no causal effect of different COVID-19 infection statuses on depression and anxiety as determined by MR analysis. In addition, in the reverse MR analysis, we found a significant causal effect of anxiety on severe symptoms after COVID-19 infection. The results of the MR Egger regression, weighted median, and weighted mode methods were consistent with the IVW method. Based on sensitivity analyses, horizontal pleiotropy was unlikely to influence the final results.

Conclusion

Our findings indicate that anxiety is a risk factor for severe symptoms following COVID-19 infection. However, the mechanism of interaction between the two needs further investigation.

The Effect of Using Virtual Reality Glasses on Anxiety and Fatigue in Women with Breast Cancer Receiving Adjuvant Chemotherapy: A Pretest-Posttest Randomized Controlled Study

OBJECTIVE

To determine the effect of using virtual reality glasses on anxiety and fatigue in women with breast cancer receiving adjuvant chemotherapy.

DATA SOURCES

A total of 66 women with breast cancer receiving adjuvant chemotherapy. The intervention group watched and listened to beach and nature content with virtual reality glasses for 30 minutes. The control group also received standard care. An Introductory Information Form, the State Anxiety Scale, and the Cancer Fatigue Scale were used for data collection. The scales were administered to the groups before the intervention, followed by practice or standard care, and then the scales were re-administered. All patients were evaluated for each cycle over four cycles.

CONCLUSION

In the intervention group, the mean post-application anxiety scores decreased compared with the mean pretest scores, and the mean posttest anxiety scores decreased from the first cycle to the last cycle. In addition, the mean post-test anxiety scores of the intervention group were found to be lower in all four cycles than the mean post-test anxiety scores of the control group. In the intervention group, the mean post-test fatigue and subscales scores decreased in all cycles compared with the mean pre-test scores.

IMPLICATIONS FOR NURSING PRACTICE

This research has shown that the use of virtual reality glasses is effective in reducing anxiety and fatigue scale scores and their subscales in patients with breast cancer. For this reason, it is recommended to introduce the use of virtual reality glasses to patients and to present their use according to patients' preferences.

Effect of Yoga Intervention on Inflammatory Biomarkers among Women with Breast Cancer - A Systematic Review

Background

Inflammatory markers play a substantial role in the prognosis of breast cancer (BC). Studies have been conducted, evaluating the effect of yoga intervention (YI) on inflammatory biomarkers among BC cases. This systematic review consolidates the outcome of YI in the cancer microenvironment.

Objective

The objective of the study was to evaluate the effect of YI in the cancer microenvironment among BC women.

Materials and Methods

This review was conducted from May 2021 to December 2021. The inclusion criteria were experimental studies on adult BC cases with isolated YI. Studies conducted among paediatrics, case reports and case series were excluded from the study. Medline (PubMed), Medline (Ovid), Web of Science (WOS), Scopus, CINAHL and Cochrane Central databases were searched. The data were restricted from January 2000 to December 2021 with studies published in English. 'The Cochrane risk of bias assessment tool' was mobilised to evaluate the quality of the included studies.

Results

A total of nine studies met the inclusion criteria and comprised a sample size of 905 BC cases with a mean age of 50.26±8.27 years. Three studies evaluated tumour necrosis factor-alpha (TNF-α) and INTERLEUKIN (IL)-6, where two studies on TNF-α and one on IL-6 favoured the YI group. A study investigated soluble TNF receptor II (TNF-RII) and another on IL-1beta (IL-1β) has shown improved levels post-YI. A downward trend of cortisol levels was noted in four out of five studies. Two studies that examined the C-reactive protein and a study on IL-8 did not show any difference between the YI and the control groups.

Conclusion

This review's findings showed the downregulation of cortisol, markers of inflammation; TNF-α, IL-6, TNF-RII and IL-1β immediately to post-YI. Heterogeneities in terms of YIs, number of days of practice, duration and training received and the grade of BC cases are the concern of this review. However, YI can be considered a supportive therapy for BC.

The tumor-nerve circuit in breast cancer

It is well established that innervation is one of the updated hallmarks of cancer and that psychological stress promotes the initiation and progression of cancer. The breast tumor environment includes not only fibroblasts, adipocytes, endothelial cells, and lymphocytes but also neurons, which is increasingly discovered important in breast cancer progression. Peripheral nerves, especially sympathetic, parasympathetic, and sensory nerves, have been reported to play important but different roles in breast cancer. However, their roles in the breast cancer progression and treatment are still controversial. In addition, the brain is one of the favorite sites of breast cancer metastasis. In this review, we first summarize the innervation of breast cancer and its mechanism in regulating cancer growth and metastasis. Next, we summarize the neural-related molecular markers in breast cancer diagnosis and treatment. In addition, we review drugs and emerging technologies used to block the interactions between nerves and breast cancer. Finally, we discuss future research directions in this field. In conclusion, the further research in breast cancer and its interactions with innervated neurons or neurotransmitters is promising in the clinical management of breast cancer.

Impact of Beta Blockers on Breast Cancer Incidence and Prognosis

Several studies have investigated the link between beta blockers (BB) and breast cancer outcomes but have reported mixed results. Our aim was to investigate the relationship between BB and breast cancer outcomes. Literatures investigating the relationship between BB and breast cancer outcomes were searched through PubMed and Embase. A total 43 articles were included by meta-analysis. We found BB increased breast cancer risk (n = 22, RR: 1.169, 95% CI: 1.063-1.285). We also found BB were associated with a lower overall survival (OS, n = 19, RR: 1.125, 95% CI: 1.078-1.173) and a higher recurrence risk (n = 8, RR: 1.130, 95% CI: 1.040-1.227) for breast cancer. Interestingly, subgroup analyses found only selective BB increased breast cancer risk (n = 5, RR: 1.766, 95% CI: 1.148-2.718) and recurrence risk (n = 2, RR: 1.168 -, 95% CI: 1.026-1.328) while only nonselective BB were associated with a lower OS (n = 4, RR: 1.135, 95% CI: 1.073-1.202) for breast cancer. Moreover, we found BB were associated with a significantly lower OS (n = 3, RR: 2.751, 95% CI: 1.213-6.238) and higher recurrence (n = 2, RR: 1.284, 95% CI: 1.102-1.497) only in luminal breast cancer while with a higher PFS (n = 2, RR: 0.585, 95% CI: 0.343-0.997) in Her2+ breast cancer. No significant differences in terms of CSM (n = 19, RR: 1.009, 95% CI: 0.947-1.077), PFS (n = 4, RR: 0.932, 95% CI: 0.616-1.305), and DFS (n = 2, RR: 0.776, 95% CI: 0.512-1.176) were observed. Our results provide evidence of the relationship between BB and breast cancer incidence and prognosis.

Highly selective detection of epinephrine by a "turn-off" fluorescent sensor based on N-doped carbon quantum dots

Epinephrine (EP) is a catecholamine hormone with a variety of physiological activities. Monitoring the concentration of EP in drugs, food, biological samples and cosmetics is of great significance for their quality control. Herein, a novel fluorescence sensing method was designed for the high-specificity detection of EP based on N-doped carbon quantum dots (N-CDs). The EP could interact with the fluorescent senor of N-CDs which emits blue fluorescence to produce concentration- dependent fluorescence quenching through the photo-induced electron transfer (PET). The established sensing method has good linearity in the range of 0.5-10 μM with the LOD of 0.15 μM. More importantly, it is highly selective because similar components with phenolic hydroxyl groups or primary amino groups, even norepinephrine (NEP), could not interfere with the detection. This method can provide a low-cost, rapid and simple new way for the detection of EP, and has a good application prospect in point-of-care assay and in situ test.

The Effect of Vinyasa Yoga Practice on the Well-Being of Breast-Cancer Patients during COVID-19 Pandemic

BACKGROUND

Vinyasa yoga practice improves body fitness and potentially positively affects practitioners' well-being and health. Due to the diverse intensity of practice and positions customized to the practitioner's needs, it can also support cancer patients. Undertaking physical activity that has a potentially positive effect on well-being and health was particularly important during the self-isolation that followed the COVID-19 pandemic. The purpose of this study was to evaluate the impact of three-month mild and moderate intensity vinyasa yoga practice on breast-cancer patients' stress perception, self-confidence, and sleep quality during COVID-19 induced self-isolation.

METHODS

Female breast-cancer patients participated in twelve-weeks of online vinyasa practice during the COVID-19 induced self-isolation period. Meetings were held once a week, where 60-min vinyasa yoga sequences were followed by 15 min of relaxation. Patients completed pre- and post-intervention surveys to evaluate changes in the following outcomes: stress perception, self-confidence, and sleep quality. Forty-one female patients enrolled in the Vinyasa course completed the pre-intervention survey, while 13 attended all the meetings and completed the post-intervention survey.

RESULTS

The effect of the twelve-week yoga and relaxation practice significantly reduced sleep problems and stress of oncological patients. The participants also declared an improvement in their general well-being and self-acceptance.

CONCLUSION

Dynamic forms of yoga combined with mindfulness techniques can be applied to patients treated for oncological diseases. It contributes to improving their well-being. However, in-depth studies are needed to analyze the complexity of this effect.

Disruption of IDO signaling pathway alleviates chronic unpredictable mild stress-induced depression-like behaviors and tumor progression in mice with breast cancer

Women with breast cancer (BC) are often combined with psychological disorder such as depression and anxiety. Depression is associated or correlated with increased toxicity and severity of physical symptoms. However, the mechanism of BC progression related to the regulation of emotion-related circuitry remains to be further explored. The study aims to investigate indoleamine 2,3-dioxygenase (IDO) pathway mechanism underlying stress-induced progression of BC. BC cell line 4T1 was subcutaneously inoculated into BALB/c mice, and they then received daily chronic unpredictable mild stressors (CUMS) for 12 weeks. Depression-like behavior tests were conducted, including sucrose preference test (SPT), tail suspension test (TST), forced swimming test (FST), and novelty suppressed feeding test (NSF). The levels of 5-Hydroxytryptamine (5-HT) and inflammatory factors, IL-6, CXCL1, IL-10 and IL-4 were measured by enzyme linked immunosorbent assay (ELISA) of mouse serum. Immunohistochemical staining was performed to detect Ki67- or FOXP3-positive tumor cells. The status of IDO signaling pathway was assessed by immunoblotting analysis. CUMS induced depression-like behaviors, decreased the level of 5-HT, promoted tumor progression, enhanced the immunohistochemical staining of Ki-67, and promoted the activation of IDO signaling pathway in BC mice. The IDO signaling pathway was disrupted in mice by lentiviral transduction of shRAN-IDO. Lentivirus-mediated IDO knockdown attenuated CUMS-induced depression-like behaviors, increased the level of 5-HT, inhibited tumor progression, and reduced the immunohistochemical staining of Ki-67 in BC mice. The present study suggests that disruption of IDO signaling pathway alleviates CUMS-induced depression-like behaviors and inhibits tumor progression in BC mice.

Survival Mechanisms of Metastatic Melanoma Cells: The Link between Glucocorticoids and the Nrf2-Dependent Antioxidant Defense System

Circulating glucocorticoids increase during stress. Chronic stress, characterized by a sustained increase in serum levels of cortisol, has been associated in different cases with an increased risk of cancer and a worse prognosis. Glucocorticoids can promote gluconeogenesis, mobilization of amino acids, fat breakdown, and impair the body's immune response. Therefore, conditions that may favor cancer growth and the acquisition of radio- and chemo-resistance. We found that glucocorticoid receptor knockdown diminishes the antioxidant protection of murine B16-F10 (highly metastatic) melanoma cells, thus leading to a drastic decrease in their survival during interaction with the vascular endothelium. The BRAF^V600E mutation is the most commonly observed in melanoma patients. Recent studies revealed that VMF/PLX40-32 (vemurafenib, a selective inhibitor of mutant BRAF^V600E) increases mitochondrial respiration and reactive oxygen species (ROS) production in BRAF^V600E human melanoma cell lines. Early-stage cancer cells lacking Nrf2 generate high ROS levels and exhibit a senescence-like growth arrest. Thus, it is likely that a glucocorticoid receptor antagonist (RU486) could increase the efficacy of BRAF-related therapy in BRAF^V600E-mutated melanoma. In fact, during early progression of skin melanoma metastases, RU486 and VMF induced metastases regression. However, treatment at an advanced stage of growth found resistance to RU486 and VMF. This resistance was mechanistically linked to overexpression of proteins of the Bcl-2 family (Bcl-xL and Mcl-1 in different human models). Moreover, melanoma resistance was decreased if AKT and NF-κB signaling pathways were blocked. These findings highlight mechanisms by which metastatic melanoma cells adapt to survive and could help in the development of most effective therapeutic strategies.

Heart rate variability as an indicator of the beneficial effects of Qigong and mindfulness training on the mind-body well-being of cancer survivors

BACKGROUND

Cancer-related fatigue (CRF) and fear of recurrence (FOR) are frequently experienced by cancer patients. This study aimed to improve cancer survivors' CRF, FOR, quality of life (QOL), and heart rate variability (HRV) through Qigong and mindfulness interventions.

METHODS

A quasi-experimental design was adopted, and 125 cancer survivors were recruited using snowball sampling. The participants were assigned to 1 of 3 groups (Qigong, mindfulness, and control) based on their needs and preferences. All groups received 4 h of nutrition education at the pretest (T0). CRF, FOR, and QOL questionnaires and HRV parameters were used as the measurement tools. Data were collected at the pretest (T0), posttest (T1), and follow-up (T2).

RESULTS

Qigong had a better effect on improving CRF (ΔT1-T0 = - 0.108, ΔT2-T1 = - 0.008) and FOR (ΔT1-T0 = - 0.069, ΔT2-T1 = - 0.150) in the long term, while mindfulness improved QOL (ΔT1-T0 = 0.096, ΔT2-T1 = 0.013) better in the long term. Both Qigong and mindfulness had a short-term effect in improving SDNN (Q: ΔT1-T0 = 1.584; M: ΔT1-T0 = 6.979) and TP (Q: ΔT1-T0 = 41.601; M: ΔT1-T0 = 205.407), but the improvement in LF (Q: ΔT2-T1 = - 20.110; M: ΔT2-T1 = - 47.800) was better in the long term.

CONCLUSION

HRV evaluation showed that Qigong and the mindfulness interventions had short-term effects in significantly improving overall physical and mental health, self-emotional regulation, and QOL and relieving fatigue and autonomic dysfunction. HRV may serve as an observational indicator of interventions to improve physical and mental health. The consistent practice of mind-body interventions is the primary means of optimizing overall health and well-being.

Crosstalk between Depression and Breast Cancer via Hepatic Epoxide Metabolism: A Central Comorbidity Mechanism

Breast cancer (BC) is a serious global challenge, and depression is one of the risk factors and comorbidities of BC. Recently, the research on the comorbidity of BC and depression has focused on the dysfunction of the hypothalamic–pituitary–adrenal axis and the persistent stimulation of the inflammatory response. However, the further mechanisms for comorbidity remain unclear. Epoxide metabolism has been shown to have a regulatory function in the comorbid mechanism with scattered reports. Hence, this article reviews the role of epoxide metabolism in depression and BC. The comprehensive review discloses the imbalance in epoxide metabolism and its downstream effect shared by BC and depression, including overexpression of inflammation, upregulation of toxic diols, and disturbed lipid metabolism. These downstream effects are mainly involved in the construction of the breast malignancy microenvironment through liver regulation. This finding provides new clues on the mechanism of BC and depression comorbidity, suggesting in particular a potential relationship between the liver and BC, and provides potential evidence of comorbidity for subsequent studies on the pathological mechanism.

L, TS S, D'Souza C, Kumar S. A Systematic Review Protocol on the Effect of Yoga Intervention on Inflammatory Biomarkers among Women with Breast Cancer

A systematic review protocol acts as a guide in the review process to prevent the introduction of bias, maintain transparency and allows reproducibility. Yoga intervention had been experimented on various health aspects such as physical functioning, health-related quality of life, psychosocial and emotional well-being among breast cancer populations, and the findings have been very encouraging. Studies are being performed on the effect of yoga intervention(s) at the molecular level by assessing the inflammatory cytokines and also stress hormones such as cortisol. This protocol is developed to escort in evaluating studies that have been performed on evidence-based yoga intervention at the level of cancer microenvironment, in women diagnosed with breast cancer, by assessing the inflammatory biomarkers and cortisol level, a primary stress marker, and a potent influence of inflammation. The findings will elucidate the picture of the cancer microenvironment as a result of yoga intervention.

Review of Under-Recognized Adjunctive Therapies for Cancer

Patients and providers may not be aware that several adjunctive measures can significantly improve the quality of life, response to treatment, and possibly outcomes for cancer patients. This manuscript presents a review of practical under-recognized adjunctive therapies that are effective including exercise; stress-reduction techniques such as mindfulness, massage, yoga, Tai Chi, breathing exercises; importance of sleep quality; diet modifications such as calorie restriction at the time of chemotherapy and avoidance of high carbohydrate foods; supplements such as aspirin, green tea, turmeric, and melatonin; and repurposed prescription medications such as metformin and statins. Each recommendation should be tailored to the individual patient to assure no contraindications.

The Comparative Effect of Reduced Mindfulness-Based Stress on Heart Rate Variability among Patients with Breast Cancer

Heart rate variability (HRV) is a powerful tool for observing interactions between the sympathetic and parasympathetic nervous systems. This study evaluated HRV during a mindfulness-based stress reduction (MBSR) program among women with breast cancer after receiving treatment. A quasi-experimental, nonrandomized design was used. Patients were allocated to usual care (n = 25) and MBSR (n = 25) groups. HRV was measured using recognized methods to assess the autonomic nervous system. Two-way ANOVA and t-tests were used to examine HRV changes between and within groups, respectively. A significant interaction effect of time with group was observed on heart rate (F (1, 96) = 4.92, p = 0.029, η2 = 0.049). A significant difference was also observed within the MBSR group preintervention and postintervention with regard to heart rate (t (24) = −3.80, p = 0.001), standard deviation of the RR interval (t (24) = 5.40, p < 0.001), root-mean-square difference in the RR interval (t (24) = 2.23, p = 0.035), and high-frequency power (t (24) = 7.73, p < 0.001). Large effect sizes for heart rate and SDNN of 0.94 and 0.85, respectively, were observed between the MBSR and usual care groups. This study provides preliminary evidence that an MBSR program may be clinically useful for facilitating parasympathetic activity associated with feelings of relaxation in treated breast cancer survivors.

Contribution of adrenergic mechanisms for the stress-induced breast cancer carcinogenesis

Breast cancer is the most common and deadliest type of cancer in women. Stress exposure has been associated with carcinogenesis and the stress released neurotransmitters, noradrenaline and adrenaline, and their cognate receptors, can participate in the carcinogenesis process, either by regulating tumor microenvironment or by promoting systemic changes. This work intends to provide an overview of the research done in this area and try to unravel the role of adrenergic ligands in the context of breast carcinogenesis. In the initiation phase, adrenergic signaling may favor neoplastic transformation of breast epithelial cells whereas, during cancer progression, may favor the metastatic potential of breast cancer cells. Additionally, adrenergic signaling can alter the function and activity of other cells present in the tumor microenvironment towards a protumor phenotype, namely macrophages, fibroblasts, and by altering adipocyte's function. Adrenergic signaling also promotes angiogenesis and lymphangiogenesis and, systemically, may induce the formation of preneoplastic niches, cancer-associated cachexia and alterations in the immune system which contribute for the loss of quality of life of breast cancer patients and their capacity to fight cancer. Most studies points to a major contribution of β₂ -adrenoceptor activated pathways on these effects. The current knowledge of the mechanistic pathways activated by β₂ -adrenoceptors in physiology and pathophysiology, the availability of selective drugs approved for clinical use and a deeper knowledge of the basic cellular and molecular pathways by which adrenergic stimulation may influence cancer initiation and progression, opens the possibility to use new therapeutic alternatives to improve efficacy of breast cancer treatments.

β2-adrenergic receptor signaling regulates metabolic pathways critical to myeloid-derived suppressor cell function within the TME

Myeloid-derived suppressor cells (MDSCs) impede antitumor immunity; however, the precise mechanisms that regulate their suppressive function remain unresolved. Identifying these mechanisms could lead to therapeutic interventions to boost cancer immunotherapy efficacy. Here, we reveal that β2 adrenergic receptor (β2-AR) expression on MDSCs increases with tumor growth and that the β2-AR stress pathway drives the immune suppressive activity of MDSCs by altering their metabolism. We show that β2-AR signaling decreases glycolysis and increases oxidative phosphorylation and fatty acid oxidation (FAO). It also increases expression of the fatty acid transporter CPT1A, which is necessary for the FAO-mediated immunosuppressive function of MDSCs. Moreover, we show that β2-AR signaling increases autophagy and activates the arachidonic acid cycle, both required for increasing the release of the immunosuppressive mediator, PGE2. Our data reveal that β2-AR signaling triggered by stress is an important physiological regulator of key metabolic pathways in MDSCs, driving their immunosuppressive function.

Mohammadpour et al. show that β2-AR signaling in MDSCs alters their metabolic state and increases their immunosuppressive function. Specific processes found to be increased include fatty acid oxidation, oxidative phosphorylation, and autophagy. In addition, these metabolic alterations facilitate an increase in PGE2 production via elevated COX2 expression.

Therapeutic role of yoga in neuropsychological disorders

Yoga is considered a widely-used approach for health conservation and can be adopted as a treatment modality for a plethora of medical conditions, including neurological and psychological disorders. Hence, we reviewed relevant articles entailing various neurological and psychological disorders and gathered data on how yoga exerts positive impacts on patients with a diverse range of disorders, including its modulatory effects on brain bioelectrical activities, neurotransmitters, and synaptic plasticity. The role of yoga practice as an element of the treatment of several neuropsychological diseases was evaluated based on these findings.

A Low Dose of Hydrous Icaritin Nano-Formulation with Remarkable Efficacy and Tumor Targeting in Cancer Therapy

Background: The use of chemotherapeutic drugs is restricted in the tumor-therapy because of the severely toxic and side effects among most important factors. The active herbal extracts are always used as a high dose while in the tumortherapy to achieve good anti-tumor effects. Hydrous icaritin has a high activity while there are few existing dosage forms as a result of low solubility in water and poor bioavailability. Results: The prepared hydrous icaritin nanorods (DP-HICT NRs) using mPEG₂₀₀₀-DSPE as a stabilizer, presented a narrow distribution of particle size with of 217 nm and a properly high drug-loading content of approximately 65.3±1.5%. A low dose of hydrous icaritin nano-formulation shows remarkable efficacy in cancer therapy (tumor inhibition rate: 61.36±10.80%) compared with the same dose of Paclitaxel injection (tumor inhibition rate: 66.80±4.43%), which approved as medicaments. Not only that, DP-HICT NRs can escape the clearance of the immune system and enhance targeting ability to the tumor site with only one excipient and such a low dose. Conclusions: This kind of nanoparticles contain a low dose of HICT used mPEG₂₀₀₀-DSPE as a stabilizer, while can achieve good tumor targeting as some active targeting agents and an anti-tumor effect as the PTX injection. There are broad prospects in drug safety, anti-tumor efficacy and even prognosis.

Enhanced Thermogenesis in Triple-Negative Breast Cancer Is Associated with Pro-Tumor Immune Microenvironment

Mild cold stress induced by housing mice with a 4T1 triple-negative breast cancer (TNBC) cell implantation model at 22 °C increases tumor growth rate with a pro-tumorigenic immune microenvironment (lower CD8 +T cells, higher myeloid-derived suppressor cells (MDSCs) and regulatory T-cells (Tregs)). Since cold stress also activates thermogenesis, we hypothesized that enhanced thermogenesis is associated with more aggressive cancer biology and unfavorable tumor microenvironment (TME) in TNBC patients. A total of 6479 breast cancer patients from METABRIC, TCGA, GSE96058, GSE20194, and GSE25066 cohorts were analyzed using Kyoto Encyclopedia of Genes and Genomes (KEGG) thermogenesis score. High-thermogenesis TNBC was associated with a trend towards worse survival and with angiogenesis, adipogenesis, and fatty acid metabolism pathways. On the other hand, low-thermogenesis TNBC enriched most of the hallmark cell-proliferation-related gene sets (i.e., mitotic spindle, E2F targets, G2M checkpoint, MYC targets), as well as immune-related gene sets (i.e., IFN-α and IFN-γ response). Favorable cytotoxic T-cell-attracting chemokines CCL5, CXCL9, CXCL10, and CXCL11 were lower; while the MDSC- and Treg-attracting chemokine CXCL12 was higher. There were higher M2 but lower M1 macrophages and Tregs. In conclusion, high-thermogenesis TNBC is associated with pro-tumor immune microenvironment and may serve as biomarker for testing strategies to overcome this immunosuppression.

A Case Control Study on Serum Levels of Potential Biomarkers in Male Breast Cancer Patients

The global incidence of breast cancer among men is steadily growing. Despite this, compared to female breast cancer patients, there are very few studies on biomarkers in male breast cancer patients. A cross-sectional case control study was carried out to determine the serum levels of melatonin, ghrelin, dopamine, serotonin, epinephrine, and GABA in male breast cancer. All the recruited patients were obese, old, and had recently been diagnosed with the disease. They had not received any treatment for the cancer until the time of the study. Melatonin and epinephrine serum levels were significantly higher in breast cancer patients compared to their age-matched controls, whereas ghrelin, dopamine, GABA, and serotonin serum levels were lower in patients compared to the control group. The serum levels of most of the studied biomarkers in male breast cancer patients were similar to those observed in female breast cancer patients, except for serum melatonin levels.

Effectiveness of Complementary Therapies in Cancer Patients: A Systematic Review

According to the World Health Organization, cancer is the second leading cause of death in the world. In Spain, about a quarter of a million cases were diagnosed in 2017, and 81% of the Spanish population has used, at least once, some kind of complementary therapy. Said therapies are increasingly being used by cancer patients. The purpose of the study is to analyse the effectiveness of complementary therapies among cancer patients. A systematic peer review was conducted following the PRISMA-ScR guide in four databases (PubMed, CINAHL, Scopus and WOS). The inclusion criteria were Randomised Clinical Trials, published between 2013 and 2018, with a value of 3 or more on the Jadad Scale. The protocol was registered in PROSPERO (CRD42019127593). The study sample amounted to 1845 patients (64.55% women), the most common being breast cancer patients (794), followed by lung cancer patients (341). Fifteen complementary therapies were identified. We found two studies for each of the following: electroacupuncture, phytotherapy, hypnotherapy, guided imagery and progressive muscle relaxation. From the remaining ones, we identified a study on each therapy. The findings reveal some effective complementary therapies: auriculotherapy and acupuncture, laser moxibustion, hypnosis, Ayurveda, electroacupuncture, progressive muscle relaxation and guided imagery, yoga, phytotherapy, music therapy and traditional Chinese medicine. On the other hand, electroacupuncture, laser moxibustion and traditional Chinese medicine presented adverse effects, and kinesiology did not show effectiveness.