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Chen J, Elsaid MI, Handley D, Plascak JJ, Andersen BL, Carson WE, Pawlik TM, Fareed N, Obeng-Gyasi S. Association Between Neighborhood Opportunity, Allostatic Load, and All-Cause Mortality in Patients With Breast Cancer. J Clin Oncol 2024; 42:1788-1798. [PMID: 38364197 PMCID: PMC11095867 DOI: 10.1200/jco.23.00907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 02/18/2024] Open
Abstract
PURPOSE Adverse neighborhood contextual factors may affect breast cancer outcomes through environmental, psychosocial, and biological pathways. The objective of this study is to examine the relationship between allostatic load (AL), neighborhood opportunity, and all-cause mortality among patients with breast cancer. METHODS Women age 18 years and older with newly diagnosed stage I-III breast cancer who received surgical treatment between January 1, 2012, and December 31, 2020, at a National Cancer Institute Comprehensive Cancer Center were identified. Neighborhood opportunity was operationalized using the 2014-2018 Ohio Opportunity Index (OOI), a composite measure derived from neighborhood level transportation, education, employment, health, housing, crime, and environment. Logistic and Cox regression models tested associations between the OOI, AL, and all-cause mortality. RESULTS The study cohort included 4,089 patients. Residence in neighborhoods with low OOI was associated with high AL (adjusted odds ratio, 1.21 [95% CI, 1.05 to 1.40]). On adjusted analysis, low OOI was associated with greater risk of all-cause mortality (adjusted hazard ratio [aHR], 1.45 [95% CI, 1.11 to 1.89]). Relative to the highest (99th percentile) level of opportunity, risk of all-cause mortality steeply increased up to the 70th percentile, at which point the rate of increase plateaued. There was no interaction between the composite OOI and AL on all-cause mortality (P = .12). However, there was a higher mortality risk among patients with high AL residing in lower-opportunity environments (aHR, 1.96), but not in higher-opportunity environments (aHR, 1.02; P interaction = .02). CONCLUSION Lower neighborhood opportunity was associated with higher AL and greater risk of all-cause mortality among patients with breast cancer. Additionally, environmental factors and AL interacted to influence all-cause mortality. Future studies should focus on interventions at the neighborhood and individual level to address socioeconomically based disparities in breast cancer.
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Affiliation(s)
- J.C. Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Mohamed I. Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
- Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH
| | - Demond Handley
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
- Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH
| | - Jesse J. Plascak
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | | | - William E. Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Timothy M. Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Naleef Fareed
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
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Goel N, Hernandez AE, Mazul A. Neighborhood Disadvantage and Breast Cancer-Specific Survival in the US. JAMA Netw Open 2024; 7:e247336. [PMID: 38635268 DOI: 10.1001/jamanetworkopen.2024.7336] [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] [Indexed: 04/19/2024] Open
Abstract
Importance Despite improvements in breast cancer screening, treatment, and survival, disparate breast cancer-specific survival outcomes persist, particularly in disadvantaged neighborhoods. Most of these disparities are attributed to disparities in individual, tumor, and treatment characteristics. However, a critical knowledge gap exists as to whether disparities in breast cancer-specific survival remain after accounting for individual, tumor, and treatment characteristics. Objective To evaluate if neighborhood disadvantage is associated with shorter breast cancer-specific survival after controlling for individual, tumor, and treatment characteristics in a national population. Design, Setting, and Participants This national retrospective cohort study included patients with breast cancer diagnosed from 2013 to 2018 from the Surveillance, Epidemiology, and End Results 17 Census tract-level socioeconomic status and rurality database of the National Cancer Institute. Data analysis was performed from September 2022 to December 2023. Exposures Neighborhood disadvantage measured by Yost index quintiles. Main Outcomes and Measures Breast cancer-specific survival was evaluated using a competing risks cause-specific hazard model controlling for age, race, ethnicity, rurality, stage, subtype, insurance, and receipt of treatment. Results A total of 350 824 patients with breast cancer were included; 41 519 (11.8%) were Hispanic, 39 631 (11.3%) were non-Hispanic Black, and 234 698 (66.9%) were non-Hispanic White. A total of 87 635 patients (25.0%) lived in the most advantaged neighborhoods (group 5) and 52 439 (14.9%) lived in the most disadvantaged neighborhoods (group 1). A larger number of non-Hispanic White patients (66 529 patients [76.2%]) lived in advantaged neighborhoods, while disadvantaged neighborhoods had the highest proportion of non-Hispanic Black (16 141 patients [30.9%]) and Hispanic patients (10 168 patients [19.5%]). Breast cancer-specific survival analysis found the most disadvantaged neighborhoods (group 1) had the highest risk of mortality (hazard ratio, 1.43; 95% CI, 1.36-1.50; P < .001) compared with the most advantaged neighborhoods. Conclusions and Relevance In this national cohort study of patients with breast cancer, neighborhood disadvantage was independently associated with shorter breast cancer-specific survival even after controlling for individual-level factors, tumor characteristics, and treatment. This suggests potential unaccounted-for mechanisms, including both nonbiologic factors and biologic factors.
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Affiliation(s)
- Neha Goel
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Alexandra E Hernandez
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Angela Mazul
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Washington University School of Medicine, St Louis, Missouri
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Chow PI, Roller DG, Boukhechba M, Shaffer KM, Ritterband LM, Reilley MJ, Le TM, Kunk PR, Bauer TW, Gioeli DG. Mobile sensing to advance tumor modeling in cancer patients: A conceptual framework. Internet Interv 2023; 34:100644. [PMID: 38099095 PMCID: PMC10719510 DOI: 10.1016/j.invent.2023.100644] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/28/2023] [Accepted: 07/07/2023] [Indexed: 12/17/2023] Open
Abstract
As mobile and wearable devices continue to grow in popularity, there is strong yet unrealized potential to harness people's mobile sensing data to improve our understanding of their cellular and biologically-based diseases. Breakthrough technical innovations in tumor modeling, such as the three dimensional tumor microenvironment system (TMES), allow researchers to study the behavior of tumor cells in a controlled environment that closely mimics the human body. Although patients' health behaviors are known to impact their tumor growth through circulating hormones (cortisol, melatonin), capturing this process is a challenge to rendering realistic tumor models in the TMES or similar tumor modeling systems. The goal of this paper is to propose a conceptual framework that unifies researchers from digital health, data science, oncology, and cellular signaling, in a common cause to improve cancer patients' treatment outcomes through mobile sensing. In support of our framework, existing studies indicate that it is feasible to use people's mobile sensing data to approximate their underlying hormone levels. Further, it was found that when cortisol is cycled through the TMES based on actual patients' cortisol levels, there is a significant increase in pancreatic tumor cell growth compared to when cortisol levels are at normal healthy levels. Taken together, findings from these studies indicate that continuous monitoring of people's hormone levels through mobile sensing may improve experimentation in the TMES, by informing how hormones should be introduced. We hope our framework inspires digital health researchers in the psychosocial sciences to consider how their expertise can be applied to advancing outcomes across levels of inquiry, from behavioral to cellular.
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Affiliation(s)
- Philip I. Chow
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, University of Virginia, USA
- Cancer Center, University of Virginia, USA
| | - Devin G. Roller
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia, USA
| | - Mehdi Boukhechba
- Department of Engineering Systems and Environment, University of Virginia, USA
- Janssen Pharmaceutical Companies of Johnson & Johnson, USA
| | - Kelly M. Shaffer
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, University of Virginia, USA
| | - Lee M. Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, University of Virginia, USA
- Cancer Center, University of Virginia, USA
| | | | - Tri M. Le
- Department of Medicine, University of Virginia, USA
| | - Paul R. Kunk
- Department of Medicine, University of Virginia, USA
| | - Todd W. Bauer
- Department of Surgery, University of Virginia, USA
- Cancer Center, University of Virginia, USA
| | - Daniel G. Gioeli
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia, USA
- Cancer Center, University of Virginia, USA
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Malaval CI, Cabanillas Stanchi KM, Werle D, Thiel S, Gansel M, Lang P, Handgretinger R, Svaldi J, Döring M. Application of the National Comprehensive Cancer Network-distress thermometer in pediatric patients during autologous and allogeneic hematopoietic stem cell transplantation and relationship to blood parameters of the stress axis. J Cancer Res Clin Oncol 2023; 149:15899-15909. [PMID: 37676266 PMCID: PMC10620269 DOI: 10.1007/s00432-023-05300-1] [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: 06/26/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Hematopoietic stem cell transplantations (HSCT) are extremely stressful procedures for pediatric patients. The activation of the hypothalamic pituitary adrenocortical axis (HPA) can influence the immune system negatively and therefore the overall outcome. The distress thermometer (DT) is an easy to use tool for the self-assessment of perceived distress. METHODS In this prospective study, a DT with an attached problem list was used in 40 pediatric patients undergoing HSCT and in one parent of each patient. The patients were aged 10-18 years. The patients' cortisol, thyroid stimulating hormone, free triiodothyronine and thyroxine levels were measured regularly during the in-patient stay. RESULTS After admission to the hospital, the stress levels of the pediatric patients and their parents increased and reached their maximum on the day of HSCT. The overall stress values of the parents were higher than those of their children. There was a significant difference in the parents' stress levels on the day of HSCT, as compared to their stress levels on other days. The mean cortisol values of the pediatric patients also increased after admission, reaching significant elevated levels above the upper normal limit 1 week after HSCT and on discharge day. Although the pediatric patients experienced mainly exhaustion, especially on the day of transplantation, their parents mainly felt worry and anxiety. Interestingly, the rate of worry among children increased in the post-transplant period and reached its maximum on the day of discharge. CONCLUSIONS In summary, a significantly increased stress level is shown for both the patients and their parents. This is reflected for the patients both in the DT scores and in the increased cortisol values. For the parents, the focus is primarily on worry and anxiety, for the patients primarily on exhaustion and worry.
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Affiliation(s)
- Carmen Isolde Malaval
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Karin Melanie Cabanillas Stanchi
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Dustin Werle
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Stefanie Thiel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Melanie Gansel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Jennifer Svaldi
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
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Goel N, Hernandez AE, Ream M, Clarke ES, Blomberg BB, Cole S, Antoni MH. Effects of neighborhood disadvantage on cortisol and interviewer-rated anxiety symptoms in breast cancer patients initiating treatment. Breast Cancer Res Treat 2023; 202:203-211. [PMID: 37561280 PMCID: PMC11250915 DOI: 10.1007/s10549-023-07050-7] [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: 03/29/2023] [Accepted: 07/13/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Shorter breast cancer (BC) survival outcomes persist by neighborhood disadvantage independent of patient, tumor, and treatment characteristics. This suggests unaccounted mechanisms by which neighborhood disadvantage "gets under the skin" to impact BC survival outcomes. Here, we evaluate the relationship between neighborhood disadvantage and clinical and neuroendocrine markers of stress in BC patients. METHODS Women with stage 0-III BC were enrolled 2-10 weeks post-surgery and before initiating adjuvant treatment in a study examining stress and stress management processes. Women provided an afternoon-evening (PM) serum cortisol sample and were administered the Hamilton Anxiety Rating Scale (HAM-A). Home addresses were used to determine the Area Deprivation Index (ADI), a validated measure of neighborhood disadvantage. Multiple regression assessed the relationship between ADI and PM serum cortisol and the presence of elevated HAM-A symptoms. RESULTS Our sample (n = 225) was predominately middle-aged (M = 50.4 years; range 23-70 years), non-Hispanic White (64.3%), with stage I (38.1%), or II (38.6%) disease. The majority (n = 175) lived in advantaged neighborhoods (ADI 1-3). After controlling for age, stage, and surgery type, women from high ADI (4-10) (vs low ADI) neighborhoods had higher PM cortisol levels (β = 0.19, 95% CI [0.24, 5.00], p = 0.031) and were nearly two times as likely to report the presence of elevated anxiety symptoms (OR = 1.96, 95% CI [1.00, 3.86], p = 0.050). CONCLUSION Neighborhood disadvantage is significantly associated with higher levels of PM cortisol and elevated anxiety symptoms suggesting stress pathways could potentially contribute to relationships between neighborhood disadvantage and BC survival.
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Affiliation(s)
- Neha Goel
- Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Suite 410, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Alexandra E Hernandez
- Division of Surgical Oncology, Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Suite 410, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Molly Ream
- Department of Psychology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Estefany Saez Clarke
- Department of Psychology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie B Blomberg
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Microbiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steve Cole
- Department of Psychiatry/Biobehavioral Sciences and Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael H Antoni
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Miami Miller School of Medicine, Miami, FL, USA
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Goel N, Hernandez A, Merchant N, Rebbeck T. Translational Epidemiology: Genetic Ancestry in Breast Cancer: What Is the Role of Genetic Ancestry and Socioeconomic Status in Triple-Negative Breast Cancer? Adv Surg 2023; 57:1-14. [PMID: 37536846 DOI: 10.1016/j.yasu.2023.03.001] [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: 08/05/2023]
Abstract
Racial/ethnic and socioeconomic disparities seen in triple-negative breast cancer (TNBC) have prompted questions regarding the role of genetic ancestry in breast cancer (BC) subtype development, tumor biology, and ultimately prognosis. The causes of disparities in TNBC are influenced greatly by both sociopolitical factors and genetic ancestry, and now, the potential genomic underpinnings of social factors. To comprehensively understand disparities in TNBC, it is critical to take a translational epidemiologic approach that takes into account genomic and non-genomic factors. Understanding the interplay between genetic ancestry and social genomics and their proportional influence on outcomes can guide our priorities for screening, diagnosis, and interventions for this aggressive BC subtype.
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Affiliation(s)
- Neha Goel
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 4th Floor, Miami, FL 31336, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 4th Floor, Miami, FL 31336, USA.
| | - Alexandra Hernandez
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 4th Floor, Miami, FL 31336, USA
| | - Nipun Merchant
- Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 4th Floor, Miami, FL 31336, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 4th Floor, Miami, FL 31336, USA
| | - Timothy Rebbeck
- Harvard T.H. Chan School of Public Health and Dana-Farber Cancer Institute, 1101 Dana. 450 Brookline Avenue, Boston, MA 02215, USA
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7
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Nelson AM, Erdmann AA, Coe CL, Juckett MB, Morris K, Knight JM, Hematti P, Costanzo ES. Inflammatory cytokines and depression symptoms following hematopoietic cell transplantation. Brain Behav Immun 2023; 112:11-17. [PMID: 37236325 PMCID: PMC10524437 DOI: 10.1016/j.bbi.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 05/28/2023] Open
Abstract
Increased synthesis and release of inflammatory signalling proteins is common among individuals with hematologic malignancies undergoing hematopoietic cell transplantation (HCT) due to intensive conditioning regimens and complications such as graft-versus-host-disease and infections. Prior research indicates that inflammatory responses can activate central nervous system pathways that evoke changes in mood. This study examined relationships between markers of inflammatory activity and depression symptoms following HCT. Individuals undergoing allogeneic (n = 84) and autologous (n = 155) HCT completed measures of depression symptoms pre-HCT and 1, 3, and 6 months post-HCT. Proinflammatory (IL-6, TNF-α) and regulatory (IL-10) cytokines were assessed by ELISA in peripheral blood plasma. Mixed-effects linear regression models indicated that patients with elevated IL-6 and IL-10 reported more severe depression symptoms at the post-HCT assessments. These findings were replicated when examining both allogeneic and autologous samples. Follow-up analyses clarified that relationships were strongest for neurovegetative, rather than cognitive or affective, symptoms of depression. These findings suggest that anti-inflammatory therapeutics targeting an inflammatory mediator of depression could improve quality of life of HCT recipients.
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Affiliation(s)
- Ashley M Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra A Erdmann
- Department of Pediatrics, Division of Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Mark B Juckett
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Keayra Morris
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer M Knight
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peiman Hematti
- Department of Medicine, Division of Hematology and Oncology, School of Medicine and Public Health, 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 Medicine, Division of Hematology and Oncology, School of Medicine and Public Health, University of Wisconsin- Madison, Madison, WI, USA.
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Puzderova B, Belvoncikova P, Grossmannova K, Csaderova L, Labudova M, Fecikova S, Pastorek J, Barathova M. Propranolol, Promising Chemosensitizer and Candidate for the Combined Therapy through Disruption of Tumor Microenvironment Homeostasis by Decreasing the Level of Carbonic Anhydrase IX. Int J Mol Sci 2023; 24:11094. [PMID: 37446271 DOI: 10.3390/ijms241311094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Resistance to chemotherapy represents a persisting medical problem, ranking among main causes of chemotherapy failure and cancer mortality. There is a possibility to utilize and repurpose already existing therapeutics which were not primarily intended for oncological treatment. Overactivation of adrenergic receptors and signaling dysregulation promotes tumor progression, metastatic potential, immune system evasion, tumor angiogenesis and drug resistance. The non-selective beta-blocker propranolol, approved in infantile haemangioma treatment, has a high potential for use in cancer therapy. We analyzed the effects of propranolol and 5-fluorouracil combination on sensitive and resistant cells derived from colorectal carcinoma in monolayers, single-component and co-culture spheroids and in vivo mouse models. Our results revealed that propranolol is able to exert its effect not only in chemosensitive colorectal cells, but also in 5-fluorouracil resistant cells. Propranolol disrupts the hypoxic adaptation machinery by inhibiting HIF1α, carbonic anhydrase IX, and activates apoptosis, which may be important in the management of chemo-resistant patients. We showed that propranolol slows down the growth of xenografts formed from colorectal cancer cells, even from cells already adapted to the β-blocker. We provide clear evidence that blockade of β-adrenergic receptors affects essential signaling pathways modulating tumor microenvironment and thus the response to anticancer therapy. Our findings indicate that propranolol could be repurposed to serve as chemosensitizer in combined therapy aimed at disrupting homeostasis of tumor microenvironment.
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Affiliation(s)
- Barbora Puzderova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Petra Belvoncikova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Katarina Grossmannova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Lucia Csaderova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Martina Labudova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
| | - Silvia Fecikova
- National Institute of Lung Disaeses, Thorax Surgery and Tuberculosis, Vyšné Hágy 1, 059 84 Vysoké Tatry, Slovakia
| | | | - Monika Barathova
- Biomedical Research Center, Institute of Virology, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05 Bratislava, Slovakia
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Freeman B, Mamallapalli J, Bian T, Ballas K, Lynch A, Scala A, Huo Z, Fredenburg KM, Bruijnzeel AW, Baglole CJ, Lu J, Salloum RG, Malaty J, Xing C. Opportunities and Challenges of Kava in Lung Cancer Prevention. Int J Mol Sci 2023; 24:ijms24119539. [PMID: 37298489 DOI: 10.3390/ijms24119539] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths due to its high incidence, late diagnosis, and limited success in clinical treatment. Prevention therefore is critical to help improve lung cancer management. Although tobacco control and tobacco cessation are effective strategies for lung cancer prevention, the numbers of current and former smokers in the USA and globally are not expected to decrease significantly in the near future. Chemoprevention and interception are needed to help high-risk individuals reduce their lung cancer risk or delay lung cancer development. This article will review the epidemiological data, pre-clinical animal data, and limited clinical data that support the potential of kava in reducing human lung cancer risk via its holistic polypharmacological effects. To facilitate its future clinical translation, advanced knowledge is needed with respect to its mechanisms of action and the development of mechanism-based non-invasive biomarkers in addition to safety and efficacy in more clinically relevant animal models.
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Affiliation(s)
- Breanne Freeman
- Department of Medicinal Chemistry and Center for Natural Products, Drug Discovery and Development, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Jessica Mamallapalli
- Department of Medicinal Chemistry and Center for Natural Products, Drug Discovery and Development, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Tengfei Bian
- Department of Medicinal Chemistry and Center for Natural Products, Drug Discovery and Development, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Kayleigh Ballas
- Department of Medicinal Chemistry and Center for Natural Products, Drug Discovery and Development, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Allison Lynch
- Department of Medicinal Chemistry and Center for Natural Products, Drug Discovery and Development, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Alexander Scala
- Department of Medicinal Chemistry and Center for Natural Products, Drug Discovery and Development, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Kristianna M Fredenburg
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Adriaan W Bruijnzeel
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Carolyn J Baglole
- Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada
| | - Junxuan Lu
- Department of Pharmacology, PennState Cancer Institute, Penn State University College of Medicine, Hershey, PA 17033, USA
| | - Ramzi G Salloum
- Department of Health Outcome & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - John Malaty
- Department of Community Health & Family Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Chengguo Xing
- Department of Medicinal Chemistry and Center for Natural Products, Drug Discovery and Development, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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Robb SL, Russ KA, Holochwost SJ, Stegenga K, Perkins SM, Jacob SA, Henley AK, MacLean JA. Protocol and biomarker strategy for a multi-site randomized controlled trial examining biological mechanisms and dosing of active music engagement in children with acute lymphoblastic leukemia and lymphoma and parents. BMC Complement Med Ther 2023; 23:90. [PMID: 36973774 PMCID: PMC10041701 DOI: 10.1186/s12906-023-03909-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/04/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Music therapy is a standard palliative care service in many pediatric and adult hospitals; however, most research has focused on the use of music to improve psychosocial dimensions of health, without considering biological dimensions. This study builds on prior work examining psychosocial mechanisms of action underlying an Active Music Engagement (AME) intervention, designed to help manage emotional distress and improve positive health outcomes in young children with cancer and parents (caregivers), by examining its effects on biomarkers of stress and immune function. METHODS This two-group randomized controlled trial (R01NR019190) is designed to examine biological mechanisms of effect and dose-response relationships of AME on child/parent stress during the consolidation phase of Acute B- or T-cell Lymphoblastic Leukemia (ALL) and T-cell Lymphoblastic Lymphoma (TLyLy) treatment. Child/parent dyads (n = 228) are stratified (by age, site, risk level) and randomized in blocks of four to the AME or attention control condition. Each group receives one session (30-minutes AME; 20-minutes control) during weekly clinic visits (4 weeks standard risk B-cell ALL; 8 weeks high risk B-cell ALL/T-cell ALL/TLyLy). Parents complete questionnaires at baseline and post-intervention. Child/parent salivary cortisol samples are taken pre- and post-session (sessions 1-4). Child blood samples are reserved from routine draws before sessions 1 and 4 (all participants) and session 8 (high risk participants). We will use linear mixed models to estimate AME's effect on child/parent cortisol. Examining child/parent cortisol as mediators of AME effects on child and parent outcomes will be performed in an ANCOVA setting, fitting the appropriate mediation models using MPlus and then testing indirect effects using the percentile bootstrap approach. Graphical plots and non-linear repeated measures models will be used to examine dose-response relationship of AME on child/parent cortisol. DISCUSSION During pediatric cancer treatment there are special challenges that must be considered when measuring cortisol and immune function. In this manuscript we discuss how we addressed three specific challenges through our trial design. Findings from this trial will increase mechanistic understanding of the effects of active music interventions on multiple biomarkers and understanding of dose-response effects, with direct implications for clinical practice. TRIAL REGISTRATION ClinicalTrials.gov: NCT04400071.
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Affiliation(s)
- Sheri L Robb
- School of Nursing, Indiana University, 600 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Kristen A Russ
- School of Medicine, Indiana University , 351 W 10th Street, Indianapolis, IN, 46202, USA
| | - Steven J Holochwost
- Department of Psychology, Lehman College, City University of New York, 250 Bedford Park Boulevard, West Bronx, NY, 10468, USA
| | - Kristin Stegenga
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Susan M Perkins
- School of Medicine, Indiana University, 340 W 10th Street, Indianapolis, IN, 46202, USA
| | - Seethal A Jacob
- School of Medicine, Indiana University, 410 W 10th Street, Indianapolis, IN, 46202, USA
| | - Amanda K Henley
- Purdue School of Engineering and Technology, IUPUI, 535 W. Michigan Street, Indianapolis, IN, 46202, USA
| | - Jessica A MacLean
- School of Nursing, Indiana University, 600 Barnhill Drive, Indianapolis, IN, 46202, USA
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11
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Lord BD, Harris AR, Ambs S. The impact of social and environmental factors on cancer biology in Black Americans. Cancer Causes Control 2023; 34:191-203. [PMID: 36562901 DOI: 10.1007/s10552-022-01664-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Low socioeconomic status (SES) is associated with early onset of chronic diseases and reduced life expectancy. The involvement of neighborhood-level factors in defining cancer risk and outcomes for marginalized communities has been an active area of research for decades. Yet, the biological processes that underlie the impact of SES on chronic health conditions, such as cancer, remain poorly understood. To date, limited studies have shown that chronic life stress is more prevalent in low SES communities and can affect important molecular processes implicated in tumor biology such as DNA methylation, inflammation, and immune response. Further efforts to elucidate how neighborhood-level factors function physiologically to worsen cancer outcomes for disadvantaged communities are underway. This review provides an overview of the current literature on how socioenvironmental factors within neighborhoods contribute to more aggressive tumor biology, specifically in Black U.S. women and men, including the impact of environmental pollutants, neighborhood deprivation, social isolation, structural racism, and discrimination. We also summarize commonly used methods to measure deprivation, discrimination, and structural racism at the neighborhood-level in cancer health disparities research. Finally, we offer recommendations to adopt a multi-faceted intersectional approach to reduce cancer health disparities and develop effective interventions to promote health equity.
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Affiliation(s)
- Brittany D Lord
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bldg. 37/Room 3050, Bethesda, MD, 20892-4258, USA.
| | - Alexandra R Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bldg. 37/Room 3050, Bethesda, MD, 20892-4258, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bldg. 37/Room 3050, Bethesda, MD, 20892-4258, USA
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12
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Zhu Y, Chen J, Li J, Zhou C, Huang X, Chen B. Ginsenoside Rg1 as a promising adjuvant agent for enhancing the anti-cancer functions of granulocytes inhibited by noradrenaline. Front Immunol 2023; 14:1070679. [PMID: 36817446 PMCID: PMC9929943 DOI: 10.3389/fimmu.2023.1070679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction In recent years, numerous studies have confirmed that chronic stress is closely related to the development of cancer. Our previous research showed that high levels of stress hormones secreted in the body during chronic stress could inhibit the cancer-killing activity of granulocytes, which could further promote the development of cancer. Therefore, reversing the immunosuppressive effect of stress hormones on granulocytes is an urgent problem in clinical cancer treatment. Here, we selected noradrenaline (NA) as a representative stress hormone. Methods and results After screening many traditional Chinese herbal medicine active ingredients, a promising compound, ginsenoside Rg1, attracted our attention. We verified the immunoprotective effect of ginsenoside Rg1 on granulocytes in vitro and ex vivo, and attempted to understand its potential immunoprotective mechanism. We confirmed the immunoprotective effect of ginsenoside Rg1 on granulocytes using cell and animal experiments. Cell counting kit-8 (CCK-8) and ex vivo experiments were performed to investigate the immunoprotective effects of ginsenoside Rg1 on the anti-cancer function of granulocytes inhibited by NA. Transcriptome sequencing analysis and qRT-PCR showed that NA elevated the mRNA expression of ARG2, MMP1, S100A4, and RAPSN in granulocytes, thereby reducing the anti-cancer function of granulocytes. In contrast, ginsenoside Rg1 downregulated the mRNA expression of ARG2, MMP1, S100A4, and RAPSN, and upregulated the mRNA expression of LAMC2, DSC2, KRT6A, and FOSB, thereby enhancing the anti-cancer function of granulocytes inhibited by NA. Transwell cell migration experiments were performed to verify that ginsenoside Rg1 significantly enhanced the migration capability of granulocytes inhibited by NA. Tumor-bearing model mice were used to verify the significant immunoprotective effects in vivo. Finally, CCK-8 and hematoxylin and eosin staining experiments indicated that ginsenoside Rg1 exhibited high biosafety in vitro and in vivo. Discussion In future clinical treatments, ginsenoside Rg1 may be used as an adjuvant agent for cancer treatment to alleviate chronic stress-induced adverse events in cancer patients.
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Affiliation(s)
| | | | | | | | - Xin Huang
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Bingdi Chen
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
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13
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Fan Q, Keene DE, Banegas MP, Gehlert S, Gottlieb LM, Yabroff KR, Pollack CE. Housing Insecurity Among Patients With Cancer. J Natl Cancer Inst 2022; 114:1584-1592. [PMID: 36130291 PMCID: PMC9949594 DOI: 10.1093/jnci/djac136] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/11/2023] Open
Abstract
Social determinants of health are the economic and environmental conditions under which people are born, live, work, and age that affect health. These structural factors underlie many of the long-standing inequities in cancer care and outcomes that vary by geography, socioeconomic status, and race and ethnicity in the United States. Housing insecurity, including lack of safe, affordable, and stable housing, is a key social determinant of health that can influence-and be influenced by-cancer care across the continuum, from prevention to screening, diagnosis, treatment, and survivorship. During 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing social determinants of health, including food, housing, and transportation insecurity, and their associations with cancer care and patient outcomes. This dissemination commentary summarizes the formal presentations and panel discussions from the webinar devoted to housing insecurity. It provides an overview of housing insecurity and health care across the cancer control continuum, describes health system interventions to minimize the impact of housing insecurity on patients with cancer, and identifies challenges and opportunities for addressing housing insecurity and improving health equity. Systematically identifying and addressing housing insecurity to ensure equitable access to cancer care and reduce health disparities will require ongoing investment at the practice, systems, and broader policy levels.
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Affiliation(s)
- Qinjin Fan
- Correspondence to: Qinjin Fan, PhD, Surveillance & Health Equity Science Department, American Cancer Society, 3380 Chastain Meadows Pkwy, NW Suite 200, Kennesaw, GA 30144, USA (e-mail: )
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Sarah Gehlert
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
| | - K Robin Yabroff
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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14
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Abstract
BACKGROUND It is unclear which psychological factors (stressors, emotional correlates, and psychophysiological markers) induce cancer risk. This currently limits the potential for prevention strategies. PURPOSE The aim of this review is to bring forth evidence of stress as a determinant of cancer risk from a public health perspective, written for a broad public of practitioners and scientists. METHODS Based on a semisystematic literature search, the impact of different aspects/types of stress and the potential physiological and behavioral pathways are summarized, while highlighting further research, public health and clinical implications. RESULTS Between 2007 and 2020, 65 case-control or cohort studies have been identified. Apart from overall cancer ( N = 24), 12 cancer types have been associated with psychological stress with most for breast ( N = 21), colorectal ( N = 11) and lung/prostate/pancreas cancer ( N = 8 each). Although the evidence regarding the mechanisms is still scarce, cancer development in relation to stress might be due to interacting and combined effects of different stress(or) types, but such interaction has not really been tested yet. The path from stress towards cancer incidence consists of a biological pathway with endocrinology and immunology as well as stress-induced behavioral pathways, including smoking, alcoholism, sleep disruption, an unhealthy diet, and low physical activity together with the related phenomenon of obesity. CONCLUSION Not only the stress but also the stress-induced lifestyle should be targeted for cancer prevention and treatment. Future research should include a more diverse spectrum of cancer types (not only hormonal related like breast cancer) and of stress measures while also considering behavioral covariates.
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Affiliation(s)
- Ananyaa Mohan
- Friedman School of Nutrition Science and Policy, Boston, Massachusetts, USA
| | - Inge Huybrechts
- International Agency for Research on Cancer, Nutrition and Metabolism Section, Lyon, France and Departments of
| | - Nathalie Michels
- Public Health and Primary Care
- Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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15
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Expression pattern and clinical significance of beta 2-adrenergic receptor in oral squamous cell carcinoma: an emerging prognostic indicator and future therapeutic target. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2022; 24:2191-2199. [PMID: 35918593 DOI: 10.1007/s12094-022-02879-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/17/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Beta 2-Adrenergic Receptor (β2-AR) is significantly overexpressed in various types of malignancies, which is associated with the worst prognosis. However, the role of β2-AR in oral cancer is not well identified. The present study aimed at investigating the β2-AR gene expression and its significance in relation with the clinicopathological features and overall survival of oral squamous cell carcinoma (OSCC) patients. METHODS Immunohistochemistry, western blot and quantitative real-time PCR techniques were used to analyze β2-AR protein and mRNA levels in a total of 65 histopathologically confirmed OSCC tissues (case group) and 65 normal tissues (control group) from the oral cavity. RESULTS Out of the total of 65 OSCC tissues, 41 tissues (63.1%) exhibited high expression for β2-AR protein. Percent positivity and relative density (mean ± SD) of protein were higher in the case group as compared to the control group (positivity 40.31 ± 3.01 vs. 20.46 ± 1.93, p < 0.001; density 2.77 ± 1.17 vs. 1.28 ± 0.37, p < 0.001). In addition, β2-AR mRNA level was also upregulated in patients compared to the controls (2.36 ± 1.30 vs. 1.09 ± 0.42, p < 0.001) and showed a positive correlation with immunostaining of protein in OSCC (r = 0.48, p = 0.011). High β2-AR protein expression was significantly associated with multiple risk habits (p = 0.045), histological differentiation (p = 0.013), clinical TNM stages (p = 0.014), and poor survival (p = 0.006) of patients. In the Cox proportional hazards model, β2-AR was identified as a prognostic biomarker of OSCC (p = 0.047). CONCLUSION β2-AR protein level is identified as an independent significant prognostic factor in patients with oral carcinoma.
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16
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Udumyan R, Botteri E, Jerlstrom T, Montgomery S, Smedby KE, Fall K. Beta-blocker use and urothelial bladder cancer survival: a Swedish register-based cohort study. Acta Oncol 2022; 61:922-930. [PMID: 35881046 DOI: 10.1080/0284186x.2022.2101902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recent observational studies linked β-adrenergic receptor blocker use with improved survival in patients with several cancer types, but there is no information on the potential effects of β-blockers in patients with bladder cancer. Literature from pre-clinical studies is also limited, but urothelial cancer can exhibit significant overexpression of β-adrenergic receptors relative to normal urothelial tissue, suggesting that urothelial cancer may benefit from β-blockade therapy. We thus aimed to explore the possible association between β-blocker use and bladder cancer-specific mortality (BCSM) among patients with urothelial bladder cancer. MATERIAL AND METHODS Patients diagnosed during 2006-2014 and identified from the Swedish Cancer Register (n = 16,669) were followed until 31 December 2015. Cox regression was used to evaluate the association of β-blockers dispensed within 90 days prior to cancer diagnosis with BCSM (primary outcome) and all-cause mortality, while controlling for socio-demographic factors, tumor characteristics, comorbidity, other medications and surgical procedures. Hazard ratios (HR) with 95% confidence intervals (CI) were reported. RESULTS Overall, β-blocker use was associated with lower BCSM [HR 0.88 (95%CI 0.81-0.96)]. Especially use of nonselective β-blockers showed a clear inverse association in comparison with both nonuse [0.66 (0.50-0.86)] and use of other antihypertensive medications [0.72 (0.54-0.95)]. The inverse association was most pronounced among patients with locally advanced/metastatic disease: [0.35 (0.18-0.68)]. A lower-magnitude inverse association was observed for selective β-blocker use [0.91 (0.83-0.99)]. Largely similar inverse associations were observed for hydrophilic [0.82 (0.70-0.95)] and lipophilic [0.91 (0.83-1.00)] β-blocker use. CONCLUSION β-blocker use, particularly of the nonselective type, was associated with lower BCSM, especially in patients with locally advanced/metastatic urothelial bladder cancer.
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Affiliation(s)
- Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Edoardo Botteri
- Department of Research, Cancer Registry of Norway, Oslo, Norway.,Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Tomas Jerlstrom
- Department of Urology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Karin E Smedby
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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17
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Frankowski KJ, Patnaik S, Wang C, Southall N, Dutta D, De S, Li D, Dextras C, Lin YH, Bryant-Connah M, Davis D, Wang F, Wachsmuth LM, Shah P, Williams J, Kabir M, Zhu E, Baljinnyam B, Wang A, Xu X, Norton J, Ferrer M, Titus S, Simeonov A, Zheng W, Mathews Griner LA, Jadhav A, Aubé J, Henderson MJ, Rudloff U, Schoenen FJ, Huang S, Marugan JJ. Discovery and Optimization of Pyrrolopyrimidine Derivatives as Selective Disruptors of the Perinucleolar Compartment, a Marker of Tumor Progression toward Metastasis. J Med Chem 2022; 65:8303-8331. [PMID: 35696646 PMCID: PMC10024865 DOI: 10.1021/acs.jmedchem.2c00204] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The perinucleolar compartment (PNC) is a dynamic subnuclear body found at the periphery of the nucleolus. The PNC is enriched with RNA transcripts and RNA-binding proteins, reflecting different states of genome organization. PNC prevalence positively correlates with cancer progression and metastatic capacity, making it a useful marker for metastatic cancer progression. A high-throughput, high-content assay was developed to identify novel small molecules that selectively reduce PNC prevalence in cancer cells. We identified and further optimized a pyrrolopyrimidine series able to reduce PNC prevalence in PC3M cancer cells at submicromolar concentrations without affecting cell viability. Structure-activity relationship exploration of the structural elements necessary for activity resulted in the discovery of several potent compounds. Analysis of in vitro drug-like properties led to the discovery of the bioavailable analogue, metarrestin, which has shown potent antimetastatic activity with improved survival in rodent models and is currently being evaluated in a first-in-human phase 1 clinical trial.
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Affiliation(s)
- Kevin J Frankowski
- KU Specialized Chemistry Center, University of Kansas, 2034 Becker Drive, Lawrence, Kansas 66047, United States.,Center for Integrative Chemical Biology and Drug Discovery, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Samarjit Patnaik
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Chen Wang
- Department of Cell and Molecular Biology, Northwestern University, Chicago, Illinois 60611, United States
| | - Noel Southall
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Dipannita Dutta
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Soumitta De
- Rare Tumor Initiative, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20892, United States
| | - Dandan Li
- Rare Tumor Initiative, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20892, United States
| | - Christopher Dextras
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Yi-Han Lin
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Marthe Bryant-Connah
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Danielle Davis
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Feijun Wang
- Center for Integrative Chemical Biology and Drug Discovery, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Leah M Wachsmuth
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Pranav Shah
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Jordan Williams
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Md Kabir
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Edward Zhu
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Bolormaa Baljinnyam
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Amy Wang
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Xin Xu
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - John Norton
- Department of Cell and Molecular Biology, Northwestern University, Chicago, Illinois 60611, United States
| | - Marc Ferrer
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Steve Titus
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Anton Simeonov
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Wei Zheng
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Lesley A Mathews Griner
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Ajit Jadhav
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Jeffrey Aubé
- KU Specialized Chemistry Center, University of Kansas, 2034 Becker Drive, Lawrence, Kansas 66047, United States.,Center for Integrative Chemical Biology and Drug Discovery, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Mark J Henderson
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
| | - Udo Rudloff
- Rare Tumor Initiative, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20892, United States
| | - Frank J Schoenen
- KU Specialized Chemistry Center, University of Kansas, 2034 Becker Drive, Lawrence, Kansas 66047, United States
| | - Sui Huang
- Department of Cell and Molecular Biology, Northwestern University, Chicago, Illinois 60611, United States
| | - Juan J Marugan
- National Center for Advancing Translational Sciences, National Institutes of Health, 9800 Medical Center Drive, Rockville, Maryland 20850, United States
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Baraldi JH, Martyn GV, Shurin GV, Shurin MR. Tumor Innervation: History, Methodologies, and Significance. Cancers (Basel) 2022; 14:cancers14081979. [PMID: 35454883 PMCID: PMC9029781 DOI: 10.3390/cancers14081979] [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: 02/25/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 12/11/2022] Open
Abstract
Simple Summary This comprehensive review of tumor innervation summarizes the literature from the earliest publications on the topic to the most recent. It addresses the positive and negative evidence of tumor innervation and the historical developments in thought and methodology that have led to the consensus that tumors are innervated. The role of the immune response is described, as are some important biochemical and physiological mechanisms relevant to regulation of cancer development. Abstract The role of the nervous system in cancer development and progression has been under experimental and clinical investigation since nineteenth-century observations in solid tumor anatomy and histology. For the first half of the twentieth century, methodological limitations and opaque mechanistic concepts resulted in ambiguous evidence of tumor innervation. Differential spatial distribution of viable or disintegrated nerve tissue colocalized with neoplastic tissue led investigators to conclude that solid tumors either are or are not innervated. Subsequent work in electrophysiology, immunohistochemistry, pathway enrichment analysis, neuroimmunology, and neuroimmunooncology have bolstered the conclusion that solid tumors are innervated. Regulatory mechanisms for cancer-related neurogenesis, as well as specific operational definitions of perineural invasion and axonogenesis, have helped to explain the consensus observation of nerves at the periphery of the tumor signifying a functional role of nerves, neurons, neurites, and glia in tumor development.
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Affiliation(s)
- James H. Baraldi
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - German V. Martyn
- Biomedical Studies Program, Chatham University, Pittsburgh, PA 15232, USA;
| | - Galina V. Shurin
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Michael R. Shurin
- Department of Pathology and Immunology, Division of Clinical Immunopathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
- Correspondence:
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19
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Altshuler E, Aryan M, Kallumkal G, Gao H, Wilson J, Ouni A, De Leo E, Hanayneh W, Pan K. Impact of β-blockers on survival outcomes in patients with unresectable hepatocellular carcinoma. Hepat Oncol 2022; 9:HEP43. [PMID: 35665305 PMCID: PMC9136628 DOI: 10.2217/hep-2021-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background β-blockers (BBs) have shown promise in improving overall survival (OS) in patients with breast, ovarian, pancreatic and lung cancer. However, few studies have evaluated the impact of BBs on unresectable hepatocellular carcinoma (HCC). Methods The authors compared clinical data and outcomes between unresectable HCC patients based on whether they were prescribed BBs. Results There was significantly decreased disease progression in the BB group compared with the non-BB group (22.8 vs 28.0%; p < 0.05). No difference was seen in OS or progression-free survival between groups. Those specifically on selective BBs had improved OS (hazard ratio: 0.75; 95% CI: 0.61-0.94; p = 0.01) and progression-free survival (hazard ratio: 0.66; 95% CI: 0.45-0.96; p = 0.03) compared with non-BB patients. Conclusion Although the authors' study did not demonstrate that BBs improve OS in HCC, it did show decreased disease progression among patients with HCC who were taking BBs compared with those who were not.
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Affiliation(s)
- Ellery Altshuler
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mahmoud Aryan
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Govind Kallumkal
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hanzhi Gao
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
- Department of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA
| | - Jake Wilson
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ahmed Ouni
- Department of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA
| | - Edward De Leo
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Wissam Hanayneh
- Division of Medical Oncology, H Lee Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Kelsey Pan
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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20
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Psychological intervention to treat distress: An emerging frontier in cancer prevention and therapy. Biochim Biophys Acta Rev Cancer 2021; 1877:188665. [PMID: 34896258 DOI: 10.1016/j.bbcan.2021.188665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/27/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023]
Abstract
Psychological distress, such as chronic depression and anxiety, is a topical problem. In the context of cancer patients, prevalence rates of psychological distress are four-times higher than in the general population and often confer worse outcomes. In addition to evidence from epidemiological studies confirming the links between psychological distress and cancer progression, a growing body of cellular and molecular studies have also revealed the complex signaling networks which are modulated by psychological distress-derived chronic stress during cancer progression. In this review, aiming to uncover the intertwined networks of chronic stress-driven oncogenesis and progression, we summarize physiological stress response pathways, like the HPA, SNS, and MGB axes, that modulate the release of stress hormones with potential carcinogenic properties. Furthermore, we discuss in detail the mechanisms behind these chronic stimulations contributing to the initiation and progression of cancer through direct regulation of cancer hallmarks-related signaling or indirect promotion of cancer risk factors (including obesity, disordered circadian rhythms, and premature senescence), suggesting a novel research direction into cancer prevention and therapy on the basis of psychological interventions.
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21
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Hébert JR. Reducing Racial Disparities in Surviving Gastrointestinal Cancer Will Require Looking Beyond the Fact That African-Americans Have Low Rates of Surgery. Cancer Epidemiol Biomarkers Prev 2021; 30:438-440. [PMID: 33857014 DOI: 10.1158/1055-9965.epi-20-1808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
This article by Bliton and colleagues in this issue of the journal concludes that disproportionately low surgery rates among Black patients contribute to the known survival disparity between Blacks and Whites. Using data from the National Cancer Database (NCDB), they were able to address the implicit hypothesis that the measured outcome disparities are partly attributable to failure to deliver surgical care equitably. As with most good research on difficult and complex topics, it also raises interesting and provocative questions about the role of race in poor survival among African-American patients with gastrointestinal cancer. The main limitation of the NCDB is its inability to account for individual-level factors. Those things related to health behaviors, such as diet, physical activity, and tobacco use, but that also include characteristics of the built environment, comprehensive access to care measures, clinical decision-making, racial discrimination and other forms of psychosocial stress, and environmental contamination, would influence both the likelihood of getting cancer and the probability of having aggressive disease with poor prognosis. These factors also may be related to clinical decision-making. Suggestions are made to design studies and collect data that would help to inform future investigations to deepen our understanding of racial disparities in cancer survival.See related article by Bliton et al., p. 529.
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Affiliation(s)
- James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
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22
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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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23
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Iftikhar A, Islam M, Shepherd S, Jones S, Ellis I. Cancer and Stress: Does It Make a Difference to the Patient When These Two Challenges Collide? Cancers (Basel) 2021; 13:cancers13020163. [PMID: 33418900 PMCID: PMC7825104 DOI: 10.3390/cancers13020163] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Head and neck cancers are the sixth most common cancer in the world. The burden of the disease has remained challenging over recent years despite the advances in treatments of other malignancies. The very use of the word malignancy brings about a stress response in almost all adult patients. Being told you have a tumour is not a word anyone wants to hear. We have embarked on a study which will investigate the effect of stress pathways on head and neck cancer patients and which signalling pathways may be involved. In the future, this will allow clinicians to better manage patients with head and neck cancer and reduce the patients’ stress so that this does not add to their tumour burden. Abstract A single head and neck Cancer (HNC) is a globally growing challenge associated with significant morbidity and mortality. The diagnosis itself can affect the patients profoundly let alone the complex and disfiguring treatment. The highly important functions of structures of the head and neck such as mastication, speech, aesthetics, identity and social interactions make a cancer diagnosis in this region even more psychologically traumatic. The emotional distress engendered as a result of functional and social disruption is certain to negatively affect health-related quality of life (HRQoL). The key biological responses to stressful events are moderated through the combined action of two systems, the hypothalamus–pituitary–adrenal axis (HPA) which releases glucocorticoids and the sympathetic nervous system (SNS) which releases catecholamines. In acute stress, these hormones help the body to regain homeostasis; however, in chronic stress their increased levels and activation of their receptors may aid in the progression of cancer. Despite ample evidence on the existence of stress in patients diagnosed with HNC, studies looking at the effect of stress on the progression of disease are scarce, compared to other cancers. This review summarises the challenges associated with HNC that make it stressful and describes how stress signalling aids in the progression of cancer. Growing evidence on the relationship between stress and HNC makes it paramount to focus future research towards a better understanding of stress and its effect on head and neck cancer.
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24
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Holochwost SJ, Robb SL, Henley AK, Stegenga K, Perkins SM, Russ KA, Jacob SA, Delgado D, Haase JE, Krater CM. Active Music Engagement and Cortisol as an Acute Stress Biomarker in Young Hematopoietic Stem Cell Transplant Patients and Caregivers: Results of a Single Case Design Pilot Study. Front Psychol 2020; 11:587871. [PMID: 33224077 PMCID: PMC7667234 DOI: 10.3389/fpsyg.2020.587871] [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: 07/27/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
This paper reports the results of a single case design pilot study of a music therapy intervention [the Active Music Engagement (AME)] for young children (age 3.51 to 4.53 years) undergoing hematopoietic stem cell transplantation (HCST) and their caregivers. The primary aims of the study were to determine feasibility/acceptability of the AME intervention protocol and data collection in the context of HCST. Secondary aims were to examine caregivers' perceptions of the benefit of AME and whether there were changes in child and caregiver cortisol levels relative to the AME intervention. Results indicated that the AME could be implemented in this context and that data could be collected, though the collection of salivary cortisol may constitute an additional burden for families. Nevertheless, data that were collected suggest that families derive benefit from the AME, which underscores the need for devising innovative methods to understand the neurophysiological impacts of the AME.
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Affiliation(s)
| | - Sheri L Robb
- School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Amanda K Henley
- School of Nursing, Indiana University, Indianapolis, IN, United States
| | | | - Susan M Perkins
- School of Medicine, Indiana University, Indianapolis, IN, United States.,Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Kristen A Russ
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, United States
| | - Seethal A Jacob
- School of Medicine, Indiana University, Indianapolis, IN, United States.,Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
| | - David Delgado
- Astellas Pharma Global Development, Northbrook, IL, United States
| | - Joan E Haase
- School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Caitlin M Krater
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
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25
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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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26
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Shurin MR, Shurin GV, Zlotnikov SB, Bunimovich YL. The Neuroimmune Axis in the Tumor Microenvironment. THE JOURNAL OF IMMUNOLOGY 2020; 204:280-285. [PMID: 31907270 DOI: 10.4049/jimmunol.1900828] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022]
Abstract
Cancer is a complex ecosystem and should be considered in the context of its cellular and molecular microenvironment, which includes the nerves. Peripheral nerves can modulate phenotype and behavior of the malignant cells and thus affect tumor growth and metastasis. Only recently has the role of neuroimmune cross-talk surfaced as a key contributor to cancer progression. However, little is known about the immunomodulatory role of the neuroglial cells in cancer progression and metastasis and the response to therapy. Schwann cells, the principal glial cells of the peripheral nervous system, are now considered to be important players in the tumor microenvironment. They can directly accelerate malignant cell migration and the formation of metastases. Better understanding of the neuroimmune circuits in the tumor milieu will be instrumental in the development of novel therapeutic approaches for the malignancies known to be associated with inflammation and dysregulated immune responses.
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Affiliation(s)
- Michael R Shurin
- Department of Pathology, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232; .,Department of Immunology, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232; and
| | - Galina V Shurin
- Department of Pathology, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232
| | - Samuel B Zlotnikov
- Department of Pathology, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232
| | - Yuri L Bunimovich
- Department of Dermatology, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA 15232
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27
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Udumyan R, Montgomery S, Duberg AS, Fang F, Valdimarsdottir U, Ekbom A, Smedby KE, Fall K. Beta-adrenergic receptor blockers and liver cancer mortality in a national cohort of hepatocellular carcinoma patients. Scand J Gastroenterol 2020; 55:597-605. [PMID: 32412855 DOI: 10.1080/00365521.2020.1762919] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: β-adrenergic signaling has been implicated in the pathology of hepatocellular carcinoma (HCC), but the evidence from clinical studies is limited. In this national population-based cohort study, we investigated the possible association of β-adrenergic receptor blockers and cancer-specific mortality among patients with primary HCC diagnosed in Sweden between 2006 and 2014.Methods: Patients were identified from the Swedish Cancer Register (n = 2104) and followed until 31 December 2015. We used Cox regression to evaluate the association of β-blockers dispensed within 90 days prior to cancer diagnosis, ascertained from the national Prescribed Drug Register, with liver cancer mortality identified from the Cause of Death Register, while controlling for socio-demographic factors, tumor characteristics, comorbidity, other medications and treatment procedures.Results: Over a median follow-up of 9.9 months, 1601 patients died (of whom 1309 from liver cancer). Compared with non-use, β-blocker use at cancer diagnosis [n = 714 (predominantly prevalent use, 93%)] was associated with lower liver cancer mortality [0.82 (0.72-0.94); p = .005]. Statistically significant associations were observed for non-selective [0.71 (0.55-0.91); p = .006], β1-receptor selective [0.86 [0.75-1.00); p = .049] and lipophilic [0.78 (0.67-0.90); p = .001] β-blockers. No association was observed for hydrophilic β-blockers [1.01 (0.80-1.28); p = .906] or other antihypertensive medications. Further analysis suggested that the observed lower liver cancer mortality rate was limited to patients with localized disease at diagnosis [0.82 (0.67-1.01); p = .062].Conclusion: β-blocker use was associated with lower liver cancer mortality rate in this national cohort of patients with HCC. A higher-magnitude inverse association was observed in relation to non-selective β-blocker use.
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Affiliation(s)
- Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Valdimarsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Anders Ekbom
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.,Hematology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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28
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Reis JC, Travado L, Antoni MH, Oliveira FPM, Almeida SD, Almeida P, Heller AS, Sousa B, Costa DC. Negative affect and stress-related brain metabolism in patients with metastatic breast cancer. Cancer 2020; 126:3122-3131. [PMID: 32286691 DOI: 10.1002/cncr.32902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/25/2020] [Accepted: 03/20/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cancer and its treatment represent major stressors requiring that patients make multiple adaptations. Despite evidence that poor adaptation to stressors is associated with more distress and negative affect (NA), neuroimmune dysregulation and poorer health outcomes, current understanding is very limited of how NA covaries with central nervous system changes to account for these associations. METHODS NA was correlated with brain metabolic activity using 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) in several regions of interest in 61 women with metastatic breast cancer. Patients underwent 18 F-FDG PET/CT and completed an assessment of NA using the Brief Symptom Inventory. RESULTS Regression analyses revealed that NA was significantly negatively correlated with the standardized uptake value ratio of the insula, thalamus, hypothalamus, ventromedial prefrontal cortex, and lateral prefrontal cortex. Voxel-wise correlation analyses within these 5 regions of interest demonstrated high left-right symmetry and the highest NA correlations with the anterior insula, thalamus (medial and ventral portion), lateral prefrontal cortex (right Brodmann area 9 [BA9], left BA45, and right and left BA10 and BA8), and ventromedial prefrontal cortex (bilateral BA11). CONCLUSIONS The regions of interest most strongly negatively associated with NA represent key areas for successful adaptation to stressors and may be particularly relevant in patients with metastatic breast cancer who are dealing with multiple challenges of cancer and its treatment.
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Affiliation(s)
- Joaquim C Reis
- Institute of Biophysics and Biomedical Engineering, Faculty of Science, University of Lisbon, Lisbon, Portugal
| | - Luzia Travado
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Michael H Antoni
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Department of Psychology and Cancer Control Program, Miami, Florida
| | - Francisco P M Oliveira
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Silvia D Almeida
- Institute of Biophysics and Biomedical Engineering, Faculty of Science, University of Lisbon, Lisbon, Portugal
| | - Pedro Almeida
- Institute of Biophysics and Biomedical Engineering, Faculty of Science, University of Lisbon, Lisbon, Portugal
| | - Aaron S Heller
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Department of Psychology and Cancer Control Program, Miami, Florida
| | - Berta Sousa
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Durval C Costa
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
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29
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Russ KA, Holochwost SJ, Perkins SM, Stegenga K, Jacob SA, Delgado D, Henley AK, Haase JE, Robb SL. Cortisol as an Acute Stress Biomarker in Young Hematopoietic Cell Transplant Patients/Caregivers: Active Music Engagement Protocol. J Altern Complement Med 2020; 26:424-434. [PMID: 32073877 PMCID: PMC7232696 DOI: 10.1089/acm.2019.0413] [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: 11/24/2022] Open
Abstract
Objective: Primary aims of the proposed protocol are to determine the feasibility/acceptability of the active music engagement intervention protocol during hematopoietic stem cell transplantation (HSCT) and clinical feasibility/acceptability of the biological sample collection schedule. Design: The authors propose a single-case, alternating treatment design to compare levels of child and caregiver cortisol in blood and saliva collected on alternating days, when the dyad receives and does not receive AME sessions. Included are the scientific rationale for this design and detailed intervention and sample collection schedules based on transplant type. Setting/Location: Pediatric inpatient HSCT unit. Subjects: Eligible participants are dyads of children 3–8 years old, hospitalized for HSCT, and their caregiver. Children with malignant and nonmalignant conditions will be eligible, regardless of transplant type. Intervention: AME intervention is delivered by a board-certified music therapist who tailors music-based play experiences to encourage active engagement in, and independent use of, music play to manage the inter-related emotional distress experienced by children and their caregivers during HSCT. Dyads will receive two 45-min AME sessions each week during hospitalization. Outcome Measures: Eight collections of blood (child) and saliva (child/caregiver) will be performed for cortisol measurement. The authors will also collect self-report and caregiver proxy measures for dyad emotional distress, quality of life, and family function. At study conclusion, qualitative caregiver interviews will be conducted. Results: Planned analyses will be descriptive and evaluate the feasibility of participant recruitment, cortisol collection, planned evaluations, and AME delivery. Analysis of qualitative interviews will be used to gain an understanding about the ease/burden of biological sample collection and any perceived benefit of AME. Conclusions: Behavioral intervention studies examining biological mechanisms of action in pediatric transplant populations are rare. Findings will provide important information about the feasibility/acceptability of collecting cortisol samples during a high-intensity treatment and advance understanding about the use of active music interventions to mitigate child/caregiver distress during the transplant period.
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Affiliation(s)
- Kristen A Russ
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | | | - Susan M Perkins
- Indiana University School of Medicine, Indianapolis, IN, USA.,Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | | | - Seethal A Jacob
- Indiana University School of Medicine, Indianapolis, IN, USA.,Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - David Delgado
- Astellas Pharma Global Development, Northbrook, IL, USA
| | | | - Joan E Haase
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Sheri L Robb
- Indiana University School of Nursing, Indianapolis, IN, USA
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30
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Emotional distress, brain functioning, and biobehavioral processes in cancer patients: a neuroimaging review and future directions. CNS Spectr 2020; 25:79-100. [PMID: 31010446 DOI: 10.1017/s1092852918001621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Despite emerging evidence that distress and adversity can contribute to negative health outcomes in cancer, little is known about the brain networks, regions, or circuits that can contribute to individual differences in affect/distress states and health outcomes in treated cancer patients. To understand the state-of-the-science in this regard, we reviewed neuroimaging studies with cancer patients that examined the associations between negative affect (distress) and changes in the metabolism or structure of brain regions. Cancer patients showed changes in function and/or structure of key brain regions such as the prefrontal cortex, thalamus, amygdala, hippocampus, cingulate cortex (mainly subgenual area), hypothalamus, basal ganglia (striatum and caudate), and insula, which are associated with greater anxiety, depression, posttraumatic stress disorder (PTSD) symptoms, and distress. These results provide insights for understanding the effects of these psychological and emotional factors on peripheral stress-related biobehavioral pathways known to contribute to cancer progression and long-term health outcomes. This line of work provides leads for understanding the brain-mediated mechanisms that may explain the health effects of psychosocial interventions in cancer patients and survivors. A multilevel and integrated model for distress management intervention effects on psychological adaptation, biobehavioral processes, cancer pathogenesis, and clinical outcomes is proposed for future research.
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31
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Huang X, Le W, Chen Q, Chen J, Zhu Y, Shi D, Chen B, Cui Z. Suppression of the innate cancer-killing activity in human granulocytes by stress reaction as a possible mechanism for affecting cancer development. Stress 2020; 23:87-96. [PMID: 31311393 DOI: 10.1080/10253890.2019.1645112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Psychological stress may be linked to cancer incidence; however, more direct evidence is required to support this viewpoint. In this study, we investigated the effects of stress on immunosurveillance against cancer cells using a previously established examination stress model. We showed that the cancer killing activity (CKA) of granulocytes (also known as polymorphic nuclear cells, PMNs) is sharply reduced during examination stress stimulation in some donors who are psychologically sensitive to examination stress, with the concentration of plasma stress hormones (cortisone, epinephrine, and norepinephrine) increasing accordingly. The effects of stress hormones on immune cell CKA were also investigated under two in vitro co-incubation conditions, with all three hormones found to exert inhibitory effects on the CKA of PMNs and mononuclear cells. We showed that stress triggered the release of stress hormones which had profound inhibitory effects on the innate anticancer functions of PMNs. These results provide a possible explanation for the relationship between psychological stress and cancer incidence.
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Affiliation(s)
- Xin Huang
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Wenjun Le
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Qian Chen
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Jingyao Chen
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Yuqian Zhu
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Donglu Shi
- Materials Science and Engineering Program, Department of Mechanical and Materials Engineering, College of Engineering and Applied Science, University of Cincinnati, Cincinnati, OH, USA
| | - Bingdi Chen
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Zheng Cui
- Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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32
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Seiler A, von Känel R, Slavich GM. The Psychobiology of Bereavement and Health: A Conceptual Review From the Perspective of Social Signal Transduction Theory of Depression. Front Psychiatry 2020; 11:565239. [PMID: 33343412 PMCID: PMC7744468 DOI: 10.3389/fpsyt.2020.565239] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
Losing a spouse is considered one of the most stressful life events a person can experience. Particularly in the immediate weeks and months after the loss, bereavement is associated with a significantly increased risk of morbidity and mortality. Despite an abundance of research aimed at identifying risk factors for adverse health outcomes following marital death, the mechanisms through which mental and physical health problems emerge following bereavement remain poorly understood. To address this issue, the present review examines several pathways that may link bereavement and health, including inflammation and immune dysregulation, genetic and epigenetic changes, gut microbiota activity, and biological aging. We then describe how these processes may be viewed from the perspective of the Social Signal Transduction Theory of Depression to provide a novel framework for understanding individual differences in long-term trajectories of adjustment to interpersonal loss. Finally, we discuss several avenues for future research on psychobiological mechanisms linking bereavement with mental and physical health outcomes.
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Affiliation(s)
- Annina Seiler
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Udumyan R, Montgomery S, Fang F, Valdimarsdottir U, Hardardottir H, Ekbom A, Smedby KE, Fall K. Beta-Blocker Use and Lung Cancer Mortality in a Nationwide Cohort Study of Patients with Primary Non-Small Cell Lung Cancer. Cancer Epidemiol Biomarkers Prev 2019; 29:119-126. [PMID: 31641010 DOI: 10.1158/1055-9965.epi-19-0710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/21/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND β-Adrenergic receptor blockers have been associated with improved survival among patients with different types of malignancies, but available data for patients with non-small cell lung cancer (NSCLC) are contradictory and limited to small hospital-based studies. We therefore aimed to investigate whether β-blocker use at the time of cancer diagnosis is associated with lung cancer mortality in the largest general population-based cohort of patients with NSCLC to date. METHODS For this retrospectively defined nationwide cohort study, we used prospectively collected data from Swedish population and health registers. Through the Swedish Cancer Register, we identified 18,429 patients diagnosed with a primary NSCLC between 2006 and 2014 with follow-up to 2015. Cox regression was used to estimate the association between β-blocker use at time of cancer diagnosis ascertained from the Prescribed Drug Register and cancer-specific mortality identified from the Cause of Death Register. RESULTS Over a median follow-up of 10.2 months, 14,994 patients died (including 13,398 from lung cancer). Compared with nonuse, β-blocker use (predominantly prevalent use, 93%) was not associated with lung cancer mortality [HR (95% confidence interval): 1.01 (0.97-1.06)]. However, the possibility that diverging associations for specific β-blockers and some histopathologic subtypes exist cannot be excluded. CONCLUSIONS In this nationwide cohort of patients with NSCLC, β-blocker use was not associated with lung cancer mortality when assessed in aggregate in the total cohort, but evidence for some β-blockers is less conclusive. IMPACT Our results do not indicate that β-blocker use at lung cancer diagnosis reduces the cancer-specific mortality rate in patients with NSCLC.
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Affiliation(s)
- Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Valdimarsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Hronn Hardardottir
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Anders Ekbom
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Hematology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Recio A. Tumour growth activation by the central nervous system-An integrative theory of cancer. Stress Health 2019; 35:569-581. [PMID: 31397066 DOI: 10.1002/smi.2890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 01/11/2023]
Abstract
The currently recognized mechanisms of the biology of cancer are not yet enough to explain the high incidence of the disease in industrialized countries. Survival and proliferation of cancer cells demand a well-orchestrated combination of functional capabilities, or hallmarks, which requires complex signalling networks that often exceed the tumour boundaries. Based on latest research on environmental health and aiming to provide cancer with a coherent set of organizing principles, we propose an integrative model of carcinogenesis founded on tumour growth activation by the central nervous system as an adaptive, allostatic response to both environmental and emotional challenges. In this way, chronicity of physical as well as psychological stressors may be directly involved in cancer genesis and progression, after an early inflammatory stage. The model also contemplates accidental activation of the tumour growth programme following direct DNA damage, but as a rare event that does not account for most cancers in humans. Bodily and cellular mechanisms designed to facilitate tumorigenesis may include exacerbation of the sympathetic activity, overexpression of membrane ion channels, promotion of selected mutations and methylations, degradation of the mitochondria and reprogramming of adult stem cells.
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Affiliation(s)
- Alberto Recio
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain
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35
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Flaherty RL, Falcinelli M, Flint MS. Stress and drug resistance in cancer. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2019; 2:773-786. [PMID: 35582576 PMCID: PMC8992509 DOI: 10.20517/cdr.2019.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 06/15/2023]
Abstract
Patients diagnosed with cancer often undergo considerable psychological distress, and the induction of the psychological stress response has been linked with a poor response to chemotherapy. The psychological stress response is mediated by fluctuations of the hormones glucocorticoids (GCs) and catecholamines. Binding to their respective receptors, GCs and the catecholamines adrenaline/noradrenaline are responsible for signalling a wide range of processes involved in cell survival, cell cycle and immune function. Synthetic GCs are also often prescribed as co-medication alongside chemotherapy, and increasing evidence suggests that GCs may induce chemoresistance in multiple cancer types. In this review, we bring together evidence linking psychological stress hormone signalling with resistance to chemo- and immune therapies, as well as mechanistic evidence regarding the effects of exogenous stress hormones on the efficacy of chemotherapies.
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Affiliation(s)
- Renée L. Flaherty
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton, BN2 4GJ, UK
| | - Marta Falcinelli
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton, BN2 4GJ, UK
| | - Melanie S. Flint
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton, BN2 4GJ, UK
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Zhao Y, Jia Y, Shi T, Wang W, Shao D, Zheng X, Sun M, He K, Chen L. Depression promotes hepatocellular carcinoma progression through a glucocorticoid-mediated upregulation of PD-1 expression in tumor-infiltrating NK cells. Carcinogenesis 2019; 40:1132-1141. [PMID: 30715244 DOI: 10.1093/carcin/bgz017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/09/2019] [Accepted: 01/28/2019] [Indexed: 12/13/2022] Open
Abstract
There is a growing belief that depression was positively associated with the progression of liver cancer. However, the driving molecular events behind the depression in liver cancer are poorly understood and need to be elucidated. Since hyperactivity of the hypothalamic-pituitary-adrenal axis during depression leads to the excessive release of glucocorticoids (GCs), which suppress the activity of natural killer (NK) cells, we hypothesized that high levels of GCs during depression may inhibit function of tumor-infiltrating NK cells during the progress of the liver cancer. Using chronic unpredictable mild stress-induced depressed mice model, we showed that the progression of liver cancer was significantly accelerated in the depressed mice. The high levels of GCs were observed in both depressed mice and depressed patients with liver cancer. Importantly, the expression of programmed death (PD)-1 on NK cells was specifically increased in the tumor microenvironment rather than that in blood or spleen. Coculture studies demonstrated that the expression of PD-1 was significantly increased and cytotoxicity of NK92 cells was remarkably decreased by the dexamethasone treatment through PD-L1-dependent pathway. To the best of our knowledge, we first found that PD-1/PD-L1-mediated exhaustion of infiltrated NK cells promoted hepatocellular carcinoma progression under depression and provided a novel strategy for GC-mediated antidepressant therapy in patients with liver cancer.
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Affiliation(s)
- Yawei Zhao
- Department of Pharmacology, College of Basic Medical Sciences
| | - Yong Jia
- School of Nursing, Jilin University, Changchun, China
| | - Tongfei Shi
- Department of Pharmacology, College of Basic Medical Sciences
| | - Wencong Wang
- Department of Pharmacology, College of Basic Medical Sciences
| | - Dan Shao
- Department of Pharmacology, College of Basic Medical Sciences
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Xiao Zheng
- Department of Pharmacology, College of Basic Medical Sciences
| | - Madi Sun
- Department of Pharmacology, College of Basic Medical Sciences
| | - Kan He
- Department of Pharmacology, College of Basic Medical Sciences
| | - Li Chen
- Department of Pharmacology, College of Basic Medical Sciences
- School of Nursing, Jilin University, Changchun, China
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Saini G, Ogden A, McCullough LE, Torres M, Rida P, Aneja R. Disadvantaged neighborhoods and racial disparity in breast cancer outcomes: the biological link. Cancer Causes Control 2019; 30:677-686. [PMID: 31111277 PMCID: PMC7043809 DOI: 10.1007/s10552-019-01180-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
Neighborhoods encompass complex environments comprised of unique economic, physical, and social characteristics that have a profound impact on the residing individual's health and, collectively, on the community's wellbeing. Neighborhood disadvantage (ND) is one of several factors that prominently contributes to racial breast cancer (BC) health disparities in American women. African American (AA) women develop more aggressive breast cancer features, such as triple-negative receptor status and more advanced histologic grade and tumor stage, and suffer worse clinical outcomes than European American (EA) women. While the adverse effects of neighborhood disadvantage on health, including increased risk of cancer and decreased longevity, have recently come into focus, the specific molecular mechanisms by which neighborhood disadvantage increases BC risk and worsens BC outcomes (survivorship, recurrence, mortality) are not fully elucidated. This review illuminates the probable biological links between neighborhood disadvantage and predominantly BC risk, with an emphasis on stress reactivity and inflammation, epigenetics and telomere length in response to adverse neighborhood conditions.
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Affiliation(s)
- Geetanjali Saini
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Angela Ogden
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Mylin Torres
- Department of Radiation Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Padmashree Rida
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA.
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Liu Y, Zhang H, Wang Z, Wu P, Gong W. 5-Hydroxytryptamine1a receptors on tumour cells induce immune evasion in lung adenocarcinoma patients with depression via autophagy/pSTAT3. Eur J Cancer 2019; 114:8-24. [PMID: 31009821 DOI: 10.1016/j.ejca.2019.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/13/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cancer patients frequently suffer from fatigue and depression. Dysregulation of the immune system, tumour recurrence and metastasis are more common in cancer patients with depression. 5-Hydroxytryptamine (5-HT), a neurotransmitter, contributes to immune evasion in lung adenocarcinoma patients by activating 5-HTRs, but the mechanism for this phenomenon is still unclear. In this study, we examined the function of 5-HT1a receptors (5-HT1aRs) in immune evasion in a mouse model and in samples from lung adenocarcinomas patients. EXPERIMENTAL DESIGN Sixty-four human lung adenocarcinoma patients with depression and 64 lung adenocarcinoma patients without depression were recruited for this study. The expression of 5-HT receptors on lung adenocarcinoma cells from tumour tissues were detected by using immunohistochemistry (IHC) and fluorescence-activated cell sorting (FACS). The depression models were established in vitro and in vivo. The effects of immunosuppression were evaluated by testing the function of cytotoxic lymphocyte (CTLs) and Tregs, measuring tumour weight or volume, assessing the survival of mice and staining of tissues by IHC. Changes in the expression of immunoregulatory factor genes were assessed to elucidate the mechanism of immune evasion induced by the 5- hydroxytryptamine receptor (HTRs). RESULTS Higher levels of 5-HT, increased expression of 5-HT1Rs and decreased overall survival were observed in lung adenocarcinomas patients with depression compared with those without depression. Moreover, 5-HT1aR, a critical factor for increasing the number of CD4+CD25+Foxp3+ Treg cells and decreasing the ratio of Th1/Th2 cells, which suggested immune system dysregulation. In addition, expression of 5-HT1aR on tumour cells was also negatively associated with CTL activity in both peripheral blood and tumour infiltrating lymphocytes. In a depressive state, 5-HT1aR activates p-signal transducer and activator of transcription 3 (STAT3) and autophagy, and programmed death ligand-1, a downstream gene of autophagy/p-STAT3 signalling, mediates an immunosuppressive environment. Moreover, in both the mouse model and lung adenocarcinoma patients, the activation of 5HT1aR and the elevated tumour autophagy/p-STAT3 axis were associated with reduced overall survival. CONCLUSIONS The 5-HT1aR/autophagy/p-STAT3 axis influences both tumour cells and immune cells, resulting in immunosuppression in lung adenocarcinomas patients with depression.
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Affiliation(s)
- Yi Liu
- Department of Medicinal Chemistry, School of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Hao Zhang
- Department of Cardiothoracic Surgery, XiangYang Central Hospital, Hubei University of Arts and Science, XiangYang 441021, China
| | - ZhiYong Wang
- Department of Neurosurgery, XiangYang Central Hospital, Hubei University of Arts and Science, XiangYang 441021, China
| | - Pin Wu
- Department of Medicinal Chemistry, School of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Wei Gong
- Department of Oncology, XiangYang Central Hospital, Hubei University of Arts and Science, XiangYang 441021, China.
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Bucsek MJ, Giridharan T, MacDonald CR, Hylander BL, Repasky EA. An overview of the role of sympathetic regulation of immune responses in infectious disease and autoimmunity. Int J Hyperthermia 2019; 34:135-143. [PMID: 29498310 DOI: 10.1080/02656736.2017.1411621] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Stress in patients and pre-clinical research animals plays a critical role in disease progression Activation of the sympathetic nervous system (SNS) by stress results in secretion of the catecholamines epinephrine (Epi) and norepinephrine (NE) from the adrenal gland and sympathetic nerve endings. Adrenergic receptors for catecholamines are present on immune cells and their activity is affected by stress and the accompanying changes in levels of these neurotransmitters. In this short review, we discuss how this adrenergic stress impacts two categories of immune responses, infections and autoimmune diseases. Catecholamines signal primarily through the β2-adrenergic receptors present on innate and adaptive immune cells which are critical in responding to infections caused by pathogens. In general, this adrenergic input, particularly chronic stimulation, suppresses lymphocytes and allows infections to progress. On the other hand, insufficient adrenergic control of immune responses allows progression of several autoimmune diseases.
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Affiliation(s)
- Mark J Bucsek
- a Department of Immunology , Roswell Park Cancer Institute , Buffalo , NY , USA
| | | | - Cameron R MacDonald
- a Department of Immunology , Roswell Park Cancer Institute , Buffalo , NY , USA
| | - Bonnie L Hylander
- a Department of Immunology , Roswell Park Cancer Institute , Buffalo , NY , USA
| | - Elizabeth A Repasky
- a Department of Immunology , Roswell Park Cancer Institute , Buffalo , NY , USA
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Noll KR, Sullaway CM, Wefel JS. Depressive symptoms and executive function in relation to survival in patients with glioblastoma. J Neurooncol 2019; 142:183-191. [PMID: 30680509 DOI: 10.1007/s11060-018-03081-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/15/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Depression and neurocognitive function, particularly executive functioning (EF), have been associated with overall survival (OS) in patients with glioblastoma (GBM). However, the combined effect of depressive symptoms and impaired EF upon OS has not been reported. METHODS Patients with GBM (N = 102) completed neuropsychological assessment postoperatively, including the Beck Depression Inventory-Second Edition (BDI-II) and the Trail Making Test Part B (TMTB). Median splits were used to determine cut-points denoting elevated depressive symptoms on the BDI-II and impaired EF on TMTB. Patients were stratified into four groups: low depressive symptoms/low EF impairment (- Dep/- Imp; N = 23), high depressive symptoms/low EF impairment (+ Dep/- Imp; N = 28), low depressive symptoms/high EF impairment (- Dep/+Imp; N = 28), and high depressive symptoms/high EF impairment (+ Dep/+Imp; N = 23). The Kaplan-Meier method, log-rank test, and Cox regression were used to examine differences in survival between groups. RESULTS Relative to - Dep/- Imp patients (median OS = 22.8 months), median OS in all other patient groups was shorter (+ Dep/- Imp OS = 16.6; - Dep/+Imp OS = 14.8; +Dep/+Imp OS = 10.8; all p < .05). With the exception of KPS and age, groups did not differ in distribution of clinical and demographic characteristics. Neither KPS nor age modified the independent effect of BDI-II and TMTB on OS in Cox regression models. CONCLUSIONS The presence of depressive symptoms and impaired EF are independently associated with shorter OS in patients with GBM. These results suggest that routine neuropsychological assessment of mood and cognition may help refine prognosis and facilitate initiation of psychological and cognitive interventions, which can improve patient quality of life, and warrants further investigation.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Catherine M Sullaway
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA. .,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA.
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Osann K, Wilford J, Wenzel L, Hsieh S, Tucker JA, Wahi A, Monk BJ, Nelson EL. Relationship between social support, quality of life, and Th2 cytokines in a biobehavioral cancer survivorship trial. Support Care Cancer 2019; 27:3301-3310. [PMID: 30612237 DOI: 10.1007/s00520-018-4617-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 12/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Benefits of social support (SS) during cancer survivorship are complex. This study examines change in SS over time in cervical cancer (CXCA) survivors who have completed definitive treatment and how changing SS impacts quality of life (QOL) and T-helper type 2 (Th2) cytokines. METHODS We conducted a randomized trial in 204 CXCA survivors to test if psychosocial telephone counseling (PTC) could improve QOL compared to usual care (UC). Although PTC did not target SS, data were collected at baseline, 4 and 9 months post-enrollment using the Medical Outcomes Survey Social Support scale. Biospecimens were collected to investigate associations with patient-reported outcomes. Data were analyzed using multivariate linear models and stepwise regression. RESULTS Participants' mean age was 43. PTC participants experienced increasing SS compared to UC at 4 months (PTC-UC = 5.1; p = 0.055) and 9 months (PTC-UC = 6.0; p = 0.046). Higher baseline SS and increasing SS were independently associated with improved QOL at 4 and 9 months after adjusting for patient characteristics (p < 0.05). Differences between study arms were not statistically significant. Improvements in QOL at 4 months were observed with increases in emotional/informational and tangible SS. Increasing SS predicted significant longitudinal decreases in IL-4 and IL-13 at 4 months that were larger in the PTC arm (interactions p = 0.041 and p = 0.057, respectively). CONCLUSION Improved SS was significantly associated with improved QOL independent of patient characteristics and study arm. Decreasing Th2 cytokines with increasing SS and QOL are consistent with a biobehavioral paradigm in which modulation of the chronic stress response is associated with shifts in immune stance.
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Affiliation(s)
- Kathryn Osann
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, 204 Sprague Hall, Irvine, CA, 92697, USA.
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA.
| | - Justin Wilford
- Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - Lari Wenzel
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA
- Program in Public Health, University of California Irvine, Irvine, CA, USA
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Susie Hsieh
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Jo A Tucker
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, 204 Sprague Hall, Irvine, CA, 92697, USA
| | - Aditi Wahi
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Bradley J Monk
- School of Medicine, St. Joseph's Hospital and Medical Center, Creighton University, Phoenix, AZ, USA
| | - Edward L Nelson
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, 204 Sprague Hall, Irvine, CA, 92697, USA
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA, USA
- Institute for Immunology, University of California Irvine, Irvine, CA, USA
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Udumyan R, Montgomery S, Fang F, Valdimarsdottir U, Fall K. Stress Resilience in Late Adolescence and Survival among Cancer Patients: A Swedish Register-Based Cohort Study. Cancer Epidemiol Biomarkers Prev 2018; 28:400-408. [PMID: 30333220 DOI: 10.1158/1055-9965.epi-18-0451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/28/2018] [Accepted: 10/10/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic stress has been suggested to play a role in cancer progression, but few studies have so far examined the potential influence of stress susceptibility. This national register-based cohort study utilizes a unique data source to investigate whether a stress resilience measure is associated with survival in cancer patients. METHODS The cohort includes 9,318 Swedish male cancer patients born during 1952 to 1956 who had their stress resilience evaluated at a semistructured interview with a psychologist during mandatory conscription examination in late adolescence. RESULTS Over a median of 3 years of follow-up from cancer diagnosis, a total of 2,541 patients died (2,322 from cancer). Overall, low (23%) compared with high (25%) stress resilience was associated with increased mortality (adjusted hazard ratio estimated by Cox regression 1.45; 95% confidence interval 1.28-1.65), particularly among men with carcinomas of the oropharynx (2.62, 1.24-5.56), upper respiratory tract (4.64, 1.05-20.41), and prostate (2.20, 1.04-4.62), as well as with Hodgkin lymphoma (3.52, 1.40-8.86). An association was evident for both cancer types associated with smoking (1.35, 1.10-1.66) and malignancies without an established smoking etiology (1.32, 1.12-1.56). The association between low stress resilience and mortality could partly be explained by tumor stage, marital status, and psychiatric comorbidity at cancer diagnosis. CONCLUSIONS We observed an association between low stress resilience and mortality among men diagnosed with cancer, particularly oropharyngeal cancer, upper respiratory tract cancers, prostate cancer, and Hodgkin lymphoma. IMPACT These results suggest that individual variation in stress resilience may influence survival among men with some cancer types.
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Affiliation(s)
- Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Valdimarsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Bastos DB, Sarafim-Silva BAM, Sundefeld MLMM, Ribeiro AA, Brandão JDP, Biasoli ÉR, Miyahara GI, Casarini DE, Bernabé DG. Circulating catecholamines are associated with biobehavioral factors and anxiety symptoms in head and neck cancer patients. PLoS One 2018; 13:e0202515. [PMID: 30125310 PMCID: PMC6101398 DOI: 10.1371/journal.pone.0202515] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023] Open
Abstract
Studies have shown that stress-related catecholamines may affect cancer progression. However, little is known about catecholamine secretion profiles in head and neck cancer patients. The present study investigated plasma norepinephrine and epinephrine levels in head and neck squamous cell carcinoma (HNSCC) patients and patients with oral leukoplakia, as well as their association with clinicopathological and biobehavioral variables and anxiety symptoms. A total of 93 patients with HNSCC and 32 patients with oral leukoplakia were included. Plasma norepinephrine and epinephrine levels were measured by high performance liquid chromatography with electrochemical detection (HPLC-ED), and psychological anxiety levels were measured by the Beck Anxiety Inventory (BAI). Plasma norepinephrine and epinephrine concentrations were significantly higher in patients with oral and oropharyngeal squamous cell carcinoma (SCC) compared to non-cancer patients. Oral SCC patients displayed plasma norepinephrine levels about six times higher than oropharyngeal SCC patients, and nine times higher than oral leukoplakia patients (p < .001). Plasma epinephrine levels in oral SCC patients were higher compared to the oropharyngeal SCC (p = .0097) and leukoplakia (p < .0001) patients. Oropharyngeal SCC patients had higher plasma norepinephrine (p = .0382) and epinephrine levels (p = .045) than patients with oral leukoplakia. Multiple regression analyses showed that a history of high alcohol consumption was predictive for reduced plasma norepinephrine levels in the oral SCC group (p < .001). Anxiety symptom of “hand tremor” measured by the BAI was an independent predictor for higher plasma norepinephrine levels in HNSCC patients (β = 157.5, p = .0377), while the “heart pounding/racing” symptom was independently associated with higher plasma epinephrine levels in the oropharyngeal SCC group (β = 15.8, p = .0441). In oral leukoplakia patients, sleep deprivation and worse sleep quality were independent predictors for higher plasma norepinephrine levels, while severe tobacco consumption and higher anxiety levels were factors for higher plasma epinephrine levels. These findings suggest that head and neck cancer patients display sympathetic nervous system hyperactivity, and that changes in circulating catecholamines may be associated with alcohol consumption, as well as withdrawal-related anxiety symptoms.
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Affiliation(s)
- Daniela B. Bastos
- Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Bruna A. M. Sarafim-Silva
- Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Maria Lúcia M. M. Sundefeld
- Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Amanda A. Ribeiro
- Department of Medicine, Nephrology Division, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Juliana D. P. Brandão
- Department of Medicine, Nephrology Division, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Éder R. Biasoli
- Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Glauco I. Miyahara
- Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Dulce E. Casarini
- Department of Medicine, Nephrology Division, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Daniel G. Bernabé
- Psychosomatic Research Center and Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
- * E-mail:
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Horwitz RI, Charlson ME, Singer BH. Medicine based evidence and personalized care of patients. Eur J Clin Invest 2018; 48:e12945. [PMID: 29700817 DOI: 10.1111/eci.12945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/21/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND For the past 70- years patient care has been dominated by Evidence Based Medicine (EBM) with its emphasis on Randomized Controlled Trials (RCTs) and clinical guidelines to standardize medical decision-making. METHODS Critical assessment of the literature and analyses of the arguments that favor patient care based primarily on individual variability in disease risk or treatment response versus emphasis on group standardization. RESULTS Medicine Based Evidence (MBE) is used to guide decision making for an individual patient at hand by profiling the clinical features (biology) and life experience (biography) of the patient and then finding approximate matches to the patient in a clinical library of patients assembled from diverse sources (RCTs, cohorts, registries, electronic health records and more). CONCLUSION Medicine is transitioning from population based model of clinical care that relies on average results from RCTs to an individual-based model of "personalized" medicine. For individualized care of the patient at hand, MBE is the preferred scientific strategy to generate evidence for patient care.
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Affiliation(s)
- Ralph I Horwitz
- Temple Transformative Medicine Institute, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Mary E Charlson
- Weill Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Dong H, Liao XX, Mai HM, Zhou N, Wang DY, Peng JB, Yang LH. Expression of beta adrenergic receptor in oral squamous cell carcinoma and its significance to the prognosis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:10431-10440. [PMID: 31966380 PMCID: PMC6965752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 08/15/2017] [Indexed: 06/10/2023]
Abstract
The aim of this study was to detect the expression of β-AR (Beta Adregenic Receptor) in Oral squamous cell carcinoma (OSCC), para-cancerous and normal oral mucosa and to investigate the relationship between the expression intensity and the characteristics and prognosis of oral cancer. 100 cases of OSCC were collected; 20 cases of paraneoplastic tissues and 10 cases of normal oral mucosa were taken as control. The expression of β-AR was detected by immunohistochemical method and the average optical density determination using Image J software. Finally, the difference of β-AR expression and the correlation with the clinicopathological factors were analyzed statistically. The expression of β-AR in OSCC was higher than that in paracarcinoma and normal mucosa (P<0.01). The expression intensity of β1, β2-AR in preoperative lymph node metastasis group was higher than that in patients without lymph node metastasis (P<0.01). The expression intensity of β3-AR was not related to pathological grade and tumor size (P>0.05). β1 and β2-AR in early stage of OSCC were higher than those in early stage (P<0.05). Lymph node metastasis, recurrence, TNM clinical stage, and the expression intensity of β1-AR all had an effect on the cumulative survival rate. All the β1, 2, 3-AR were expressed in OSCC. β1 and β2-AR were involved in lymphatic metastasis and had influence on clinical staging. Metastasis, recurrence, TNM stage and expression of β1-AR had an effect on the cumulative survival rate of tumor. The expression of β3-AR in OSCC was not associated with the pathological grades and tumor growth.
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Affiliation(s)
- Hao Dong
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical UniversityNanning, China
- Department of Oral and Maxillofacial Surgery, Guangxi Zhuang Autonomous Region People’s HospitalNanning, China
| | - Xian-Xiang Liao
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical UniversityNanning, China
| | - Hua-Ming Mai
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical UniversityNanning, China
| | - Nuo Zhou
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical UniversityNanning, China
| | - Dai-You Wang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical UniversityNanning, China
| | - Jian-Bo Peng
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical UniversityNanning, China
| | - Liang-Hui Yang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Guangxi Medical UniversityNanning, China
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Udumyan R, Montgomery S, Fang F, Almroth H, Valdimarsdottir U, Ekbom A, Smedby KE, Fall K. Beta-Blocker Drug Use and Survival among Patients with Pancreatic Adenocarcinoma. Cancer Res 2017; 77:3700-3707. [PMID: 28473530 DOI: 10.1158/0008-5472.can-17-0108] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/31/2017] [Accepted: 04/28/2017] [Indexed: 11/16/2022]
Abstract
Preclinical studies have suggested that β-adrenergic signaling is involved in pancreatic cancer progression. Prompted by such studies, we investigated an association between beta-blocker drug use with improved cancer-specific survival in a large, general population-based cohort of patients with pancreatic ductal adenocarcinoma (PDAC). All patients diagnosed with a first primary PDAC in Sweden between 2006 and 2009 were identified through the Swedish Cancer Register (n = 2,394). We obtained information about use of beta-blockers and other medications through linkage with the national Prescribed Drug Register. Cancer-specific mortality was assessed using the Swedish Cause of Death Register. We used multivariable Cox regression adjusted for sociodemographic factors, tumor characteristics, comorbidity score, and other medications to estimate HRs and 95% confidence intervals (CI) for cancer-specific mortality associated with beta-blocker use during the 90-day period before cancer diagnosis. A total of 2,054 (86%) died, with pancreatic cancer recorded as the underlying cause of death during a maximum of 5-year follow-up (median 5 months). Patients who used beta-blockers (n = 522) had a lower cancer-specific mortality rate than nonusers (adjusted HR, 0.79; 95% CI, 0.70-0.90; P < 0.001). This observed rate reduction was more pronounced among patients with localized disease at diagnosis (n = 517; adjusted HR, 0.60; 95% CI, 0.43-0.83; P = 0.002), especially for users with higher daily doses (HR, 0.54; 95% CI, 0.35-0.83; P = 0.005). No clear rate differences were observed by beta-blocker receptor selectivity. Our results support the concept that beta-blocker drugs may improve the survival of PDAC patients, particularly among those with localized disease. Cancer Res; 77(13); 3700-7. ©2017 AACR.
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Affiliation(s)
- Ruzan Udumyan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Almroth
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Unnur Valdimarsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Anders Ekbom
- Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Erdman SE, Poutahidis T. Gut microbiota modulate host immune cells in cancer development and growth. Free Radic Biol Med 2017; 105:28-34. [PMID: 27840315 PMCID: PMC5831246 DOI: 10.1016/j.freeradbiomed.2016.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/25/2016] [Accepted: 11/06/2016] [Indexed: 12/20/2022]
Abstract
Emerging evidence shows that microbe interactions with the host immune system impact diverse aspects of cancer development and treatment. As a result, exciting new opportunities exist for engineering diets and microbe cocktails to lower cancer risks with fewer adverse clinical effects than traditional strategies. Microbe-based therapies may ultimately be used to reinforce host immune balance and extinguish cancer for generations to come.
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Affiliation(s)
- Susan E Erdman
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Theofilos Poutahidis
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Pathology, College of Veterinary Medicine, Aristotle University, Thessaloniki, Greece
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48
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Flaherty RL, Owen M, Fagan-Murphy A, Intabli H, Healy D, Patel A, Allen MC, Patel BA, Flint MS. Glucocorticoids induce production of reactive oxygen species/reactive nitrogen species and DNA damage through an iNOS mediated pathway in breast cancer. Breast Cancer Res 2017; 19:35. [PMID: 28340615 PMCID: PMC5366114 DOI: 10.1186/s13058-017-0823-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Psychological stress increases the circulating levels of the stress hormones cortisol and norepinephrine (NE). Chronic exposure to elevated stress hormones has been linked to a reduced response to chemotherapy through induction of DNA damage. We hypothesize that stress hormone signalling may induce DNA damage through the production of reactive oxygen species (ROS)/reactive nitrogen species (RNS) and interference in DNA repair processes, promoting tumourigenesis. METHODS Breast cancer cell lines were incubated with physiological levels of cortisol and NE in the presence and absence of receptor antagonists and inducible nitric oxide synthase (iNOS) inhibitors and DNA damage measured using phosphorylated γ-H2AX. The rate of DNA repair was measured using comet assays and electrochemical sensors were used to detect ROS/RNS in the cell lysates from cells exposed to stress hormones. A syngeneic mouse model was used to assess the presence of iNOS in mammary tumours in stressed versus control animals and expression of iNOS was examined using western blotting and qRT-PCR. RESULTS Acute exposure to cortisol and NE significantly increased levels of ROS/RNS and DNA damage and this effect was diminished in the presence of receptor antagonists. Cortisol induced DNA damage and the production of RNS was further attenuated in the presence of an iNOS inhibitor. An increase in the expression of iNOS in response to psychological stress was observed in vivo and in cortisol-treated cells. Inhibition of glucocorticoid receptor-associated Src kinase also produced a decrease in cortisol-induced RNS. CONCLUSION These results demonstrate that glucocorticoids may interact with iNOS in a non-genomic manner to produce damaging levels of RNS, thus allowing an insight into the potential mechanisms by which psychological stress may impact breast cancer.
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Affiliation(s)
- Renée L Flaherty
- School of Pharmacy and Biomolecular Sciences, Stress, Aging and Disease Group, University of Brighton, Brighton, BN2 4GJ, UK
| | - Matthew Owen
- Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Aidan Fagan-Murphy
- School of Pharmacy and Biomolecular Sciences, Stress, Aging and Disease Group, University of Brighton, Brighton, BN2 4GJ, UK
| | - Haya Intabli
- School of Pharmacy and Biomolecular Sciences, Stress, Aging and Disease Group, University of Brighton, Brighton, BN2 4GJ, UK
| | - David Healy
- Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Anika Patel
- School of Pharmacy and Biomolecular Sciences, Stress, Aging and Disease Group, University of Brighton, Brighton, BN2 4GJ, UK
| | - Marcus C Allen
- School of Pharmacy and Biomolecular Sciences, Stress, Aging and Disease Group, University of Brighton, Brighton, BN2 4GJ, UK
| | - Bhavik A Patel
- School of Pharmacy and Biomolecular Sciences, Stress, Aging and Disease Group, University of Brighton, Brighton, BN2 4GJ, UK
| | - Melanie S Flint
- School of Pharmacy and Biomolecular Sciences, Stress, Aging and Disease Group, University of Brighton, Brighton, BN2 4GJ, UK.
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49
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Deciphering the Roles of Thiazolidinediones and PPAR γ in Bladder Cancer. PPAR Res 2017; 2017:4810672. [PMID: 28348577 PMCID: PMC5350343 DOI: 10.1155/2017/4810672] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/12/2017] [Indexed: 12/17/2022] Open
Abstract
The use of thiazolidinedione (TZD) therapy in type II diabetic patients has proven useful in the lowering of blood glucose levels. However, recent investigations have shown that there may be potential health concerns associated, including the risk of developing bladder cancer as well as complications in the cardiovasculature. TZDs are ligands for the nuclear receptor PPARγ, and activation causes lipid uptake and insulin sensitization, both of which are critical processes for diabetic patients whose bodies are unable to utilize insulin effectively. Several studies have shown that PPARγ/TZDs decrease IGF-1 levels and, thus, reduce cancer growth in carcinomas such as the pancreas, colon, liver, and prostate. However, other studies have shed light on the potential of the receptor as a biomarker for uroepithelial carcinomas, particularly due to its stimulatory effect on migration of bladder cancer cells. Furthermore, PPARγ may provide the tumor-promoting microenvironment by de novo synthesis of nutrients that are needed for bladder cancer development. In this review, we closely examine the TZD class of drugs and their effects on PPARγ in patient studies along with additional molecular factors that are positive modulators, such as protein phosphatase 5 (PP5), which may have considerable implications for bladder cancer therapy.
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50
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Honorato NP, Abumusse LVDM, Coqueiro DP, Citero VDA. PERSONALITY TRAITS, ANGER AND PSYCHIATRIC SYMPTOMS RELATED TO QUALITY OF LIFE IN PATIENTS WITH NEWLY DIAGNOSED DIGESTIVE SYSTEM CANCER. ARQUIVOS DE GASTROENTEROLOGIA 2017; 54:156-162. [PMID: 28198915 DOI: 10.1590/s0004-2803.201700000-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/29/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The presence of psychiatric symptoms, anger, and personality characteristics are factors that affect the quality of life of newly diagnosed digestive system cancer patients. OBJECTIVE This study aims to identify which stable characteristics of the individual's personality interfere with quality of life, even when reactive emotional characteristics of falling ill are controlled. METHODS A cross-sectional study was performed at the Oncology Clinic ( Hospital das Clínicas ), Marília/SP, Brazil, in which 50 adult patients with digestive system cancer and diagnosed less than 6 months answered the State-Trait Anger Expression Inventory, Temperament and Character Inventory, Hospital Anxiety and Depression Scale and WHOQOL-BREF. Multiple regression was performed to verify if quality of life was related to stable characteristics of the subject's personality (anger trait, temperament and character) after controlling to the transient emotional aspects (anger state, psychiatric symptoms). RESULTS The quality of life psychological health score was higher in presence of self-directedness character and reward dependence temperament and quality of life environment score was higher in presence of self-directedness character and lower in presence of harm avoidance temperament. CONCLUSION The psychological well-being and the adaptive needs to the environment that favoring a better quality of life were reinforced mainly by the self-directedness character; which means that patients more autonomous cope better with the disease. On the other hand, the harm avoidance temperament (meaning the patient has fear of aversive situations) impaired the adaptive capacity to deal with the changes of the day-to-day imposed by the disease. Understanding these personality traits is important to the health professionals drive the patient to more successful treatment.
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Affiliation(s)
- Noemi Peres Honorato
- Faculdade de Medicina de Marília (FAMEMA), Marília, SP, Brazil.,Faculdade de Ensino Superior do Interior Paulista (FAIP), Marília, SP, Brazil
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