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McCarrick D, Prestwich A, O'Connor DB. Perseverative cognition and health behaviours: exploring the role of intentions and perceived behavioural control. Psychol Health 2024; 39:1183-1199. [PMID: 36214097 DOI: 10.1080/08870446.2022.2130921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/29/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Worry and rumination (Perseverative Cognition, PC) have been associated with health behaviours, but the underlying mechanisms are unknown. Given the role of physiological experiences on perceived behavioural control (PBC) and emotion regulation on intention-health behaviour relationships, we tested whether: PC prospectively predicts poorer health behaviours; PC moderates the relationship(s) between intentions/PBC and health behaviour, as well as whether the relationship between PC and health behaviour is mediated by intentions and PBC. METHODS AND MEASURES In a prospective design, 650 participants (mean age = 38.21 years; 49% female) completed baseline measures of intentions, PBC and PC (worry and rumination) and 590 (mean age = 38.68 years; 50% female) completed follow-up (Time 2) measures of health behaviours (physical activity, sleep, sedentary activity, unhealthy snacking) 1-week later. RESULTS Worry and rumination (at T1) predicted poorer sleep quality. Worry, but not rumination, moderated PBC-physical activity frequency relations. Consistent with mediation, the indirect paths from both worry and rumination, through PBC, to sleep quality and total sleep time were significant. CONCLUSION PC is associated with poorer sleep quality and PBC can play a mediating role in such relationships. Future research should further consider the role that PBC plays in PC-health behaviour relations.
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Christian LM. Turning stress into success: A festschrift in honor of Janice Kiecolt-Glaser. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 19:100251. [PMID: 39170082 PMCID: PMC11338126 DOI: 10.1016/j.cpnec.2024.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 08/23/2024] Open
Affiliation(s)
- Lisa M. Christian
- Department of Psychiatry & Behavioral Health and the Institute for Behavioral Medicine Research and The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Renna ME, Shrout MR. You can't spell distress without stress: Expanding our perspective of the intersection between mental and physical health in cancer survivors. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 19:100240. [PMID: 38774516 PMCID: PMC11107216 DOI: 10.1016/j.cpnec.2024.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/23/2024] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
Although many breast cancer survivors adjust to cancer treatment and survivorship, a sizable subgroup of women do not do so, resulting in psychological distress. Over time, this psychological distress can contribute to immune dysfunction and accompanying worsened physical symptoms as women navigate survivorship. Dr. Kiecolt-Glaser's work and mentorship has been integral to our understanding of breast cancer survivors' immune risks, and how behavioral factors may enhance these risks. As a postdoctoral fellow in the Stress and Health Lab, under Dr. Kiecolt-Glaser's mentorship, my research focused on understanding how distress is associated with immune functioning and physical health in breast cancer survivors. In this paper, we highlight Dr. Kiecolt-Glaser's influence on our careers as a strong female research and mentor, the work completed under her mentorship, and how the field of psychoneuroimmunology can continue to expand her research to better understand how distress in the cancer context confers long-term health risks.
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Kantor J, Aasi SZ, Alam M, Paoli J, Ratner D. Development and Validation of the Oxford Skin Cancer Treatment Scale, a Patient-Reported Outcome Measure for Health-Related Quality of Life and Treatment Satisfaction After Skin Cancer Treatment. Dermatol Surg 2024:00042728-990000000-00886. [PMID: 38996368 DOI: 10.1097/dss.0000000000004305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are necessary to assess the value of skin cancer treatment and to better compare therapeutic options. OBJECTIVE To develop and validate the Oxford Skin Cancer Treatment (OxSCanTr) scale, evaluating health-related quality of life and satisfaction after skin cancer treatment. MATERIALS AND METHODS After qualitative patient interviews, international expert consultation, and item reduction, 2 separate patient samples were used to assess the factor structure of the scale. Exploratory factor analysis with categorical variables and a polychoric correlation matrix followed by promax oblique rotation was performed to establish a factor structure on Group A. Confirmatory factor analysis with a Satorra-Bentler scaled test statistic evaluating the root mean squared error of approximation (RMSEA), standardized root mean squared residual (SRMR), and comparative fit index (CFI) was conducted on Group B. Reliability as internal consistency was assessed using McDonald omega. Convergent and discriminant validity were assessed using the Pearson correlation coefficient. RESULTS A total of 480 subjects returned completed surveys (completion rate 96%). A 12-item scale was developed encompassing 4 domains: aesthetic satisfaction, treatment choice satisfaction, treatment experience, and future concerns regarding recurrence/spread. Confirmatory factor analysis showed excellent goodness-of-fit characteristics, with RMSEA = 0.048, SRMR = 0.051, and CFI = 0.962 using the 4-factor model. Reliability was very good (McDonald omega 0.81-0.82), as was convergent validity with the FACE-Q skin cancer module appraisal of scars subscale (r = 0.55). Discriminant validity with a single question regarding being conservative was similarly excellent (r = -0.02). CONCLUSION The OxSCanTr scale is a parsimonious, feasible, and valid PROM for the holistic assessment of the experience of patients who have undergone skin cancer treatment.
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Affiliation(s)
- Jonathan Kantor
- Department of Dermatology, Center for Clinical Epidemiology and Biostatistics, and Center for Global Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Engineering Science & Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
- Florida Center for Dermatology, St. Augustine, Florida
| | - Sumaira Z Aasi
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Murad Alam
- Departments of Dermatology
- Otolaryngology
- Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - John Paoli
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - Désirée Ratner
- Department of Dermatology, New York University, New York, New York
- Department of Dermatology, NYU Grossman School of Medicine, New York, New York
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Budak SE, Ay Kaatsız MA. The Effect of Perceived Social Support and Spiritual Care Needs in Predicting Hope in Oncology Patients. Cancer Nurs 2024:00002820-990000000-00260. [PMID: 38865611 DOI: 10.1097/ncc.0000000000001370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND Hope has an influential role in oncology patients and is related to perceived social support and spirituality. However, studies on the extent to which the concepts of perceived social support and spiritual care needs affect hope are still limited. OBJECTIVE To examine the effect of perceived social support and spiritual care needs in predicting hope in adult oncology patients. METHODS Study questionnaires, a demographic form, the Herth Hope Scale, the Multidimensional Perceived Social Support Scale, and the Spiritual Care Needs Scale were administered to participants. Correlation and regression analyses were conducted. RESULTS A total of 134 oncology patients completed the study questionnaires. Significant correlations were found between hope and perceived social support and between hope and spiritual care needs (P < .05). Perceived support explained 11.7% of the variance in hope scores. A 1-unit increase in the support score was associated with a 0.344-unit increase in the hope score. Spiritual care needs did not significantly predict hope. CONCLUSION In line with the results, interventions that promote social support may increase hope in oncology patients. IMPLICATIONS FOR PRACTICE Nurses could incorporate interventions into their care to improve social support as one way to enhance hope levels among oncology patients. Further studies are required to understand more about the impact of spiritual care needs on hope.
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Affiliation(s)
- Simay Ezgi Budak
- Authors' Affiliation: Department of Psychiatric Nursing, Hacettepe University, Ankara, Turkey
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Renna ME, Madison AA, Peng J, Rosie Shrout M, Lustberg M, Ramaswamy B, Wesolowski R, VanDeusen JB, Williams NO, Sardesai SD, Noonan AM, Reinbolt RE, Stover DG, Cherian M, Malarkey WB, Andridge R, Kiecolt-Glaser JK. Worry and Mindfulness Differentially Impact Symptom Burden Following Treatment Among Breast Cancer Survivors: Findings From a Randomized Crossover Trial. Ann Behav Med 2023; 57:888-898. [PMID: 37335884 PMCID: PMC10498820 DOI: 10.1093/abm/kaad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Breast cancer survivors often experience many somatic and cognitive side effects resulting from their cancer diagnosis and treatment, including higher rates of pain, fatigue, and memory/concentration problems. Emotion regulation offers opportunities to either enhance or dampen physical health. PURPOSE In a secondary analysis of a double-blind randomized controlled trial (RCT) using a typhoid vaccine to assess factors associated with breast cancer survivors' inflammatory responses, we assessed how two specific aspects of emotion regulation, mindfulness, and worry, corresponded to acute changes in focus problems, memory problems, and fatigue along with performance on pain sensitivity and cognitive tasks across two visits among breast cancer survivors. METHODS Breast cancer survivors (N = 149) completed two 8.5-hr visits at a clinical research center. Survivors were randomized to either the vaccine/saline placebo or a placebo/vaccine sequence. Worry and mindfulness questionnaires provided data on trait-level emotion regulation abilities. Fatigue, memory problems, and focus difficulties were assessed via Likert scales six times-once before the injections and then every 90 min for 7.5 hr thereafter. Women also completed a pain sensitivity task and several cognitive tasks at each visit. RESULTS Findings from this study showed that breast cancer survivors who worried more and were less mindful experienced subjective memory problems, focus problems, and cold pain sensitivity across two visits and irrespective of injection type. Lower mindfulness also corresponded to higher subjective fatigue and hot pain sensitivity and objective ratings. Emotion regulation skills did not predict objective pain sensitivity or cognitive problems. CONCLUSION Results from this study highlight the benefits of adaptive emotion regulation in helping mitigate symptoms associated with breast cancer survivorship.
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Affiliation(s)
- Megan E Renna
- School of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA
| | | | - Juan Peng
- Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Marcella Rosie Shrout
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
| | - Maryam Lustberg
- Yale Cancer Hospital, Yale School of Medicine, New Haven, CT, USA
| | | | - Robert Wesolowski
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey B VanDeusen
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Nicole O Williams
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sagar D Sardesai
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anne M Noonan
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Raquel E Reinbolt
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Daniel G Stover
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mathew Cherian
- James Cancer Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - William B Malarkey
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rebecca Andridge
- Department of Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, Columbus, OH, USA
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Renna ME, Shrout MR, Madison AA, Lustberg M, Povoski SP, Agnese DM, Reinbolt RE, Wesolowski R, Williams NO, Ramaswamy B, Sardesai SD, Noonan AM, VanDeusen JB, Stover DG, Cherian M, Malarkey WB, Di Gregorio M, Kiecolt-Glaser JK. Distress Disorder Histories Relate to Greater Physical Symptoms Among Breast Cancer Patients and Survivors: Findings Across the Cancer Trajectory. Int J Behav Med 2023; 30:463-472. [PMID: 35831698 PMCID: PMC10278051 DOI: 10.1007/s12529-022-10115-4] [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] [Accepted: 07/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Psychological disorders can substantially worsen physical symptoms associated with breast cancer diagnosis and treatment, reducing survivors' quality of life and increasing recurrence risk. Distress disorders may be particularly detrimental given their physical correlates. Across two studies, we examined the relationship between a distress disorder history and physical symptoms pre- and post-adjuvant treatment - two important periods of the cancer trajectory. METHODS Breast cancer patients awaiting adjuvant treatment (n = 147; mean age = 52.54) in study 1 and survivors 1-10 years post-treatment (n = 183; mean age = 56.11) in study 2 completed a diagnostic interview assessing lifetime presence of psychological disorders. They also rated their pain, fatigue, physical functioning, and self-rated health. Covariates included body mass index, age, cancer stage, menopause status, and physical comorbidities. RESULTS Results from both studies indicated that a distress disorder history was associated with higher pain, fatigue, and sleep difficulties as well as lower self-rated health compared to those without such a history. CONCLUSIONS These findings suggest that breast cancer survivors with a distress disorder may be particularly at risk for more physical symptoms, poorer sleep, and worse self-rated health both prior to and following adjuvant treatment.
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Affiliation(s)
- Megan E Renna
- School of Psychology, University of Southern Mississippi, 118 College Drive #5025, Hattiesburg, MS, 39406, USA.
| | | | | | | | | | - Doreen M Agnese
- The Ohio State University College of Medicine, Columbus, USA
| | | | | | | | | | | | - Anne M Noonan
- The Ohio State University College of Medicine, Columbus, USA
| | | | - Daniel G Stover
- The Ohio State University College of Medicine, Columbus, USA
| | - Mathew Cherian
- The Ohio State University College of Medicine, Columbus, USA
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Gibson B, Rosser BA, Schneider J, Forshaw MJ. The role of uncertainty intolerance in adjusting to long-term physical health conditions: A systematic review. PLoS One 2023; 18:e0286198. [PMID: 37267292 DOI: 10.1371/journal.pone.0286198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/10/2023] [Indexed: 06/04/2023] Open
Abstract
Long-term physical health conditions (LTPHCs) are associated with poorer psychological well-being, quality of life, and longevity. Additionally, individuals with LTPHCs report uncertainty in terms of condition aetiology, course, treatment, and ability to engage in life. An individual's dispositional ability to tolerate uncertainty-or difficulty to endure the unknown-is termed intolerance of uncertainty (IU), and may play a pivotal role in their adjustment to a LTPHC. Consequently, the current review sought to investigate the relationship between IU and health-related outcomes, including physical symptoms, psychological ramifications, self-management, and treatment adherence in individuals with LTPHCs. A systematic search was conducted for papers published from inception until 27 May 2022 using the databases PsycINFO, PubMed (MEDLINE), CINAHL Plus, PsycARTICLES, and Web of Science. Thirty-one studies (N = 6,201) met the inclusion criteria. Results indicated that higher levels of IU were associated with worse psychological well-being outcomes and poorer quality of life, though impacts on self-management were less clear. With the exception of one study (which looked at IU in children), no differences in IU were observed between patients and healthy controls. Although findings highlight the importance of investigating IU related to LTPHCs, the heterogeneity and limitations of the existing literature preclude definite conclusions. Future longitudinal and experimental research is required to investigate how IU interacts with additional psychological constructs and disease variables to predict individuals' adjustment to living with a LTPHC.
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Affiliation(s)
- Benjamin Gibson
- School of Applied Social Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Benjamin A Rosser
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jekaterina Schneider
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and, University of the West of England, Bristol, United Kingdom
| | - Mark J Forshaw
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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Maculaitis MC, Liu X, Berk A, Massa A, Weiss MC, Kurosky SK, Li B, McRoy L. Psychosocial Wellbeing among Patients with Breast Cancer during COVID-19. Curr Oncol 2023; 30:3886-3900. [PMID: 37185407 PMCID: PMC10136618 DOI: 10.3390/curroncol30040294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
The impact of coronavirus disease 2019 (COVID-19) on the wellbeing of breast cancer (BC) patients is not well understood. This study described psychosocial problems among these patients in the United States (US) during the COVID-19 pandemic. Data were collected from BC patients via an online self-report survey between 30 March-6 July 2021 to assess the prevalence of COVID-19 diagnosis history and potential depression, health-related quality of life, COVID-related stress, and financial toxicity. Patients with early-stage (eBC) and metastatic (mBC) disease were compared. Of 669 patients included in the analysis, the prevalence of COVID-19 diagnosis history (10.9% versus 7.7%) and potential depression (33.7% versus 28.3%) were higher in mBC than eBC patients. Patients with eBC (versus mBC) had higher scores on nearly all Functional Assessment of Cancer Therapy-Breast scales (all, p < 0.001). For the Psychological Impact of Cancer subscales measuring negative coping strategies, the emotional distress score was the highest (9.1 ± 1.8) in the overall sample. Comprehensive Score for Financial Toxicity scores were higher in eBC than in mBC patients (24.2 ± 11.3 vs. 21.3 ± 10.2, p < 0.001). Overall, the COVID-19-related stress score was highest for danger/contamination fears (8.2 ± 5.6). In conclusion, impairments to psychosocial wellbeing among patients during the pandemic were observed, particularly financial toxicity and poor mental health and emotional functioning, with greater problems among mBC patients.
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Affiliation(s)
| | | | | | | | - Marisa C Weiss
- Breastcancer.org, Ardmore, PA 19003, USA
- Lankenau Medical Center, Wynnewood, PA 19096, USA
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Seo GT, Urken ML, Wein LE, Saturno MP, Kapustin D, Xing MH, Yue LE, Dowling EM, Revenson TA, Roberts KJ, Tuttle RM. Psychological adjustment to initial treatment for low-risk thyroid cancer: Preliminary study. Head Neck 2023; 45:439-448. [PMID: 36495223 DOI: 10.1002/hed.27265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Low-risk papillary thyroid carcinoma (LR-PTC) can be managed by immediate surgery (IS) or active surveillance (AS). We compare the psychological impact of these treatments on patients with LR-PTC. METHODS Psychological data were collected over 1 year, with assessments at the time of treatment decision (T1), at 6 months (T2) and 12 months (T3) follow-up. Assessments included 13 validated psychological tools. RESULTS Of 27 enrolled patients, 20 chose AS and 7 chose IS. The average times to T2 and T3 were 5.7 and 11.3 months, respectively. For both groups, Impact of Events Scale scores significantly decreased (p = 0.001) at T2, and depressive/anxiety symptoms remained low. CONCLUSIONS This study demonstrates the feasibility of assessing psychological outcomes among patients treated for LR-PTC. Further studies are needed to evaluate the impact of AS versus IS on quality of life and changes that patients experience over longer time periods following their treatment decision.
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Affiliation(s)
- Gabriella T Seo
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren E Wein
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Michael P Saturno
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Danielle Kapustin
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Monica H Xing
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Lauren E Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Eric M Dowling
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tracey A Revenson
- Department of Psychology, Hunter College, City University of New York, New York, New York, USA
| | - Katherine J Roberts
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York, USA
| | - Robert Michael Tuttle
- Endocrinology Service-Division of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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The Relationship Between Self-reported Cognitive Abilities and Psychological Symptoms in Breast Cancer Survivors. Cancer Nurs 2023; 46:29-35. [PMID: 35283471 DOI: 10.1097/ncc.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many breast cancer survivors (BCSs) report numerous symptoms following cancer treatment, including cognitive concerns and psychological symptoms (anxiety and depression). However, the association among these symptoms is not well understood. OBJECTIVES The objectives were to, primarily, examine the relationship between self-reported cognitive ability and psychological symptoms (anxiety and depressive symptoms) controlling for potential confounders of age, education, and time posttreatment and, secondarily, examine the relationship between self-reported cognitive domains (attention, language, visuoperception, visual memory, and verbal memory) and psychological symptoms. METHODS This secondary data analysis pooled data from 2 theoretically and conceptually congruent, institutional review board-approved studies of BCSs. Breast cancer survivors completed the Multiple Ability Self-report Questionnaire (cognitive ability), Spielberger State Trait Anxiety Inventory-State (anxiety), and Center for Epidemiological Studies-Depression Scale (depressive symptoms). Data were analyzed using descriptive statistics, Pearson correlations, and separate linear regression. RESULTS One hundred fifty-five BCSs who were on average 54.8 (SD, 8.9) years of age, approximately 5 years (mean, 5.2 [SD, 3.8] years) posttreatment, and well-educated (mean, 15.2 [SD, 2.2] years) completed questionnaires. In bivariate correlations, higher anxiety and depressive symptoms were significantly related to cognitive abilities in all domains ( P = <.01). In the regression model, increased anxiety was associated with poorer cognitive abilities in all domains ( P < .01). CONCLUSIONS Anxiety and depressive symptoms were associated with decrements in self-reported cognitive abilities among BCSs. IMPLICATIONS FOR PRACTICE With increasing numbers of BCSs, more research is needed to address psychological symptoms, which correlate with cognitive function. Findings from this analysis can inform clinical BCS survivorship care planning and future interventional research, focused on comprehensive symptom management.
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Lichtl A, Casaw C, Edwards J, Popkin K, Yu J, Li QS, Cadwell M, Mao JJ, Liou KT. Music Therapy for Pain in Black and White Cancer Patients: A Retrospective Study. J Pain Symptom Manage 2022; 64:478-485. [PMID: 35870654 PMCID: PMC9588734 DOI: 10.1016/j.jpainsymman.2022.07.007] [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: 04/11/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Racial pain disparities present challenges to cancer symptom management. Music therapy has demonstrated benefits for pain and is a promising treatment option for diverse populations due to music's multicultural presence. However, Black cancer patients are under-represented in music therapy trials. OBJECTIVES This study compared pain severity, treatment approaches, and responses to music therapy between Black and white cancer patients. The findings will be used to generate hypotheses for future music therapy research to address racial disparities in pain management. METHODS We conducted a retrospective program evaluation of Black and white patients who received music therapy at an NCI-Designated Comprehensive Cancer Center. We used the Edmonton Symptom Assessment Scale (ESAS) to assess pain. We abstracted opioid use, music therapy referral reasons, and treatment approaches from the electronic health record. RESULTS Among 358 patients, 18% were Black, 42% reported moderate-to-severe pain, and 47% received opioids. Black patients reported higher baseline pain than white patients, but similar proportions of Black and white patients received opioids. Greater proportions of Black patients received music therapy referrals for pain (73% vs. 56%, P = 0.04) and engaged in active techniques (92% vs. 82%, P = 0.04). Black and white patients reported clinically meaningful pain reduction of similar magnitude after music therapy. Black patients discussed spirituality more commonly during music therapy, whereas white patients focused on family bonds. CONCLUSION Black and white patients reported clinically meaningful pain reduction through varying music therapy approaches. Our findings may help inform cultural adaptations of music therapy to address racial pain disparities in oncology.
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Affiliation(s)
- Alexandria Lichtl
- New York University Grossman School of Medicine (A.L.), New York, NY, USA
| | - Camila Casaw
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jasmine Edwards
- Steinhardt School of Culture, Education, and Human Development (J.E.), New York University, New York, NY, USA
| | - Karen Popkin
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer Yu
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qing S Li
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Malik Cadwell
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin T Liou
- Integrative Medicine Service, Department of Medicine (C.C., K.P., J.Y., Q.S.L., M.C., J.J.M., K.T.L.), Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Üzar‐Özçetin YS, Öcalan S. Covid-19-related ruminations: A qualitative study based on the perspectives of the cancer survivors. Nurs Health Sci 2022; 24:882-891. [PMID: 36184767 PMCID: PMC9538934 DOI: 10.1111/nhs.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 12/27/2022]
Abstract
Cancer survivors can develop repetitive ruminations due to the unexpected and challenging effects of Covid-19. This qualitative descriptive design study aimed to comprehend the Covid-19-related ruminations from the subjective perspective of cancer survivors (n = 33), accessed via online Facebook self-help groups of a cancer association. A semi-structured interview guide was used for data collection followed by systematic analysis. Based on the descriptive analysis of the data, three main themes emerged-"Welcome to my life," "Cancer versus Covid-19," and "Fight versus lose"-based on cancer survivors' experience and having two subthemes each. The findings suggested that cancer survivors have many ruminations about cancer and the pandemic. Their ruminations were mainly concerned with the possibility of suffering from cancer again and catching Covid-19. Nonetheless, participants also had positive cognitions that they could overcome the pandemic as they have previously beat cancer. The findings may also offer a promising resource for nurses to understand the ruminations of cancer survivors and develop novel approaches and interventions to help cancer survivors replace their intrusive ruminations with deliberate ones.
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Affiliation(s)
- Yeter Sinem Üzar‐Özçetin
- University College DublinSchool of Nursing, Midwifery, and Health Systems, UCD Health Sciences CentreDublinIreland
| | - Sinem Öcalan
- Hacettepe University Faculty of Nursing Psychiatric Nursing DepartmentAnkaraTurkey
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14
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Zhang A, Wang K, Acquati C, Kamat A, Walling E. Age as a moderator for the association between depression and self-rated health among cancer survivors: a U.S. based population study. J Psychosoc Oncol 2022:1-16. [PMID: 36154823 DOI: 10.1080/07347332.2022.2124393] [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: 10/14/2022]
Abstract
BACKGROUND Self-rated health (SRH) is a salient outcome for cancer survivors. Although depression is a well-studied correlate with SRH, few studies have focused on the role of cancer survivors' age on the association between depression and SRH. This study evaluates demographic and psychosocial factors associated with cancer survivors' SRH. We also assess the moderating role of age to the association between depression and SRH. MATERIALS AND METHODS This paper analyzed 2,470 U.S. cancer survivors from the 2019 National Health Interview Survey. Two ordered logistic regression models with complex survey weights were used for analyses. Missing data was addressed using multiple imputations by chained equations. RESULTS Being female, higher education and higher income were positively associated with better SRH. While the relationship between higher education and higher income was consistent with previous findings, the positive association between being female and SRH was different from previous studies. Age significantly moderated the association between depression and SRH, evidenced by results of the joint tests of all interaction term coefficients being statistically significant, F(2, 544.6) = 5.13, p < 0.01. CONCLUSIONS The findings of the study highlighted the significance of screening for social determinants of health and health disparity when supporting cancer survivors. Additionally, findings of this study emphasized the significance of adopting an age-specific approach when evaluating and addressing depression across different age groups of cancer survivors.
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Affiliation(s)
- Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, Texas, USA.,Department of Health Disparities Research, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Aarti Kamat
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Walling
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
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15
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Hatchard T, Penta S, Mioduzsewski O, Correia S, Tissera T, Brown O, Haefner SA, Poulin P, Smith AM. Increased gray matter following mindfulness-based stress reduction in breast cancer survivors with chronic neuropathic pain: preliminary evidence using voxel-based morphometry. Acta Neurol Belg 2022; 122:735-743. [PMID: 35113361 DOI: 10.1007/s13760-022-01877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/20/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the impact of Mindfulness-Based Stress Reduction (MBSR) on gray matter volume (GMV) in female breast cancer survivors who suffer from chronic neuropathic pain (CNP). METHODS Voxel-based morphometry (VBM) was used to explore differences in GMV in 13 MBSR trainees and 10 waitlisted controls, with MRI scans and self-report measures completed pre- and post-8 weeks of training. RESULTS Compared to controls, the MBSR group had greater GMV in the angular gyrus and middle frontal gyrus post-training. The MBSR group's right parahippocampal gyrus GMV increased from pre- to post-training, whereas the control group's left parahippocampal gyrus, precuneus, middle temporal gyrus, and right cuneus GMV decreased over the same time period. Pain interference was significantly reduced and mindfulness was significantly increased following MBSR for the intervention group only. CONCLUSIONS MBSR was associated with increased GMV in regions where GMV is known to (1) increase with mindfulness and reorientation of attention and (2) decrease with the experience of chronic neuropathic pain. By contrast, the control group's decreases in GMV may be due to the negative effects of CNP which potentially may be reduced with MBSR, though further research is needed. IMPLICATIONS FOR CANCER SURVIVORS Given the poor efficiency of pharmacotherapies in a high percentage of women with neuropathic pain following breast cancer treatment, adjunct methods are required. MBSR may affect the brain to help alter attention and perception of pain, thus playing a potentially important role in the path to wellness for breast cancer survivors.
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Affiliation(s)
- Taylor Hatchard
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Stephanie Penta
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | | | - Stacey Correia
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Talia Tissera
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Olivier Brown
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Sasha A Haefner
- Youth Wellness Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Patricia Poulin
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andra M Smith
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.
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16
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Öcalan S, Üzar-Özçetin YS. The relationship between rumination, fatigue and psychological resilience among cancer survivors. J Clin Nurs 2021; 31:3595-3604. [PMID: 34957629 DOI: 10.1111/jocn.16187] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/17/2021] [Accepted: 12/10/2021] [Indexed: 12/16/2022]
Abstract
AIM AND OBJECTIVES The study's purpose was to examine the association between rumination, fatigue and psychological resilience among cancer survivors. BACKGROUND Cancer is a disease that causes difficult lives in individuals. Individuals can struggle with cancer-related fatigue (CRF) and ruminative thoughts during and after the disease process. However, it can also be seen that some individuals make sense out of their cancer experience and turn into stronger individuals. DESIGN A cross-sectional design. METHODS This study was conducted from February through November 2020. Data were collected from 159 cancer survivors using Event Related Rumination Inventory, Cancer Fatigue Scale and Connor-Davidson Resilience Scale. RESULTS The findings showed that intrusive rumination significantly and negatively mediated psychological resilience but significantly and positively mediated with CRF. In contrast, deliberate rumination was significantly and positively mediated psychological resilience but significantly and negatively mediated with CRF. The effects of intrusive and deliberate rumination on fatigue were .431 (CI =0.042-0.635) and -.285 (CI = -0.163 to 0.491), respectively. In addition, the effects of intrusive and deliberate rumination on psychological resilience were -.253 (CI = -0.177 to 0.447) and .304 (CI = 0.045-0.124), respectively. CONCLUSIONS The findings underline the mediating role of rumination on CRF and psychological resilience among cancer survivors. The findings also delineate the associations between rumination, CRF and psychological resilience, which differ based on rumination type. RELEVANCE TO CLINICAL PRACTICE The findings are particularly important to oncology nurses, who are the main sources of psychosocial care. To support cancer survivors and mobilise their resources, oncology nurses should be made aware of the different types and effects of rumination. With the help of this awareness, oncology nurses can enhance managing intrusive rumination, replacing intrusive ruminations with deliberate ones, mobilising resources and promoting psychological resilience.
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Affiliation(s)
- Sinem Öcalan
- Psychiatric Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
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17
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Renna ME. A review and novel theoretical model of how negative emotions influence inflammation: The critical role of emotion regulation. Brain Behav Immun Health 2021; 18:100397. [PMID: 34927103 PMCID: PMC8649080 DOI: 10.1016/j.bbih.2021.100397] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
Psychological distress is an inevitable part of life. Research drawing on theories from clinical psychology, health psychology, and psychoneuroimmunology (PNI) has identified relationships between negative emotions such as anxiety and sadness with inflammation. When not regulated properly, negative emotions can create biological wear and tear on the body that can increase risk for morbidity and mortality. This review discusses previously available research on relationships between negative emotions and emotion regulation with inflammation among both physically healthy adults and those with chronic illnesses. I then present a novel comprehensive biobehavioral model of negative emotionality. This model emphasizes the influence of negative emotions and their contribution to heightened inflammation. Further, I also discuss how emotion regulation (including perseverative processes such as worry and rumination) mediates this association. The relationships between negative emotionality and emotion regulation may be bidirectional, and empirical investigation of this model should specifically seek to disentangle these relationships. The proposed model offers the opportunity to advance PNI research through understanding how emotional factors alter inflammation and contribute to accelerated biological aging and disease risk.
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Affiliation(s)
- Megan E. Renna
- School of Psychology, University of Southern Mississippi, USA
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18
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Madison AA. Boosting stress resilience using flexibility as a framework to reduce depression risk. Brain Behav Immun Health 2021; 18:100357. [PMID: 34632428 PMCID: PMC8493491 DOI: 10.1016/j.bbih.2021.100357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/22/2022] Open
Abstract
Stress exposure is inevitable, and major life events often precede depression onset. However, a majority do not develop depression after a major life event. Inflexible physiological responses to stress, in which the magnitude or duration is disproportionate to the stressor, may increase risk for depression - especially in the context of frequent or repetitive stress. Although past psychoneuroimmunology (PNI) research focused primarily on stress response magnitude, two relatively recent stress theories - the Perseverative Cognition Hypothesis and Generalized Unsafety Theory - shift the focus to response duration, including anticipatory reactivity and poor recovery. Using these theories as framework, this article reviews evidence suggesting that psychological inflexibility, such as perseverative cognition, and the inability to recognize safety promote heightened and prolonged (i.e., inflexible) physiological stress responses. Moreover, interventions that increase psychological flexibility or safety recognition may foster more flexible physiological responses to psychological stress. By adopting the lens of flexibility to examine physiological responses to stress, PNI will speak the same language as clinical psychology, which has identified inflexibility as an etiological and maintenance factor of depression.
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Affiliation(s)
- Annelise A. Madison
- Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, 460 Medical Center Drive, USA
- Department of Psychology, The Ohio State University, Columbus, OH, 43210, USA
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19
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Examining the Pathoplastic Moderating Role of Education on the Association between Depressive Mood and Self-Rated Health among Cancer Survivors: A Population-Based Study. Curr Oncol 2021; 28:4042-4052. [PMID: 34677261 PMCID: PMC8534924 DOI: 10.3390/curroncol28050343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Self-rated health (SRH) is a salient patient outcome for cancer survivors, and depressive mood and education are known determinants of cancer survivors' SRH. Moving beyond the well-established direct association between depressive mood, education, and SRH among cancer survivors, this epidemiological study investigated the pathoplastic role of education on depressive mood in relation to SRH among a nationally representative sample of cancer survivors in the United States. METHODS The 2019 National Health Interview Survey was analyzed using data from adult participants (≥18 years old) who self-reported as cancer survivors (n = 3844). Ordered logistic regression was used to evaluate the direct impact of depressive mood and education in relation to SRH. In addition, the pathoplastic moderating effect was evaluated using ordered logistic regression with an interaction term of depressive mood and education in the regression model. All analyses adjusted for complex sample weights so that findings are nationally representative. RESULTS After adjusting for all covariates, U.S. cancer survivors' depressive mood was significantly associated with lower SRH, and U.S. cancer survivors' higher education was significantly associated with higher SRH. As a pathoplastic moderator, cancer survivors' education significantly moderated the association between depressive mood and SRH. The negative association between depressive mood and SRH was significantly greater among those with higher education. CONCLUSION Moving beyond the direct association between depressive mood, education, and SRH, education served as a pathoplastic moderator in relation to depressive mood and SRH. Psycho-oncology providers need to be mindful of the "protective-risk" effect of education in relation to cancer survivors' depressive mood and SRH.
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Tang W, Zhu S, Liang X, Liu C, Song L. The Crosstalk Between Long Non-Coding RNAs and Various Types of Death in Cancer Cells. Technol Cancer Res Treat 2021; 20:15330338211033044. [PMID: 34278852 PMCID: PMC8293842 DOI: 10.1177/15330338211033044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
With the increasing aging population, cancer has become one of the leading causes of death worldwide, and the number of cancer cases and deaths is only anticipated to grow further. Long non-coding RNAs (lncRNAs), which are closely associated with the expression level of downstream genes and various types of bioactivity, are regarded as one of the key regulators of cancer cell proliferation and death. Cell death, including apoptosis, necrosis, autophagy, pyroptosis, and ferroptosis, plays a vital role in the progression of cancer. A better understanding of the regulatory relationships between lncRNAs and these various types of cancer cell death is therefore urgently required. The occurrence and development of tumors can be controlled by increasing or decreasing the expression of lncRNAs, a method which confers broad prospects for cancer treatment. Therefore, it is urgent for us to understand the influence of lncRNAs on the development of different modes of tumor death, and to evaluate whether lncRNAs have the potential to be used as biological targets for inducing cell death and predicting prognosis and recurrence of chemotherapy. The purpose of this review is to provide an overview of the various forms of cancer cell death, including apoptosis, necrosis, autophagy, pyroptosis, and ferroptosis, and to describe the mechanisms of different types of cancer cell death that are regulated by lncRNAs in order to explore potential targets for cancer therapy.
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Affiliation(s)
- Wenwen Tang
- School of Medical and Life Sciences/Reproductive & Women-Children Hospital, 118385Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Shaomi Zhu
- School of Medical and Life Sciences/Reproductive & Women-Children Hospital, 118385Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Xin Liang
- School of Medical and Life Sciences/Reproductive & Women-Children Hospital, 118385Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Chi Liu
- School of Medical and Life Sciences/Reproductive & Women-Children Hospital, 118385Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Linjiang Song
- School of Medical and Life Sciences/Reproductive & Women-Children Hospital, 118385Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
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21
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Choobin MH, Mirabolfathi V, Chapman B, Moradi AR, Grunfeld EA, Derakshan N. The Impact of COVID-19 Outbreak on Emotional and Cognitive Vulnerability in Iranian Women With Breast Cancer. Front Psychol 2021; 12:663310. [PMID: 34177718 PMCID: PMC8220448 DOI: 10.3389/fpsyg.2021.663310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women’s COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience.
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Affiliation(s)
| | - Vida Mirabolfathi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Bethany Chapman
- Centre for Building Resilience in Breast Cancer; Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Ali Reza Moradi
- Department of Clinical Psychology, Kharazmi University, Tehran, Iran.,Department of Cognitive Psychology, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Elizabeth A Grunfeld
- Centre for Building Resilience in Breast Cancer; Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
| | - Nazanin Derakshan
- Centre for Building Resilience in Breast Cancer; Department of Psychological Sciences, Birkbeck, University of London, London, United Kingdom
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