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Faviana P, Boldrini L, Gronchi L, Galli L, Erba P, Gentile C, Lippolis PV, Marchetti E, Di Stefano I, Sammarco E, Chapman AD, Bardi M. Steroid Hormones as Modulators of Emotional Regulation in Male Urogenital Cancers. Int J Behav Med 2023; 30:836-848. [PMID: 36459332 PMCID: PMC10713796 DOI: 10.1007/s12529-022-10139-w] [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] [Accepted: 10/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Tumors develop within an organism operating in a specific social and physical environment. Cortisol and dehydroepiandrosterone (DHEA), two of the most abundant steroid hormones in humans, are involved in both emotional regulation and the tumor progression. Several studies reported preclinical findings that DHEA can have preventive and therapeutic efficacy in treating major age-associated diseases, including cancer, although the mechanisms of action are not yet defined. The main aim of current study was to investigate the relationship between psychological and physiological emotional regulation and cancer development. METHOD This study assessed the quality of life of urogenital cancer male patients using several validated tools, including the Functional Assessment of Cancer Therapy-General and the Profile of Mood States. Saliva samples were collected to monitor peripheral activity of both cortisol and DHEA. It was hypothesized that patients with a better quality of life would have higher levels of the DHEA/cortisol ratios. RESULTS We found that the quality of life was positively related to DHEA, but not cortisol levels. Negative mood increases were related to lower levels of DHEA. Logistic regression of the predictors of metastases indicated three main independent factors involved: DHEA, age, and cortisol. In other words, the higher the DHEA levels in comparison to cortisol levels, controlling for age, the lower the probability of metastases. CONCLUSION Our results appear to support the hypothesis that emotional dysregulation mediated by DHEA/cortisol activity is a key factor in the probability of metastasis in urogenital cancers.
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Affiliation(s)
- Pinuccia Faviana
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Via Roma, 57, Pisa, Italy.
| | - Laura Boldrini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Via Roma, 57, Pisa, Italy
| | - Lisa Gronchi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 57, Pisa, Italy
| | - Luca Galli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 57, Pisa, Italy
| | - Paola Erba
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 57, Pisa, Italy
| | - Carlo Gentile
- Istituto Europeo Di Oncologia, Via Ripamonti 435, I-20132, Milan, Italy
| | | | - Elio Marchetti
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Via Roma, 57, Pisa, Italy
| | - Iosè Di Stefano
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Via Roma, 57, Pisa, Italy
| | - Enrico Sammarco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 57, Pisa, Italy
| | - Alex D Chapman
- Department of Psychology and Neuroscience, Randolph-Macon College, Ashland, VA, 23005, USA
| | - Massimo Bardi
- Department of Psychology and Neuroscience, Randolph-Macon College, Ashland, VA, 23005, USA
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Aquino-Acevedo AN, Knochenhauer H, Castillo-Ocampo Y, Ortiz-León M, Rivera-López YA, Morales-López C, Cruz-Robles ME, Hernández-Cordero ER, Russell S, Whitaker R, Bonilla-Claudio M, Chen DT, Dutil J, Gaillard SL, Yi JS, Previs RA, Armaiz-Pena GN. Stress hormones are associated with inflammatory cytokines and attenuation of T-cell function in the ascites from patients with high grade serous ovarian cancer. Brain Behav Immun Health 2022; 26:100558. [PMID: 36439058 PMCID: PMC9694096 DOI: 10.1016/j.bbih.2022.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/18/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Mounting evidence suggests that chronic stress and subsequent distress can promote ovarian cancer progression. These altered psychological states have been linked to sustained release of stress hormones, activation of the β-adrenergic receptors in ovarian cancer cells, and induction of pro-tumoral signaling pathways. In addition, data suggest that chronic stress promotes an inflammatory landscape highlighted by increased infiltration of tumor-associated macrophages into the ovarian tumor microenvironment (TME). In ovarian cancer, ascites is a unique TME comprised of tumor, and immune cells, which secrete pro-tumoral cytokines and chemokines that modulate tumor-associated immunity. However, our knowledge about how stress hormones impact the ascites TME remains limited. We hypothesized that the ascites harbors measurable levels of stress hormones, and accumulation of these in the ascites generates a pro-tumorigenic, inflammatory, and immunosuppressive TME. We evaluated ascites samples from 49 patients with high grade serous ovarian cancer (HGSOC) and quantified cortisol and stress hormones metabolites, metanephrine (MN), and normetanephrine (NMN) in all samples. We also measured 38 individual cytokines in the ascites, including several pro-inflammatory cytokines, such as IL-6, which were positively correlated to MN or NMN levels of those samples. Conversely, we found cortisol levels were negatively correlated to several pro-inflammatory cytokines. As T-cells are integral to the TME and our analyses identified cytokines in the ascites known to modulate T-cell function, we characterized ascites-derived T-cells and assessed the impact of stress hormones on the T-cell phenotype. Our data show an altered CD4+/CD8+ T-cell ratio and a heterogeneous expression of exhaustion markers in T-cells from the ascites, while ascites-derived CD8+ T-cells exposed to epinephrine had decreased co-expression CD38 and Granzyme B. To extend these findings to animal models, we subjected ovarian cancer-bearing mice to daily restraint stress, which resulted in increased tumor growth in two models. Congruent with our human analyses, we detected corticosterone, MN, and NMN in the ascites from tumor-bearing mice, and these stress hormones correlated with several inflammatory cytokines. Moreover, daily restraint stress leads to increased CD4+PD-1+/CD8+PD-1+ T-cell ratio in the ovarian tumor microenvironment. Overall, these data highlight a role of stress hormones in the ascites TME as a driver of tumor-associated inflammation, T-cell suppression, and disease progression.
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Affiliation(s)
- Alexandra N. Aquino-Acevedo
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Hope Knochenhauer
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, School of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Yesenia Castillo-Ocampo
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Melanie Ortiz-León
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Yadiel A. Rivera-López
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Camily Morales-López
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Melanie E. Cruz-Robles
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Elvin R. Hernández-Cordero
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Shonagh Russell
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, School of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Regina Whitaker
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, School of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Margarita Bonilla-Claudio
- School of Dental Medicine, Ponce Health Sciences University, Ponce, PR, USA
- Division of Cancer Biology, Ponce Research Institute, Ponce, PR, USA
| | - Dung-Tsa Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julie Dutil
- Department of Basic Sciences, Division of Biochemistry, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
- Division of Cancer Biology, Ponce Research Institute, Ponce, PR, USA
- Division of Women's Health, Ponce Research Institute, Ponce, PR, USA
| | - Stephanie L. Gaillard
- Departments of Oncology and Gynecology and Obstetrics, John Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medicine, Division of Medical Oncology, School of Medicine, Duke University, Durham, NC, USA
| | - John S. Yi
- Department of Surgery, Division of Surgical Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Rebecca A. Previs
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, School of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Guillermo N. Armaiz-Pena
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
- Division of Cancer Biology, Ponce Research Institute, Ponce, PR, USA
- Division of Women's Health, Ponce Research Institute, Ponce, PR, USA
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3
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Agbayani CJ, Tucker JA, Nelson EL, Martinez F, Cortes H, Khoury D, Kain ZN, Lin C, Torno L, Fortier MA. Immunological and psychosocial functioning in parents of children with cancer. Support Care Cancer 2022; 30:3379-3388. [PMID: 34994860 PMCID: PMC9833860 DOI: 10.1007/s00520-021-06770-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Research has shown that parents of children with cancer exhibit an altered immune profile compared to parents of healthy children, reflective of increased susceptibility to illness. These parents are also at risk for poorer psychosocial outcomes and quality of life. The current study compares peripheral blood cell analyses and psychosocial self-reports from parents of children being treated for cancer (n = 21) to parents of healthy children (n = 30). METHODS A blood sample was drawn from parents to analyze immune profiles. Parents also completed the Perceived Stress Scale (PSS), Medical Outcomes Study Short Form-36 (MOS), and Patient-Reported Outcomes Measurement Information System Short Form v1.0 Emotional Distress-Anxiety 8a, and Emotional Distress-Depression 8a (PROMIS). Mann-Whitney U tests and independent samples t-tests were conducted to examine differences in outcomes between parent groups. RESULTS Parents of children with cancer exhibited higher monocyte percentages in their peripheral blood compared to peers with healthy children. Parents of children with cancer also reported poorer psychosocial outcomes: higher perceived stress, higher anxiety and depression symptoms, more role disability resulting from emotional problems, poorer general and mental health, and poorer social functioning. CONCLUSION These findings support research that has shown a direct effect of chronic stress on the immune system. Symptoms reported by parents of children with cancer indicate unmet psychosocial needs that could potentially affect long-term health. Given the central role of parents in their children's cancer care, it is compelling to address and work to improve parent immunological and psychosocial well-being.
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Affiliation(s)
- Crystle-Joie Agbayani
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Psychological Science, University of California-Irvine, Irvine, CA, USA
| | - Jo A. Tucker
- Department of Medicine, Division of Hematology Oncology, University of California-Irvine, Irvine, CA, USA,Institute for Immunology, University of California-Irvine, Irvine, CA, USA
| | - Edward L. Nelson
- Department of Medicine, Division of Hematology Oncology, University of California-Irvine, Irvine, CA, USA,Institute for Immunology, University of California-Irvine, Irvine, CA, USA,NCI-Designated Chao Family Comprehensive Cancer Center, Irvine, CA, USA
| | - Freddy Martinez
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Haydee Cortes
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA, USA
| | - Dina Khoury
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Medicine, Division of Hematology Oncology, University of California-Irvine, Irvine, CA, USA
| | - Zeev N. Kain
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA, USA,Department of Pediatrics, CHOC, Orange, CA, USA,Child Study Center, School of Medicine, Yale University, New Haven, CT, USA
| | - Carol Lin
- Hyundai Cancer Institute, CHOC, Orange, CA, USA
| | | | - Michelle A Fortier
- UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA,Department of Psychological Science, University of California-Irvine, Irvine, CA, USA,NCI-Designated Chao Family Comprehensive Cancer Center, Irvine, CA, USA,Department of Anesthesiology & Perioperative Care, University of California-Irvine, Irvine, CA, USA,Department of Psychology, CHOC, Orange, CA, USA,Sue & Bill Gross School of Nursing, University of California-Irvine, Irvine, CA, USA
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4
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Chang A, Sloan EK, Antoni MH, Knight JM, Telles R, Lutgendorf SK. Biobehavioral Pathways and Cancer Progression: Insights for Improving Well-Being and Cancer Outcomes. Integr Cancer Ther 2022; 21:15347354221096081. [PMID: 35579197 PMCID: PMC9118395 DOI: 10.1177/15347354221096081] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/17/2022] Open
Abstract
The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.
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Affiliation(s)
- Aeson Chang
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia
| | - Erica K. Sloan
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Peter MacCallum Cancer Centre, Division of Surgery, Melbourne, VIC, Australia
| | - Michael H. Antoni
- Departments of Psychology, Psychiatry, and Behavioral Sciences, and Cancer Control Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Jennifer M. Knight
- Department of Psychiatry and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Telles
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Susan K. Lutgendorf
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
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5
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Singh AK, Chatterjee U, MacDonald CR, Repasky EA, Halbreich U. Psychosocial stress and immunosuppression in cancer: what can we learn from new research? BJPSYCH ADVANCES 2021; 27:187-197. [PMID: 34295535 PMCID: PMC8294471 DOI: 10.1192/bja.2021.9] [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] [Indexed: 12/24/2022]
Abstract
It is generally believed that the physiological consequences of stress could contribute to poor outcomes for patients being treated for cancer. However, despite preclinical and clinical evidence suggesting that stress promotes increased cancer-related mortality, a comprehensive understanding of the mechanisms involved in mediating these effects does not yet exist. We reviewed 47 clinical studies published between 2007 and 2020 to determine whether psychosocial stress affects clinical outcomes in cancer: 6.4% of studies showed a protective effect; 44.6% showed a harmful effect; 48.9% showed no association. These data suggest that psychosocial stress could affect cancer incidence and/or mortality, but the association is unclear. To shed light on this potentially important relationship, objective biomarkers of stress are needed to more accurately evaluate levels of stress and its downstream effects. As a potential candidate, the neuroendocrine signalling pathways initiated by stress are known to affect anti-tumour immune cells, and here we summarise how this may promote an immunosuppressive, pro-tumour microenvironment. Further research must be done to understand the relationships between stress and immunity to more accurately measure how stress affects cancer progression and outcome.
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Affiliation(s)
- Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Udit Chatterjee
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Cameron R MacDonald
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Uriel Halbreich
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
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6
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Colon-Echevarria CB, Lamboy-Caraballo R, Aquino-Acevedo AN, Armaiz-Pena GN. Neuroendocrine Regulation of Tumor-Associated Immune Cells. Front Oncol 2019; 9:1077. [PMID: 31737559 PMCID: PMC6828842 DOI: 10.3389/fonc.2019.01077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022] Open
Abstract
Mounting preclinical and clinical evidence continues to support a role for the neuroendocrine system in the modulation of tumor biology and progression. Several studies have shown data supporting a link between chronic stress and cancer progression. Dysregulation of the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in promoting angiogenesis, tumor cell proliferation and survival, alteration of the immune response and exacerbating inflammatory networks in the tumor microenvironment. Here, we review how SNS and HPA dysregulation contributes to disturbances in immune cell populations, modifies cancer biology, and impacts immunotherapy response. We also highlight several interventions aimed at circumventing the adverse effects stress has on cancer patients.
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Affiliation(s)
- Claudia B Colon-Echevarria
- Division of Pharmacology, Department of Basic Sciences, School of Medicine, Ponce Health Sciences University, Ponce, PR, United States
| | - Rocio Lamboy-Caraballo
- Division of Pharmacology, Department of Basic Sciences, School of Medicine, Ponce Health Sciences University, Ponce, PR, United States
| | - Alexandra N Aquino-Acevedo
- Division of Pharmacology, Department of Basic Sciences, School of Medicine, Ponce Health Sciences University, Ponce, PR, United States
| | - Guillermo N Armaiz-Pena
- Division of Pharmacology, Department of Basic Sciences, School of Medicine, Ponce Health Sciences University, Ponce, PR, United States.,Divisions of Cancer Biology and Women's Health, Ponce Research Institute, Ponce, PR, United States
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7
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Witek Janusek L, Tell D, Mathews HL. Mindfulness based stress reduction provides psychological benefit and restores immune function of women newly diagnosed with breast cancer: A randomized trial with active control. Brain Behav Immun 2019; 80:358-373. [PMID: 30953776 DOI: 10.1016/j.bbi.2019.04.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/16/2019] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Women newly diagnosed with breast cancer experience psychological distress, accompanied by reduced Natural Killer Cell Activity (NKCA) and altered levels of cytokines, which may compromise cancer control. Few studies have evaluated psycho-immune outcomes of mindfulness-based stress reduction (MBSR) for women newly diagnosed with breast cancer in comparison to an active control condition. OBJECTIVE The purpose of this study was to determine whether MBSR benefits psychological, behavioral, and immunological function in women recently diagnosed with breast cancer. DESIGN After confirmation of breast cancer staging, women diagnosed with early-stage breast cancer (n = 192) were randomized to an 8-week MBSR program or an 8-week active control condition (ACC). The ACC consisted of a series of cancer recovery and health education classes. Both MBSR and the ACC were administered in group format. METHODS Women completed psychometric instruments and provided blood for NKCA and cytokine levels at pre-, mid-, and completion of program, as well as at 1- and 6-months post-program. One hundred and twenty four women completed all five-assessments (MBSR, n = 63; ACC, n = 61). Hierarchical linear modeling was used to analyze trajectories of outcomes over time and between groups. RESULTS Compared to the ACC group, women randomized to MBSR exhibited decreasing trajectories of perceived stress, fatigue, sleep disturbance, and depressive symptoms. Further, compared to women randomized to ACC, MBSR women exhibited trajectories demonstrating significantly more rapid restoration of NKCA, accompanied by lower circulating TNF-alpha levels, lower IL-6 production, and greater IFN-gamma production. CONCLUSIONS These results demonstrate early provision of MBSR for women newly diagnosed with breast cancer provides not only psychological benefit, but also optimizes immune function supportive of cancer control.
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Affiliation(s)
- Linda Witek Janusek
- Marcella Niehoff School of Nursing, Department of Health Promotion, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States.
| | - Dina Tell
- Marcella Niehoff School of Nursing, Department of Health Promotion, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States
| | - Herbert L Mathews
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States
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Ashmore JA, Ditterich KW, Conley CC, Wright MR, Howland PS, Huggins KL, Cooreman J, Andrews PS, Nicholas DR, Roberts L, Hewitt L, Scales JN, Delap JK, Gray CA, Tyler LA, Collins C, Whiting CM, Brothers BM, Ryba MM, Andersen BL. Evaluating the effectiveness and implementation of evidence-based treatment: A multisite hybrid design. AMERICAN PSYCHOLOGIST 2019; 74:459-473. [PMID: 30024215 PMCID: PMC6339615 DOI: 10.1037/amp0000309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The gap between treatment development and efficacy testing to scaled up implementations of evidence-based treatment (EBT) is an estimated 20 years, and hybrid research designs aim to reduce the gap. One was used for a multisite study in cancer control, testing coprimary aims: (a) determine the feasibility and utility of a flexible EBT implementation strategy and (b) determine the clinical effectiveness of an EBT as implemented by newly trained providers. Therapists from 15 diverse sites implemented the biobehavioral intervention (BBI) for cancer patients (N = 158) as part of standard care. For implementation, therapists determined treatment format, number of sessions, and so forth and reported session-by-session fidelity. Patients completed fidelity and outcome assessments. Results showed therapists BBI implementation was done with fidelity, for example, session "dose" (59%), core content coverage (60-70%), and others. Patient reported fidelity was favorable and comparable to the BBI efficacy trial. Effectiveness data show the primary outcome, patients' scores on the Profile of Mood States total mood disturbance, significantly improved (R² = 0.06, β = -0.24, p < .01) as did a secondary outcome, physical activity (R² = 0.02, β = 0.13, p < .05). This first use of a hybrid design in health psychology provided support for a novel strategy that allowed providers implementation flexibility. Still, the EBT was delivered with fidelity and in addition, therapists generated novel procedures to enhance setting-specific usage of BBI and its ultimate effectiveness with patients. This research is an example of translational research spanning theory and efficacy tests to dissemination and implementation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Kirk W. Ditterich
- Patient and Family Support Services, Tahoe Forest Cancer Center, Truckee, CA
| | | | | | | | | | - Jena Cooreman
- Department of Supportive Oncology, UC Davis Comprehensive Cancer Center, Davis, CA
| | | | - Donald R. Nicholas
- Department of Counseling Psychology, Social Psychology and Counseling, Ball State University, Muncie, IN
| | - Lind Roberts
- Providence St. John’s Cancer Center, Santa Monica, CA
| | - Larissa Hewitt
- Department of Pediatric Psychosocial Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Joan N. Scales
- Psych-Oncology Services, University of Kentucky, Lexington, KY
| | - Jenny K. Delap
- Psych-Oncology Services, University of Kentucky, Lexington, KY
| | | | - Lynelle A. Tyler
- Patient and Family Support Services, Tahoe Forest Cancer Center, Truckee, CA
| | - Charlotte Collins
- Department of Adult Psychology and Behavioral Medicine, Geisinger Medical Center, Danville, PA
| | | | - Brittany M. Brothers
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - Marlena M. Ryba
- Department of Psychology, Ohio State University, Columbus, OH
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Sibulwa S, Chansa-Kabali T, Hapunda G. "Every part of me has changed"-shared lived experiences of adolescents living with cancer in Zambia. Health Psychol Open 2019; 6:2055102919833537. [PMID: 30915226 PMCID: PMC6429662 DOI: 10.1177/2055102919833537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study explored experiences of adolescents living with cancer, focusing on physical and psychosocial problems. Semi-structured interviews were carried out on 18 adolescents aged between 12 and 18 years. Transcripts were analyzed using thematic analysis. Results showed that the adolescents faced a lot of physical, psychological, and social problems due to cancer diagnosis, treatment, and care. In order to improve their well-being and quality of life, psychosocial interventions should be incorporated in biomedical interventions that adolescents with cancer receive. This study proposes cost-effective interventions that can be implemented in resource-restricted sub-Saharan countries like Zambia.
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Affiliation(s)
| | | | - Given Hapunda
- Department of Psychology, University of Zambia, Zambia
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10
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Salivary secretory immunoglobulin A reactivity: a comparison to cortisol and α-amylase patterns in the same breast cancer survivors. Contemp Oncol (Pozn) 2018; 22:191-201. [PMID: 30455592 PMCID: PMC6238094 DOI: 10.5114/wo.2018.78946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/13/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction One way to examine the extent to which the stress associated with a breast cancer experience (BC) impacts stress-related physiological mechanisms is to study the secretion patterns of associated biomarkers. Unlike cortisol and α-amylase (sAA), biomarkers of immune functioning such as secretory immunoglobulin A (SIgA) have rarely been examined in BC survivors. Aim of the study This study had two principal aims: the first was to evaluate the basal secretion profiles of SIgA as well as its response to an acute stressor as a marker of immune health in BC survivors and women with no history of BC, and the second was to determine how SIgA stress-related patterns compare to published cortisol and sAA patterns in the same women. Results Overall, the findings indicate that BC survivors exhibit a blunted cortisol reaction to an acute stressor, a generally elevated diurnal sAA concentration pattern, and normal SIgA profiles, compared to women with no history of cancer. This study serves as a foundation for future research to elucidate the relationships between BC experience variables, stress biomarkers, and health outcomes in BC survivors.
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Yang YL, Li MY, Liu L, Wang L. Perceived stress and its associated demographic-clinical characteristics and positive expectations among Chinese cervical, kidney, and bladder cancer patients. Support Care Cancer 2018; 26:2303-2312. [PMID: 29404843 DOI: 10.1007/s00520-018-4081-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/29/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Positive expectations about personal abilities and future outcomes are important in shaping human behavior and emotion, which may influence the psychological adjustment in cancer patients. We aimed to assess two basic kinds of perceived stress in Chinese cancer patients and to investigate their associations with demographic-clinical characteristics and positive expectations. METHODS A multi-center, cross-sectional study was conducted in consecutive cervical, kidney, and bladder cancer inpatients from three general hospitals in Liaoning province from February 2013 to August 2014. A total of 790 patients eligible for this study completed questionnaires on demographic-clinical variables, optimism, general self-efficacy, perceived global, and cancer-related stress anonymously. Hierarchical regression analyses were conducted to examine the relationships between optimism, general self-efficacy, and perceived stress, after controlling for possible covariates. RESULTS Mean score of perceived global stress was 17.85 (SD 4.43). Mean score of perceived cancer-related stress was 37.15 (SD 12.66); 38.1% of the sample scored 44 and above, 20.1% scored 50 and above. Education, physical activity, cancer stage, and time since diagnosis were significantly associated with perceived stress. Optimism and general self-efficacy accounted for an additional variance in perceived global (14.9%) and cancer-related stress (16.9%), and both of them were independent and protective variables of perceived stress. CONCLUSIONS This study recognized cancer patients at risk for high levels of perceived stress and extended the understanding of the association between positive expectations and perceived global and cancer-related stress. Enhancing or maintaining optimism and general self-efficacy might be potential targets for future psychosocial interventions aimed at relieving perceived stress in cancer patients.
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Affiliation(s)
- Yi-Long Yang
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Meng-Yao Li
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Li Liu
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China.
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12
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Sommershof A, Scheuermann L, Koerner J, Groettrup M. Chronic stress suppresses anti-tumor T CD8+ responses and tumor regression following cancer immunotherapy in a mouse model of melanoma. Brain Behav Immun 2017; 65:140-149. [PMID: 28457810 DOI: 10.1016/j.bbi.2017.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 11/19/2022] Open
Abstract
Animal tumor models and human cancer studies have provided convergent evidence that chronic psychological stress plays a decisive role in modulating anti-tumor T cell immunity. However, whether chronic stress also affects anti-cancer vaccine strategies that rely on the induction of functional tumor-specific TCD8+ cells has not been investigated yet. In this study we provide direct evidence that chronic stress suppresses the therapeutic efficacy of a biodegradable poly(d,l-lactide-co-glycolide) microsphere (PLGA-MS) based cancer vaccine in a murine melanoma model. Exposure of mice to social disruption stress (SDR), a well-established model mimicking psychological chronic stress in humans, significantly impaired tumor protection in response to cancer vaccination under both prophylactic and therapeutic conditions. Vaccine failure in stressed mice correlated with significantly reduced generation of interferon-γ (IFN-γ)-producing TCD8+ effectors and CTL-mediated killing. Phenotypic analysis of dendritic cells (DCs) revealed that both migratory and lymphoid-resident DCs failed to undergo full maturation upon antigen uptake. Notably, decreased DC maturation was associated with a significant impairment of peripheral DCs to migrate to draining LNs and to prime subsequent TCD8+ responses in vivo. In conclusion, chronic stress represents an important factor mediating immunosuppression in cancer-vaccinated hosts by impairing DC functions and subsequent TCD8+ priming. Potentially, the mechanistic insights gained in this study open new avenues in utilizing the full potential of anti-cancer vaccination strategies.
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Affiliation(s)
- Annette Sommershof
- Division of Immunology, Department of Biology, University of Konstanz, D-78457 Konstanz, Germany.
| | - Lisa Scheuermann
- Division of Immunology, Department of Biology, University of Konstanz, D-78457 Konstanz, Germany
| | - Julia Koerner
- Division of Immunology, Department of Biology, University of Konstanz, D-78457 Konstanz, Germany
| | - Marcus Groettrup
- Division of Immunology, Department of Biology, University of Konstanz, D-78457 Konstanz, Germany; Biotechnology Institute Thurgau (BITg) at the University of Konstanz, CH-8280 Kreuzlingen, Switzerland
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13
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The Integration of Emotional, Physiologic, and Communication Responses to Medical Oncology Surveillance Appointments During Breast Cancer Survivorship. Cancer Nurs 2017; 40:124-134. [PMID: 27088607 DOI: 10.1097/ncc.0000000000000375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast cancer survivors regularly interact with providers during routine surveillance medical oncology visits, discussing uncertainty and anxiety about potential cancer recurrence for many years after treatment. Physiologic alteration can also occur as a stress response, triggered by an upcoming surveillance visit. Survivor-provider communication can theoretically allay emotional distress. OBJECTIVE The aim of this study was to evaluate associations between emotional (uncertainty, anxiety, concerns about recurrence) and physiologic responses (cytokine levels, lymphocyte counts), and survivor-provider communication (women's plans for their visit, negotiation of decision-making roles). METHODS Twenty-seven community-dwelling breast cancer survivors participated. Blood specimens, and self-reported data focusing on the previous month, were collected immediately before and the morning after a regularly scheduled medical oncology visit. RESULTS Global concerns about cancer recurrence and acute anxiety and uncertainty were associated with changes in immune status before and after the visit. Postvisit natural killer cells increased in 70% of women, and uncertainty/anxiety decreased. Thirty-three percent of women reported a previous minor illness. Most women had a visit plan; 66% successfully negotiated decision-making roles with providers. CONCLUSIONS Triggered by an upcoming medical oncology visit, women experience uncertainty, anxiety, and altered immunity, potentially placing them at risk of disease exacerbations. IMPLICATIONS FOR PRACTICE Not all women respond similarly to a routine surveillance visit; thus, providers must determine who may be at increased risk of emotional distress and physiologic alteration. Survivor-provider communication facilitates immediate resolution of concerns. Explanations of symptom meaning reduce anxiety and uncertainty and by extension may help resolve immune alteration. Between visits, this could be done by nurse-operated telephone-based "help lines."
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Kenne Sarenmalm E, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med 2017; 6:1108-1122. [PMID: 28421677 PMCID: PMC5430085 DOI: 10.1002/cam4.1052] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 12/26/2022] Open
Abstract
Many breast cancer survivors have to deal with a variety of psychological and physiological sequelae including impaired immune responses. The primary purpose of this randomized controlled trial was to determine the efficacy of a mindfulness‐based stress reduction (MBSR) intervention for mood disorders in women with breast cancer. Secondary outcomes were symptom experience, health status, coping capacity, mindfulness, posttraumatic growth, and immune status. This RTC assigned 166 women with breast cancer to one of three groups: MBSR (8 weekly group sessions of MBSR), active controls (self‐instructing MBSR) and non‐MBSR. The primary outcome measure was the Hospital Anxiety and Depression Scale. Secondary outcome measures were: Memorial Symptom Assessment Scale, SF‐36, Sense of Coherence, Five Facets of Mindfulness Questionnaire, and Posttraumatic Growth Index. Blood samples were analyzed using flow cytometry for NK‐cell activity (FANKIA) and lymphocyte phenotyping; concentrations of cytokines were determined in sera using commercial high sensitivity IL‐6 and IL‐8 ELISA (enzyme‐linked immunosorbent assay) kits. Results provide evidence for beneficial effects of MBSR on psychological and biological responses. Women in the MBSR group experienced significant improvements in depression scores, with a mean pre‐MBSR HAD‐score of 4.3 and post‐MBSR score of 3.3 (P = 0.001), and compared to non‐MBSR (P = 0.015). Significant improvements on scores for distress, symptom burden, and mental health were also observed. Furthermore, MBSR facilitated coping capacity as well as mindfulness and posttraumatic growth. Significant benefits in immune response within the MBSR group and between groups were observed. MBSR have potential for alleviating depression, symptom experience, and for enhancing coping capacity, mindfulness and posttraumatic growth, which may improve breast cancer survivorship. MBSR also led to beneficial effect on immune function; the clinical implications of this finding merit further research.
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Affiliation(s)
| | - Lena B Mårtensson
- School of Health and Education, University of Skövde; Skövde, Sweden
| | - Bengt A Andersson
- Department of Clinical immunology and transfusion medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Sweden University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Bergh
- School of Health and Education, University of Skövde; Skövde, Sweden
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15
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Life Out of Balance: Stress-Related Disorders in Animals and Humans. Comp Med 2017. [DOI: 10.1007/978-3-319-47007-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Lutgendorf SK, Andersen BL. Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. ACTA ACUST UNITED AC 2016; 70:186-97. [PMID: 25730724 DOI: 10.1037/a0035730] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the last decade, there have been groundbreaking strides in our understanding of the multiple biological pathways by which psychosocial and behavioral factors can affect cancer progression. It is now clear that biobehavioral factors not only affect cellular immunity but both directly and indirectly modulate fundamental processes in cancer growth, including inflammation, angiogenesis, invasion, and metastasis. There is also an emerging understanding of how psychological and behavioral factors used in interventions can impact these physiological processes. This review outlines our current understanding of the physiological mechanisms by which psychological, social, and behavioral processes can affect cancer progression. The intervention literature is discussed, along with recommendations for future research to move the field of biobehavioral oncology forward.
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17
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Andersen BL, Goyal NG, Westbrook TD, Bishop B, Carson WE. Trajectories of Stress, Depressive Symptoms, and Immunity in Cancer Survivors: Diagnosis to 5 Years. Clin Cancer Res 2016; 23:52-61. [PMID: 27407091 DOI: 10.1158/1078-0432.ccr-16-0574] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/06/2016] [Accepted: 07/03/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Five-year disease endpoint trajectories are available for every cancer site. In contrast, there are few longitudinal, biobehavioral studies of survivors extending beyond the first or second year following diagnosis. This gap is addressed with stress, depressive symptom, and immunity data from breast cancer patients followed continuously for 5 years. EXPERIMENTAL DESIGN Women (N = 113) diagnosed and surgically treated for breast cancer and awaiting adjuvant therapy completed self-report measures of stress and depressive symptoms and provided blood for immune assays [natural killer cell cytotoxicity (NKCC) and T-cell blastogenesis]. Assessments (N = 12) were repeated every 4 to 6 months for 5 years. RESULTS Multiphase linear mixed models show phases of change and identified specific time points of change. Cancer stress shows two distinct phases of decline, with the change point being 12 months. In contrast, a steep decline in depressive symptoms occurs by 7 months, with stable, low levels thereafter. NKCC shows a steady upward trajectory through 18 months and upper limit stability thereafter, whereas there was no reliable trajectory for T-cell blastogenesis. CONCLUSIONS For the first time, trajectories and specific time points of change in biobehavioral data for breast cancer survivors are provided, traced through 5 years. Following diagnosis, the breast survivor experience is one of a co-occurrence of change (recovery) in psychologic and innate immunity markers from diagnosis to18 months, and a pattern of stability (depression, NKCC) or continued improvement (stress) through year 5. These data provide new directions for survivorship care and detail of the biobehavioral trajectory. Clin Cancer Res; 23(1); 52-61. ©2016 AACR.
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18
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McFarland DC, Andreotti C, Harris K, Mandeli J, Tiersten A, Holland J. Early Childhood Adversity and its Associations With Anxiety, Depression, and Distress in Women With Breast Cancer. PSYCHOSOMATICS 2015; 57:174-84. [PMID: 26876888 DOI: 10.1016/j.psym.2015.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Certain vulnerability factors have been found to place patients at risk for depression and anxiety, especially within the context of medical illness. OBJECTIVES We sought to describe the relationships among early childhood adversity (ECA) and anxiety, depression and distress in patients with breast cancer. METHODS Patients with breast cancer (stages 0-IV) were assessed for ECA (i.e., the Risky Families Questionnaire subscales include Abuse/Neglect/Chaotic Home Environment), distress (i.e., Distress Thermometer and Problem List), anxiety (Hospital Anxiety and Depression Scale-Anxiety), depression (Hospital Anxiety and Depression Scale-Depression), meeting standardized cut-off thresholds for distress (Distress Thermometer and Problem List ≥4 or ≥7)/anxiety (Hospital Anxiety and Depression Scale-Anxiety ≥8)/depression (Hospital Anxiety and Depression Scale-Depression ≥8) and demographic factors. RESULTS A total of 125 participants completed the study (78% response rate). ECA was associated with depression (p <0.001), anxiety (p = 0.001), and distress (p = 0.006), meeting cut-off threshold criteria for distress (p = 0.024), anxiety (p = 0.048), and depression (p = 0.001). On multivariate analysis, only depression (p = 0.04) and emotional issues (i.e., component of Distress Thermometer and Problem List) (p = 0.001) were associated with ECA. Neglect, but not Abuse and Chaotic Home Environment, was associated with depression (β = 0.442, p < 0.001), anxiety (β = 0.342, p = 0.002), and self-identified problems with family (β = 0.288, p = 0.022), emotion (β = 0.345, p = 0.004), and physical issues (β = 0.408, p < 0.001). CONCLUSION ECA and neglect are associated with multiple psychologic symptoms, but most specifically depression in the setting of breast cancer. ECA contributes to psychologic burden as a vulnerability factor. ECA may help to explain individual patient trajectories and influence the provision of patient-centered care for psychologic symptoms in patients with breast cancer.
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Affiliation(s)
- Daniel C McFarland
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
| | - Charissa Andreotti
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kirk Harris
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - John Mandeli
- Department of Preventative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Tiersten
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Jimmie Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
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19
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Comparison of groups with different patterns of symptom cluster intensity across the breast cancer treatment trajectory. Cancer Nurs 2015; 37:88-96. [PMID: 23448957 DOI: 10.1097/ncc.0b013e31828293e0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Comparing subgroups with different patterns of change in symptom intensity would assist in sorting out individuals at risk for more severe symptoms and worse functional outcomes. OBJECTIVES The objectives of this study were to identify and compare subgroups of breast cancer patients with different patterns of change in a psychoneurological symptom cluster intensity across the treatment trajectory. METHODS This secondary analysis used the data from 160 breast cancer patients undergoing chemotherapy or radiation treatment. Psychoneurological symptom cluster intensity was a composite score of 5 symptoms (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) in a psychoneurological cluster at each of 3 time points (ie, at baseline and at 2 follow-ups after chemotherapy or radiation treatment). RESULTS Five distinct subgroups representing different patterns of psychoneurological symptom cluster intensity during breast cancer treatment were identified: the gradually increasing pattern subgroup (group 1), the constantly low pattern subgroup (group 2), the start low with dramatic increase and decrease pattern subgroup (group 3), the constantly high pattern subgroup (group 4), and the start high with dramatic decrease and leveling pattern subgroup (group 5). Patients without previous cancer treatment experience, with higher level of education, treated with chemotherapy, and/or with more limitations at the baseline were more likely to follow the pattern group 4. Patients in group 4 had the most serious functional limitations measured at the second follow-up time point. CONCLUSION The results suggest the need to evaluate interventions for specific subgroups and to examine the causal mechanisms underlying a psychoneurological symptom cluster. IMPLICATION Clinicians should consider these diverse symptom experiences for assessment/management.
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20
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Slade GD, Sanders AE, Ohrbach R, Bair E, Maixner W, Greenspan JD, Fillingim RB, Smith S, Diatchenko L. COMT Diplotype Amplifies Effect of Stress on Risk of Temporomandibular Pain. J Dent Res 2015. [PMID: 26198390 DOI: 10.1177/0022034515595043] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
When measured once, psychological stress predicts development of painful temporomandibular disorder (TMD). However, a single measurement fails to characterize the dynamic nature of stress over time. Moreover, effects of stress on pain likely vary according to biological susceptibility. We hypothesized that temporal escalation in stress exacerbates risk for TMD, and the effect is amplified by allelic variants in a gene, catechol-O-methyltransferase (COMT), regulating catechol neurotransmitter catabolism. We used data from the Orofacial Pain: Prospective Evaluation and Risk Assessment prospective cohort study of 2,707 community-dwelling adults with no lifetime history of TMD on enrollment. At baseline and quarterly periods thereafter, the Perceived Stress Scale (PSS) measured psychological stress. Genotyped DNA from blood samples determined COMT diplotypes. During follow-up of 0.25 to 5.2 y, 248 adults developed examiner-verified incident TMD. PSS scores at baseline were 20% greater (P < 0.001) in adults who developed incident TMD compared with TMD-free controls. Baseline PSS scores increased by 9% (P = 0.003) during follow-up in cases but remained stable in controls. This stress escalation was limited to incident cases with COMT diplotypes coding for low-activity COMT, signifying impaired catabolism of catecholamines. Cox regression models confirmed significant effects on TMD hazard of both baseline PSS (P < 0.001), modeled as a time-constant covariate, and change in PSS (P < 0.001), modeled as a time-varying covariate. Furthermore, a significant (P = 0.04) interaction of COMT diplotype and time-varying stress showed that a postbaseline increase of 1.0 standard deviation in PSS more than doubled risk of TMD incidence in subjects with low-activity COMT diplotypes (hazard ratio = 2.35; 95% confidence limits: 1.66, 3.32), an effect not found in subjects with high-activity COMT diplotypes (hazard ratio = 1.42; 95% confidence limits: 0.96, 2.09). Findings provide novel insights into dynamic effects of psychological stress on TMD pain, highlighting that effects are most pronounced in individuals whose genetic susceptibility increases responsiveness to catecholamine neurotransmitters.
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Affiliation(s)
- G D Slade
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A E Sanders
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, NY, USA
| | - E Bair
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - W Maixner
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J D Greenspan
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA Brotman Facial Pain Clinic, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - R B Fillingim
- Department of Community Dentistry & Behavioral Science, University of Florida, Gainesville, FL, USA
| | - S Smith
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L Diatchenko
- Allan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
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Partridge AH, Jacobsen PB, Andersen BL. Challenges to Standardizing the Care for Adult Cancer Survivors: Highlighting ASCO's Fatigue and Anxiety and Depression Guidelines. Am Soc Clin Oncol Educ Book 2015:188-194. [PMID: 25993156 DOI: 10.14694/edbook_am.2015.35.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There are over 14 million survivors of cancer living in the United States alone and tens of millions more worldwide, with this population expected to nearly double in the next decade. The successes of prevention, early detection, and better therapies have lead to an emerging understanding of the substantial medical and psychosocial issues for this growing population that must be tackled for individuals and from the health care system and societal perspectives.
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Affiliation(s)
- Ann H Partridge
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Moffitt Cancer Center, Tampa, FL; Department of Psychology, The Ohio State University, Columbus, OH
| | - Paul B Jacobsen
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Moffitt Cancer Center, Tampa, FL; Department of Psychology, The Ohio State University, Columbus, OH
| | - Barbara L Andersen
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Moffitt Cancer Center, Tampa, FL; Department of Psychology, The Ohio State University, Columbus, OH
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22
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Andersen BL, DeRubeis RJ, Berman BS, Gruman J, Champion VL, Massie MJ, Holland JC, Partridge AH, Bak K, Somerfield MR, Rowland JH. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 2014; 32:1605-19. [PMID: 24733793 PMCID: PMC4090422 DOI: 10.1200/jco.2013.52.4611] [Citation(s) in RCA: 470] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE A Pan-Canadian Practice Guideline on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults With Cancer was identified for adaptation. METHODS American Society of Clinical Oncology (ASCO) has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The guideline was reviewed for developmental rigor and content applicability. RESULTS On the basis of content review of the pan-Canadian guideline, the ASCO panel agreed that, in general, the recommendations were clear, thorough, based on the most relevant scientific evidence, and presented options that will be acceptable to patients. However, for some topics addressed in the pan-Canadian guideline, the ASCO panel formulated a set of adapted recommendations based on local context and practice beliefs of the ad hoc panel members. It is recommended that all patients with cancer be evaluated for symptoms of depression and anxiety at periodic times across the trajectory of care. Assessment should be performed using validated, published measures and procedures. Depending on levels of symptoms and supplementary information, differing treatment pathways are recommended. Failure to identify and treat anxiety and depression increases the risk for poor quality of life and potential disease-related morbidity and mortality. This guideline adaptation is part of a larger survivorship guideline series. CONCLUSION Although clinicians may not be able to prevent some of the chronic or late medical effects of cancer, they have a vital role in mitigating the negative emotional and behavioral sequelae. Recognizing and treating effectively those who manifest symptoms of anxiety or depression will reduce the human cost of cancer.
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Affiliation(s)
- Barbara L Andersen
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Robert J DeRubeis
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Barry S Berman
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Jessie Gruman
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Victoria L Champion
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Mary Jane Massie
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Jimmie C Holland
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Ann H Partridge
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Kate Bak
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Mark R Somerfield
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
| | - Julia H Rowland
- Barbara L. Andersen, The Ohio State University, Columbus, OH; Robert J. DeRubeis, University of Pennsylvania, Philadelphia, PA; Barry S. Berman, Broward Health Medical Center, Fort Lauderdale, FL; Jessie Gruman, Center for Advancing Health, Washington, DC; Victoria L. Champion, Indiana University, Indianapolis, IN; Mary Jane Massie, Jimmie C. Holland, Memorial Sloan-Kettering Cancer Institute, New York, NY; Ann H. Partridge, Dana Farber Cancer Institute, Boston, MA; Kate Bak and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; Julia H. Rowland, National Cancer Institute, Bethesda, MD
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Wu SM, Yang HC, Thayer JF, Andersen BL. Association of the physiological stress response with depressive symptoms in patients with breast cancer. Psychosom Med 2014; 76:252-6. [PMID: 24804879 PMCID: PMC4056449 DOI: 10.1097/psy.0000000000000060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The literature on the relationship of depressive symptoms and stress hormones after cancer diagnosis has been mixed, with some studies showing a relationship and other studies showing none. Time since diagnosis may explain these contradictory findings. This study examined the relationship of depressive symptoms to stress hormones in patients with breast cancer using 12-month longitudinal data. METHODS Patients with Stage II or III breast cancer (n = 227) were assessed every 4 months from diagnosis/surgery to 12 months. They completed the Centers for Epidemiological Studies Depression Scale (CES-D) Iowa Short Form and the Perceived Stress Scale and blood samples were obtained to measure stress hormones (i.e., cortisol, adrenocorticotropin hormone, norepinephrine, and epinephrine). RESULTS Depressive symptoms were negatively related to cortisol levels (β= -0.023, p = .002) but were positively related to rate of change in cortisol (β = 0.003, p = .003). Adrenocorticotropin hormone, epinephrine, and norepinephrine did not covary with depressive symptoms (all p values > .05). When the CES-D and Perceived Stress Scale were both used to predict cortisol, only the CES-D was significantly related (β = -0.025, p = .017). CONCLUSIONS Depressive symptoms were negatively related to cortisol, but this relationship changed from the time of diagnosis/surgery through 12 months. Cortisol may initially provide a buffering effect against depression during the stress of initial diagnosis and treatment, but this relationship seems to change over time.
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Affiliation(s)
- Salene M. Wu
- Department of Psychology, The Ohio State University,
Columbus, Ohio
| | - Hae-Chung Yang
- Yongmoon Graduate School of Counseling Psychology, Seoul,
Korea
| | - Julian F. Thayer
- Department of Psychology, The Ohio State University,
Columbus, Ohio
| | - Barbara L. Andersen
- Department of Psychology, The Ohio State University,
Columbus, Ohio
- Comprehensive Cancer Center and Solove Research Institute,
The Ohio State University, Columbus, Ohio
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24
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Abstract
The recently developed Perceived Stress Reactivity Scale (PSRS; Schlotz, Yim, Zoccola, Jansen, & Schulz, 2011) examines perceived stress reactivity with 6 different subscales. The authors of the current study build on initial validation work with this scale by evaluating patterns of the convergent and discriminant validity of scores on its 6 substantially correlated subscales. Examination of the relationships between the 6 PSRS subscales and other variables (personality, depressive affect, eudaimonic well-being, environmental demands, and aspects of work) indicated some differentiation between the different facets of stress reactivity. The PSRS scales also correlated highly with the Perceived Stress Scale (PSS). To account for all of these relationships, a structural regression model specifying a hierarchical factor model for the PSRS scales showed that some relationships (e.g., with neuroticism) were best modeled at the general stress factor level using a latent variable also defined by both the PSS and the PSRS subscales. The model also demonstrated lower level specific relationships that generated better fit than when all predictors were forced to relate to the PSRS only through the general stress factor. Results indicate that domain-specific aspects of stress can be differentiated, which ultimately could prove useful in research on mental health consequences of stress originating from different life domains.
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25
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Kenne Sarenmalm E, Mårtensson LB, Holmberg SB, Andersson BA, Odén A, Bergh I. Mindfulness based stress reduction study design of a longitudinal randomized controlled complementary intervention in women with breast cancer. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:248. [PMID: 24088535 PMCID: PMC3850932 DOI: 10.1186/1472-6882-13-248] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 09/10/2013] [Indexed: 11/10/2022]
Abstract
Background The stress of a breast cancer diagnosis and its treatment can produce a variety of psychosocial sequelae including impaired immune responses. Mindfulness Based Stress Reduction (MBSR) is a structured complementary program that incorporates meditation, yoga and mind-body exercises. Despite promising empirical evidence for the efficacy of MBSR, there is a need for randomized controlled trials (RCT). There is also a need for RCTs investigating the efficacy of psychosocial interventions on mood disorder and immune response in women with breast cancer. Therefore, the overall aim is to determine the efficacy of a Mindfulness Based Stress Reduction (MBSR) intervention on well-being and immune response in women with breast cancer. Methods and design In this RCT, patients diagnosed with breast cancer, will consecutively be recruited to participate. Participants will be randomized into one of three groups: MBSR Intervention I (weekly group sessions + self-instructing program), MBSR Intervention II (self-instructing program), and Controls (non-MBSR). Data will be collected before start of intervention, and 3, 6, and 12 months and thereafter yearly up to 5 years. This study may contribute to evidence-based knowledge concerning the efficacy of MBSR to support patient empowerment to regain health in breast cancer disease. Discussion The present study may contribute to evidence-based knowledge concerning the efficacy of mindfulness training to support patient empowerment to regain health in a breast cancer disease. If MBSR is effective for symptom relief and quality of life, the method will have significant clinical relevance that may generate standard of care for patients with breast cancer. Trial registration ClinicalTrials.gov: NCT01591915
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26
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Green McDonald P, O'Connell M, Lutgendorf SK. Psychoneuroimmunology and cancer: a decade of discovery, paradigm shifts, and methodological innovations. Brain Behav Immun 2013; 30 Suppl:S1-9. [PMID: 23333846 PMCID: PMC3907949 DOI: 10.1016/j.bbi.2013.01.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 12/11/2022] Open
Abstract
This article introduces the supplement Advances in Cancer and Brain, Behavior, and Immunity and outlines important discoveries, paradigm shifts, and methodological innovations that have emerged in the past decade to advance mechanistic and translational understanding of biobehavioral influences on tumor biology, cancer treatment-related sequelae, and cancer outcomes. We offer a heuristic framework for research on biobehavioral pathways in cancer. The shifting survivorship landscape is highlighted, and we propose that the changing demographics suggest prudent adoption of a life course perspective of cancer and cancer survivorship. We note opportunities for psychoneuroimmunology (PNI) research to ameliorate the long-term, unintended consequences of aggressive curative intent and call attention to the critical role of reciprocal translational pathways between animal and human studies. Lastly, we briefly summarize the articles included in this compilation and offer our perspectives on future research directions.
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Affiliation(s)
- Paige Green McDonald
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program (BRP), Division of Cancer Control and Population Sciences (DCCPS), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD 20892, USA.
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27
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Armaiz-Pena GN, Cole SW, Lutgendorf SK, Sood AK. Neuroendocrine influences on cancer progression. Brain Behav Immun 2013; 30 Suppl:S19-25. [PMID: 22728325 PMCID: PMC3467346 DOI: 10.1016/j.bbi.2012.06.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/14/2012] [Accepted: 06/14/2012] [Indexed: 01/11/2023] Open
Abstract
During the past decade, new studies have continued to shed light on the role of neuroendocrine regulation of downstream physiological and biological pathways relevant to cancer growth and progression. More specifically, our knowledge of the effects of the sympathetic nervous system (SNS) on cancer biology has been greatly expanded by new data demonstrating how the cellular immune response, inflammatory processes, tumor-associated angiogenesis, and tumor cell invasion and survival converge to promote tumor growth. This review will summarize these studies, while synthesizing clinical, cellular and molecular research that has continued to unearth the biological events mediating the interplay between SNS-related processes and cancer progression.
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Affiliation(s)
- Guillermo N. Armaiz-Pena
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Steve W. Cole
- Department of Medicine, Division of Hematology–Oncology, UCLA School of Medicine, Los Angeles, California
| | - Susan K. Lutgendorf
- Departments of Psychology, Urology, Obstetrics and Gynecology, and the Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Anil K. Sood
- Departments of Gynecologic Oncology, Cancer Biology and Center for RNA Interference and Non-coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas
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28
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Witek Janusek L, Tell D, Albuquerque K, Mathews HL. Childhood adversity increases vulnerability for behavioral symptoms and immune dysregulation in women with breast cancer. Brain Behav Immun 2013; 30 Suppl:S149-62. [PMID: 22659062 PMCID: PMC3492527 DOI: 10.1016/j.bbi.2012.05.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 04/24/2012] [Accepted: 05/22/2012] [Indexed: 10/28/2022] Open
Abstract
Women respond differentially to the stress-associated with breast cancer diagnosis and treatment, with some women experiencing more intense and/or sustained behavioral symptoms and immune dysregulation than others. Childhood adversity has been identified to produce long-term dysregulation of stress response systems, increasing reactivity to stressors encountered during adulthood. This study determined whether childhood adversity increased vulnerability for more intense and sustained behavioral symptoms (fatigue, perceived stress, and depressive symptoms), poorer quality of life, and greater immune dysregulation in women (N=40) with breast cancer. Evaluation was after breast surgery and through early survivorship. Hierarchical linear modeling was used to examine intra-individual and inter-individual differences with respect to initial status and to the pattern of change (i.e. trajectory) of outcomes. At initial assessment, women exposed to childhood emotional neglect/abuse had greater perceived stress, fatigue, depressive symptoms and poorer quality of life, as well as lower natural killer cell activity (NKCA). Although these outcomes improved over time, women with greater childhood emotional neglect/abuse exhibited worse outcomes through early survivorship. No effect was observed on the pattern of change for these outcomes. In contrast, childhood physical neglect predicted sustained trajectories of greater perceived stress, worse quality of life, and elevated plasma IL-6; with no effect observed at initial assessment. Thus, childhood adversity leaves an enduring imprint, increasing vulnerability for behavioral symptoms, poor quality of life, and elevations in IL-6 in women with breast cancer. Further, childhood adversity predisposes to lower NKCA at a critical time when this immune-effector mechanism is most effective at halting nascent tumor seeding.
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Affiliation(s)
- Linda Witek Janusek
- Marcella Niehoff School of Nursing, Loyola University Chicago, Health Science Division, Maywood, IL 60153, USA.
| | - Dina Tell
- Marcella Niehoff School of Nursing, Loyola University Chicago, Health Science Division, Maywood, IL 60153
| | - Kevin Albuquerque
- Stritch School of Medicine, Loyola University Chicago, Health Science Division, Maywood, IL 60153
| | - Herbert L. Mathews
- Stritch School of Medicine, Loyola University Chicago, Health Science Division, Maywood, IL 60153
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29
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Kang DH, Park NJ, McArdle T. Cancer-specific stress and mood disturbance: implications for symptom perception, quality of life, and immune response in women shortly after diagnosis of breast cancer. ISRN NURSING 2012; 2012:608039. [PMID: 23316388 PMCID: PMC3539323 DOI: 10.5402/2012/608039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/28/2012] [Indexed: 11/26/2022]
Abstract
Purpose. To determine the levels of cancer-specific stress and mood disturbance in women shortly after diagnosis of breast cancer and to assess their associations with symptom perception, quality of life, and immune response. Design. Descriptive and correlational. Sample and Setting. One hundred women with newly diagnosed breast cancer were recruited from interdisciplinary breast clinics. Methods. Baseline data were collected using standardized questionnaires and established bioassay prior to the initiation of cancer adjuvant therapy. Blood samples were collected about the same time of day. Results. High cancer-specific stress was significantly correlated with high mood disturbance, which, in turn, was correlated with high symptom perception, poor quality of life, and an immune profile indicating high neutrophils and low lymphocytes. Conclusions. High cancer-specific stress and related mood disturbance show extensive negative relationships with multiple behavioral, clinical, and biological factors. Implications for Nursing. Routine screening for cancer-related stress and mood disturbance should be incorporated into nursing practice for all patients diagnosed with cancer. Given broad negative associations with other biobehavioral factors, early identification of patients at risk and provision and evaluation of stress and mood management programs may have a beneficial effect on subsequent health outcomes over time.
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Affiliation(s)
- Duck-Hee Kang
- University of Texas School of Nursing at Houston, 6901 Bertner Avenue, CNR No. 536, Houston, TX 77030, USA
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30
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Albuquerque K, Tell D, Lobo P, Millbrandt L, Mathews HL, Janusek LW. Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer. BMC Cancer 2012; 12:251. [PMID: 22708709 PMCID: PMC3542587 DOI: 10.1186/1471-2407-12-251] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 05/29/2012] [Indexed: 12/02/2022] Open
Abstract
Introduction This pilot study used a prospective longitudinal design to compare the effect of adjuvant whole breast radiation therapy (WBRT) versus partial breast radiation therapy (PBRT) on fatigue, perceived stress, quality of life and natural killer cell activity (NKCA) in women receiving radiation after breast cancer surgery. Methods Women (N = 30) with early-stage breast cancer received either PBRT, Mammosite brachytherapy at dose of 34 Gy 10 fractions/5 days, (N = 15) or WBRT, 3-D conformal techniques at dose of 50 Gy +10 Gy Boost/30 fractions, (N = 15). Treatment was determined by the attending oncologist after discussion with the patient and the choice was based on tumor stage and clinical need. Women were assessed prior to initiation of radiation therapy and twice after completion of radiation therapy. At each assessment, blood was obtained for determination of NKCA and the following instruments were administered: Perceived Stress Scale (PSS), Functional Assessment of Cancer Therapy-Fatigue (FACT-F), and Functional Assessment of Cancer Therapy-General (FACT-G). Hierarchical linear modeling (HLM) was used to evaluate group differences in initial outcomes and change in outcomes over time. Results Fatigue (FACT-F) levels, which were similar prior to radiation therapy, demonstrated a significant difference in trajectory. Women who received PBRT reported progressively lower fatigue; conversely fatigue worsened over time for women who received WBRT. No difference in perceived stress was observed between women who received PBRT or WBRT. Both groups of women reported similar levels of quality of life (FACT-G) prior to initiation of radiation therapy. However, HLM analysis revealed significant group differences in the trajectory of quality of life, such that women receiving PBRT exhibited a linear increase in quality of life over time after completion of radiation therapy; whereas women receiving WBRT showed a decreasing trajectory. NKCA was also similar between therapy groups but additional post hoc analysis revealed that better quality of life significantly predicted higher NKCA regardless of therapy. Conclusions Compared to WBRT, PBRT results in more rapid recovery from cancer-related fatigue with improved restoration of quality of life after radiation therapy. Additionally, better quality of life predicts higher NKCA against tumor targets, emphasizing the importance of fostering quality of life for women undergoing adjuvant radiation therapy.
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Affiliation(s)
- Kevin Albuquerque
- Department of Radiation Oncology, Loyola University Health System, Maywood, IL, USA.
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31
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Gregorio SWD, Carpenter KM, Dorfman CS, Yang HC, Simonelli LE, Carson WE. Impact of breast cancer recurrence and cancer-specific stress on spouse health and immune function. Brain Behav Immun 2012; 26:228-33. [PMID: 21807090 PMCID: PMC3250556 DOI: 10.1016/j.bbi.2011.07.237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 07/15/2011] [Accepted: 07/17/2011] [Indexed: 12/01/2022] Open
Abstract
Spouses of cancer patients are at-risk for poor psychological and physical health as they cope with the complex nature of the disease and fears of losing their partner. Moreover, spouses often serve as patients' primary informal caregivers, a group that evidences poor outcomes across a variety of domains. The present study examines the relative contributions of cancer recurrence - a cancer-specific stressful event - and the subjective experience of cancer-specific stress (IES) in a sample of male spouses of breast cancer survivors. We hypothesized that stress would contribute to poorer physical health and compromised immune function. Spouses (recurrence; n=16) of patients who were coping with their first recurrence were matched to spouses of patients with no evidence of disease (disease-free; n=16). Self-reported physical health (physical symptoms and fatigue) and immune function [T-cell blastogenic response to the mitogens Concanavalin A (ConA) and phytohemagglutanin (PHA) and T3 monoclonal antibody (T3 Mab)] were included as outcomes. Results indicated that patient recurrence status was not a significant unique predictor of physical health or immune function; rather, among all spouses, cancer-specific stress symptoms were associated with increased physical symptoms and altered T-cell blastogenesis. These data suggest that the health implications of caregiving for spouses of cancer survivors is more strongly linked to their subjective experience of cancer as stressful, rather than simply the patients' disease status.
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Affiliation(s)
- Sharla Wells-Di Gregorio
- Department of Psychiatry, Center for Palliative Care, The Ohio State University, Columbus, OH 43210–1222, USA.
| | | | | | | | | | - William E. Carson
- Department of Surgery, College of Medicine and Comprehensive Cancer Center, The Ohio State University
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32
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Epigenetic patterns associated with the immune dysregulation that accompanies psychosocial distress. Brain Behav Immun 2011; 25:830-9. [PMID: 21146603 PMCID: PMC3079772 DOI: 10.1016/j.bbi.2010.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 12/05/2010] [Accepted: 12/06/2010] [Indexed: 11/21/2022] Open
Abstract
The molecular basis for psychosocial-distress mediated immune-dysregulation is not well understood. The purpose of this study was to determine whether peripheral blood mononuclear cell (PBMC) epigenetic pattern associates with this form of immune dysregulation. Women newly diagnosed with early stage breast cancer were enrolled into the study and psychosocial, immunological and epigenetic assessments were made at diagnosis and four months later, after completion of cancer treatment. At diagnosis women reported increased perceived stress, anxiety, and mood disturbance and the PBMC of these women exhibited reduced natural killer cell activity and reduced production of interferon gamma, which contrasted with results, obtained after completion of treatment. At the epigenetic level, a PBMC subset derived from women at diagnosis exhibited a distinct epigenetic pattern, with reduced nuclear acetylation of histone residues H4-K8 and H4-K12, as well as reduced phosphorylation of H3-S10, when compared to similar cells derived after the completion of treatment. Natural killer cell activity and interferon-gamma production were associated with nuclear acetylation and phosphorylation status of these histone residues. These findings demonstrate associations among nuclear epigenetic pattern and the immune dysregulation that accompanies psychosocial distress.
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33
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Costanzo ES, Sood AK, Lutgendorf SK. Biobehavioral influences on cancer progression. Immunol Allergy Clin North Am 2011; 31:109-32. [PMID: 21094927 DOI: 10.1016/j.iac.2010.09.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This review focuses on the contributions of stress-related behavioral factors to cancer growth and metastasis and the biobehavioral mechanisms underlying these relationships. Behavioral factors that are important in modulation of the stress response and the pivotal role of neuroendocrine regulation in the downstream alteration of physiologic pathways relevant to cancer control, including the cellular immune response, inflammation, and tumor angiogenesis, invasion, and cell signaling pathways are described. Consequences for cancer progression and metastasis, as well as quality of life, are delineated. Behavioral and pharmacologic interventions with the potential to alter these biobehavioral pathways for patients with cancer are discussed.
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Affiliation(s)
- Erin S Costanzo
- Department of Psychiatry, Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, 6001 Research Park Boulevard, Madison, WI 53719, USA.
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34
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Kang DH, McArdle T, Park NJ, Weaver MT, Smith B, Carpenter J. Dose Effects of Relaxation Practice on Immune Responses in Women Newly Diagnosed With Breast Cancer: An Exploratory Study. Oncol Nurs Forum 2011; 38:E240-52. [DOI: 10.1188/11.onf.e240-e252] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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35
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Moreno-Smith M, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncol 2011; 6:1863-81. [PMID: 21142861 DOI: 10.2217/fon.10.142] [Citation(s) in RCA: 282] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The influence of psychosocial factors on the development and progression of cancer has been a longstanding hypothesis since ancient times. In fact, epidemiological and clinical studies over the past 30 years have provided strong evidence for links between chronic stress, depression and social isolation and cancer progression. By contrast, there is only limited evidence for the role of these behavioral factors in cancer initiation. Recent cellular and molecular studies have identified specific signaling pathways that impact cancer growth and metastasis. This article provides an overview of the relationship between psychosocial factors, specifically chronic stress, and cancer progression.
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Affiliation(s)
- Myrthala Moreno-Smith
- Department of Gynecologic Oncology, UTMD Anderson Cancer Center, 1155 Herman Pressler, Houston, TX 77030, USA
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36
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Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity. J Altern Complement Med 2011; 16:531-8. [PMID: 20455784 DOI: 10.1089/acm.2009.0018] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mindfulness-based stress reduction (MBSR) programs have consistently been shown to enhance the psychosocial well-being of participants. Given the well-established association between psychosocial factors and immunologic functioning, it has been hypothesized that enhanced psychosocial well-being among MBSR participants would be associated with corresponding changes in markers of immune activity. OBJECTIVES The objectives of this study were to examine changes in psychosocial and immunologic measures in a heterogeneous patient sample following participation in a MBSR program. DESIGN A single-group, pretest/post-test design was utilized. SETTING The intervention was conducted at an academic health center. SUBJECTS This pilot study involved 24 participants (aged 28-72 years). Inclusion criteria were as follows: > or =18 years of age, English-speaking, and no known autoimmune disorder. INTERVENTION The intervention was an 8-week MBSR program. OUTCOME MEASURES Distress and quality of life (QOL) measures included the Brief Symptom Inventory-18 and the Medical Outcomes Survey Short-Form Health Survey, respectively. Immunologic measures included natural killer (NK) cell cytolytic activity and C-reactive protein (CRP). RESULTS Patients completed psychosocial assessments and provided a blood sample at baseline (pre-MBSR) and within 2 weeks post-MBSR. Significant improvements in anxiety and overall distress as well as across multiple domains of QOL were observed from baseline to post-MBSR. Reductions in anxiety and overall distress were associated with reductions in CRP. Patients who reported improvement in overall mental well-being also showed increased NK cytolytic activity from pre- to post-MBSR, whereas patients who reported no improvement in mental well-being showed no change in NK cytolytic activity. CONCLUSIONS Positive improvement in psychologic well-being following MBSR was associated with increased NK cytolytic activity and decreased levels of CRP.
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37
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Krukowski K, Eddy J, Kosik KL, Konley T, Janusek LW, Mathews HL. Glucocorticoid dysregulation of natural killer cell function through epigenetic modification. Brain Behav Immun 2011; 25:239-49. [PMID: 20656012 PMCID: PMC2989339 DOI: 10.1016/j.bbi.2010.07.244] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 07/11/2010] [Accepted: 07/18/2010] [Indexed: 11/18/2022] Open
Abstract
It is well-established that psychological distress reduces natural killer cell activity (NKCA) and dysregulates cytokine balance. This may be mediated by stress-induced release of glucocorticoids, which have broad effects on the immune system, including the suppression of NKCA and alteration of cytokine production. The purpose of this study was to evaluate epigenetic mechanisms that may underlie the effect of glucocorticoids on NK cells, using the human NK cell line, NK92. Treatment of NK92 cells with the synthetic glucocorticoid, dexamethasone, at a concentration of 10⁻⁷M, produced a significant reduction in NKCA. Glucocorticoid inhibition was a consequence of not only a reduced capacity of the NK cells to bind to tumor targets but also a reduced production of granule constituents (perforin and granzyme B) with no detectable effect on granule exocytosis. Glucocorticoids also reduced the constitutive and the stimulated production of the cytokines, IL-6, TNF alpha and IFN gamma, and reduced the surface expression of LFA-1. Glucocorticoid treatment also reduced global histone acetylation, the acetylation of histone 4 lysine position 8, and the accessibility of the proximal promoters of perforin, interferon gamma and granzyme B. Histone acetylation was recovered by treatment of the NK cells with a histone deacetylase inhibitor, which also restored NKCA and IFN gamma production. These results demonstrate glucocorticoids to dysregulate NK cell function at least in part through an epigenetic mechanism, which reduces promoter accessibility through modification of histone acetylation status. This epigenetic modification decreases the expression of effector proteins necessary to the full functional activity of NK cells.
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Affiliation(s)
- Karen Krukowski
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University of Chicago, Maywood, IL 60153 USA
| | - Justin Eddy
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University of Chicago, Maywood, IL 60153 USA
| | - Kelly Loster Kosik
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University of Chicago, Maywood, IL 60153 USA
| | - Teresa Konley
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University of Chicago, Maywood, IL 60153 USA
| | - Linda Witek Janusek
- Marcella Niehoff School of Nursing, Loyola University of Chicago, Maywood, IL 60153 USA
| | - Herbert L. Mathews
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University of Chicago, Maywood, IL 60153 USA
- Correspondence author. Herbert L. Mathews, Department of Microbiology and Immunology, Loyola University of Chicago, 2160 South First Ave., Maywood, IL 60153 USA. Tel. (708) 216-4586, Fax. (708) 216-9574,
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Abstract
Epidemiologic evidence increasingly has supported the role of biobehavioral risk factors such as social adversity, depression, and stress in cancer progression. This review describes in vitro, in vivo, and clinical studies demonstrating relationships between such processes and pathways involved in cancer progression. These include effects on the cellular immune response, angiogenesis, invasion, anoikis, and inflammation. Biobehavioral factors have been shown to contribute to the cross talk between tumor and host cells in the tumor microenvironment, and stress effects on host cells such as macrophages seem to be critical for many pathways involved in tumor progression. Some effects are bidirectional in that tumor-derived inflammation seems to affect central nervous system processes, giving rise to vegetative symptoms and contributing to dysregulation of the hypothalamic-pituitary-adrenal axis with downstream effects on inflammatory control. Findings to date are reviewed, and fruitful areas for future research are discussed.
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Lutgendorf SK, Mullen-Houser E, Russell D, Degeest K, Jacobson G, Hart L, Bender D, Anderson B, Buekers TE, Goodheart MJ, Antoni MH, Sood AK, Lubaroff DM. Preservation of immune function in cervical cancer patients during chemoradiation using a novel integrative approach. Brain Behav Immun 2010; 24:1231-40. [PMID: 20600809 PMCID: PMC3010350 DOI: 10.1016/j.bbi.2010.06.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 06/23/2010] [Accepted: 06/23/2010] [Indexed: 11/19/2022] Open
Abstract
Patients receiving chemoradiation for cervical cancer are at risk for distress, chemoradiation-related side-effects, and immunosuppression. This prospective randomized clinical trial examined effects of a complementary therapy, Healing Touch (HT), versus relaxation training (RT) and usual care (UC) for (1) supporting cellular immunity, (2) improving mood and quality of life (QOL), and (3) reducing treatment-associated toxicities and treatment delay in cervical cancer patients receiving chemoradiation. Sixty women with stages IB1 to IVA cervical cancer were randomly assigned to receive UC or 4 ×/weekly individual sessions of either HT or RT immediately following radiation during their 6-week chemoradiation treatment. Patients completed psychosocial assessments and blood sampling before chemoradiation at baseline, weeks 4 and 6. Multilevel regression analyses using orthogonal contrasts tested for differences between treatment conditions over time. HT patients had a minimal decrease in natural killer cell cytotoxicity (NKCC) over the course of treatment whereas NKCC of RT and UC patients declined sharply during chemoradiation (group by time interaction: p = 0.018). HT patients showed greater decreases in two different indicators of depressed mood (CES-D depressed mood subscale and POMS depression scale) compared to RT and UC (group by time interactions: p<0.05). No between group differences were observed in QOL, treatment delay, or clinically-rated toxicities. HT may benefit cervical cancer patients by moderating effects of chemoradiation on depressed mood and cellular immunity. Effects of HT on toxicities, treatment delay, QOL, and fatigue were not observed. Long-term clinical implications of findings are not known.
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Rausch SM, Clark MM, Patten C, Liu H, Felten S, Li Y, Sloan J, Yang P. Relationship between cytokine gene single nucleotide polymorphisms and symptom burden and quality of life in lung cancer survivors. Cancer 2010; 116:4103-13. [PMID: 20564140 DOI: 10.1002/cncr.25255] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous research has demonstrated that many lung cancer survivors report difficulties with symptom control and experience a poor quality of life (QOL). Although recent studies have suggested a relationship of single nucleotide polymorphisms (SNPs) in several cytokine genes with cancer susceptibility and prognosis, associations with symptom burden and QOL have not been examined. The current study was conducted to identify SNPs related to symptom burden and QOL outcomes in lung cancer survivors. METHODS All participants were enrolled in the Mayo Clinic Lung Cancer Cohort following diagnosis of lung cancer. A total of 1149 Caucasian lung cancer survivors completed questionnaires and had genetic samples available. The main outcome measures were symptom burden as measured by the Lung Cancer Symptom Scale and health-related QOL as measured by the Short-Form General Health Survey. RESULTS Twenty-one SNPs in cytokine genes were associated with symptom burden and QOL outcomes. Our results suggested both specificity and consistency of cytokine gene SNPs in predicting outcomes. CONCLUSIONS These results provide support for genetic predisposition to QOL and symptom burden and may aid in identification of lung cancer survivors at high risk for symptom management and QOL difficulties.
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Affiliation(s)
- Sarah M Rausch
- H. Lee Moffitt Cancer Center and Research Institute, Inc, Tampa, Florida 33612, USA.
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Lutgendorf SK, Sood AK, Antoni MH. Host factors and cancer progression: biobehavioral signaling pathways and interventions. J Clin Oncol 2010; 28:4094-9. [PMID: 20644093 PMCID: PMC2940426 DOI: 10.1200/jco.2009.26.9357] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 05/25/2010] [Indexed: 01/06/2023] Open
Abstract
Whereas evidence for the role of psychosocial factors in cancer initiation has been equivocal, support continues to grow for links between psychological factors such as stress, depression, and social isolation and progression of cancer. In vitro, in vivo, and clinical studies show that stress- related processes can impact pathways implicated in cancer progression, including immuno-regulation, angiogenesis, and invasion. Contributions of systemic factors, such as stress hormones to the crosstalk between tumor and stromal cells, appear to be critical in modulating downstream signaling pathways with important implications for disease progression. Inflammatory pathways may also be implicated in fatigue and other factors related to quality of life. Although substantial evidence supports a positive effect of psychosocial interventions on quality of life in cancer, the clinical evidence for efficacy of stress-modulating psychosocial interventions in slowing cancer progression remains inconclusive, and the biobehavioral mechanisms that might explain such effects are still being established. This article reviews research findings to date and outlines future avenues of research in this area.
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Affiliation(s)
- Susan K. Lutgendorf
- From the Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; University of Texas M. D. Anderson Comprehensive Cancer Center, Houston, TX; and the Sylvester Cancer Center, University of Miami, Miami, FL
| | - Anil K. Sood
- From the Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; University of Texas M. D. Anderson Comprehensive Cancer Center, Houston, TX; and the Sylvester Cancer Center, University of Miami, Miami, FL
| | - Michael H. Antoni
- From the Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; University of Texas M. D. Anderson Comprehensive Cancer Center, Houston, TX; and the Sylvester Cancer Center, University of Miami, Miami, FL
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Psychological factors in immunomodulation induced by cancer surgery: a review. Biol Psychol 2010; 85:1-13. [PMID: 20576501 DOI: 10.1016/j.biopsycho.2010.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 05/21/2010] [Accepted: 05/22/2010] [Indexed: 12/30/2022]
Abstract
The immune system's efficacy in detecting and destroying cancer cells varies considerably throughout the stages of cancer development and its role may be critical particularly during the surgical period. Although surgery causes tumor cells to shed into the blood, immune cells have the capacity to destroy these tumor cells. However, surgery also suppresses cytotoxic capacity. It is particularly during this surgical period that psychological factors can have a significant dampening or strengthening impact on surgery-related immunomodulation response, thus exerting an effect on survival. This review describes the immune changes during the peri-surgical period and the influences psychological factors have on immune function, including the immune effects caused by psychological interventions in cancer patients. We recommend that future studies exploring the role of psychological factors on immune function and survival focus more on their influence during the peri-surgical period.
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Andersen BL, Golden-Kreutz DM, Emery CF, Thiel DL. Biobehavioral Intervention for Cancer Stress: Conceptualization, Components, and Intervention Strategies. COGNITIVE AND BEHAVIORAL PRACTICE 2009. [DOI: 10.1016/j.cbpra.2008.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rohleder N, Marin TJ, Ma R, Miller GE. Biologic cost of caring for a cancer patient: dysregulation of pro- and anti-inflammatory signaling pathways. J Clin Oncol 2009; 27:2909-15. [PMID: 19433690 DOI: 10.1200/jco.2008.18.7435] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Caring for a family member with cancer is a psychologically demanding experience. However, it remains unclear whether the distress that caregiving provokes also takes a physiologic toll on the body. This study observed familial caregivers of patients with brain cancer for a year after diagnosis and tracked changes in neurohormonal and inflammatory processes. PATIENTS AND METHODS Eighteen caregivers (age 50.4 +/- 3.5 years) and 19 controls (age 50.2 +/- 2.6 years) were assessed four times during a year (before and after radiotherapy, as well as 6 weeks and 4 months thereafter). Salivary biomarkers of hypothalamus-pituitary-adrenal axis and sympathetic nervous system (SNS) activity were collected, and blood was drawn for assessment of the systemic inflammatory markers C-reactive protein (CRP) and interleukin-6 (IL-6). Blood was also used to monitor in vitro IL-6 production by endotoxin-stimulated leukocytes and expression of mRNA for pro- and anti-inflammatory signaling molecules. RESULTS Caregivers showed marked changes over time in diurnal output of salivary amylase, a marker of SNS activity, whereas secretions in controls were stable during follow-up. Cortisol output was similar in caregivers and controls. During the year, caregivers showed a profound linear increase in systemic inflammation, as indexed by CRP. At the same time, they displayed a linear decline in mRNA for anti-inflammatory signaling molecules and diminished in vitro glucocorticoid sensitivity. CONCLUSION These preliminary data show that familial caregivers of patients with cancer experience marked changes in neurohormonal and inflammatory processes in the year after diagnosis. These changes may place them at risk for morbidity and mortality from diseases fostered by excessive inflammation.
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Affiliation(s)
- Nicolas Rohleder
- Brandeis University, Department of Psychology, Waltham, MA 02454, USA.
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Thornton LM, Andersen BL, Carson WE. Immune, endocrine, and behavioral precursors to breast cancer recurrence: a case-control analysis. Cancer Immunol Immunother 2008; 57:1471-81. [PMID: 18327581 PMCID: PMC2574681 DOI: 10.1007/s00262-008-0485-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 02/11/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND A period of tumor growth precedes the clinical detection of breast cancer recurrence. We explore immune, endocrine, and behavioral parameters during this period. METHODS We conducted a phase III clinical trial in which women with surgically treated stage II/III breast cancer (N = 227) were randomized to receive a psychological intervention or assessment-only and then regularly assessed for 10 years. Patients who recurred (R, n = 48) were matched with patients remaining disease-free (DF, n = 48) on demographic and prognostic characteristics, treatment, and duration of disease-free follow-up. Data at three assessment points, occurring, on average, 17, 11, and 4 months before the recurrence was detected clinically, with equivalent time points for the disease-free group, were examined. Mixed-effects models tested for group differences in immune cell counts and function as well as endocrine and behavioral parameters. RESULTS In the 17 months prior to recurrence detection, patients exhibited higher white blood cell count, neutrophil, lymphocyte, and natural killer cell counts, relative to DF patients. R patients also showed higher cortisol, worse physical functioning, fatigue, and quality of life. Follow-up analyses showed patients with local recurrences to differ from those with distant recurrence, with the former exhibiting elevated natural killer cell cytotoxicity, lymphocyte proliferative response, fatigue, pain, and emotional distress (depression, anxiety), and the latter exhibiting higher neutrophil, lymphocyte, and natural killer cell counts. CONCLUSION Patients who would recur showed reliable biobehavioral alterations more than a year prior to their diagnosis. This novel observation may contribute to our understanding of the disease relapse processes.
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Affiliation(s)
- Lisa M Thornton
- Department of Psychology, Ohio State University, Columbus, OH, 43210, USA.
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Lutgendorf SK, Lamkin DM, DeGeest K, Anderson B, Dao M, McGinn S, Zimmerman B, Maiseri H, Sood AK, Lubaroff DM. Depressed and anxious mood and T-cell cytokine expressing populations in ovarian cancer patients. Brain Behav Immun 2008; 22:890-900. [PMID: 18276105 PMCID: PMC2605940 DOI: 10.1016/j.bbi.2007.12.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 12/08/2007] [Accepted: 12/31/2007] [Indexed: 12/26/2022] Open
Abstract
The adaptive immune response of ovarian cancer patients has been linked to survival, and is known to be impaired in the tumor microenvironment. Little is known about relationships between biobehavioral factors such as depressed mood and anxiety and the adaptive immune response in ovarian cancer. Thirty-seven patients with epithelial ovarian cancer and 14 patients with benign ovarian neoplasms completed psychosocial questionnaires pre-surgery. Lymphocytes from peripheral blood, tumor, and ascites (fluid around the tumor), were obtained on the day of surgery. Expression of the Type-1 cytokine interferon-gamma (IFN gamma), and the Type-2 cytokine interleukin-4 (IL-4) by T-helper (CD4(+)) and T-cytotoxic (CD8(+)) cells was measured under autologous tumor-stimulated, polyclonally-stimulated, or unstimulated conditions. Links with mood were examined. Among cancer patients, marked elevations in unstimulated and tumor-stimulated Type-2 responses were seen, particularly in ascites and tumor-infiltrating lymphocytes (P values<0.01). With polyclonal stimulation, lymphocytes from all compartments expressed elevated Type-1 cytokines (P values<0.014). Depressed and anxious mood were both associated with significantly lower ratios of polyclonally-stimulated CD4(+) cells producing IFN gamma (TH(1) cells) vs. IL-4 (TH(2) cells) in all compartments (depressed mood: P=0.012; anxiety: P=0.038) and depressed mood was also related to lower ratios of polyclonally-stimulated CD8(+) cells producing IFN gamma (TC(1)) vs. IL-4 (TC(2)) (P=0.035). Although effects of polyclonal stimulation should be generalized with caution to the in vivo immune response, findings suggest that depressed and anxious mood are associated with greater impairment of adaptive immunity in peripheral blood and in the tumor microenvironment among ovarian cancer patients.
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Affiliation(s)
- Susan K. Lutgendorf
- Department of Psychology, University of Iowa, Iowa City, IA, USA,Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA,Department of Urology, University of Iowa, Iowa City, IA, USA,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Donald M. Lamkin
- Department of Psychology, University of Iowa, Iowa City, IA, USA
| | - Koen DeGeest
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | - Barrie Anderson
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | - Minh Dao
- Department of Obstetrics and Gynecology, U. of Texas Medical Branch, Galveston, TX, USA
| | - Stephanie McGinn
- Department of Psychology, University of Iowa, Iowa City, IA, USA
| | - Bridget Zimmerman
- Departments of Gynecologic Oncology and Cancer Biology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Heena Maiseri
- Department of Psychology, University of Iowa, Iowa City, IA, USA
| | - Anil K. Sood
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - David M. Lubaroff
- Department of Urology, University of Iowa, Iowa City, IA, USA,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA,Department of Microbiology, University of Iowa, Iowa City, IA, USA,Veterans Affairs Medical Center, Iowa City, IA, USA
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Yang HC, Thornton LM, Shapiro CL, Andersen BL. Surviving recurrence: psychological and quality-of-life recovery. Cancer 2008; 112:1178-87. [PMID: 18253948 DOI: 10.1002/cncr.23272] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND To the authors' knowledge, data characterizing patients' psychosocial experiences after a recurrence diagnosis are limited. This report provides the physical, psychological, and quality-of-life trajectories of patients with recurrent breast cancer. In addition, patients with a well-documented trajectory -- patients with their initial diagnosis of breast cancer -- were included as a referent group, providing a metric against which to gauge the impact and course of cancer recurrence. METHODS Patients with a newly diagnosed, recurrent (n = 69) or initial (n = 113) breast cancer were accrued. The groups did not differ with regard to age, race, education, family income, or partner status (all P values > .18). All patients were assessed shortly after diagnosis (baseline) and 4 months, 8 months, and 12 months later. Mixed-effects models were used to determine health status, stress, mood, and quality-of-life trajectories. RESULTS In the year after a recurrence diagnosis, patients' physical health and functioning showed no improvement, whereas quality of life and mood generally improved, and stress declined. Compared with patients who were coping with their first diagnosis, patients with recurrence had significantly lower anxiety and confusion. In contrast, physical functioning was poorer among recurrence patients, quality-of-life improvement was slower, and cancer-related distress was high as that of the initially diagnosed patient. Slower quality-of-life recovery was most apparent among younger patients (aged <54 years). CONCLUSIONS Despite the physical burden, patients with recurrent breast cancer exhibit considerable resilience, with steady improvements in psychological adjustment and quality of life during the year after diagnosis. Management of patients' physical symptoms is particularly important, because patients cope with recurrent breast cancer as a chronic illness.
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Affiliation(s)
- Hae-Chung Yang
- Department of Psychology, Ohio State University, Columbus, OH 43210-1222, USA
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Abstract
PURPOSE OF REVIEW The objectives of this review are to identify new studies in the area of psychooncology, and ascertain the directions current studies are taking. RECENT FINDINGS New studies relate to the measurement of distress, which is being strongly proposed as the sixth vital sign in the assessment of patients with cancer. Attempts to use different scales and instruments to screen for depression and psychiatric morbidity in patients with cancer have also been made. Posttraumatic stress disorder, fatigue, somatization and cognitive dysfunctions have been studied. The field of psychoneuroimmunology has further strengthened our understanding of the impact of stress on immune function. Cancer survivors and their coping methods, sexual health, and suicidality have been the focus of research in the last year. Quality of life of caregivers has also been studied, as has spirituality. Cognitive behaviour group therapy in relatives of patients with cancer appears to be helpful. SUMMARY New studies in psychooncology have focused on the relationship between psychosocial factors and cancer, such as detection of distress and psychiatric morbidity, intervention, coping methods used by survivors, and psychoneuroimmunology. Research in psychooncology is an exciting area despite numerous challenges.
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