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Irwin MR, Hoang D, Olmstead R, Sadeghi N, Breen EC, Bower JE, Cole S. Tai Chi compared with cognitive behavioral therapy and the reversal of systemic, cellular and genomic markers of inflammation in breast cancer survivors with insomnia: A randomized clinical trial. Brain Behav Immun 2024; 120:159-166. [PMID: 38777285 DOI: 10.1016/j.bbi.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/06/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Insomnia contributes to inflammation in breast cancer survivors. This study evaluates whether insomnia treatment reverses inflammation in breast cancer survivors with insomnia. METHODS Participants (n = 90) were randomized to 3 months of Tai Chi (n = 45) or cognitive behavioral therapy for insomnia (CBT-I)(n = 45), and followed for one year post-intervention to 15 month endpoint. Our previous report found that Tai Chi as compared to CBT-I resulted in similar rates of insomnia response and remission over 15 months. Here, we analyze changes in plasma C-reactive protein and pro- and anti-inflammatory cytokines, Toll-like receptor (TLR)-4 stimulated monocyte production of interleukin (IL)-6 and tumor necrosis factor-α (TNF), and cellular pro-inflammatory and anti-viral gene expression (Conserved Transcriptional Response to Adversity RNA profile; CTRA) over 15 months. RESULTS Insomnia treatment resulted in decreases in the TLR-4 stimulated monocyte production of IL-6, TNF, and their co-expression, as well as decreases in the CTRA profile, decreases inflammatory gene transcripts, and increases in anti-viral gene transcripts over 15 months (all P's < 0.01). In addition, as compared to CBT-I, Tai Chi resulted in greater decreases in plasma IL-6 (P < 0.05), and greater decreases in TLR-4 activated monocyte production of IL-6 and co-expression of IL-6 and TNF at 15 month endpoint. CBT-I resulted in greater increases in anti-viral gene transcripts. CONCLUSIONS Administration of either CBT-I or Tai Chi effectively treats insomnia, and shows additional benefits of reducing cellular and genomic markers of inflammation, and increasing anti-viral genomic markers in breast cancer survivors with insomnia. Tai Chi, as compared to CBT-I, yields greater and more durable decreases in systemic- and cellular inflammation. Targeting insomnia might mitigate the risk of inflammation-related co-morbidities in breast cancer survivors.
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Affiliation(s)
- Michael R Irwin
- Cousins Center for Psychoneuroimmunology (MRI, DH, RO, CC, NS, ECB, JEB, SC), UCLA Semel Institute for Neuroscience, Department of Psychiatry and Biobehavioral Sciences (MRI, RO, ECB, SC), UCLA David Geffen School of Medicine (DH), Department of Psychology (JEB), University of California, Los Angeles, United States.
| | - Danny Hoang
- Cousins Center for Psychoneuroimmunology (MRI, DH, RO, CC, NS, ECB, JEB, SC), UCLA Semel Institute for Neuroscience, Department of Psychiatry and Biobehavioral Sciences (MRI, RO, ECB, SC), UCLA David Geffen School of Medicine (DH), Department of Psychology (JEB), University of California, Los Angeles, United States.
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology (MRI, DH, RO, CC, NS, ECB, JEB, SC), UCLA Semel Institute for Neuroscience, Department of Psychiatry and Biobehavioral Sciences (MRI, RO, ECB, SC), UCLA David Geffen School of Medicine (DH), Department of Psychology (JEB), University of California, Los Angeles, United States.
| | - Nina Sadeghi
- Cousins Center for Psychoneuroimmunology (MRI, DH, RO, CC, NS, ECB, JEB, SC), UCLA Semel Institute for Neuroscience, Department of Psychiatry and Biobehavioral Sciences (MRI, RO, ECB, SC), UCLA David Geffen School of Medicine (DH), Department of Psychology (JEB), University of California, Los Angeles, United States.
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology (MRI, DH, RO, CC, NS, ECB, JEB, SC), UCLA Semel Institute for Neuroscience, Department of Psychiatry and Biobehavioral Sciences (MRI, RO, ECB, SC), UCLA David Geffen School of Medicine (DH), Department of Psychology (JEB), University of California, Los Angeles, United States.
| | - Julienne E Bower
- Cousins Center for Psychoneuroimmunology (MRI, DH, RO, CC, NS, ECB, JEB, SC), UCLA Semel Institute for Neuroscience, Department of Psychiatry and Biobehavioral Sciences (MRI, RO, ECB, SC), UCLA David Geffen School of Medicine (DH), Department of Psychology (JEB), University of California, Los Angeles, United States.
| | - Steve Cole
- Cousins Center for Psychoneuroimmunology (MRI, DH, RO, CC, NS, ECB, JEB, SC), UCLA Semel Institute for Neuroscience, Department of Psychiatry and Biobehavioral Sciences (MRI, RO, ECB, SC), UCLA David Geffen School of Medicine (DH), Department of Psychology (JEB), University of California, Los Angeles, United States.
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Christian LM, Kiecolt-Glaser JK, Cole SW, Burd CE, Madison AA, Wilson SJ, Rosko AE. Psychoneuroimmunology in multiple myeloma and autologous hematopoietic stem cell transplant: Opportunities for research among patients and caregivers. Brain Behav Immun 2024; 119:507-519. [PMID: 38643954 DOI: 10.1016/j.bbi.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple myeloma (MM) is an incurable cancer and is the leading indication for autologous hematopoietic stem cell transplantation (HSCT). To be eligible for HSCT, a patient must have a caregiver, as caregivers play a central role in HSCT preparation and recovery. MM patients remain on treatment indefinitely, and thus patients and their caregivers face long-term challenges including the intensity of HSCT and perpetual therapy after transplant. Importantly, both patients and their caregivers show heightened depressive and anxiety symptoms, with dyadic correspondence evidenced and caregivers' distress often exceeding that of patients. An extensive psychoneuroimmunology (PNI) literature links distress with health via immune and neuroendocrine dysregulation as well as biological aging. However, data on PNI in the context of multiple myeloma - in patients or caregivers - are remarkably limited. Distress in MM patients has been associated with poorer outcomes including higher inflammation, greater one year post-HSCT hospital readmissions, and worse overall survival. Further, anxiety and depression are linked to biological aging and may contribute to the poor long-term health of both patients and caregivers. Because MM generally affects older adults, individual differences in biological aging may represent an important modifier of MM biology and HSCT treatment outcomes. There are a number of clinical scenarios in which biologically younger people could be prescribed more intensive therapies, with potential for greater benefit, by using a personalized cancer therapy approach based on the quantification of physiologic reserve. Further, despite considerable psychological demands, the effects of distress on health among MM caregivers is largely unexamined. Within this context, the current critical review highlights gaps in knowledge at the intersection of HSCT, inflammation, and biological aging in the context of MM. Research in this area hold promise for opportunities for novel and impactful psychoneuroimmunology (PNI) research to enhance health outcomes, quality of life, and longevity among both MM patients and their caregivers.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Janice K Kiecolt-Glaser
- The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Steve W Cole
- Departments of Psychiatry and Biobehavioral Sciences and Medicine, Division of Hematology-Oncology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Christin E Burd
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH 43210, USA; Department of Molecular Genetics, The Ohio State University, Columbus, OH 43210, USA
| | - Annelise A Madison
- The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Department of Psychology, The Ohio State University, Columbus, OH 43210, USA; Veteran's Affairs Boston Healthcare System, Boston, MA 02130, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA; Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
| | - Stephanie J Wilson
- Department of Psychology, Southern Methodist University, Dallas, TX 75206, USA
| | - Ashley E Rosko
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Buiting HM, Sonke GS. Setting the Stage for Cancer: Stay Soft and Optimistic. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:247-252. [PMID: 38947106 PMCID: PMC11202115 DOI: 10.59249/fqvx3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
In the Netherlands, one out of two people will be confronted with the diagnosis of cancer sometime in their life. Against this increased number of patients, a large proportion luckily can be cured. Today, a rather high proportion of people receive treatment to control cancer growth or stabilize the disease, sometimes, for the rest of their lives. If such long-standing treatment is administered for more than 10-20 years, the stage of cancer is presently often not referred to as "palliative" anymore, but much more often as "chronic." It could be argued that regardless of the cancer disease stage you are in and whether you are or can be cured, your cancer diagnosis nevertheless has become part of your life, including the experience of chronicity. Discussions surrounding the chronicity of cancer in the context of cancer are still ongoing. This is especially the case because "experiencing chronicity" is dependent on the type of cancer and is less applicable in cancers where the prognosis is often less than one year, such as is more frequently the case with lung or pancreatic cancer. In all situations, experiencing chronicity nevertheless brings along uncertainty, either with or without chronic stress. Combatting stress by choosing the right wording, maintaining an optimistic stance along with physical activity and/or psychosocial education seems important to optimize well-being and to stabilize tumor growth or remove the tumor. In conclusion, chronicity in the context of treating and caring for cancer seems a somewhat gray area. However, regardless in how we, as medical professionals, speak about cancer with long-standing disease trajectories (that sometimes even can be cured), it first of all seems important to approach, take care, and treat patients well. This can facilitate discussions with patients about their disease and disease experiences. Moreover, it can stimulate patients themselves to take responsibility for their own health, which can be of added value to the entire disease trajectory.
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Affiliation(s)
- Hilde M. Buiting
- Antoni van Leeuwenhoek, Netherlands Cancer Institute,
Amsterdam, the Netherlands
- University of Amsterdam, Amsterdam, the
Netherlands
| | - Gabe S. Sonke
- Antoni van Leeuwenhoek, Netherlands Cancer Institute,
Amsterdam, the Netherlands
- University of Amsterdam, Amsterdam, the
Netherlands
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Nissen ER, Neumann H, Knutzen SM, Henriksen EN, Amidi A, Johansen C, von Heymann A, Christiansen P, Zachariae R. Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis. JNCI Cancer Spectr 2024; 8:pkae041. [PMID: 38781520 PMCID: PMC11188797 DOI: 10.1093/jncics/pkae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Considering the persistent nature and higher prevalence of insomnia in cancer patients and survivors compared with the general population, there is a need for effective management strategies. This systematic review and meta-analysis aimed to comprehensively evaluate the available evidence for the efficacy of pharmacological and nonpharmacological interventions for insomnia in adult cancer patients and survivors. METHODS Following the PRISMA guidelines, we analyzed data from 61 randomized controlled trials involving 6528 participants. Interventions included pharmacological, physical, and psychological treatments, with a focus on insomnia severity and secondary sleep and non-sleep outcomes. Frequentist and Bayesian analytical strategies were employed for data synthesis and interpretation. RESULTS Cognitive-Behavioral Therapy for Insomnia (CBT-I) emerged as the most efficacious intervention for reducing insomnia severity in cancer survivors and further demonstrated significant improvements in fatigue, depressive symptoms, and anxiety. CBT-I showed a large postintervention effect (g = 0.86; 95% confidence interval [CI] = 0.57 to 1.15) and a medium effect at follow-up (g = 0.55; 95% CI = 0.18 to 0.92). Other interventions such as bright white light therapy, sleep medication, melatonin, exercise, mind-body therapies, and mindfulness-based therapies showed benefits, but the evidence for their efficacy was less convincing compared with CBT-I. Brief Behavioral Therapy for Insomnia showed promise as a less burdensome alternative for patients in active cancer treatment. CONCLUSIONS CBT-I is supported as a first-line treatment for insomnia in cancer survivors, with significant benefits observed across sleep and non-sleep outcomes. The findings also highlight the potential of less intensive alternatives. The research contributes valuable insights for clinical practice and underscores the need for further exploration into the complexities of sleep disturbances in cancer patients and survivors.
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Affiliation(s)
- Eva Rames Nissen
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Henrike Neumann
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Sofie Møgelberg Knutzen
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Emilie Nørholm Henriksen
- Centre for Involvement of Relatives, Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE) – a Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE) – a Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
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Altieri M, Sergi MR, Tommasi M, Santangelo G, Saggino A. The efficacy of telephone-delivered cognitive behavioral therapy in people with chronic illnesses and mental diseases: A meta-analysis. J Clin Psychol 2024; 80:223-254. [PMID: 37428900 DOI: 10.1002/jclp.23563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/20/2023] [Accepted: 06/10/2023] [Indexed: 07/12/2023]
Abstract
COVID-19 pandemic led to an increase of remote treatments, such as telephone-delivery cognitive behavioral therapy (T-CBT). To our knowledge, no meta-analyses studied the effect of T-CBT in chronic and/or mental illnesses on multiple psychological outcomes. Therefore, our study aims to evaluating the efficacy of T-CBT compared to other interventions (treatment as usual, TAU, or face-to-face CBT). Each effect size (ES) was calculated in Hedges' g and pooled together to produce a mean ES for each outcome (depression, anxiety, mental and physical QoL, worry, coping, and sleep disturbances). The meta-analysis included 33 studies with a randomized controlled trial design. A large ES was found when comparing the efficacy of T-CBT against TAU on depression (g = 0.84, p < 0.001), whereas a moderate ES was found on anxiety (g = 0.57; p < 0.001), and a small effect on mental quality of life (g = 0.33, p < 0.001), sleep disturbances (g = 0.37, p = 0.042), coping (g = 0.20, p = 0.016) and worry (g = 0.43, p = 0.001). The meta-analysis comparing the efficacy of T-CBT and CBT on depression revealed a not significant pooled ES (g = 0.06, p = 0.466). The results provided evidence that T-CBT could be to be more effective than TAU conditions in multiple psychological outcomes, and as efficient as face-to-face CBT in treating depression.
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Affiliation(s)
- Manuela Altieri
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Maria R Sergi
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
| | - Marco Tommasi
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Aristide Saggino
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy
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Luo F, Lu Y, Chen C, Chang D, Jiang W, Yin R. Analysis of the Risk Factors for Negative Emotions in Patients with Esophageal Cancer During the Peri-Radiotherapy Period and Their Effects on Malnutrition. Int J Gen Med 2023; 16:6137-6150. [PMID: 38162686 PMCID: PMC10757788 DOI: 10.2147/ijgm.s444255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024] Open
Abstract
Background Esophageal cancer has a high incidence in China. Many patients also have a heavy psychological burden due to clinical features such as wasting and choking on food. This study analyzed the risk factors of negative emotions in esophageal cancer patients during the peri-radiotherapy period and its effects on malnutrition. Methods We retrospectively analyzed 339 patients with esophageal cancer during the peri-radiotherapy who received treatment at our hospital from April 2017 to April 2020, and followed up for 3 years. t test and Chi-square test were used to analyze the relationship between patients' negative emotions and clinical data. Binary logistics regression was performed to analyze the independent risk factors for the occurrence of negative mood and malnutrition in the patients. Kaplan-Meier survival curves were used to analyze survival rates. Results Our results showed that 18.3% of patients undergoing radiotherapy for esophageal cancer had negative emotions, and 41.9% suffered from malnutrition. The results of the binary logistic regression analysis showed that monthly household income (OR = 0.470, P = 0.022), the TNM stage (OR = 2.030, P = 0.044), concomitant gastrointestinal symptoms (OR = 2.071, P = 0.024), sleep status (OR = 2.540, P = 0.003), swallowing disorders (OR = 1.919, P = 0.048), and post-radiotherapy complications were independent risk factors for the development of negative emotions in patients. Negative emotions (OR = 2.547, P = 0.038) were also a risk factor for malnutrition in patients with esophageal cancer. Conclusion Many patients with esophageal cancer suffer from anxiety and depression in the peri-radiotherapy period, which might lead to complications such as malnutrition or aggravate and affect the prognosis of patients. Therefore, psychological care should be provided based on conventional care to effectively relieve their psychological pressure, and improve their prognosis and quality of life.
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Affiliation(s)
- Feng Luo
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Yingying Lu
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Chen Chen
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Dongdong Chang
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Wei Jiang
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
| | - Ronghua Yin
- Department of Oncology Zone II, Hai’an People’s Hospital, Haian, People’s Republic of China
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Vang S. Health-related Quality of Life in Elderly Asian American and Non-Hispanic White Cancer Survivors. J Prev Med Public Health 2023; 56:440-448. [PMID: 37735828 PMCID: PMC10579642 DOI: 10.3961/jpmph.22.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 09/03/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess predictors of health-related quality of life (HRQoL) in elderly Asian American and non-Hispanic White cancer survivors. METHODS We conducted cross-sectional secondary data analyses using the combined datasets from the Surveillance, Epidemiology, and End Results program and the Medicare Health Outcomes Survey. RESULTS Elderly Asian American cancer survivors reported a lower mental HRQoL but a comparable physical HRQoL relative to elderly non-Hispanic White cancer survivors. Stress factors, such as comorbidities, difficulties with activities of daily living, and a history of depressive symptoms, along with coping resources like self-rated health and the ability to take the survey in English, were significantly associated with mental and physical HRQoL. Among elderly Asian American cancer survivors, a significantly lower mental HRQoL was observed among those taking the survey in the Chinese language. CONCLUSIONS The findings suggest that race exerts a differential impact on HRQoL. Interventions should be designed to address the distinct cultural, linguistic, and systemic needs of elderly Asian American cancer survivors. Such an approach could assist in reducing cancer-related health disparities.
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8
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Sheeran P, Wright CE, Listrom O, Klein WMP, Rothman AJ. Which Intervention Strategies Promote the Adoption and Maintenance of Physical Activity? Evidence From Behavioral Trials With Cancer Survivors. Ann Behav Med 2023; 57:708-721. [PMID: 37078961 PMCID: PMC10847901 DOI: 10.1093/abm/kaad002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND/PURPOSE We address four questions about interventions to promote physical activity in cancer survivors: (a) How often is both the adoption and maintenance of behavior change tested in trials? (b) How often do interventions generate adoption-plus-maintenance of behavior change? (c) Are intervention strategies specifically geared at promoting maintenance of behavior change deployed in trials? and (d) Which intervention strategies distinguish trials that promote both the adoption and maintenance of physical activity from trials that promote adoption-only or generate no behavioral changes? METHODS Computerized literature searches identified 206 reports of randomized trials that measured physical activity in the wake of the intervention. RESULTS Only 51 reports (24%) measured both behavioral adoption (postintervention) and behavioral maintenance (≥3 months follow-up). The 51 reports included 58 tests of interventions; 22% of tests observed both adoption and maintenance of physical activity, 26% reported adoption-only, and 52% found no change in behavior. Change techniques designed to promote behavioral maintenance were used much less frequently than adoption techniques or adoption and maintenance techniques. Interventions that aimed to improve quality of life, used supervised exercise sessions, were undertaken in community centers, and deployed fewer behavior change techniques were associated with adoption-plus-maintenance of physical activity in cancer survivors. CONCLUSIONS The present findings offer new insights into the adoption and maintenance of physical activity and highlight the need to routinely assess these forms of behavior change in future trials. More extensive testing of intervention strategies specifically geared at maintenance of behavior change is warranted.
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Affiliation(s)
- Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Charles E Wright
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Olivia Listrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, Gaithersburg, MD, USA
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Leonhardt J, Winkler M, Kollikowski A, Schiffmann L, Quenzer A, Einsele H, Löffler C. Mind-body-medicine in oncology-from patient needs to tailored programs and interventions: a cross-sectional study. Front Psychol 2023; 14:1140693. [PMID: 37484070 PMCID: PMC10357839 DOI: 10.3389/fpsyg.2023.1140693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction National and international guidelines recommend early integration of evidence-based multimodal interventions and programs, especially with a focus on relaxation techniques and other Mind-Body-based methods to maintain the quality of life of oncology patients, improve treatment tolerability, and promote healthy lifestyle behaviors. Consequently, we aim to understand what drives patients and how they navigate integrative medicine to best advise them. This study aimed to detect possible topics of particular interest to patients and identify the patient groups that could benefit most from further programs. Furthermore, we aimed to investigate if patients are open-minded toward integrative oncology concepts and learn about their motivational level to maintain or change behavior. Methods Between August 2019 and October 2020 we surveyed patients undergoing oncological therapy in a university oncological outpatient center using a custom-developed questionnaire based on established Mind-Body Medicine concepts. Results We included 294 patients with various cancers. More than half reported problems sleeping through (61%) and 42% felt stressed frequently, invariably rating this as detrimental to their health. Moreover, a slight majority (52%) felt physically limited due to their disease and only 30% performed defined exercise programs. Women were significantly more likely to feel stressed and reported with alarming frequency that they often feel "everything was up to them." The 40-65-year-olds reported significantly less restful sleep, more stress and were more dissatisfied with their situation. However, this group already used natural remedies most frequently and was most often motivated to use relaxation techniques in the next 6 months. The lower the perceived individual energy level (EL), the less frequently patients did sport, the more frequently they felt their disease impaired their activity, mostly feeling stressed and tense. We also found significant associations between negative emotions/thoughts and the variables "sleep," "use of relaxation techniques," "personal stress perception," and "successful lifestyle modification." Conclusion Mind-Body programs that focus on patient's individual resources, with tools to explore impairing patterns of self-perception and cognitive biases, can be a valuable resource for oncology patients and should therefore be part of an integrative medical treatment concept.
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Affiliation(s)
- Jonas Leonhardt
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Marcela Winkler
- Department of Natural and Integrative Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Anne Kollikowski
- Comprehensive Cancer Center, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Lisa Schiffmann
- Comprehensive Cancer Center, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Anne Quenzer
- Department of Gynecology and Obstetrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Claudia Löffler
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center, University Hospital of Wuerzburg, Wuerzburg, Germany
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10
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Sun W, Ren Z, Zhu S, Cheng S, Liu W, Li HCW, Xia W, Yuan C, Adeloye D, Rudan I, Canoy D, Song P. Spousal concordance in adverse childhood experiences and the association with depressive symptoms in middle-aged and older adults: findings across China, the US, and Europe. Front Public Health 2023; 11:1158590. [PMID: 37383257 PMCID: PMC10297162 DOI: 10.3389/fpubh.2023.1158590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/12/2023] [Indexed: 06/30/2023] Open
Abstract
Background Adverse childhood experiences (ACEs) are associated with higher depressive risks in adulthood. Whether respondents' ACEs are associated with their own depressive symptoms in adulthood and whether this association extends to their spouses' depressive symptoms remain unexplored. Methods Data were from China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), and the Survey of Health, Ageing and Retirement in Europe (SHARE). ACEs were categorized into overall, intra-familial, and extra-familial ACEs. Correlations of couples' ACEs were calculated using Cramer's V and partial Spearman's correlation. Associations of respondents' ACEs with spousal depressive symptoms were assessed using logistic regression, and mediation analyses were conducted to explore the mediating role of respondents' depressive symptoms. Results Significant associations between husbands' ACEs and wives' depressive symptoms, with odds ratios (ORs) and 95% confidence intervals (CIs) of 2.09 (1.36-3.22) for 4 or more ACEs in CHARLS, and 1.25 (1.06-1.48) and 1.38 (1.06-1.79) for 2 or more ACEs in HRS and SHARE. However, wives' ACEs were associated with husbands' depressive symptoms only in CHARLS and SHARE. Findings in intra-familial and extra-familial ACEs were consistent with our main results. Additionally, respondents' depressive symptoms mediated more than 20% of the effect of respondents' ACEs on spousal depressive symptoms. Conclusion We found that ACEs were significantly correlated between couples. Respondents' ACEs were associated with spousal depressive symptoms, with respondents' depressive symptoms mediating the association. The bidirectional implications of ACEs on depressive symptoms should be considered within household and effective interventions are warranted.
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Affiliation(s)
- Weidi Sun
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ziyang Ren
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Siyu Zhu
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Siqing Cheng
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital, International 16 Institutes of Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wen Liu
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ho Cheung William Li
- Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Wei Xia
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Davies Adeloye
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Dexter Canoy
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Women’s and Reproductive Health, Medical Science Division, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Peige Song
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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11
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Martín-Núñez J, Linares-Moya M, Calvache-Mateo A, Lazo-Prados A, Heredia-Ciuró A, López-López L, Valenza MC. Barriers and applied activity, quality of life and self-efficacy in prostate cancer survivors 1 year after completing radiotherapy. Support Care Cancer 2023; 31:284. [PMID: 37079161 PMCID: PMC10119230 DOI: 10.1007/s00520-023-07729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE The aims of the study were to assess self-reported physical activity (PA) levels, barriers to PA, quality of life and self-efficacy to manage chronic disease of prostate cancer survivor 1 year after radiotherapy treatment. METHODS A cross-sectional case-control study was performed. Prostate cancer survivor patients treated with radiotherapy were recruited from the Radiation Oncology Service of the "Complejo Hospitalario Universitario" (Granada) and compared with age-matched healthy men. Outcomes included were perception of benefits for physical activity and potential barriers (Exercise Benefits/Barriers Scale), physical activity levels assessed by the International Physical Activity Questionnaire (IPAQ), quality of life (EuroQol five-dimension three-levels) and self-efficacy (Self-Efficacy to Manage Chronic Disease). RESULTS A total of 120 patients were included in our study. Significant differences were found between groups with worse results for the prostate cancer patient group in the variable perception of the benefit of physical activity, potential barriers, and physical activity. Regarding quality of life and self-efficacy, significant differences were also observed between groups with a greater score in the control group. CONCLUSION In conclusion, the results of this study reveal that self-reported PA levels, as measured using the IPAQ, were low in prostate cancer survivors after treatment. Results also showed worse perception of benefits for PA and potential barriers by the cancer survivors. Similarly, the quality of life and self-efficacy to manage chronic disease of prostate cancer survivors was lower.
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Affiliation(s)
- Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Marta Linares-Moya
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain.
| | - Antonio Lazo-Prados
- Oncological Radiotherapy Service of the "Hospital PTS", Clínico San Cecilio University Hospital, Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
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12
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Bade BC, Faiz SA, Ha DM, Tan M, Barton-Burke M, Cheville AL, Escalante CP, Gozal D, Granger CL, Presley CJ, Smith SM, Chamberlaine DM, Long JM, Malone DJ, Pirl WF, Robinson HL, Yasufuku K, Rivera MP. Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e6-e28. [PMID: 36856560 PMCID: PMC10870898 DOI: 10.1164/rccm.202210-1963st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.
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13
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Alembagheri A, Hajimehdipoor H, Khoramjouy M, Esmaeili S, Faizi M. Antifatigue Effects of the Aqueous Extracts of Myrtle Berries, Apple and Clove: An Animal Study. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2023; 22:e140323. [PMID: 38444713 PMCID: PMC10912872 DOI: 10.5812/ijpr-140323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/13/2023] [Accepted: 09/23/2023] [Indexed: 03/07/2024]
Abstract
Background Fatigue is one of the most prevalent symptoms, increasing worldwide with no specific medication for fatigue. Iranian traditional medicine (ITM), or Persian medicine, is a reliable source for discovering natural medicine for diseases and their symptoms. Myrtus communis L. (Myrtle), Malus domestica Borkh. (Apple), and Syzygium aromaticum (L.) Merr. & L. M. Perry (Clove) have been utilized as brain and heart tonics in ITM. Based on ITM, cardiac tonics decrease fatigue by enhancing heart function and increasing blood flow to tissues. These plants, particularly myrtle berries, have been utilized as potent enlivening agents that reduce mental fatigue. Objectives This study aims to investigate the effects of aqueous extracts of these plants on weight-loaded forced swimming (WLFS) tests and three doses of aqueous myrtle extract in an animal model of chronic sleep deprivation-induced fatigue. Methods Five groups of rats (n = 6) were evaluated: Sham, control, apple-treated, clove-treated, and myrtle-treated groups. After 28 days of treatment, the WLFS test was performed, and swimming time was recorded. Subsequently, central fatigue was induced in rats by chronic sleep deprivation for 21 days. Five groups of rats (n = 6) were evaluated: Sham, control (sleep-deprived, which received water), and three sleep-deprived + treatment groups, which received aqueous myrtle extract (350, 700, and 1000 mg/kg). An open field test on the 20th day and a WLFS test on the 21st day were performed. Results The myrtle berries significantly increased glucose, reduced lactate dehydrogenase (LDH) levels, and enhanced swimming time. Fatigue caused by chronic sleep deprivation increased malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and LDH while decreased superoxide dismutase (SOD), glucose, and swimming time. In all treatment groups, SOD levels and swimming time were increased, whereas MDA, IL-1β, and TNF-α levels were decreased significantly. Only the 1000 mg/kg dose significantly reduced LDH levels (P < 0.001). The treatment significantly improved the velocity and the total distance moved in the open-field test. Conclusions According to the results, the myrtle berries reduced fatigue in two animal models, probably due to its phenolic compounds, flavonoids, and polysaccharides.
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Affiliation(s)
- Akram Alembagheri
- Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homa Hajimehdipoor
- Department of Traditional Pharmacy, Traditional Medicine and Materia Medica Research Center, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Khoramjouy
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Esmaeili
- Department of Traditional Pharmacy, Traditional Medicine and Materia Medica Research Center, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Pharmacognosy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Faizi
- Department of Pharmacology and Toxicology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Lemos R, Areias-Marques S, Ferreira P, O’Brien P, Beltrán-Jaunsarás ME, Ribeiro G, Martín M, del Monte-Millán M, López-Tarruella S, Massarrah T, Luís-Ferreira F, Frau G, Venios S, McManus G, Oliveira-Maia AJ. A prospective observational study for a Federated Artificial Intelligence solution for moniToring mental Health status after cancer treatment (FAITH): study protocol. BMC Psychiatry 2022; 22:817. [PMID: 36544126 PMCID: PMC9769034 DOI: 10.1186/s12888-022-04446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Depression is a common condition among cancer patients, across several points in the disease trajectory. Although presenting higher prevalence rates than the general population, it is often not reported or remains unnoticed. Moreover, somatic symptoms of depression are common in the oncological context and should not be dismissed as a general symptom of cancer. It becomes even more challenging to track psychological distress in the period after the treatment, where connection with the healthcare system typically becomes sporadic. The main goal of the FAITH project is to remotely identify and predict depressive symptoms in cancer survivors, based on a federated machine learning (ML) approach, towards optimization of privacy. METHODS FAITH will remotely analyse depression markers, predicting their negative trends. These markers will be treated in distinct categories, namely nutrition, sleep, activity and voice, assessed in part through wearable technologies. The study will include 300 patients who have had a previous diagnosis of breast or lung cancer and will be recruited 1 to 5 years after the end of primary cancer. The study will be organized as a 12-month longitudinal prospective observational cohort study, with monthly assessments to evaluate depression symptoms and quality of life among cancer survivors. The primary endpoint is the severity of depressive symptoms as measured by the Hamilton Depression Rating Scale (Ham-D) at months 3, 6, 9 and 12. Secondary outcomes include self-reported anxiety and depression symptoms (HADS scale), and perceived quality of life (EORTC questionnaires), at baseline and monthly. Based on the predictive models gathered during the study, FAITH will also aim at further developing a conceptual federated learning framework, enabling to build machine learning models for the prediction and monitoring of depression without direct access to user's personal data. DISCUSSION Improvements in the objectivity of psychiatric assessment are necessary. Wearable technologies can provide potential indicators of depression and anxiety and be used for biofeedback. If the FAITH application is effective, it will provide healthcare systems with a novel and innovative method to screen depressive symptoms in oncological settings. TRIAL REGISTRATION Trial ID: ISRCTN10423782 . Date registered: 21/03/2022.
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Affiliation(s)
- Raquel Lemos
- grid.421010.60000 0004 0453 9636Champalimaud Research & Clinical Centre, Champalimaud Foundation, Lisbon, Portugal ,grid.410954.d0000 0001 2237 5901ISPA – Instituto Universitário de Ciências Psicológicas, Sociais E da Vida, Lisbon, Portugal
| | - Sofia Areias-Marques
- grid.421010.60000 0004 0453 9636Champalimaud Research & Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Pedro Ferreira
- grid.421010.60000 0004 0453 9636Champalimaud Research & Clinical Centre, Champalimaud Foundation, Lisbon, Portugal ,grid.10772.330000000121511713Department of Electrical and Computer Engineering, Faculdade de Ciências E Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Philip O’Brien
- grid.516064.0Waterford Institute of Technology, Waterford, Ireland
| | - María Eugenia Beltrán-Jaunsarás
- grid.5690.a0000 0001 2151 2978LifeSTech, Department of Photonics and Bioengineering, Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Gabriela Ribeiro
- grid.421010.60000 0004 0453 9636Champalimaud Research & Clinical Centre, Champalimaud Foundation, Lisbon, Portugal ,grid.10772.330000000121511713NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Miguel Martín
- grid.4795.f0000 0001 2157 7667Medical Oncology Department, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERONC, Geicam, Universidad Complutense, Madrid, Spain
| | - María del Monte-Millán
- grid.410526.40000 0001 0277 7938Medical Oncology Department, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERONC, Madrid, Spain
| | - Sara López-Tarruella
- grid.4795.f0000 0001 2157 7667Medical Oncology Department, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERONC, Geicam, Universidad Complutense, Madrid, Spain
| | - Tatiana Massarrah
- grid.410526.40000 0001 0277 7938Medical Oncology Department, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERONC, Madrid, Spain
| | - Fernando Luís-Ferreira
- grid.10772.330000000121511713Department of Electrical and Computer Engineering, Faculdade de Ciências E Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Giuseppe Frau
- grid.424043.50000 0004 1805 0444Deep Blue, Rome, Italy
| | - Stefanos Venios
- Suite5 Data Intelligence Solutions Limited, Limassol, Cyprus
| | - Gary McManus
- grid.516064.0Waterford Institute of Technology, Waterford, Ireland
| | - Albino J. Oliveira-Maia
- grid.421010.60000 0004 0453 9636Champalimaud Research & Clinical Centre, Champalimaud Foundation, Lisbon, Portugal ,grid.10772.330000000121511713NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
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15
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Aronsen S, Conway R, Lally P, Roberts A, Croker H, Beeken RJ, Fisher A. Determinants of sleep quality in 5835 individuals living with and beyond breast, prostate, and colorectal cancer: a cross-sectional survey. J Cancer Surviv 2022; 16:1489-1501. [PMID: 34750779 DOI: 10.1007/s11764-021-01127-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The present study aimed to quantify the level of sleep problems in 5835 breast, prostate, and colorectal cancer survivors, and explore a number of potential determinants of poor sleep quality in the present sample. BMI, diet, and physical activity were of particular interest as potential determinants. METHODS Participants who completed the 'Health and Lifestyle after Cancer' survey were adults who had been diagnosed with breast, prostate, or colorectal cancer (mean time since cancer diagnosis was 35.5 months, SD=13.56). Sleep quality was assessed using the Pittsburgh Sleep Quality Index. BMI was calculated from self-reported height and weight. Participants were categorised as meeting/not meeting the World Cancer Research Fund (WCRF) recommendations for fibre, fruit and vegetables, added sugar, red meat, processed meat, fat, alcohol, and physical activity. Analyses accounted for demographic and clinical factors. RESULTS Fifty-seven percent of those with sleep data were classified as poor sleepers (response rate 79%). Being female, having a higher number of cancer treatments, more comorbid conditions, and being more anxious/depressed increased the odds of being a poor sleeper. After adjustment for these factors, there were no associations between diet/alcohol/physical activity and sleep. However, BMI was associated with sleep. Individuals in the overweight and obese categories had 22% and 79% higher odds of being poor sleepers than individuals in the underweight/healthy weight category, respectively. CONCLUSIONS The findings suggest that there may be a need to develop sleep quality interventions for cancer survivors with obesity. Even after adjustment for multiple clinical and demographic factors, BMI (particularly obesity) was associated with poor sleep. Thus, researchers and health professionals should find ways to support individuals with overweight and obesity to improve their sleep quality. IMPLICATIONS FOR CANCER SURVIVORS The present findings highlight that poor sleep is a common issue in cancer survivors. Interventions seeking to improve outcomes for cancer survivors over the longer term should consider sleep quality.
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Affiliation(s)
- Silje Aronsen
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Rana Conway
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Anna Roberts
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Helen Croker
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
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16
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Kwon M, Dickerson SS, Wilding GE, Aquilina AT, Reid M, Dean GE. A nurse-delivered intervention to reduce insomnia in cancer survivors: Study protocol for a randomized-controlled trial. Contemp Clin Trials 2022; 122:106939. [PMID: 36182027 PMCID: PMC10380006 DOI: 10.1016/j.cct.2022.106939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/27/2023]
Abstract
Insomnia has been frequently reported as one of the most burdensome symptoms among cancer survivors. To date, little research exists on strategies to effectively reduce insomnia in cancer survivors, especially in the application of cognitive behavioral therapy for insomnia (CBTI) at the bedside by nurses. The current objective is to determine efficacy and durability of a streamlined, individually delivered version of CBTI, specifically Brief Behavioral Therapy for Insomnia (BBTI) versus a healthy eating attention control, using a large heterogeneous sample of 158 cancer survivors. Study participants will be adults ≥18 years of age; ≥1 month from treatment (except hormones and targeted therapies are acceptable) for stages I through III breast, colorectal, lung or prostate cancers; meet criteria for insomnia defined by Insomnia Severity Index (ISI) >7; screen negative for obstructive sleep apnea <15 events/h; and ability to complete data collection instruments in English. Baseline, and then 1-, 3-, and 12-month objective (i.e., actigraphy) and subjective sleep, mood, and quality of life assessments after the interventions are planned. The primary outcome will be measured with the ISI, a psychometrically-sound instrument used to measure perceived insomnia severity. The results of this trial will demonstrate the application of BBTI in a larger heterogenous sample of cancer survivors for the first time and may lead to implementation strategies that will promote the dissemination and sustainability of this intervention. Clinical trials identifier: http://ClinicalTrials.gov, NCT03810365.
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Affiliation(s)
- Misol Kwon
- School of Nursing, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Suzanne S Dickerson
- School of Nursing, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Gregory E Wilding
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Alan T Aquilina
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Mary Reid
- Cancer Screening, Survivorship and Mentorship, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Grace E Dean
- School of Nursing, University at Buffalo, The State University of New York, NY 14214, USA.
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17
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Rehman A, Drake CL, Shiramizu V, Fleming L. Sleep reactivity predicts insomnia in patients diagnosed with breast cancer. J Clin Sleep Med 2022; 18:2597-2604. [PMID: 35912701 PMCID: PMC9622996 DOI: 10.5664/jcsm.10170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the role of sleep reactivity as a predictor of insomnia in patients diagnosed with breast cancer. METHODS A total of 173 women with breast cancer participated and were followed up over a period of 9 months. At baseline, participants were assigned to a high (n = 114) or low (n = 59) sleep reactivity group, based on their responses to the Ford Insomnia Response to Stress Test (FIRST). We assessed whether these FIRST groupings (high/low sleep reactivity) predicted changes in insomnia over time using the Insomnia Severity Index. We also tested if these FIRST groupings predicted insomnia disorder (using Insomnia Severity Index cutoffs) at 3 different time points (T3, T6, and T9). RESULTS Individuals with high sleep reactivity were more likely to experience a worsening of insomnia. Using logistic regression, we also found that FIRST grouping predicted insomnia disorder. Results remained significant after controlling for estimated premorbid sleep, age, and whether someone had chemotherapy. CONCLUSIONS Our study shows that sleep reactivity may be a robust predictor of insomnia within breast cancer populations. Sleep reactivity should be considered in routine clinical assessments as a reliable way to identify patients at risk of developing insomnia. This would facilitate early sleep intervention for those patients who are considered high risk. CITATION Rehman A, Drake CL, Shiramizu V, Fleming L. Sleep reactivity predicts insomnia in patients diagnosed with breast cancer. J Clin Sleep Med. 2022;18(11):2597-2604.
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Affiliation(s)
- Aliyah Rehman
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Christopher L. Drake
- Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan
| | - Victor Shiramizu
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Leanne Fleming
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
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18
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Oliva D, Andersson BÅ, Lewin F, Jensen LD. Opposing inflammatory biomarker responses to sleep disruption in cancer patients before and during oncological therapy. Front Neurosci 2022; 16:945784. [PMID: 36213755 PMCID: PMC9534604 DOI: 10.3389/fnins.2022.945784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundSleep disruption is known to be highly prevalent in cancer patients, aggravated during oncological treatment and closely associated with reduced quality of life, therapeutic outcome and survival. Inflammatory factors are associated with sleep disruption in healthy individuals and cancer patients, but heterogeneity and robustness of inflammatory factors associated with sleep disruption and how these are affected by oncological therapy remain poorly understood. Furthermore, due to the complex crosstalk between sleep-, and therapy-associated factors, including inflammatory factors, there are currently no established biomarkers for predicting sleep disruption in patients undergoing oncological therapy.MethodsWe performed a broad screen of circulating biomarkers with immune-modulating or endocrine functions and coupled these to self-reported sleep quality using the Medical Outcomes Study (MOS) sleep scale. Ninety cancer patients with gastrointestinal, urothelial, breast, brain and tonsillar cancers, aged between 32 and 86 years, and scheduled for adjuvant or palliative oncological therapy were included. Of these, 71 patients were evaluable. Data was collected immediately before and again 3 months after onset of oncological therapy.ResultsSeventeen among a total of 45 investigated plasma proteins were found to be suppressed in cancer patients exhibiting sleep disruption prior to treatment onset, but this association was lost following the first treatment cycle. Patients whose sleep quality was reduced during the treatment period exhibited significantly increased plasma levels of six pro-inflammatory biomarkers (IL-2, IL-6, IL-12, TNF-a, IFN-g, and GM-CSF) 3 months after the start of treatment, whereas biomarkers with anti-inflammatory, growth factor, immune-modulatory, or chemokine functions were unchanged.ConclusionOur work suggests that biomarkers of sleep quality are not valid for cancer patients undergoing oncological therapy if analyzed only at a single timepoint. On the other hand, therapy-associated increases in circulating inflammatory biomarkers are closely coupled to reduced sleep quality in cancer patients. These findings indicate a need for testing of inflammatory and other biomarkers as well as sleep quality at multiple times during the patient treatment and care process.
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Affiliation(s)
- Delmy Oliva
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Delmy Oliva,
| | - Bengt-Åke Andersson
- Department of Natural Science and Biomedicine, School of Welfare, Jönköping University, Jönköping, Sweden
| | - Freddi Lewin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lasse D. Jensen
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Lasse D. Jensen,
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Rowe RK, Green TRF, Giordano KR, Ortiz JB, Murphy SM, Opp MR. Microglia Are Necessary to Regulate Sleep after an Immune Challenge. BIOLOGY 2022; 11:1241. [PMID: 36009868 PMCID: PMC9405260 DOI: 10.3390/biology11081241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 12/31/2022]
Abstract
Microglia play a critical role in the neuroimmune response, but little is known about the role of microglia in sleep following an inflammatory trigger. Nevertheless, decades of research have been predicated on the assumption that an inflammatory trigger increases sleep through microglial activation. We hypothesized that mice (n = 30) with depleted microglia using PLX5622 (PLX) would sleep less following the administration of lipopolysaccharide (LPS) to induce inflammation. Brains were collected and microglial morphology was assessed using quantitative skeletal analyses and physiological parameters were recorded using non-invasive piezoelectric cages. Mice fed PLX diet had a transient increase in sleep that dissipated by week 2. Subsequently, following a first LPS injection (0.4 mg/kg), mice with depleted microglia slept more than mice on the control diet. All mice were returned to normal rodent chow to repopulate microglia in the PLX group (10 days). Nominal differences in sleep existed during the microglia repopulation period. However, following a second LPS injection, mice with repopulated microglia slept similarly to control mice during the dark period but with longer bouts during the light period. Comparing sleep after the first LPS injection to sleep after the second LPS injection, controls exhibited temporal changes in sleep patterns but no change in cumulative minutes slept, whereas cumulative sleep in mice with repopulated microglia decreased during the dark period across all days. Repopulated microglia had a reactive morphology. We conclude that microglia are necessary to regulate sleep after an immune challenge.
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Affiliation(s)
- Rachel K. Rowe
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80301, USA
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
| | - Tabitha R. F. Green
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
| | - Katherine R. Giordano
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ 85012, USA
| | - J. Bryce Ortiz
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ 85012, USA
| | - Sean M. Murphy
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA
| | - Mark R. Opp
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80301, USA
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Gall AJ, Shuboni-Mulligan DD. Keep Your Mask On: The Benefits of Masking for Behavior and the Contributions of Aging and Disease on Dysfunctional Masking Pathways. Front Neurosci 2022; 16:911153. [PMID: 36017187 PMCID: PMC9395722 DOI: 10.3389/fnins.2022.911153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Environmental cues (e.g., light-dark cycle) have an immediate and direct effect on behavior, but these cues are also capable of “masking” the expression of the circadian pacemaker, depending on the type of cue presented, the time-of-day when they are presented, and the temporal niche of the organism. Masking is capable of complementing entrainment, the process by which an organism is synchronized to environmental cues, if the cues are presented at an expected or predictable time-of-day, but masking can also disrupt entrainment if the cues are presented at an inappropriate time-of-day. Therefore, masking is independent of but complementary to the biological circadian pacemaker that resides within the brain (i.e., suprachiasmatic nucleus) when exogenous stimuli are presented at predictable times of day. Importantly, environmental cues are capable of either inducing sleep or wakefulness depending on the organism’s temporal niche; therefore, the same presentation of a stimulus can affect behavior quite differently in diurnal vs. nocturnal organisms. There is a growing literature examining the neural mechanisms underlying masking behavior based on the temporal niche of the organism. However, the importance of these mechanisms in governing the daily behaviors of mammals and the possible implications on human health have been gravely overlooked even as modern society enables the manipulation of these environmental cues. Recent publications have demonstrated that the effects of masking weakens significantly with old age resulting in deleterious effects on many behaviors, including sleep and wakefulness. This review will clearly outline the history, definition, and importance of masking, the environmental cues that induce the behavior, the neural mechanisms that drive them, and the possible implications for human health and medicine. New insights about how masking is affected by intrinsically photosensitive retinal ganglion cells, temporal niche, and age will be discussed as each relates to human health. The overarching goals of this review include highlighting the importance of masking in the expression of daily rhythms, elucidating the impact of aging, discussing the relationship between dysfunctional masking behavior and the development of sleep-related disorders, and considering the use of masking as a non-invasive treatment to help treat humans suffering from sleep-related disorders.
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Affiliation(s)
- Andrew J. Gall
- Department of Psychology and Neuroscience Program, Hope College, Holland, MI, United States
- *Correspondence: Andrew J. Gall,
| | - Dorela D. Shuboni-Mulligan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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21
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FOND G, FERNANDES S, LUCAS G, Greenberg N, BOYER L. Depression in healthcare workers: results from the nationwide AMADEUS survey. Int J Nurs Stud 2022; 135:104328. [PMID: 35952535 PMCID: PMC9359895 DOI: 10.1016/j.ijnurstu.2022.104328] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 10/31/2022]
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Substituting bouts of sedentary behavior with physical activity: adopting positive lifestyle choices in people with a history of cancer. Cancer Causes Control 2022; 33:1083-1094. [PMID: 35699799 PMCID: PMC9194779 DOI: 10.1007/s10552-022-01592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/22/2022] [Indexed: 11/23/2022]
Abstract
Purpose To determine in people with a history of cancer, whether substituting sitting time with other daily activities (i.e., sleeping, walking, moderate and vigorous physical activity) was associated with changes in waist circumference (WC), an important surrogate marker of cardiometabolic risk. Methods Cross-sectional analyses from the Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) cohort was conducted using isotemporal substitution models to explore the associations of substituting sedentary time, physical activity behavior (International Physical Activity Questionnaire), or sleep (Pittsburgh Sleep Quality Index) with changes in WC. Analyses were conducted using sex-specific WC classifications. Results In 3,684 people with a history of cancer [mean age (SD) 58.2 (7.3) years; BMI 28.9 (5.2) kg m−2; 71% female], reallocating 10 min of sleep or sedentary time for 10 min of walking was associated with lower WC in women (p < 0.01). In men, PA intensity appeared to be more strongly associated with a reduced WC. Replacing 10 min of sedentary time with 10 min of moderate or vigorous PA and replacing 10 min of sleep with moderate PA were associated with a significantly reduced WC (p < 0.001). The largest effect was when 10 min of moderate PA was replaced with vigorous PA, a reduction in WC (p < 0.01) was evident. Conclusion For people with a history of cancer, adopting small but positive changes in lifestyle behaviors could help reduce WC and potentially offset negative health-related outcomes associated with higher WC. Further research is required to examine whether such an intervention may be acceptable and manageable among this population.
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23
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Carroll JE, Olmstead R, Haque R, Irwin MR. Accelerated mononuclear cell telomere attrition in breast cancer survivors with depression history: A 2-year longitudinal cohort study. Cancer 2022; 128:3109-3119. [PMID: 35670038 DOI: 10.1002/cncr.34329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cancer treatments are thought to accelerate biological aging, although this trajectory is highly variable. Depression is more prevalent in breast cancer survivors and is thought to be a vulnerability factor for biological aging. A lifetime history of depression and cumulative lifetime number of depression episodes could hypothetically be associated with an accelerated rate of biological aging as indexed by attrition of telomere length in a prospective cohort of breast cancer survivors who were not currently depressed. METHODS Breast cancer survivors (n = 206) without current depression were recruited from a large community-based health plan and were assessed for depression history by a structured diagnostic interview. Blood specimens were provided at baseline and every 8 months over 24 months to measure peripheral blood mononuclear cell (PBMC) telomere length. Mixed linear models examined associations of depression history and number of depression episodes with change in telomere length, adjusting for demographic, comorbidity, and cancer-specific factors. RESULTS In the fully adjusted model, depression history predicted attrition of PBMC telomere length over 24 months (Beta [SE] = -.006 [.002], p = .001). Greater number of depressive episodes over the lifetime was also associated with accelerated attrition of PBMC telomere length over 24 months (Beta [SE] = -.004 [.001], p = .001). CONCLUSIONS In breast cancer survivors without current depression, telomere attrition over 24 months was greatest in those with a lifetime depression history, particularly those with the greatest number of episodes of major depressive disorder over their lifetime. Depression history and its cumulative burden may contribute to accelerated biological aging, with implications for risk of morbidity and mortality in breast cancer survivors.
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Affiliation(s)
- Judith E Carroll
- Cousins Center for Psychoneuroimmunology, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Reina Haque
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Agostinelli G, Muzzatti B, Serpentini S, Spina M, Annunziata MA. Cancer-Related Psychological Distress in Lymphoma Survivor: An Italian Cross-Sectional Study. Front Psychol 2022; 13:872329. [PMID: 35558708 PMCID: PMC9088809 DOI: 10.3389/fpsyg.2022.872329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Cancer is becoming a chronic disease, and the number of cancer survivors continues to increase. Lymphoma survivors are also increasing in numbers, and anxiety and depression are among the consequences they face. This study aimed to explore psychological distress in a sample of 212 lymphoma survivors. Information through a socio-demographic form and the compilation of questionnaires to assess anxiety, depression, quality of life, and the impact of cancer on lymphoma survivors was collected and analyzed. In the sample examined, 17% of lymphoma survivors were anxiety caseness, and 12.3% were depression caseness, and of these, 8% presented with concomitant anxiety depression. This study identified some variables associated with psychological distress in lymphoma survivors: female sex; living as a couple; a diagnosis of Hodgkin lymphoma; systematic treatment and/or radiotherapy; sleep disorders; no regular physical activity; and present or past use of psychiatric drugs. Our cross-sectional study results suggest that some of the variables investigated may be useful in identifying lymphoma survivors who are more likely to report psychological distress. It is important to monitor psychological distress along the entire trajectory of survivorship in order to identify early the presence of anxiety and depression and to provide timely psychological support.
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Affiliation(s)
- Giulia Agostinelli
- Unit of Oncological Psychology - Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Barbara Muzzatti
- Unit of Oncological Psychology - Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | | | - Michele Spina
- Unit of Oncological Medicine - Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
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Kwon S, Kim J, Kim T, Jeong W, Park EC. Association between gastric cancer and the risk of depression among South Korean adults. BMC Psychiatry 2022; 22:207. [PMID: 35313847 PMCID: PMC8935705 DOI: 10.1186/s12888-022-03847-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/11/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The diagnosis and treatment of cancer are stressful events that could trigger psychological distress in a large number of cancer patients. The aim of this study was to examine the association between gastric cancer and the risk of new onset of depression among South Korean adults. METHODS Data from 12,664 participants aged over 40 years was derived from the National Health Service National Sample Cohort (2002-2013). The case cohort consists of patients who received a diagnosis of gastric cancer between 2002 and 2009, and the corresponding control group was selected through 1:1 propensity score matching (case: 6332, control: 6332). The new onset of depression was considered as the dependent variable. A Cox proportional hazards regression model was built to analyze the associations between variables in consideration. RESULTS Individuals with gastric cancer had a higher risk of new onset of depression than those without cancer (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.13-1.45.) Female gastric patients had a higher risk of depression compared to male patients (Female; HR = 1.89, 95% CI = 1.66-2.16, Male; HR = 1.25, 95% CI = 1.10-1.41). Gastric cancer patients in their 60s had the highest risk of new onset of depression compared to other age groups and no cancer group (HR = 1.61, 95% CI = 1.40-1.85). Gastric cancer patients who were previously diagnosed with depression prior to their diagnosis of cancer had a higher risk of new onset of depression than gastric cancer patients without antecedent diagnosis of depression (Past Depression (Yes); HR = 5.17, 95% CI = 4.10-6.51, Past Depression (No); HR = 1.35, CI = 1.21-1.51). CONCLUSIONS The study identified a significant relationship between gastric cancer and depression among South Korean adults, suggesting that the diagnosis and treatment of gastric cancer increases the risk of new onset of depression, especially among female patients between 60 and 69 years old of high income and living in metropolitan regions. Pre-existing health conditions also appeared to be a risk factor. Thus, in consideration of treatment efficacy and patients' quality of life, the results of the study emphasizes the need for attentive intervention, while distinguishing the most vulnerable groups.
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Affiliation(s)
- Sinyoung Kwon
- grid.15444.300000 0004 0470 5454Premedical Cource, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinyeong Kim
- grid.15444.300000 0004 0470 5454Premedical Cource, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taeyeon Kim
- grid.15444.300000 0004 0470 5454Premedical Cource, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonjeong Jeong
- Department of Preventive Medicine, Gachon University College of Medicine, 38-13, Dokjeom-ro 3beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea. .,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea. .,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Cancer-related accelerated ageing and biobehavioural modifiers: a framework for research and clinical care. Nat Rev Clin Oncol 2022; 19:173-187. [PMID: 34873313 PMCID: PMC9974153 DOI: 10.1038/s41571-021-00580-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
A growing body of evidence indicates that patients with cancer who receive cytotoxic treatments (such as chemotherapy or radiotherapy) have an increased risk of accelerated physical and cognitive ageing. Furthermore, accelerated biological ageing is a suspected driving force behind many of these observed effects. In this Review, we describe the mechanisms of biological ageing and how they apply to patients with cancer. We highlight the important role of specific behavioural factors, namely stress, sleep and lifestyle-related factors such as physical activity, weight management, diet and substance use, in the accelerated ageing of patients with cancer and cancer survivors. We also present a framework of how modifiable behaviours could operate to either increase the risk of accelerated ageing, provide protection, or promote resilience at both the biological level and in terms of patient-reported outcomes.
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Ng SM, Yin MXC, Chan JSM, Chan CHY, Fong TCT, Li A, So KF, Yuen LP, Chen JP, Chung KF, Chan CLW. Impact of mind-body intervention on proinflammatory cytokines interleukin 6 and 1β: A three-arm randomized controlled trial for persons with sleep disturbance and depression. Brain Behav Immun 2022; 99:166-176. [PMID: 34634445 DOI: 10.1016/j.bbi.2021.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 01/14/2023] Open
Abstract
Depressed people are prone to sleep disturbance, which may in return perpetuate the depression. Both depression and sleep disturbance influence proinflammatory cytokines interleukin (IL) 6 and 1β. Thus interventions for depression should consider the effect on sleep disturbance, and vice versa. Integrative Body-Mind-Spirit (IBMS) and Qigong interventions have been applied in a wide range of health and mental health conditions, including depression and sleep disturbance. This study aimed to evaluate the effect of these two mind-body therapies for persons with both depressive symptoms and sleep disturbance. A three-arm randomized controlled trial was conducted among 281 participants, who were randomly assigned to either IBMS, Qigong or wait list control group. Participants in IBMS and Qigong groups received eight weekly sessions of intervention. Outcome measures were plasma concentrations of IL-6 and IL-1β, and a questionnaire containing Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies Depression Scale, Somatic Symptom Inventory, Perceived Stress Scale and Body-Mind-Spirit Holistic Well-being Scale. Outcomes were assessed at baseline (T0), immediate post-intervention (T1) and at three-months post-intervention (T2). Besides intervention efficacy analysis, path analysis was performed to explore the relations among perceived stress, depression, sleep disturbance, and IL-6 and IL-1β values. The study found both IBMS and Qigong reduced depression, sleep disturbance, painful and painless somatic symptoms, IL-6 and IL-1β levels, and increased holistic well-being. The effect sizes of IBMS and Qigong, mostly in the medium magnitude range, were approximatively equivalent. Path analysis models revealed a predictive role of perceived stress in depression and sleep disturbance, a bidirectional relationship between depression and sleep disturbance, and significant influence of depression and sleep disturbance on IL-6 and IL-1β. Compared with control, the findings support the efficacy of IBMS and Qigong interventions in relieving depression and sleep disturbance, and in reducing IL-6 and IL-1β levels.
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Affiliation(s)
- Siu-Man Ng
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Margaret X C Yin
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Jessie S M Chan
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Celia H Y Chan
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Ted C T Fong
- Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Ang Li
- Guangdong-Hong Kong-Macau Institute of CNS Regeneration, Guangdong Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou 510632, China; Departments of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; State Key Laboratory of Brain and Cognitive Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Kwok-Fai So
- Guangdong-Hong Kong-Macau Institute of CNS Regeneration, Guangdong Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou 510632, China; Departments of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; State Key Laboratory of Brain and Cognitive Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Lai-Ping Yuen
- International Association for Health and Yangsheng, Hong Kong Special Administrative Region
| | - Jian-Ping Chen
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Ka-Fai Chung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Cecilia L W Chan
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
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Goklemez S, Saligan LN, Pirsl F, Holtzman NG, Ostojic A, Steinberg SM, Hakim FT, Rose JJ, Kang Z, Yu Y, Cao L, Mitchell SA, Im A, Pavletic SZ. Clinical characterization and cytokine profile of fatigue in hematologic malignancy patients with chronic graft-versus-host disease. Bone Marrow Transplant 2021; 56:2934-2939. [PMID: 34433916 PMCID: PMC8639672 DOI: 10.1038/s41409-021-01419-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
Limited information is available regarding clinical and biological properties of fatigue in patients with chronic graft-versus-host disease (cGvHD). Patients with moderate-to-severe cGvHD per NIH criteria were enrolled on a cross-sectional study and categorized as "fatigued" if SF-36 vitality score was <40. Clinical and laboratory parameters of fatigued (n = 109) and nonfatigued patients (n = 72) were compared. In univariate analysis, walk velocity, NIH joint-fascia score, human activity profile, and SF-36 physical and mental health self-report scales were correlates of fatigue. No cGvHD biomarkers were associated with fatigue. NIH joint score, Lee sleep and depression questions, and PG-SGA activities and function score jointly predicted fatigue. Though higher rates of depression and insomnia were reported in the fatigued group, antidepressant or sleep aid use did not differ between groups. Survival ratio was not significantly different by fatigue status. Pathophysiology of fatigue in patients with cGvHD is complex and may involve mechanisms unrelated to disease activity. Patients with cGvHD experiencing fatigue had higher rates of untreated depression and insomnia, highlighting the need to focus clinical management of these conditions to improve health-related quality of life.
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Affiliation(s)
- Sencer Goklemez
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | | | - Filip Pirsl
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Noa G. Holtzman
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Alen Ostojic
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD,Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Frances T. Hakim
- Experimental Transplantation and Immunotherapy Branch, NCI, NIH, Bethesda, MD
| | - Jeremy J. Rose
- Experimental Transplantation and Immunotherapy Branch, NCI, NIH, Bethesda, MD
| | - Zhigang Kang
- Center for Cancer Research, NCI, NIH, Bethesda, MD
| | - Yunkai Yu
- Center for Cancer Research, NCI, NIH, Bethesda, MD
| | - Liang Cao
- Center for Cancer Research, NCI, NIH, Bethesda, MD
| | - Sandra A. Mitchell
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, MD
| | - Annie Im
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA
| | - Steven Z. Pavletic
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
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Celiac plexus neurolysis for abdominal cancers: going beyond pancreatic cancer pain. Pain Rep 2021; 6:e930. [PMID: 34712884 PMCID: PMC8546843 DOI: 10.1097/pr9.0000000000000930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/19/2021] [Accepted: 04/03/2021] [Indexed: 02/07/2023] Open
Abstract
Celiac plexus neurolysis is primarily used for pancreatic cancer pain, but other symptoms and other cancers may also benefit from this intervention. Introduction: Celiac plexus neurolysis (CPN) has been verified for mitigating pancreatic cancer pain. However, information regarding CPN's use beyond this remains limited. Objectives: Identify which cancers benefit from CPN, which symptoms improve, and when symptoms improve. Methods: Retrospective analysis was conducted on 173 patients who received CPN for pain caused by various malignancies. Mean symptom changes on the MD Anderson Symptom Inventory (MDASI) from baseline to 2 weeks, 1 month, and 2 months after CPN were analyzed overall and then by cancer type: pancreatic (all stages and stages III–IV), hepatobiliary, and nonpancreatic, nonhepatobiliary gastrointestinal (NPNH-gastrointestinal). Results: Eighty-two pancreatic, 43 NPNH-gastrointestinal, 14 hepatobiliary, and 34 patients with other cancers met inclusion criteria. Statistically significant changes included decrease in the pain score at 1 month by 1.01 points for all cancers, 1.65 points for all pancreatic cancers, and 1.88 points for late-stage pancreatic cancers. At 2 months, pain decreased by 1.50 points for all cancers, 1.68 points for all pancreatic cancers, 2.37 points for late-stage pancreatic cancers, and 1.50 points in NPNH-gastrointestinal cancers. At 2 months, quality of life improved by 1.07 points for all cancers and 1.53 points for all pancreatic cancers. Sleep improved at 2 months for all cancers by 0.73 points and 1.60 points in late-stage pancreatic cancers. At 2 months, pancreatic cancer patients improved in general activity by 0.93 points, walking by 1.00 points, and working by 1.12 points. Conclusion: Celiac plexus neurolysis can decrease cancer symptom burden beyond pain including quality of life and sleep for pancreatic and nonpancreatic cancers, as well as general activity for pancreatic cancers.
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Hernandez-Garcia E, Chrysikou E, Kalea AZ. The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10891. [PMID: 34682637 PMCID: PMC8536084 DOI: 10.3390/ijerph182010891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 12/11/2022]
Abstract
Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with the central role in low-grade systemic inflammation-are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.
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Affiliation(s)
- Eva Hernandez-Garcia
- The Bartlett Real Estate Institute, The Bartlett School of Sustainable Construction, University College London, London WC1E 6BT, UK;
| | - Evangelia Chrysikou
- The Bartlett Real Estate Institute, The Bartlett School of Sustainable Construction, University College London, London WC1E 6BT, UK;
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, 700 13 Heraklion, Greece
| | - Anastasia Z. Kalea
- Division of Medicine, University College London, London WC1E 6JF, UK;
- Institute of Cardiovascular Science, University College London, London WC1E 6HX, UK
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Rentscher KE, Carroll JE, Juckett MB, Coe CL, Broman AT, Rathouz PJ, Hematti P, Costanzo ES. Sleep Disruption, Fatigue, and Depression as Predictors of 6-Year Clinical Outcomes Following Allogeneic Hematopoietic Cell Transplantation. J Natl Cancer Inst 2021; 113:1405-1414. [PMID: 33693799 PMCID: PMC8633423 DOI: 10.1093/jnci/djab032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/04/2021] [Accepted: 03/04/2021] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) is a widely used treatment for hematologic cancers, with survival rates ranging from 25% to 78%. Known risk factors for chronic graft-versus-host disease (cGVHD), a serious and common long-term complication, disease relapse, and mortality following HCT have been identified, but much of the variability in HCT outcomes is unexplained. Biobehavioral symptoms including depression, sleep disruption, and fatigue are some of the most prevalent and distressing for patients; yet research on biobehavioral risk factors for HCT outcomes is limited. This study evaluated patient-reported depression, sleep disruption, and fatigue as risk factors for cGVHD, disease relapse, and mortality. METHODS Adults receiving allogeneic HCT for a hematologic malignancy (N = 241) completed self-report measures of depression symptoms, sleep quality, and fatigue (severity, interference) pre-HCT and 100 days post-HCT. Clinical outcomes were monitored for up to 6 years. RESULTS Cox proportional hazard models (2-tailed) adjusting for patient demographic and medical characteristics revealed that high pre-HCT sleep disruption (Pittsburgh Sleep Quality Index >9; hazard ratio [HR] = 2.74, 95% confidence interval [CI] = 1.27 to 5.92) and greater post-HCT fatigue interference (HR = 1.32, 95% CI = 1.05 to 1.66) uniquely predicted increased risk of mortality. Moderate pre-HCT sleep disruption (Pittsburgh Sleep Quality Index 6-9) predicted increased risk of relapse (HR = 1.99, 95% CI = 1.02 to 3.87). Biobehavioral symptoms did not predict cGVHD incidence. CONCLUSIONS Biobehavioral symptoms, particularly sleep disruption and fatigue interference, predicted an increased risk for 6-year relapse and mortality after HCT. Because these symptoms are amenable to treatment, they offer specific targets for intervention to improve HCT outcomes.
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Affiliation(s)
- Kelly E Rentscher
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Judith E Carroll
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Mark B Juckett
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison, Madison, WI, USA
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Aimee T Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul J Rathouz
- Department of Population Health, University of Texas at Austin, Austin, TX, USA
| | - Peiman Hematti
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison, Madison, WI, USA
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Erin S Costanzo
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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Gage-Bouchard EA, Pailler M, Devine KA, Flores T. Optimizing Patient-Centered Psychosocial Care to Reduce Suicide Risk and Enhance Survivorship Outcomes Among Cancer Patients. J Natl Cancer Inst 2021; 113:1129-1130. [PMID: 33464289 PMCID: PMC8418430 DOI: 10.1093/jnci/djaa185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Elizabeth A Gage-Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Megan Pailler
- Department of Psychology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Katie A Devine
- Section of Pediatric Population Science, Outcomes, and Disparities Research, Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, The State University of New Jersey, Rutgers, NJ, USA
| | - Tessa Flores
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Neijenhuijs KI, Peeters CFW, van Weert H, Cuijpers P, Leeuw IVD. Symptom clusters among cancer survivors: what can machine learning techniques tell us? BMC Med Res Methodol 2021; 21:166. [PMID: 34399698 PMCID: PMC8369803 DOI: 10.1186/s12874-021-01352-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 07/21/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Knowledge regarding symptom clusters may inform targeted interventions. The current study investigated symptom clusters among cancer survivors, using machine learning techniques on a large data set. METHODS Data consisted of self-reports of cancer survivors who used a fully automated online application 'Oncokompas' that supports them in their self-management. This is done by 1) monitoring their symptoms through patient reported outcome measures (PROMs); and 2) providing a personalized overview of supportive care options tailored to their scores, aiming to reduce symptom burden and improve health-related quality of life. In the present study, data on 26 generic symptoms (physical and psychosocial) were used. Results of the PROM of each symptom are presented to the user as a no well-being risk, moderate well-being risk, or high well-being risk score. Data of 1032 cancer survivors were analysed using Hierarchical Density-Based Spatial Clustering of Applications with Noise (HDBSCAN) on high risk scores and moderate-to-high risk scores separately. RESULTS When analyzing the high risk scores, seven clusters were extracted: one main cluster which contained most frequently occurring physical and psychosocial symptoms, and six subclusters with different combinations of these symptoms. When analyzing moderate-to-high risk scores, three clusters were extracted: two main clusters were identified, which separated physical symptoms (and their consequences) and psycho-social symptoms, and one subcluster with only body weight issues. CONCLUSION There appears to be an inherent difference on the co-occurrence of symptoms dependent on symptom severity. Among survivors with high risk scores, the data showed a clustering of more connections between physical and psycho-social symptoms in separate subclusters. Among survivors with moderate-to-high risk scores, we observed less connections in the clustering between physical and psycho-social symptoms.
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Affiliation(s)
- Koen I Neijenhuijs
- Department of Clinical, Vrije Universiteit Amsterdam, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.,Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Carel F W Peeters
- Department of Epidemiology & Biostatistics, Amsterdam UMC, location VUmc, Boelelaan, 1117, Amsterdam, The Netherlands.,Mathematical & Statistical Methods Group (Biometris), Wageningen University & Research, Wageningen, The Netherlands
| | - Henk van Weert
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health, Meibergdreef 9, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Vrije Universiteit Amsterdam, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands
| | - Irma Verdonck-de Leeuw
- Department of Clinical, Vrije Universiteit Amsterdam, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands. .,Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, The Netherlands. .,Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, location VUmc, Boelelaan, 1117, Amsterdam, The Netherlands.
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Efficacy and Safety of Auricular Acupuncture for the Treatment of Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial. Cancers (Basel) 2021; 13:cancers13164082. [PMID: 34439234 PMCID: PMC8394534 DOI: 10.3390/cancers13164082] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/10/2023] Open
Abstract
Among women, breast cancer is the most commonly diagnosed cancer worldwide. Sleep problems impair 40-70% of breast cancer survivors. This randomized controlled trial evaluates the effect of auricular acupuncture on sleep quality in breast cancer survivors suffering from insomnia. Fifty-two female breast cancer survivors with insomnia (mean age 55.73 ± 8.10 years) were randomized either to 10 treatments of auricular acupuncture within five weeks (n = 26), or to a single session of psychoeducation plus an insomnia advice booklet (n = 26). The primary outcome was sleep quality (measured by the Pittsburgh Sleep Quality Index) at week 5. Secondary outcomes were inflammation parameter (interleukin-6), stress, anxiety, depression, quality of life, and fatigue at week 5, and sleep quality, stress, anxiety, depression, quality of life, and fatigue 17 and 29 weeks after randomization. Intention-to-treat analysis showed a significantly stronger increase in sleep quality in the auricular acupuncture group compared to the psychoeducation group (p = 0.031; η2p = 0.094) at week 5. Furthermore, auricular acupuncture improved stress (p = 0.030; η2p = 0.094), anxiety (p = 0.001; η2p = 0.192), and fatigue (p = 0.006; η2p = 0.148) at week 5 compared to psychoeducation. No significant group difference was found concerning the other outcomes at week 5, or in any outcome at week 17 or week 29. No serious adverse events occurred during the study period. In conclusion, a semi-standardized group auricular acupuncture might be an effective and safe intervention in treating insomnia in breast cancer survivors in the short term, and may reduce stress, anxiety, and fatigue as well. Long-term effects remain questionable.
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The Incidence of Mental Disorders Increases over Time in Patients with Cancer Pain: Data from a Retrospective Cohort Study. Pain Res Manag 2021; 2021:5515629. [PMID: 34188734 PMCID: PMC8195649 DOI: 10.1155/2021/5515629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
Background It is well known that cancer patients more seldom have a psychiatric disorder than noncancer patients with chronic pain. Conversely, earlier studies have suggested that, at the psychiatric level, long-term cancer survivors (LCSs) have more in common with noncancer patients affected by chronic pain. Materials and Methods We investigated 89 cancer patients with acute pain (Acute Cancer Pain Patients, ACPPs) treated at a university outpatient chemotherapy department and compared these with 61 LCSs (living >5 yr after the first diagnosis) admitted by general practitioners for the treatment of noncancer pain. Upon administration, each patient was psychiatrically assessed by a liaison-psychiatrist conducting a semistructured interview. In a second step, we compared the LCS patients with hitherto treated noncancer patients suffering from chronic pain and ACPPs with data published by Derogatis in 1983. Results In a comparison of LCSs with ACPPs, LCSs have more patients with brain organic disorders and more addictions. The largest cancer group within the LCSs is patients with urogenital (Uro) cancer (44.3%), while within the ACPPs, these are patients with cancer of the gastrointestinal (GI) tract (ACPP-GI, 57.2%). As far as the distribution of mental disorders is concerned, long-term cancer survivors show some similarities to noncancer patients. The data of ACPPs are similar to those of cancer patients, published by Derogatis. Discussion. The higher values of addiction and brain organic disorders, in particular, and the slight differences for psychic disorders in general of LCSs vs. ACPPs may result from the different cancer types and a longer survival time for urogenital tract cancer compared to GI cancer. In an additional examination, we compared patients with acute cancer of the GI tract (ACPP-GI, n = 50) with those of the urogenital tract (ACPP-Uro, n = 43). ACPP-Uro had the lowest percentage of patients with psychiatric disorders in general (ACPP-Uro 37.2%, ACPP-GI 50.0%, all LCSs 65.6%, and LCS-Uro 74.1%) and addiction, in particular (ACPP-Uro 2.3%, ACPP-GI 4.0%, and LCSs 13.1%). Conclusion Cancer patients can develop a process of chronification with an increase in the prevalence of mental disorders. For urogenital cancer, an increase in the probability to develop mental disorders is a function of time.
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Sleep Disorders and Psychological Profile in Oral Cancer Survivors: A Case-Control Clinical Study. Cancers (Basel) 2021; 13:cancers13081855. [PMID: 33924533 PMCID: PMC8069491 DOI: 10.3390/cancers13081855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 01/20/2023] Open
Abstract
Simple Summary Sleep disorders have been increasingly investigated in several medical illnesses as their presence may affect patients’ quality of life. However, the research examining sleep disorders in oral cancer is relatively weak. Indeed, the majority of the available studies present a cross-sectional or retrospective designs. Moreover, very few of them have evaluated quality of sleep in oral cancer survivors (OC survivors). We aimed to carry out a case-control study with the purpose to investigate sleep disorders and mood impairment in 50 OC survivors. Our research has shown that quality of sleep is significantly affected in OC survivors compared to a healthy population and that OC survivors suffers from higher levels of anxiety and depression. Our results may suggest that an appropriate assessment of quality of sleep and psychological profile should be performed in OC survivors as a prompt treatment for both sleep and mood disorders is crucial for the overall improvement of patients’ quality of life. Abstract Quality of sleep (QoS) and mood may impair oral cancer survivors’ wellbeing, however few evidences are currently available. Therefore, we aimed to assess the prevalence of sleep disorders, anxiety and depression among five-year oral cancer survivors (OC survivors). 50 OC survivors were compared with 50 healthy subjects matched for age and sex. The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Hamilton Rating Scales for Depression and Anxiety (HAM-D, HAM-A), the Numeric Rating Scale (NRS), the Total Pain Rating Index (T-PRI) were administered. The global score of the PSQI, ESS, HAM-A, HAM-D, NRS, T-PRI, was statistically higher in the OC survivors than the controls (p-value: <0.001). QoS of OC survivors was significantly impaired, especially with regard to some PSQI sub-items as the subjective sleep quality, sleep latency and daytime dysfunction (p-value: 0.001, 0.029, 0.004). Moreover, poor QoS was negatively correlated with years of education (p-value: 0.042 *) and positively correlated with alcohol consumption (p-value: 0.049 *) and with the use of systemic medications (p-value: 0.044 *). Sleep disorders and mood disorders are common comorbidities in OC survivors; therefore, early assessment and management before, during and after treatment should be performed in order to improve the quality of life of OC survivors.
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Chen J, Hua Y, Su L, Wang C, Zhang H, Ye J, Song X, Li R, Tian J, Zhang W, Hong J. The effect of psychological condition before radiotherapy on prognosis in 390 patients initially treated for nasopharyngeal carcinoma. Support Care Cancer 2021; 29:5967-5972. [PMID: 33765206 DOI: 10.1007/s00520-021-06130-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 03/04/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE To explore whether anxiety and depression are prognostic indexes for overall survival in patients with nasopharyngeal carcinoma (NPC) who underwent intensity-modulated radiotherapy (IMRT). METHODS Clinical data were collected for NPC patients who underwent IMRT. Anxiety and depression were investigated before radiotherapy by using the Hospital Anxiety and Depression Scale (HADS). The survival rate was calculated by the Kaplan-Meier method, and survival curves were compared among patients with different levels of anxiety and depression. The Cox risk regression model was used to screen the factors affecting survival. RESULTS A total of 390 initially treated NPC patients were included in the study. Among them, 166 patients suffered from anxiety, and 95 patients suffered from depression before radiotherapy. The 5-year overall survival rates for patients with and without anxiety before radiotherapy were 71.6% and 81.8% (χ2 = 5.31, P = 0.021), respectively. The 5-year overall survival rates for patients with and without depression before radiotherapy were 74.3% and 78.1% (χ2 = 0.05, P = 0.82), respectively. Cox regression analysis indicated clinical stages (HR = 3.982, 95% CI: 2.365~6.705), anxiety (HR = 1.832, 95% CI: 1.140~2.944), and gender (HR = 0.555, 95% CI: 0.313~0.984) as independent prognostic factors. CONCLUSION Anxiety before radiotherapy is associated with poor prognosis in NPC patients.
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Affiliation(s)
- Jinmei Chen
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Yangjingling Hua
- The Graduate School, Fujian Medical University, Fuzhou, Fujian, China
| | - Li Su
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Caihong Wang
- The Graduate School, Fujian Medical University, Fuzhou, Fujian, China
| | - Hairong Zhang
- The Graduate School, Fujian Medical University, Fuzhou, Fujian, China
| | - Jinru Ye
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiurong Song
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Rong Li
- The Graduate School, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun Tian
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Weijian Zhang
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jinsheng Hong
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China. .,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China.
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Manigault AW, Kuhlman KR, Irwin MR, Cole SW, Ganz PA, Crespi CM, Bower JE. Vulnerability to inflammation-related depressive symptoms: Moderation by stress in women with breast cancer. Brain Behav Immun 2021; 94:71-78. [PMID: 33705868 PMCID: PMC8058308 DOI: 10.1016/j.bbi.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Stress precipitates depression and may do so in part by increasing susceptibility to inflammation-induced depressive symptoms. However, this has not been examined among individuals facing a major life stressor. Accordingly, the present study tested the moderating role of stress on the longitudinal association between inflammation and depressive symptoms among women with breast cancer. METHODS Women recently diagnosed with early-stage breast cancer (N = 187) were enrolled before starting adjuvant/neoadjuvant treatment. Blood draws and self-reported depressive symptoms were collected pre-treatment, post-treatment, and at 6, 12, and 18-month post-treatment follow ups. C-reactive protein (CRP) was used to index inflammation. Measures of psychological stress, including cancer-related stress, general stress perceptions, and childhood stress, were administered pre-treatment. RESULTS Stress moderated the association between CRP and depressive symptoms, such that higher levels of CRP were associated with elevated depressive symptoms only among women who reported high cancer-related stress (β = 0.080, p = .002) and perceived stress (β = 0.053, p = .044); childhood stress effects were non-significant. Moreover, elevated CRP was associated with increased odds of exhibiting clinically significant depressive symptoms (OR = 1.64, p < .001) among women who reported high cancer-related stress. Results were independent of age, BMI, race and cancer-related covariates. CONCLUSIONS Stress was found to heighten sensitivity to inflammation-associated depressive symptoms over a 2-year period, with notably stronger effects for subjective stress responses to a concurrent life event. Individuals who are most distressed following a major life event may exhibit the greatest risk for inflammation-induced depression.
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Affiliation(s)
| | - Kate R. Kuhlman
- Department of Psychological Science, UCI, Irvine, CA,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Michael R. Irwin
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Steve W. Cole
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA,David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Patricia A. Ganz
- David Geffen School of Medicine, UCLA, Los Angeles, CA,Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Catherine M. Crespi
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Julienne E. Bower
- Department of Psychology, UCLA, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
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Perez-Tejada J, Aizpurua-Perez I, Labaka A, Vegas O, Ugartemendia G, Arregi A. Distress, proinflammatory cytokines and self-esteem as predictors of quality of life in breast cancer survivors. Physiol Behav 2021; 230:113297. [DOI: 10.1016/j.physbeh.2020.113297] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022]
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Tucker JA, Osann K, Hsieh S, Wahi A, Monk BJ, Wenzel L, Nelson EL. Longitudinal Changes in Sleep: Associations with Shifts in Circulating Cytokines and Emotional Distress in a Cancer Survivor Population. Int J Behav Med 2021; 28:140-150. [PMID: 33598780 PMCID: PMC7925505 DOI: 10.1007/s12529-020-09950-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sleep disturbances are associated with numerous mood disorders. Similarly, anxiety and depression are associated with modulation of the psychoneuroimmune (PNI) axis. This study hypothesized that changes in both monitored and self-reported measures of sleep would relate to changes in circulating cytokine levels in an emotionally distressed population of cervical cancer survivors. METHODS Biospecimens, patient-reported outcome (PRO) measures, and actigraphy were collected from cervical cancer survivors enrolled in a biobehavioral clinical trial. Longitudinal changes over a 4-month period were examined. Sleep time measured by actigraphy and PRO were analyzed for correlative changes with emotional distress and serum cytokines (n = 71). RESULTS Longitudinal change in the actigraph measure of sleep time was inversely associated with changes in depression and anxiety (test for linear trend, p = 0.02 and p = 0.05 respectively), as well as acute-phase response/pro-inflammatory cytokines (test for linear trend, p = 0.003, interleukin (IL)-2; 0.022, IL-1β; 0.0002, IL-6; and 0.049, tumor necrosis factor α). Conversely, changes in self-reported sleep problems were related to an increase in depression and anxiety (p = 0.001 and p = 0.01 respectively), the T helper 2 (Th2) cytokine IL-5 (p = 0.027), and the counter-regulatory cytokine IL-10 (0.016). CONCLUSION This study showed that an increase in sleep time or decrease in sleep problems corresponded with a reduction in self-reported emotional distress and attenuation of pro-inflammatory, Th2, and counter-regulatory cytokines. Our results support sleep measurement as a meaningful biobehavioral variable in cancer survivorship. This study also indicates that sleep investigators should be aware that choice of methodology might influence concordance with different classes of immune parameters.
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Affiliation(s)
- Jo A. Tucker
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, CA USA
| | - Kathryn Osann
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, CA USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA USA
| | - Susie Hsieh
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine, CA USA
| | - Aditi Wahi
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine, CA USA
| | - Bradley J. Monk
- Arizona Oncology, US Oncology Network, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ USA
| | - Lari Wenzel
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA USA
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine, CA USA
- Program in Public Health, University of California, Irvine, CA USA
| | - Edward L. Nelson
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, CA USA
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine, CA USA
- Institute for Immunology, University of California, Irvine, CA 92617 USA
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Prescribed Walking for Glycemic Control and Symptom Management in Patients Without Diabetes Undergoing Chemotherapy. Nurs Res 2021; 70:6-14. [PMID: 32852358 DOI: 10.1097/nnr.0000000000000468] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hyperglycemia may potentiate symptom experiences. Exercise is a nonpharmacological intervention that can potentially improve glycemic control and mitigate symptom experiences in patients undergoing chemotherapy for cancer. OBJECTIVES The primary objective was to assess the feasibility of patients engaging in a walking exercise study for 6 months. We also evaluated the effects of a prescribed walking program on glycemic control and for changes over time in the severity of pain, fatigue, depression, and sleep disturbance in patients undergoing chemotherapy for breast, lung, gynecologic, or gastrointestinal cancer. METHODS A randomized pilot intervention study was conducted to evaluate differences within and between a prescribed walking program intervention group and a control group. All patients were followed for 6 months, had glycosylated hemoglobin A1c measured at enrollment and 6 months, and completed symptom questionnaires at enrollment, 3 months, and 6 months. Data were analyzed using descriptive statistics and analysis of covariance. RESULTS Most of the patients who enrolled completed the 6-month study. The few who withdrew expressed feeling overwhelmed. The sample was predominately non-Hispanic White female patients with breast cancer with a normal-to-slightly-overweight body mass index. The intervention group had a slight decrease in glycosylated hemoglobin A1c at 6 months. In addition, at 6 months, compared to the control group, the intervention group had significantly less sleep disturbance and depression. No other within- or between-group differences were found. DISCUSSION It is feasible for patients undergoing chemotherapy to participate in a prescribed walking program. Exercise, such as walking, may decrease hyperglycemia and symptom severity. Additional research with larger samples is warranted.
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McFarland DC, Saracino RM, Miller AH, Breitbart W, Rosenfeld B, Nelson C. Prognostic implications of depression and inflammation in patients with metastatic lung cancer. Future Oncol 2021; 17:183-196. [PMID: 33305608 PMCID: PMC7857340 DOI: 10.2217/fon-2020-0632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Lung cancer-related inflammation is associated with depression. Both elevated inflammation and depression are associated with worse survival. However, outcomes of patients with concomitant depression and elevated inflammation are not known. Materials & methods: Patients with metastatic lung cancer (n = 123) were evaluated for depression and inflammation. Kaplan-Meier plots and Cox proportional hazard models provided survival estimations. Results: Estimated survival was 515 days for the cohort and 323 days for patients with depression (hazard ratio: 1.12; 95% CI: 1.05-1.179), 356 days for patients with elevated inflammation (hazard ratio: 2.85, 95% CI: 1.856-4.388), and 307 days with both (χ2 = 12.546; p < 0.001]). Conclusion: Depression and inflammation are independently associated with inferior survival. Survival worsened by inflammation is mediated by depression-a treatable risk factor.
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Affiliation(s)
- Daniel C McFarland
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Rebecca M. Saracino
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Andrew H. Miller
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - William Breitbart
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, NY 10458, USA
| | - Christian Nelson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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43
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Samuel SR, Gururaj R, Kumar KV, Vira P, Saxena PUP, Keogh JWL. Randomized control trial evidence for the benefits of massage and relaxation therapy on sleep in cancer survivors-a systematic review. J Cancer Surviv 2020; 15:799-810. [PMID: 33269414 PMCID: PMC8448699 DOI: 10.1007/s11764-020-00972-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/17/2020] [Indexed: 12/02/2022]
Abstract
Purpose Cancer survivors may experience sleep disturbances during and after their cancer treatments. While pharmacological approaches are commonly used to address sleep disturbances, they may have a number of adverse effects. This review studied the effect of two non-pharmacological interventions (massage and relaxation therapy) on sleep disturbances in cancer survivors. Methods A search for randomised controlled trials (RCTs) was conducted on PubMed, Scopus, Web of Science, PEDro, and CINAHL using relevant keywords. Results The search yielded 371 articles, with 4 RCTs studying massage therapy and 3 RCTs studying relaxation therapy included for qualitative analysis. Massage therapy studies showed statistically significant improvement in self-reported sleep questionnaires and objectively recorded long sleep episodes, as assessed via an accelerometer. No significant improvements in sleep outcomes were observed in the relaxation therapy studies, although there were trends for improved self-reported sleep quality. Conclusion While massage therapy provided by massage therapists may have some potential for improving sleep outcomes for cancer survivors, there is no such current evidence regarding relaxation therapy. Implications for Cancer Survivors Cancer survivors who experience sleep disturbances may benefit from regular sessions with a massage therapist. However, future studies should examine the long-term feasibility of massage therapist–delivered services, particularly for cancer survivors with limited finances, and determine if benefits can be obtained if massage is provided by non-certified individuals. Relaxation therapy appears to be safe for cancer survivors, but future RCTs involving larger sample sizes need to be conducted to better determine its feasibility and efficacy.
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Affiliation(s)
- Stephen Rajan Samuel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Rachita Gururaj
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - K Vijaya Kumar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Prina Vira
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - P U Prakash Saxena
- Department of Radiation Oncology at Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Justin William Leslie Keogh
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,Human Potential Centre, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Australia
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44
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Borgi M, Collacchi B, Ortona E, Cirulli F. Stress and coping in women with breast cancer:unravelling the mechanisms to improve resilience. Neurosci Biobehav Rev 2020; 119:406-421. [PMID: 33086128 DOI: 10.1016/j.neubiorev.2020.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
Breast cancer diagnosis, surgery, adjuvant therapies and survivorship can all be extremely stressful. In women, concerns about body image are common as a result of the disease and can affect interpersonal relationships, possibly leading to social isolation, increasing the likelihood for mood disorders. This is particularly relevant as women are at greater risk to develop anxiety and depressive symptoms in response to highly stressful situations. Here we address the mechanisms and the pathways activated as a result of stress and contributing to changes in the pathophysiology of breast cancer, as well as the potential of stress management factors and interventions in buffering the deleterious effects of chronic stress in a gender perspective. An improved understanding of the biological mechanisms linking stress-management resources to health-relevant biological processes in breast cancer patients could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve cancer outcomes, ultimately offering a unique opportunity to improve contemporary cancer treatments.
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Affiliation(s)
- Marta Borgi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Barbara Collacchi
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Elena Ortona
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Francesca Cirulli
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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45
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Sadeghmousavi S, Eskian M, Rahmani F, Rezaei N. The effect of insomnia on development of Alzheimer's disease. J Neuroinflammation 2020; 17:289. [PMID: 33023629 PMCID: PMC7542374 DOI: 10.1186/s12974-020-01960-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease (AD) is the most common type of dementia and a neurodegenerative disorder characterized by memory deficits especially forgetting recent information, recall ability impairment, and loss of time tracking, problem-solving, language, and recognition difficulties. AD is also a globally important health issue but despite all scientific efforts, the treatment of AD is still a challenge. Sleep has important roles in learning and memory consolidation. Studies have shown that sleep deprivation (SD) and insomnia are associated with the pathogenesis of Alzheimer's disease and may have an impact on the symptoms and development. Thus, sleep disorders have decisive effects on AD; this association deserves more attention in research, diagnostics, and treatment, and knowing this relation also can help to prevent AD through screening and proper management of sleep disorders. This study aimed to show the potential role of SD and insomnia in the pathogenesis and progression of AD.
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Affiliation(s)
- Shaghayegh Sadeghmousavi
- Neuroimaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Eskian
- Neuroimaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Farzaneh Rahmani
- Neuroimaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Nima Rezaei
- Neuroimaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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46
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Hsieh CC, Ho CC, Lin ZZ, Yu CJ, Jow GM, Huang FY, Shih JY, Hsiao FH. Trait mindfulness and depressive symptoms in non-small cell lung cancer patients: the mediating roles of quality of life and meaning in life. Psychol Health 2020; 36:1102-1114. [PMID: 32998574 DOI: 10.1080/08870446.2020.1825713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The present study examined the potential mediating influences of meaning in life and quality of life in the relationship of trait mindfulness and depressive symptoms in lung cancer patients. Design: We adopted a cross-sectional design studying a sample of patients with non-small cell lung cancer, aged 20-65 years, and receiving cancer treatments or follow-up care. Main Outcome Measures: The outcome measures included Beck Depression Inventory-II, European Organisation for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and lung cancer specific complementary measure (EORTC QLQ-LC13), Five Facet Mindfulness Questionnaire, and the meaning in life questionnaire. Results: Among 116 lung cancer patients, 26.72% of them had clinically significant depressive symptoms. The presence of meaning, quality of life (QOL) functioning and symptom distress mediated the relationship of trait mindfulness and depressive symptoms. Multiple mediation analyses found that the presence of meaning in life was the main mediator. Conclusion: The reductions of depressive symptoms might be related to trait mindfulness enhancing lung cancer patients' perceptions of meaning in life. A mindfulness program has the potential to improve depressive symptoms in people with lung cancer.
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Affiliation(s)
- Chia-Chen Hsieh
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chao-Chi Ho
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Zhong-Zhe Lin
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chong-Jen Yu
- College of Medicine, National Taiwan University, Taipei, Taiwan.,BioMedical Park Branch, National Taiwan University Hospital, , Hsinchu, Taiwan
| | - Guey-Mei Jow
- School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Feng-Ying Huang
- Department of Education, National Taipei University of Education, Taipei, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fei-Hsiu Hsiao
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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Jaumally BA, Das A, Cassell NC, Pachecho GN, Majid R, Bashoura L, Balachandran DD, Faiz SA. Excessive daytime sleepiness in cancer patients. Sleep Breath 2020; 25:1063-1067. [PMID: 32939599 DOI: 10.1007/s11325-020-02151-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Excessive daytime sleepiness (EDS) is commonly reported in patients with cancer, and it is also a cardinal feature of central disorders of hypersomnolence. Multiple sleep latency testing (MSLT) is used for objective assessment. METHODS A retrospective review of patients with cancer history who underwent formal sleep evaluation and MSLT from 2006 to 2019 was performed. Clinical characteristics, sleep-related history, and polysomnographic data were reviewed. RESULTS Of 16 patients with cancer history, 9 were women (56%) and median age was 49. Cancer diagnoses included 4 central nervous system, 3 breast, 1 lymphoma, and 9 other solid malignancies, and 31% were undergoing active treatment. Comorbid conditions included depression, obstructive sleep apnea, and cancer-related fatigue. Daytime fatigue (94%), daily naps (81%), and EDS (69%) were the most common symptoms. Hypnopompic and hypnogogic hallucinations, sleep paralysis, sleep attacks, and cataplexy were present in a few. Epworth Sleepiness Scale scores were consistent with EDS in 88%, and mean sleep latency was less than 8 min in 69%. Only 31% had more than 2 sleep-onset REM periods. MSLT supported diagnoses of central disorders of hypersomnolence in 5 patients (4 narcolepsy, 1 idiopathic hypersomnia); 5 hypersomnia due to a medical disorder, psychiatric condition, or medication; and 6 with normal results. Pharmacotherapy was prescribed in 5 patients. CONCLUSIONS EDS in patients with cancer may be multifactorial, but persistent symptoms may indicate an underlying disorder of hypersomnolence. Sleep referral and polysomnography to exclude other sleep disorders may be indicated. MSLT can help confirm the diagnosis. In those with normal MSLT, further evaluation for mood disorder should be considered.
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Affiliation(s)
- Bibi Aneesah Jaumally
- Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Aneesa Das
- Division of Pulmonary, Critical Care and Sleep, The Ohio State University, Columbus, OH, USA
| | - Nathaniel C Cassell
- Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - G Nancy Pachecho
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77030-1402, USA
| | - Ruckshanda Majid
- Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Lara Bashoura
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77030-1402, USA
| | - Diwakar D Balachandran
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77030-1402, USA
| | - Saadia A Faiz
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77030-1402, USA.
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Effects of a wearable technology-based physical activity intervention on sleep quality in breast cancer survivors: the ACTIVATE Trial. J Cancer Surviv 2020; 15:273-280. [PMID: 32875536 DOI: 10.1007/s11764-020-00930-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Physical activity interventions can improve sleep quality in breast cancer survivors. This paper examines the effects of the ACTIVATE Trial, a wearable-based physical activity intervention (Garmin Vivofit2® coupled with behavioral feedback, goal setting, and health coaching) on sleep outcomes. METHODS Post-primary treatment, inactive, postmenopausal breast cancer survivors were recruited and randomized to primary intervention or waitlist. Wrist-worn actigraphy (sleep onset latency, SOL; total sleep time, TST; sleep efficiency, SE; wake after sleep onset, WASO; and number of awakenings, NWAKE) and questionnaire-derived sleep measures (Pittsburgh Sleep Quality Index) were assessed at baseline (T1), 12 weeks (end of primary intervention and start of waitlist intervention, T2), and at 24 weeks (T3). RESULTS Eighty-three women (mean age = 62 years) were randomized; trial retention was 94% at T2 and 87% at T3. At T2, primary intervention participants had greater improvements in WASO (- 5.7 min, 95% CI - 11.7 to - 0.2) and NWAKE compared with the waitlist arm (- 2.0, 95% CI - 3.6 to - 0.4). At T3, within-group improvements were observed for SE (both groups), WASO (both groups), NWAKE (primary intervention group only), total PSQI score (primary intervention group), and sleep efficacy (primary intervention group). CONCLUSIONS The intervention reduced actigraphy-measured sleep disturbances. Within-group analyses suggest that improvements in sleep quality are sustained over a longer duration, and there may be similar benefits from an abridged intervention (wearable device only). Actigraphy-measured effects appeared stronger in participants who were poor sleepers at study entry. IMPLICATIONS FOR CANCER SURVIVORS Wearable technology can increase physical activity and improve sleep for breast cancer survivors.
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Andrijauskaite K, Wargovich MJ. Role of natural products in breast cancer related symptomology: Targeting chronic inflammation. Semin Cancer Biol 2020; 80:370-378. [PMID: 32891720 DOI: 10.1016/j.semcancer.2020.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer in women worldwide. There have been many advancements in the treatment of breast cancer leading to an increased population of patients living with this disease. Accumulating evidence suggests that cancer diagnosis and aftermath experienced stress could not only affect the quality of life of cancer patients, but it could also influence their disease outcome. The magnitude of stress experienced by breast cancer patients is often compared to the post-traumatic stress disorder-like symptoms suggested to be mediated by the chronic inflammation including NF-κB, AKt, p53 and other inflammatory pathways. Here, we describe the symptomology of PTSD-like symptoms in breast cancer patients and argue that they may in fact be caused by or maintained through aspects of chronic inflammation mediated by the pro-inflammatory markers. Evidence exists that natural products that might attenuate or lessen the effects of chronic inflammation abound in the diet. We summarize some possible agents that might abate the genesis of symptoms experienced by breast cancer patients while mitigating the effect of inflammation.
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Affiliation(s)
- Kristina Andrijauskaite
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, TX, 78229, United States.
| | - Michael J Wargovich
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, TX, 78229, United States
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50
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Moon SY, Jerng UM, Kwon OJ, Jung SY, Lee JY, Yoon SW, Shin WC, Byun JI, Lee JH. Comparative Effectiveness of Cheonwangbosimdan (Tian Wang Bu Xin Dan) Versus Cognitive-Behavioral Therapy for Insomnia in Cancer Patients: A Randomized, Controlled, Open-Label, Parallel-Group, Pilot Trial. Integr Cancer Ther 2020; 19:1534735420935643. [PMID: 32627605 PMCID: PMC7338643 DOI: 10.1177/1534735420935643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cancer patients have a 2 times higher prevalence of insomnia than healthy
populations and cancer-related insomnia has received minimal attention while
insomnia can aggravate the rehabilitation of cancer patients. Cheonwangbosimdan
is a Korean herbal medicine generally used to relieve sleep deprivation,
however, few studies presented the effects of Cheonwangbosimdan on
cancer-related insomnia. The purpose of study is to examine the feasibility of
Cheonwangbosimdan treatments for cancer patients. Twenty-two participants were
allocated into a Cheonwangbosimdan or cognitive-behavioral therapy for insomnia
(CBT-I) control group by equal number. The intervention group took
Cheonwangbosimdan liquid once in a day and attend visits once a week for 4
weeks. The CBT-I group underwent individualized behavioral therapy 4 times in 4
weeks. The primary outcome is changes in the Insomnia Severity Index (ISI) from
baseline to the end of the trial. Responses to the Pittsburgh Sleep Quality
Index (PSQI), Epworth Sleepiness Scale (ESS), Zung Self-Rating Anxiety Scale
(SAS), Brief Fatigue Inventory (BFI), Euroqol-5 Dimensions-5 Levels (EQ-5D-5L),
and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) were
secondary outcomes used to evaluate the quality of sleep. Outcomes were measured
at a follow-up visit (visit 5) in the fifth week of the trial. There is no
difference between 2 groups, but both groups showed tendency to alleviate cancer
insomnia symptoms. SAS-K showed significant difference between the 2 groups (P
< .001), as treatment group score was highly lowered than control group
score. The study can contribute to more attentive care for insomnia in cancer
patients.
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Affiliation(s)
- Sun-Young Moon
- Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.,University of Science and Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ui Min Jerng
- Sang-ji University Korean Medicine Hospital, Wonju, Republic of Korea
| | - O-Jin Kwon
- Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - So-Young Jung
- Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jee Young Lee
- Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Kyung Hee University, Seoul, Republic of Korea
| | - Seong Woo Yoon
- Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.,Kyung Hee University, Seoul, Republic of Korea
| | - Won-Chul Shin
- Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung-Ick Byun
- Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jun-Hwan Lee
- Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.,University of Science and Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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