1
|
Wilson M, Rankin K, Ludi D, Sweeny K. Emotional, cognitive, and physical well-being during the wait for breast biopsy results. Psychol Health 2024; 39:858-877. [PMID: 36047680 DOI: 10.1080/08870446.2022.2117811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 07/21/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study is a replication and extension of previous work examining the well-being of patients at a breast biopsy appointment. Expanding on a previous study, we aim to identify predictors of well-being following the appointment (i.e. waiting for results). DESIGN In this longitudinal study, female patients (N = 197) were surveyed at their breast biopsy appointments and then completed daily surveys assessing distress and coping during the week-long wait for results. MAIN OUTCOME MEASURES Surveys asked about patient characteristics, subjective health, cancer history, support availability, outcome expectations, and distress. RESULTS/CONCLUSIONS Consistent with the previous study, health history and demographic factors were largely unassociated with distress, this time while waiting for biopsy results. Latina ethnicity emerged one of the few predictors of coping, pointing to opportunities for differential clinical interventions that take cultural factors into account. Finally, anxiety was highest at the beginning and end of the wait for biopsy results, suggesting that interventions may be most effective following a breast biopsy and the days prior to learning one's result.
Collapse
Affiliation(s)
- Melissa Wilson
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Kyla Rankin
- Department of Psychology, Moreno Valley College, Moreno Valley, CA, USA
| | - Daniel Ludi
- Department of Surgery, Riverside University Health System, Moreno Valley, CA, USA
| | - Kate Sweeny
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| |
Collapse
|
2
|
Broadbridge E, Greene K, Venetis MK, Lee LE, Banerjee SC, Saraiya B, Devine KA. Facilitating psychological adjustment for breast cancer patients through empathic communication and uncertainty reduction. PATIENT EDUCATION AND COUNSELING 2023; 114:107791. [PMID: 37244129 PMCID: PMC11046425 DOI: 10.1016/j.pec.2023.107791] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study examined the degree to which breast cancer patients' psychological well-being is facilitated through empathic provider communication. We explored symptom/prognostic uncertainty reduction as a mechanism through which provider communication influences patient psychological adjustment. Additionally, we tested if treatment status moderates this relationship. METHODS Informed by uncertainty in illness theory, current (n = 121) and former (n = 187) breast cancer patients completed questionnaires about perceptions of their oncologists' empathy and their symptom burden, uncertainty, and adjustment to their diagnosis. Structural equation modeling (SEM) was conducted to test hypothesized relationships between perceived provider empathic communication, uncertainty, symptom burden, and psychological adjustment. RESULTS SEM supported the following: (1) higher symptom burden was associated with increased uncertainty and reduced psychological adjustment, (2) lower uncertainty was associated with increased adjustment, and (3) increased empathic communication was associated with lower symptom burden and uncertainty for all patients (χ2(139) = 307.33, p < .001; RMSEA = .063 (CI .053, .072); CFI = .966; SRMR = .057). Treatment status moderated these relationships (Δχ2 = 264.07, Δdf = 138, p < .001) such that the strength of the relationship between uncertainty and psychological adjustment was stronger for former patients than for current patients. CONCLUSIONS Results of this study reinforce the importance of perceptions of provider empathic communication as well as the potential benefits of eliciting and addressing patient uncertainty about treatment and prognosis throughout the cancer care continuum. PRACTICE IMPLICATIONS Patient uncertainty should be a priority for cancer-care providers both throughout and post-treatment for breast cancer patients.
Collapse
Affiliation(s)
| | - Kathryn Greene
- Department of Communication, Rutgers University, New Brunswick, NJ, USA.
| | - Maria K Venetis
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Lauren E Lee
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Smita C Banerjee
- Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Katie A Devine
- Division of Pediatric Hematology/Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| |
Collapse
|
3
|
Hoogland AI, Small BJ, Oswald LB, Bryant C, Rodriguez Y, Gonzalez BD, Li X, Janelsins MC, Bulls HW, James BW, Arboleda B, Colon-Echevarria C, Townsend MK, Tworoger SS, Rodriguez PC, Bower JE, Apte SM, Wenham RM, Jim HSL. Relationships among Inflammatory Biomarkers and Self-Reported Treatment-Related Symptoms in Patients Treated with Chemotherapy for Gynecologic Cancer: A Controlled Comparison. Cancers (Basel) 2023; 15:3407. [PMID: 37444517 PMCID: PMC10340589 DOI: 10.3390/cancers15133407] [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: 05/15/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Previous research suggests that inflammation triggers cancer-treatment-related symptoms (i.e., fatigue, depression, and disruptions in sleep and physical activity), but evidence is mixed. This study examined relationships between inflammatory biomarkers and symptoms in patients with gynecologic cancer compared to age-matched women with no cancer history (i.e., controls). Patients (n = 121) completed assessments before chemotherapy cycles 1, 3, and 6, and 6 and 12 months later. Controls (n = 105) completed assessments at similar timepoints. Changes in inflammation and symptomatology were evaluated using random-effects mixed models, and cross-sectional differences between patients and controls in inflammatory biomarkers and symptoms were evaluated using least squares means. Associations among inflammatory biomarkers and symptoms were evaluated using random-effects fluctuation mixed models. The results indicated that compared to controls, patients typically have higher inflammatory biomarkers (i.e., TNF-alpha, TNFR1, TNFR2, CRP, IL-1ra) and worse fatigue, depression, and sleep (ps < 0.05). Patients reported lower levels of baseline physical activity (p = 0.02) that became more similar to controls over time. Significant associations were observed between CRP, depression, and physical activity (ps < 0.05), but not between inflammation and other symptoms. The results suggest that inflammation may not play a significant role in fatigue or sleep disturbance among gynecologic cancer patients but may contribute to depression and physical inactivity.
Collapse
Affiliation(s)
- Aasha I. Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Brent J. Small
- School of Aging Studies, University of South Florida, Tampa, FL 33612, USA
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Crystal Bryant
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Yvelise Rodriguez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Xiaoyin Li
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| | - Michelle C. Janelsins
- Department of Surgery and Neuroscience, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Hailey W. Bulls
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Brian W. James
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Bianca Arboleda
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | | | - Mary K. Townsend
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Julienne E. Bower
- Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Sachin M. Apte
- Department of Obstetrics and Gynecology, Huntsman Cancer Institute, Salt Lake City, UT 84132, USA
| | - Robert M. Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA; (A.I.H.)
| |
Collapse
|
4
|
Kwong FL, Davenport C, Sundar S. Evaluating the Harms of Cancer Testing-A Systematic Review of the Adverse Psychological Correlates of Testing for Cancer and the Effectiveness of Interventions to Mitigate These. Cancers (Basel) 2023; 15:3335. [PMID: 37444445 DOI: 10.3390/cancers15133335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Several studies have described the psychological harms of testing for cancer. However, most were conducted in asymptomatic subjects and in cancers with a well-established screening programme. We sought to establish cancers in which the literature is deficient, and identify variables associated with psychological morbidity and interventions to mitigate their effect. (2) Methods: Electronic bibliographic databases were searched up to December 2020. We included quantitative studies reporting on variables associated with psychological morbidity associated with cancer testing and primary studies describing interventions to mitigate these. (3) Results: Twenty-six studies described individual, testing-related, and organisational variables. Thirteen randomised controlled trials on interventions were included, and these were categorised into five groups, namely the use of information aids, music therapy, the use of real-time videos, patient navigators and one-stop clinics, and pharmacological or homeopathic therapies. (4) Conclusions: The contribution of some factors to anxiety in cancer testing and their specificity of effect remains inconclusive and warrants further research in homogenous populations and testing contexts. Targeting young, unemployed patients with low levels of educational attainment may offer a means to mitigate anxiety. A limited body of research suggests that one-stop clinics and patient navigators may be beneficial in patients attending for diagnostic cancer testing.
Collapse
Affiliation(s)
- Fong Lien Kwong
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Clare Davenport
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| |
Collapse
|
5
|
Pang L, Li W, Yao S, Jing Y, Yin X, Cheng H. Psychological distress is involved in CRCI in breast cancer survivors via mediating cytokine levels. Cancer Med 2023. [PMID: 36965094 DOI: 10.1002/cam4.5847] [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: 11/27/2022] [Revised: 02/28/2023] [Accepted: 03/12/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI) is a frequent consequence in breast cancer survivors after chemotherapy and lowers their quality of life (QOL). Psychological distress is frequently experienced by breast cancer survivors. There are currently few studies investigating the role of psychological distress in the genesis of CRCI. METHODS In total, 122 breast cancer survivors after standard chemotherapy within a year were recruited and assessed using the Psychological Distress Thermometer (DT). Sixty breast cancer survivors had non-psychological distress (NPD group) and sixty-two breast cancer survivors with psychological distress (PD group). The scores of the Mini-Mental State Examination (MMSE), prospective and retrospective memory (PM and RM) Questionnaire (PRMQ), and Functional Assessment of Cancer Therapy-General (FACT-G) and the levels of cytokines including interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin-4 (IL-4) were compared between the two groups. Using PROCESS, we investigated whether psychological distress predicted cognitive function based on MMSE through IL-1β, TNF-α, and IL-4. RESULTS The PD group had higher scores on RM, PM, and FACT-G and lower scores on MMSE than the NPD group (t = -11.357, t = -10.720, t = -15.419, t = 10.162, respectively; p < 0.05). Meanwhile, a higher level of IL-1β, TNF-α, and IL-4 was observed in the PD group than in the NPD group (t = -3.961, t = -3.396, t = -3.269, respectively; p < 0.05). The link between psychological distress and cognitive function as measured by the MMSE was also mediated by IL-1β, TNF-α, and IL-4 (effect size: 26%, 25%, and 24%). CONCLUSION Breast cancer patients with psychological distress displayed poor cognitive function, poor memory, and inferior quality of life, which was accompanied by higher cytokine levels of IL-1β, TNF-α, and IL-4. This study demonstrated IL-1β, TNF-α, and IL-4 as potential pathways to CRCI in response to ongoing psychological distress, which provided evidence for the involvement of psychological distress in CRCI in breast cancer survivors.
Collapse
Affiliation(s)
- Lulian Pang
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen Li
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Senbang Yao
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanyan Jing
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiangxiang Yin
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, China
| |
Collapse
|
6
|
Romo-González T, Barranca-Enríquez A, León-Díaz R, Del Callejo-Canal E, Gutiérrez-Ospina G, Jimenez Urrego AM, Bolaños C, Botero Carvajal A. Psychological suppressive profile and autoantibodies variability in women living with breast cancer: A prospective cross-sectional study. Heliyon 2022; 8:e10883. [PMID: 36237972 PMCID: PMC9552120 DOI: 10.1016/j.heliyon.2022.e10883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/23/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022] Open
Abstract
Breast cancer (BC) is a leading cause of women's morbimortality worldwide. Unfortunately, attempts to predict women's susceptibility to developing BC well before it becomes symptomatic, based on their genetic, family, and reproductive background have proved unsatisfactory. Here we analyze the matching of personality traits and protein serum profiles to predict women's susceptibility to developing cancer. We conducted a prospective study among 150 women (aged 18-70 years), who were distributed into three groups (n = 50): women without breast pathology and women diagnosed with BC or benign breast pathology. Psychological data were obtained through standardized psychological tests and serum protein samples were analyzed through semiquantitative protein immunoblotting. The matching for psychological and immunological profiles was constructed from these data using a mathematical generalized linear model.The model predicted that women who have stronger associations between high-intensity stress responses, emotional containment, and an increased number and reduced variability of serum proteins (detected by IgG autoantibodies) have the greatest susceptibility to develop BC before the disease has manifested clinically. Hence, the present study endorses the possibility of using psychological and biochemical tests in combination to increase the possibility of identifying women at risk of developing BC before the disease shows clinical manifestations. A longitudinal study must be instrumented to test the prediction ability of the instrument in real scenarios. Trial registration Committee of Ethical Research of the Hospital General de México "Dr. Eduardo Liceaga," Ministry of Health (DI/12/111/03/064).
Collapse
Affiliation(s)
- Tania Romo-González
- Biology and Integral Health Area of the Biological Research Institute of the Universidad Veracruzana. Dr. Luis Castelazo Ayala S/N, Industrial Animas, Rubí Animas, C.P. 91190, Xalapa-Enríquez, Veracruz, Mexico,Corresponding author.
| | - Antonia Barranca-Enríquez
- Center for Health Studies and Services, in the Universidad Veracruzana at Veracruz, Veracruz, Mexico
| | - Rosalba León-Díaz
- Biology and Integral Health Area of the Biological Research Institute of the Universidad Veracruzana. Dr. Luis Castelazo Ayala S/N, Industrial Animas, Rubí Animas, C.P. 91190, Xalapa-Enríquez, Veracruz, Mexico
| | - Enrique Del Callejo-Canal
- Biology and Integral Health Area of the Biological Research Institute of the Universidad Veracruzana. Dr. Luis Castelazo Ayala S/N, Industrial Animas, Rubí Animas, C.P. 91190, Xalapa-Enríquez, Veracruz, Mexico
| | - Gabriel Gutiérrez-Ospina
- Department of Cell Biology and Physiology in the Institute for Biomedical Research of the National Autonomous University of Mexico, Mexico City, Mexico
| | - Angela María Jimenez Urrego
- Psychology Program, Faculty of Human and Social Sciences, Universidad de San Buenaventura Cali, Cali, Colombia
| | - Cristina Bolaños
- Medicine Program, Fundación Universitaria San Martin, Pasto, Colombia
| | | |
Collapse
|
7
|
Saban KL, Collins EG, Mathews HL, Bryant FB, Tell D, Gonzalez B, Bhoopalam S, Chroniak CP, Janusek LW. Impact of a Mindfulness-Based Stress Reduction Program on Psychological Well-Being, Cortisol, and Inflammation in Women Veterans. J Gen Intern Med 2022; 37:751-761. [PMID: 36042095 PMCID: PMC9481828 DOI: 10.1007/s11606-022-07584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 04/01/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Women veterans experience higher levels of stress-related symptoms than their civilian counterparts. Psychological stress is associated with greater inflammation and may increase risk for cardiovascular disease (CVD). Mindfulness-based stress reduction (MBSR) has been found to improve psychological well-being in other populations but no randomized controlled trials (RCT) have been conducted examining the impact of MBSR on well-being and inflammation in women veterans at risk for CVD. OBJECTIVE Determine the effectiveness of MBSR in improving psychological well-being, cortisol, and inflammation associated with CVD in women veterans. DESIGN The design is a RCT comparing MBSR to an active control condition (ACC) consisting of a health education program. PARTICIPANTS Women veterans (N=164) with risk factors for CVD from the Chicagoland area participated in the study. INTERVENTION An 8-week MBSR program with weekly 2.5-h classes was compared to an ACC consisting of an 8-week health promotion education program with weekly 2.5-h classes. MAIN MEASURES The outcomes were psychological well-being [perceived stress, depressive symptoms, loneliness, and post-traumatic stress disorder (PTSD)] symptoms and stress-related markers, including diurnal salivary cortisol and cytokines interleukin-6 (IL-6) and interferon gamma (IFN-γ). Data were collected at baseline, 4 weeks (mid-point of intervention), 8 weeks (completion of intervention), and 6 months after completion of MBSR or ACC. KEY RESULTS Compared to the ACC, women who participated in MBSR reported less perceived stress, loneliness, and symptoms of PTSD. Although there were no significant differences between groups or changes over time in IL-6 or IFN-γ, participants in the MBSR program demonstrated a more rapid decline in diurnal salivary cortisol as compared to those in the ACC. CONCLUSIONS MBSR was found to improve psychological well-being and decrease diurnal salivary cortisol in women veterans at risk for CVD. Health care providers may consider MBSR for women veterans as a means by which to improve their psychological well-being.
Collapse
Affiliation(s)
- Karen L Saban
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA, 5000 S. 5th Ave., Hines, IL, 60141, USA. .,Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 S. First Ave, Center for Translational Research and Education, Maywood, IL, 60153, USA.
| | - Eileen G Collins
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA, 5000 S. 5th Ave., Hines, IL, 60141, USA.,Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Ave. MC 902, Chicago, IL, 60612, USA
| | - Herbert L Mathews
- Stritch School of Medicine, Loyola University Chicago, 2160 S. First Ave, Center for Translational Research and Education, Maywood, IL, 60153, USA
| | - Fred B Bryant
- Department of Psychology, Loyola University Chicago, 1032 W. Sheridan Road, Coffey Hall Rm. 242, Chicago, IL, 60660, USA
| | - Dina Tell
- Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 S. First Ave, Center for Translational Research and Education, Maywood, IL, 60153, USA
| | - Beverly Gonzalez
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA, 5000 S. 5th Ave., Hines, IL, 60141, USA
| | - Sudha Bhoopalam
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA, 5000 S. 5th Ave., Hines, IL, 60141, USA
| | | | - Linda Witek Janusek
- Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 S. First Ave, Center for Translational Research and Education, Maywood, IL, 60153, USA
| |
Collapse
|
8
|
The mental health impacts of receiving a breast cancer diagnosis: A meta-analysis. Br J Cancer 2021; 125:1582-1592. [PMID: 34482373 DOI: 10.1038/s41416-021-01542-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Receiving a breast cancer diagnosis can be a turning point with negative impacts on mental health, treatment and prognosis. This meta-analysis sought to determine the nature and prevalence of clinically significant psychological distress-related symptoms in the wake of a breast cancer diagnosis. METHODS Ten databases were searched between March and August 2020. Thirty-nine quantitative studies were meta-analysed. RESULTS The prevalence of clinically significant symptoms was 39% for non-specific distress (n = 13), 34% for anxiety (n = 19), 31% for post-traumatic stress (n = 7) and 20% for depression (n = 25). No studies reporting breast cancer patients' well-being in our specific time frame were found. CONCLUSION Mental health can be impacted in at least four domains following a diagnosis of breast cancer and such effects are commonplace. This study outlines a clear need for mitigating the impacts on mental health brought about by breast cancer diagnosis. CRD42020203990.
Collapse
|
9
|
Fekih-Romdhane F, Saadallah F, Mbarek M, Bouzaiene H, Cheour M. Prevalence and correlates of hopelessness in Tunisian women with benign breast disease and breast cancer. J Psychosoc Oncol 2021; 40:677-694. [PMID: 34328072 DOI: 10.1080/07347332.2021.1943103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is limited research suggesting that women with Benign Breast Disease (BBD) experience psychological distress similar to breast cancer (BC) women. We aimed to examine hopelessness and its related factors in BC and BBD women. METHOD This was a cross-sectional study. The Beck Hopelessness Scale and the Beck Depression Inventory were administered to 51 BBD and 52 BC women. RESULTS BC women had higher hopelessness scores as compared to those with BBD (6.9 ± 4.8 vs. 4.9 ± 3.6; p = .018). After controlling for confounding variables, depression and suicidal ideation/behavior were significantly associated with hopelessness in the BBD group, while only a lower socioeconomic status was associated with higher hopelessness scores in the BC group. CONCLUSION We found that not only BC but also BBD lead to a psychological burden. Early detection and handling of hopeless feelings and thoughts that may arise in this population are recommended.
Collapse
Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
| | - Fatma Saadallah
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Salah Azaiez Institute, Tunis, Tunisia
| | - Mahdi Mbarek
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Salah Azaiez Institute, Tunis, Tunisia
| | - Hatem Bouzaiene
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Salah Azaiez Institute, Tunis, Tunisia
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Razi Hospital, Manouba, Tunisia
| |
Collapse
|
10
|
Rural-Urban Differences in Neuroimmune Biomarkers and Health Status Among Women Living With Breast Cancer. Cancer Nurs 2021; 44:323-332. [PMID: 32195710 DOI: 10.1097/ncc.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of chronic emotional and psychosocial stressors following breast cancer (BC) treatment, BC survivors are at risk of neuroimmune dysfunction in survivorship. Rural BC survivors experience more health disparities than urban BC survivors. Rural-urban residence as a variable on neuroimmune activity in extended BC survivorship continuum has not been explored. OBJECTIVE To report the feasibility of studying relationships between neuroimmune activity and perceived health in rural and urban BC survivors. METHODS Data from a pilot study of BC survivors (n = 41) were analyzed. Participants were rural (n = 16) and urban (n = 25). Participants completed Medical Outcomes Study Short-Form Version 2 Health Survey questionnaires and provided salivary specimens for analysis of salivary α-amylase (sAA), cortisol, and interleukin 6 (IL-6). Rural-Urban Commuting Area Codes were used to determine rural or urban residence. RESULTS Differences in immune activity were observed between rural and urban BC survivors (U = 34, P < .05). No rural-urban group differences in neuroendocrine activity were observed. Relationships were observed between perceptions of mental health and sAA (P < .05) in rural BC survivors and between perceptions of mental health and IL-6 (P < .05) in urban BC survivors. Interleukin 6 was positively associated with perceptions of physical health (P < .05) in rural BC survivors. CONCLUSION Pilot data suggest rural-urban residence may be a factor in relationships between neuroimmune function (ie, sAA and IL-6) and perceived health status, particularly social functioning in women with BC. Additional studies with powered designs are indicated. IMPLICATIONS FOR PRACTICE Although evidence is limited, data support the feasibility of studying relationships between sAA and IL-6 and perceptions of health in women with BC.
Collapse
|
11
|
Associations between religious and spiritual variables and neuroimmune activity in survivors of breast cancer: a feasibility study. Support Care Cancer 2021; 29:6421-6429. [PMID: 33890163 DOI: 10.1007/s00520-021-06224-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/11/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Chronic stress is associated with neuroimmune inflammation and adverse outcomes in breast cancer survivors. Some breast cancer survivors rely on religious and spiritual (R/S) variables to manage stress after breast cancer treatment. A spiritually based psychoneuroimmunological (PNI) model of health suggests that R/S variables influence neuroimmune activity; however, these associations are not well-established. A pilot study was conducted to assess the feasibility of studying associations between R/S variables and neuroimmune biomarkers in breast cancer survivors. METHOD Salivary alpha-amylase (sAA) and interleukin-6 (IL-6) were sampled among women previously treated for breast cancer. The primary aim was to assess feasibility and acceptability of the sampling protocol. A secondary aim explored associations between sAA, IL-6, R/S variables, and health outcomes. RESULT Forty-one women completed the study. Biomarker sampling yielded 246 acceptable specimens used for analysis. SAA was detectable in 96% of specimens and IL-6 was detectable in 44% of specimens. The R/S variables with the strongest associations to sAA were spiritual self-rank (rs = .39; p < .05) and forgiveness (rs = .40; p < .05). The R/S variable with the strongest association to salivary IL-6 was positive congregational support (rs = .42; p < .05). CONCLUSION Feasibility and acceptability of the sampling protocol were confirmed. Reference ranges for sAA and IL-6 for female breast cancer survivors are presented. Results suggest that spiritual beliefs and religious practices are associated with neuroimmune activity, adding credence to a spiritually based PNI model of health. Findings lay the foundations for future R/S-based interventions to promote health and well-being in breast cancer survivors.
Collapse
|
12
|
Circulating levels of β-endorphin and cortisol in breast cancer. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 5:100028. [PMID: 35754450 PMCID: PMC9216423 DOI: 10.1016/j.cpnec.2021.100028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/20/2022] Open
|
13
|
Newville J, Maxwell JR, Kitase Y, Robinson S, Jantzie LL. Perinatal Opioid Exposure Primes the Peripheral Immune System Toward Hyperreactivity. Front Pediatr 2020; 8:272. [PMID: 32670993 PMCID: PMC7332770 DOI: 10.3389/fped.2020.00272] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022] Open
Abstract
The increased incidence of opioid use during pregnancy warrants investigation to reveal the impact of opioid exposure on the developing fetus. Exposure during critical periods of development could have enduring consequences for affected individuals. Particularly, evidence is mounting that developmental injury can result in immune priming, whereby subsequent immune activation elicits an exaggerated immune response. This maladaptive hypersensitivity to immune challenge perpetuates dysregulated inflammatory signaling and poor health outcomes. Utilizing an established preclinical rat model of perinatal methadone exposure, we sought to investigate the consequences of developmental opioid exposure on in vitro activation of peripheral blood mononuclear cells (PBMCs). We hypothesize that PBMCs from methadone-exposed rats would exhibit abnormal chemokine and cytokine expression at baseline, with exaggerated chemokine and cytokine production following immune stimulation compared to saline-exposed controls. On postnatal day (P) 7, pup PMBCs were isolated and cultured, pooling three pups per n. Following 3 and 24 h, the supernatant from cultured PMBCs was collected and assessed for inflammatory cytokine and chemokine expression at baseline or lipopolysaccharide (LPS) stimulation using multiplex electrochemiluminescence. Following 3 and 24 h, baseline production of proinflammatory chemokine and cytokine levels were significantly increased in methadone PBMCs (p < 0.0001). Stimulation with LPS for 3 h resulted in increased tumor necrosis factor (TNF-α) and C-X-C motif chemokine ligand 1 (CXCL1) expression by 3.5-fold in PBMCs from methadone-exposed PBMCs compared to PBMCs from saline-exposed controls (p < 0.0001). Peripheral blood mononuclear cell hyperreactivity was still apparent at 24 h of LPS stimulation, evidenced by significantly increased TNF-α, CXCL1, interleukin 6 (IL-6), and IL-10 production by methadone PMBCs compared to saline control PBMCs (p < 0.0001). Together, we provide evidence of increased production of proinflammatory molecules from methadone PBMCs at baseline, in addition to sustained hyperreactivity relative to saline-exposed controls. Exaggerated peripheral immune responses exacerbate inflammatory signaling, with subsequent consequences on many organ systems throughout the body, such as the developing nervous system. Enhanced understanding of these inflammatory mechanisms will allow for appropriate therapeutic development for infants who were exposed to opioids during development. Furthermore, these data highlight the utility of this in vitro PBMC assay technique for future biomarker development to guide specific treatment for patients exposed to opioids during gestation.
Collapse
Affiliation(s)
- Jessie Newville
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Jessie R. Maxwell
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
- Departments of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Yuma Kitase
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shenandoah Robinson
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lauren L. Jantzie
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Kennedy Krieger Institute, Baltimore, MD, United States
| |
Collapse
|
14
|
Henneghan A, Wright ML, Bourne G, Sales AC. A Cross-Sectional Exploration of Cytokine-Symptom Networks in Breast Cancer Survivors Using Network Analysis. Can J Nurs Res 2020; 53:303-315. [PMID: 32482100 DOI: 10.1177/0844562120927535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of this study is to (a) visualize the symptom-cytokine networks (perceived stress, fatigue, loneliness, perceived cognitive impairment, daytime sleepiness, sleep quality, and 13 cytokines) and (b) explore centrality metrics of symptom-cytokine networks in breast cancer survivors who completed chemotherapy treatment. METHODS Cross-sectional analysis of data collected from 66 breast cancer survivors who were on average three years post chemotherapy completion. Perceived stress, fatigue, loneliness, perceived cognitive impairment, daytime sleepiness, and sleep quality were measured with self-report instruments, and a panel of 13 cytokines was measured from serum using multiplex assays. Symptoms and cytokines were simultaneously evaluated with correlations, network analysis, and community analysis. RESULTS Network analysis revealed the nodes with the greatest degree and closeness were interleukin-2, granulocyte-macrophage colony-stimulating factor, interleukin-13, and perceived cognitive impairment. Node betweenness was highest for perceived cognitive impairment and interleukin-2. Community analysis revealed two separate communities of nodes within the network (symptoms and the cytokines). Several edges connected the two communities including perceived cognitive impairment, stress, fatigue, depression, interleukin-2, granulocyte-macrophage colony-stimulating factor, interleukin-8, interleukin-13, and interleukin-10. Partial correlation analyses revealed significant negative relationships between interleukin-2 and fatigue, loneliness, stress, and perceived cognitive impairment (rs = -.27 to -.37, ps < .05) and a significant negative relationship between perceived cognitive impairment and granulocyte-macrophage colony-stimulating factor (r = -.34, p < .01). CONCLUSIONS Our analyses support that perceived cognitive impairment, stress, loneliness, depressive symptoms, and fatigue co-occur and extend the literature by suggesting that interleukin-2 may contribute to the underlying mechanistic pathway of these co-occurring symptoms. Our findings add to a growing body of literature that is shifting to study symptoms as they co-occur, or cluster, rather than individual symptoms.
Collapse
Affiliation(s)
- Ashley Henneghan
- Livestrong Cancer Institute, School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Michelle L Wright
- School of Nursing, Dell Medical School, University of Texas at Austin, Austin, TX, USA.,Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Garrett Bourne
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Adam C Sales
- Statistics, Measurement, and Research Design Techniques in Educational Research, University of Texas at Austin College of Education, Austin, TX, USA
| |
Collapse
|
15
|
Immune dysregulation among students exposed to exam stress and its mitigation by mindfulness training: findings from an exploratory randomised trial. Sci Rep 2020; 10:5812. [PMID: 32242145 PMCID: PMC7118166 DOI: 10.1038/s41598-020-62274-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/17/2020] [Indexed: 12/12/2022] Open
Abstract
Psychological distress persisting for weeks or more promotes pro-inflammatory immune dysregulation, a risk factor for a range of chronic diseases. We have recently shown that mindfulness training reduces distress among university students. Here we present an exploratory trial to study immune dysregulation in a cohort of students who were exposed to progressively greater stress as the exam period approached, and to explore whether mindfulness training mitigated this dysregulation. Healthy University of Cambridge students were randomised to join an 8-week mindfulness course (N = 27), or to mental health support as usual (N = 27). Psychological distress, immune cell proportions, cytokines, CRP and serum cortisol were measured at baseline and during the exam period. Increased distress was associated with statistically significant increases in the proportion of B cells, regardless of trial arm (*p = 0.027). There were no other associations between any of the measured parameters, distress or mindfulness. Our finding that the proportion of B cells increases with psychological distress supports the findings of other studies. However, we found no evidence that mindfulness training is able to buffer the effects of psychological distress on healthy participants' immune system. In order to detect these effects, should they exist, larger randomised trials will be required.
Collapse
|
16
|
Henneghan A, Haley AP, Kesler S. Exploring Relationships Among Peripheral Amyloid Beta, Tau, Cytokines, Cognitive Function, and Psychosomatic Symptoms in Breast Cancer Survivors. Biol Res Nurs 2020; 22:126-138. [PMID: 31707784 PMCID: PMC7068749 DOI: 10.1177/1099800419887230] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Accelerated brain aging has been proposed to explain cancer-related cognitive impairment, but empirical evidence for this relationship is lacking. The purpose of this study was to evaluate amyloid beta (Aβ) and tau, biomarkers of neurodegeneration, in relation to cognition in breast cancer survivors (BCSs). We explored relationships among peripheral concentrations of Aβ42, Aβ-40, tau, and cytokines; cognitive function; and psychosomatic symptoms in a cohort of BCSs post-chemotherapy. METHODS This secondary analysis of a cross-sectional study was conducted with 65 BCSs. Serum total Aβ-42, Aβ-40, and tau levels were measured with single molecule array technology. Cytokines (interleukin [IL]-6, tumor necrosis factor [TNF]-α, granulocyte-macrophage colony-stimulating factor [GM-CSF], interferon [IFN]-g, IL-10, IL-12, IL-13, IL1-b, IL-2, IL-4, IL-5, IL-7, and IL-8) were simultaneously measured in serum using multiplex assays. Cognitive function was measured with five standardized neuropsychological tests and psychosomatic symptoms (stress, loneliness, anxiety, depressive symptoms, fatigue, sleep quality, and daytime sleepiness) with self-report questionnaires. Data analyses included correlations and random forest regression (RFR). RESULTS Significant correlations were identified among hip-to-waste ratio, number of treatment modalities, Aβ-42, Aβ-40, and tau levels (rs = .27-.35, ps < .05). RFR modeling including Aβ-42, Aβ-40, tau, and cytokines as features explained significant variance in cognitive function (R2 = .71, F = 9.01, p < .0001) and psychosomatic symptoms (R2 = .74, F = 10.22, p < .0001). CONCLUSIONS This study suggests that neurodegenerative biomarkers interact with cytokines to influence cognitive functioning and psychosomatic symptoms in BCSs following chemotherapy, but additional research is needed.
Collapse
Affiliation(s)
- Ashley Henneghan
- School of Nursing; Department of Oncology, University of Texas at Austin,
Austin, TX, USA
| | - Andreana P. Haley
- Department of Psychology, College of Liberal Arts, University of Texas at
Austin, Austin, TX, USA
| | - Shelli Kesler
- School of Nursing; Department of Oncology, University of Texas at Austin,
Austin, TX, USA
| |
Collapse
|
17
|
Zaza G, Leventhal J, Signorini L, Gambaro G, Cravedi P. Effects of Antirejection Drugs on Innate Immune Cells After Kidney Transplantation. Front Immunol 2019; 10:2978. [PMID: 31921213 PMCID: PMC6930910 DOI: 10.3389/fimmu.2019.02978] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022] Open
Abstract
Over the last decades, our understanding of adaptive immune responses to solid organ transplantation increased considerably and allowed development of immunosuppressive drugs targeting key alloreactive T cells mechanism. As a result, rates of acute rejection dropped and short-term graft survival improved significantly. However, long-term outcomes are still disappointing. Recently, increasing evidence supports that innate immune responses plays roles in allograft rejection and represents a valuable target to further improve long-term allograft survival. Innate immune cells are activated by molecules with stereotypical motifs produced during injury (i.e., damage-associated molecular patterns, DAMPS) or infection (i.e., pathogen-associated molecular patterns, PAMPs). Activated innate immune cells can exert direct pro- and anti-inflammatory effects, while also priming adaptive immune responses. These cells are activated after transplantation by multiple stimuli, including ischemia-reperfusion injury, rejection, and infections. Data from animal models of graft rejection, show that inhibition of innate immunity promotes development of tolerance. Therefore, understanding mechanisms of innate immunity is important to improve graft outcomes. This review discusses effects of currently used immunosuppressive agents on innate immune responses in kidney transplantation.
Collapse
Affiliation(s)
- Gianluigi Zaza
- Renal Unit, Department of Medicine, University-Hospital of Verona, Verona, Italy
| | - Jeremy Leventhal
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Lorenzo Signorini
- Renal Unit, Department of Medicine, University-Hospital of Verona, Verona, Italy
| | - Giovanni Gambaro
- Renal Unit, Department of Medicine, University-Hospital of Verona, Verona, Italy
| | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
18
|
Abstract
OBJECTIVE To determine whether psychological intervention (PI) changes the levels of immune indicators in cancer patients. METHODS We conducted a systematic search published up to July 2018, followed by a manual search. Randomized controlled trials were included. Two reviewers independently screened and extracted data, which were analyzed using Review manager 5.3. RESULTS Twenty-nine studies were included including four kinds of PI. Only stress management didn't result in immune changes; only cognitive behavior therapy affect NK cell activity. PI did not change immune indicators on cancer patients who completed therapy. Compared to patients not receiving PI, those received PI had significantly higher NK cell count and activity in whole blood; and serum levels of IL-2, IL-4, IFN-γ, lgA, and lgG. However, the differences in the serum levels of IL-6, IL-10, TNF-α, and IgM were not significant (P > .05), and the changes recorded for the CD3, CD4, and CD8 cell count, and CD4/CD8 ratios were inconsistent. CONCLUSIONS Although there are considerable evidences of PI's immune effect, but its magnitude was moderate. Therefore, it may be premature to conclude whether PI affects immunity of cancer patients. Further research is warranted, with special focus on the PI types and treatment methods.
Collapse
Affiliation(s)
- Ping Zhang
- Children's Hospital of Chongqing Medical University, Chongqing
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei
- China International Science and Technology Cooperation base of China Development and Critical Disorders, Chongqing Key Laboratory of Paediatric
- Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Lin Mo
- Children's Hospital of Chongqing Medical University, Chongqing
| | - Xia Li
- Children's Hospital of Chongqing Medical University, Chongqing
- China International Science and Technology Cooperation base of China Development and Critical Disorders, Chongqing Key Laboratory of Paediatric
- Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Qiyao Wang
- Children's Hospital of Chongqing Medical University, Chongqing
- China International Science and Technology Cooperation base of China Development and Critical Disorders, Chongqing Key Laboratory of Paediatric
- Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| |
Collapse
|
19
|
Witek Janusek L, Tell D, Mathews HL. Mindfulness based stress reduction provides psychological benefit and restores immune function of women newly diagnosed with breast cancer: A randomized trial with active control. Brain Behav Immun 2019; 80:358-373. [PMID: 30953776 DOI: 10.1016/j.bbi.2019.04.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/16/2019] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Women newly diagnosed with breast cancer experience psychological distress, accompanied by reduced Natural Killer Cell Activity (NKCA) and altered levels of cytokines, which may compromise cancer control. Few studies have evaluated psycho-immune outcomes of mindfulness-based stress reduction (MBSR) for women newly diagnosed with breast cancer in comparison to an active control condition. OBJECTIVE The purpose of this study was to determine whether MBSR benefits psychological, behavioral, and immunological function in women recently diagnosed with breast cancer. DESIGN After confirmation of breast cancer staging, women diagnosed with early-stage breast cancer (n = 192) were randomized to an 8-week MBSR program or an 8-week active control condition (ACC). The ACC consisted of a series of cancer recovery and health education classes. Both MBSR and the ACC were administered in group format. METHODS Women completed psychometric instruments and provided blood for NKCA and cytokine levels at pre-, mid-, and completion of program, as well as at 1- and 6-months post-program. One hundred and twenty four women completed all five-assessments (MBSR, n = 63; ACC, n = 61). Hierarchical linear modeling was used to analyze trajectories of outcomes over time and between groups. RESULTS Compared to the ACC group, women randomized to MBSR exhibited decreasing trajectories of perceived stress, fatigue, sleep disturbance, and depressive symptoms. Further, compared to women randomized to ACC, MBSR women exhibited trajectories demonstrating significantly more rapid restoration of NKCA, accompanied by lower circulating TNF-alpha levels, lower IL-6 production, and greater IFN-gamma production. CONCLUSIONS These results demonstrate early provision of MBSR for women newly diagnosed with breast cancer provides not only psychological benefit, but also optimizes immune function supportive of cancer control.
Collapse
Affiliation(s)
- Linda Witek Janusek
- Marcella Niehoff School of Nursing, Department of Health Promotion, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States.
| | - Dina Tell
- Marcella Niehoff School of Nursing, Department of Health Promotion, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States
| | - Herbert L Mathews
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States
| |
Collapse
|
20
|
Hulett JM, Fessele KL, Clayton MF, Eaton LH. Rigor and Reproducibility: A Systematic Review of Salivary Cortisol Sampling and Reporting Parameters Used in Cancer Survivorship Research. Biol Res Nurs 2019; 21:318-334. [PMID: 30857393 DOI: 10.1177/1099800419835321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Salivary cortisol is a commonly used biomarker in cancer survivorship research; however, variations in sampling protocols and parameter reporting limit comparisons across studies. Standardized practices to provide rigor and reproducibility of diurnal salivary cortisol sampling and reporting are not well established. Previous systematic reviews examining relationships between diurnal salivary cortisol and clinical outcomes have resulted in mixed findings. It remains unclear which sampling protocols and reporting parameters offer the greatest utility for clinical research. This review examines diurnal salivary cortisol sampling protocols and reporting parameters to evaluate whether a standardized approach is recommended. A comprehensive search of intervention studies among adult cancer survivors including diurnal salivary cortisol resulted in 30 articles for review. Sampling protocols ranged from 1 to 4 days with the majority of studies sampling cortisol for 2 days. Sampling instances ranged from 2 to 7 times per day, with the majority collecting at 4 time points per day. Diurnal cortisol slope and cortisol awakening response (CAR) were the most commonly reported parameters associated with clinical outcomes. Flattened cortisol slopes, blunted CARs, and elevated evening cortisol concentrations were associated with poorer psychosocial and physiological outcomes. Based on our review, we propose that a rigorous, standardized diurnal salivary cortisol sampling protocol should include sampling at key diurnal times across ≥3 consecutive days to report diurnal cortisol parameters (i.e., CAR and slope) and objective measures of participant protocol adherence. Diminishing budgetary resources and efforts to minimize participant burden dictate the importance of standardized cortisol sampling protocols and reporting parameters.
Collapse
Affiliation(s)
- Jennifer M Hulett
- 1 College of Nursing, University of South Carolina, Columbia, SC, USA
| | | | | | - Linda H Eaton
- 4 School of Nursing & Health Studies, University of Washington, Bothell, Bothell, WA, USA
| |
Collapse
|
21
|
Saghazadeh A, Rezaei N. The Physical Burden of Immunoperception. BIOPHYSICS AND NEUROPHYSIOLOGY OF THE SIXTH SENSE 2019. [PMCID: PMC7123546 DOI: 10.1007/978-3-030-10620-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The previous chapter introduced the ImmunoEmotional Regulatory System (IMMERS). Also, there was a brief discussion about psychological states/psychiatric disorders that so far have been linked to the IMMERS. The present chapter considers another aspect of the IMMERS in which physiological states/physical diseases can be fit to the IMMERS.
Collapse
|
22
|
Health-Related Quality of Life among Women Breast Cancer Patients in Eastern China. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1452635. [PMID: 30065931 PMCID: PMC6051298 DOI: 10.1155/2018/1452635] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/29/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
Objectives Breast cancer is one of the major cancers in Chinese women. European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30 and QLQ-BR23) are now the most common and well developed instruments assessing the health-related quality of life (HRQOL) of breast cancer patients internationally, whereas there are relatively few Chinese studies. This study has two aims: to investigate the HRQOL and explore which dimensions of HRQOL play more important roles in breast cancer patients' overall quality of life in China and to explore the latent factor structure and the potential complementary relationship between these two EORTC questionnaires. Methods This cross-sectional and descriptive study was performed from October 2014 to February 2015 in Qingdao Municipal Hospital, China. A total of 621 women breast cancer patients were enrolled. EOTRC QLQ-C30 and QLQ-BR23 were used to evaluate the HRQOL of the participants. The nonparametric test, multiple linear regression, and exploratory factor analysis (EFA) were the main statistical methods we used. Results 608 participants completed the questionnaires with a response rate of 97.9%. The mean age of the participants was 48.0 years (SD=9.6). About 33% were illiterate or only finished primary school education. Almost half participants (47.4%) only adopted chemotherapy. HRQOL was significantly different with regard to patients' social-demographic and clinical characteristics. Age, residence, educational level, employment status, and TNM stage were five significant predictors for global health status. Pain, dyspnea, sexual enjoyment, and systemic therapy side-effect were main subscales which had a significant impact on the global health status for patients in different TNM stage. The EFA result suggested that QLQ-C30 and QLQ-BR23 were complementary questionnaires. Conclusions The EORTC QLQ-C30 and QLQ-BR23 questionnaires provide complementary information regarding breast cancer patients' HRQOL, and depending on the different cancer staging functional/symptom scales which significantly contributed to the overall HRQOL differed.
Collapse
|
23
|
Kim CK, Choi YM, Bae E, Jue MS, So HS, Hwang ES. Reduced NK cell IFN-γ secretion and psychological stress are independently associated with herpes zoster. PLoS One 2018; 13:e0193299. [PMID: 29466462 PMCID: PMC5821387 DOI: 10.1371/journal.pone.0193299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 02/08/2018] [Indexed: 11/17/2022] Open
Abstract
The pathogenesis of herpes zoster is closely linked to reduced varicella-zoster virus-specific cell-mediated immunity. However, little is known about the interplay between natural killer cells and psychological stress in the pathogenesis of herpes zoster. This study aimed to investigate possible associations among natural killer cells, T cells and psychological stress in herpes zoster. Interferon-gamma secretion from natural killer cell, psychological stress events, stress cognition scale scores and cytomegalovirus-specific cell-mediated immunity were compared between 44 patients with herpes zoster and 44 age- and gender-matched control subjects. A significantly lower median level of interferon-gamma secreted by natural killer cells was observed in patients with a recent diagnosis of herpes zoster than in control subjects (582.7 pg/ml vs. 1783 pg/ml; P = 0.004), whereas cytomegalovirus-specific cell-mediated immunity was not associated with herpes zoster. Psychological stress events and high stress cognition scale scores were significantly associated in patients with herpes zoster (P<0.001 and P = 0.037, respectively). However, reduced interferon-gamma secretion from natural killer cell and psychological stress were not associated. In conclusion, patients with a recent diagnosis of herpes zoster display reduced interferon-gamma secretion from natural killer cells and frequent previous psychological stress events compared with controls. However, reduced natural killer cell activity is not an immunological mediator between psychological stress and herpes zoster.
Collapse
Affiliation(s)
- Choon Kwan Kim
- Department of Internal Medicine, Division of Infectious Diseases, Veterans Health Service Medical Center, Seoul, Korea
| | - Youn Mi Choi
- Department of Laboratory Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Eunsin Bae
- Department of Laboratory Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Mihn Sook Jue
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyung Seok So
- Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Korea
| | - Eung-Soo Hwang
- Department of Microbiology and Immunology, Seoul National University College of Medicine, and Institute of Endemic Diseases, Seoul National University Medical Research Center, Seoul, Korea
| |
Collapse
|
24
|
Misale MS, Witek Janusek L, Tell D, Mathews HL. Chromatin organization as an indicator of glucocorticoid induced natural killer cell dysfunction. Brain Behav Immun 2018; 67:279-289. [PMID: 28911980 PMCID: PMC5696065 DOI: 10.1016/j.bbi.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 11/19/2022] Open
Abstract
It is well-established that psychological distress reduces natural killer cell immune function and that this reduction can be due to the stress-induced release of glucocorticoids. Glucocorticoids are known to alter epigenetic marks associated with immune effector loci, and are also known to influence chromatin organization. The purpose of this investigation was to assess the effect of glucocorticoids on natural killer cell chromatin organization and to determine the relationship of chromatin organization to natural killer cell effector function, e.g. interferon gamma production. Interferon gamma production is the prototypic cytokine produced by natural killer cells and is known to modulate both innate and adaptive immunity. Glucocorticoid treatment of human peripheral blood mononuclear cells resulted in a significant reduction in interferon gamma production. Glucocorticoid treatment also resulted in a demonstrable natural killer cell nuclear phenotype. This phenotype was localization of the histone, post-translational epigenetic mark, H3K27me3, to the nuclear periphery. Peripheral nuclear localization of H3K27me3 was directly related to cellular levels of interferon gamma. This nuclear phenotype was determined by direct visual inspection and by use of an automated, high through-put technology, the Amnis ImageStream. This technology combines the per-cell information content provided by standard microscopy with the statistical significance afforded by large sample sizes common to standard flow cytometry. Most importantly, this technology provides for a direct assessment of the localization of signal intensity within individual cells. The results demonstrate glucocorticoids to dysregulate natural killer cell function at least in part through altered H3K27me3 nuclear organization and demonstrate H3K27me3 chromatin organization to be a predictive indicator of glucocorticoid induced immune dysregulation of natural killer cells.
Collapse
Affiliation(s)
- Michael S Misale
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States
| | - Linda Witek Janusek
- Marcella Niehoff School of Nursing, Department of Health Promotion, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States
| | - Dina Tell
- Marcella Niehoff School of Nursing, Department of Health Promotion, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States
| | - Herbert L Mathews
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Health Science Division, 2160 South First Ave., Maywood, IL 60153, United States.
| |
Collapse
|
25
|
Jones HP, Aldridge B, Boss-Williams K, Weiss JM. A role for B cells in facilitating defense against an NK cell-sensitive lung metastatic tumor is revealed by stress. J Neuroimmunol 2017; 313:99-108. [PMID: 29153616 DOI: 10.1016/j.jneuroim.2017.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 11/28/2022]
Abstract
Stressors impair immune defenses and pose risks among cancer patients. Natural Killer cells are not the sole immune defense against tumor development. Utilizing an NK-sensitive tumor model, this study evaluated immune effects to stress and determined whether lung metastasis resulted from B cells' inability to augment tumorlytic function. Lung metastasis directly correlated with delayed lung B cell accumulation compared to NK, and T cells. Decreased interleukin-12 cytokine and CD80+ molecule expression by B cells correlated with decreased tumor lysis and increased tumor development. Thus, tumor defenses in the lung given stress exposure can depend on the B cell function.
Collapse
Affiliation(s)
- Harlan P Jones
- Department of Microbiology, Immunology and Genetics, University of North Texas Health Science Center, Fort Worth, TX, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Beau Aldridge
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Katherine Boss-Williams
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jay M Weiss
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
26
|
Dorfman CS, Lamb E, Van Denburg A, Wren AA, Soo MS, Faircloth K, Gandhi V, Shelby RA. The relationship between holding back from communicating about breast concerns and anxiety in the year following breast biopsy. J Psychosoc Oncol 2017; 36:222-237. [PMID: 29064780 DOI: 10.1080/07347332.2017.1395939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Evidence suggests open communication about breast cancer concerns promotes psychological adjustment, while holding back can lead to negative outcomes. Little is known about the relationship between communication and distress following breast biopsy. Design/ Sample: Women (N = 128) were assessed at the time of breast biopsy and again one week and three, six, and 12 months post-result. METHODS Linear mixed modeling examined relationships between holding back and anxiety for women with benign results (n = 94) or DCIS/invasive disease (n = 34) following breast biopsy. FINDINGS Anxiety increased among women with a benign result engaging in high but not low or average levels of holding back. Holding back was positively associated with anxiety post-result in breast cancer survivors, with anxiety decreasing over time. Conclusions/ Implications: Interventions to enhance communication are warranted, and knowledge of the differences among women with benign results and/or DCIS/invasive disease may allow for the development of tailored interventions.
Collapse
Affiliation(s)
- Caroline S Dorfman
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| | - Eneka Lamb
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| | - Alyssa Van Denburg
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| | - Anava A Wren
- b Department of Pediatrics , Stanford University Medical Center , Stanford , CA , USA
| | - Mary Scott Soo
- c Department of Radiology , Duke University Medical Center , Durham , NC , USA
| | - Kaylee Faircloth
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| | - Vicky Gandhi
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| | - Rebecca A Shelby
- a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| |
Collapse
|
27
|
Cahn BR, Goodman MS, Peterson CT, Maturi R, Mills PJ. Yoga, Meditation and Mind-Body Health: Increased BDNF, Cortisol Awakening Response, and Altered Inflammatory Marker Expression after a 3-Month Yoga and Meditation Retreat. Front Hum Neurosci 2017; 11:315. [PMID: 28694775 PMCID: PMC5483482 DOI: 10.3389/fnhum.2017.00315] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 06/01/2017] [Indexed: 12/17/2022] Open
Abstract
Thirty-eight individuals (mean age: 34.8 years old) participating in a 3-month yoga and meditation retreat were assessed before and after the intervention for psychometric measures, brain derived neurotrophic factor (BDNF), circadian salivary cortisol levels, and pro- and anti-inflammatory cytokines. Participation in the retreat was found to be associated with decreases in self-reported anxiety and depression as well as increases in mindfulness. As hypothesized, increases in the plasma levels of BDNF and increases in the magnitude of the cortisol awakening response (CAR) were also observed. The normalized change in BDNF levels was inversely correlated with BSI-18 anxiety scores at both the pre-retreat (r = 0.40, p < 0.05) and post-retreat (r = 0.52, p < 0.005) such that those with greater anxiety scores tended to exhibit smaller pre- to post-retreat increases in plasma BDNF levels. In line with a hypothesized decrease in inflammatory processes resulting from the yoga and meditation practices, we found that the plasma level of the anti-inflammatory cytokine Interleukin-10 was increased and the pro-inflammatory cytokine Interleukin-12 was reduced after the retreat. Contrary to our initial hypotheses, plasma levels of other pro-inflammatory cytokines, including Interferon Gamma (IFN-γ), Tumor Necrosis Factor (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were increased after the retreat. Given evidence from previous studies of the positive effects of meditative practices on mental fitness, autonomic homeostasis and inflammatory status, we hypothesize that these findings are related to the meditative practices throughout the retreat; however, some of the observed changes may also be related to other aspects of the retreat such as physical exercise-related components of the yoga practice and diet. We hypothesize that the patterns of change observed here reflect mind-body integration and well-being. The increased BDNF levels observed is a potential mediator between meditative practices and brain health, the increased CAR is likely a reflection of increased dynamic physiological arousal, and the relationship of the dual enhancement of pro- and anti-inflammatory cytokine changes to healthy immunologic functioning is discussed.
Collapse
Affiliation(s)
- B. Rael Cahn
- Department of Psychiatry and Behavioral Sciences, University of Southern CaliforniaLos Angeles, CA, United States
- Brain and Creativity Institute, University of Southern CaliforniaLos Angeles, CA, United States
| | - Matthew S. Goodman
- California School of Professional Psychology, Alliant International UniversitySan Diego, CA, United States
| | - Christine T. Peterson
- Center of Excellence for Research and Training in Integrative Health, Department of Family Medicine and Public Health, University of California, San DiegoLa Jolla, CA, United States
| | - Raj Maturi
- Midwest Eye InstituteIndianapolis, IN, United States
- Department of Ophthalmology, Indiana University School of MedicineIndianapolis, IN, United States
| | - Paul J. Mills
- Center of Excellence for Research and Training in Integrative Health, Department of Family Medicine and Public Health, University of California, San DiegoLa Jolla, CA, United States
- Chopra FoundationCarlsbad, CA, United States
| |
Collapse
|
28
|
Mizzi D, Zarb F, Dennis A. A retrospective audit of the first screening round of the Maltese breast screening programme. Radiography (Lond) 2017; 23:60-66. [DOI: 10.1016/j.radi.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022]
|
29
|
Hulett JM, Armer JM. A Systematic Review of Spiritually Based Interventions and Psychoneuroimmunological Outcomes in Breast Cancer Survivorship. Integr Cancer Ther 2016; 15:405-423. [PMID: 27151592 PMCID: PMC5125023 DOI: 10.1177/1534735416636222] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 11/17/2022] Open
Abstract
Objective This is a review of spiritually based interventions (eg, mindfulness-based stress reduction) that utilized psychoneuroimmunological (PNI) outcome measures in breast cancer survivors. Specifically, this review sought to examine the evidence regarding relationships between spiritually based interventions, psychosocial-spiritual outcomes, and biomarker outcomes in breast cancer survivors. Methods A systematic search of 9 online databases was conducted for articles of original research, peer-reviewed, randomized and nonrandomized control trials from 2005-2015. Data were extracted in order to answer selected questions regarding relationships between psychosocial-spiritual and physiological measures utilized in spiritually based interventions. Implications for future spiritually based interventions in breast cancer survivorship are discussed. Results Twenty-two articles were reviewed. Cortisol was the most common PNI biomarker outcome studied. Compared with control groups, intervention groups demonstrated positive mental health outcomes and improved or stable neuroendocrine-immune profiles, although limitations exist. Design methods have improved with regard to increased use of comparison groups compared with previous reviews. There are few spiritually based interventions that specifically measure religious or spiritual constructs. Similarly, there are few existing studies that utilize standardized religious or spiritual measures with PNI outcome measures. Findings suggest that a body of knowledge now exists in support of interventions with mindfulness-breathing-stretching components; furthermore, these interventions appear to offer potential improvement or stabilization of neuroendocrine-immune activity in breast cancer survivors compared to control groups. Conclusion From a PNI perspective, future spiritually based interventions should include standardized measures of religiousness and spirituality in order to understand relationships between and among religiousness, spirituality, and neuroendocrine-immune outcomes. Future research should now focus on determining the minimum dose and duration needed to improve or stabilize neuroendocrine-immune function, as well as diverse setting needs, including home-based practice for survivors who are too ill to travel to group sessions or lack economic resources.
Collapse
|
30
|
Recio A, Linares C, Banegas JR, Díaz J. Road traffic noise effects on cardiovascular, respiratory, and metabolic health: An integrative model of biological mechanisms. ENVIRONMENTAL RESEARCH 2016; 146:359-70. [PMID: 26803214 DOI: 10.1016/j.envres.2015.12.036] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 05/09/2023]
Abstract
BACKGROUND Road traffic noise is a major public health issue, given the documented association with several diseases and the growing number of exposed persons all over the world. The effects widely investigated pertain to cardiovascular health, and to a lesser extent to respiratory and metabolic health. The epidemiological design of most studies has made it possible to ascertain long-term associations of urban noise with a number of cardiovascular, respiratory, and metabolic disorders and diseases; additionally, time series studies have reported short-term associations. OBJECTIVES To review the various biological mechanisms that may account for all long-term as well as short-term associations between road traffic noise and cardiovascular, respiratory, and metabolic health. We also aimed to review the neuroendocrine processes triggered by noise as a stressor and the role of the central nervous system in noise-induced autonomic responses. METHODS Review of the literature on road traffic noise, environmental noise in general, psychosomatics, and diseases of the cardiovascular, respiratory, and metabolic systems. The search was done using PubMed databases. DISCUSSION We present a comprehensive, integrative stress model with all known connections between the body systems, states, and processes at both the physiological and psychological levels, which allows to establish a variety of biological pathways linking environmental noise exposure with health outcomes. CONCLUSIONS The long- and short-term associations between road traffic noise and health outcomes found in latest noise research may be understood in the light of the integrative model proposed here.
Collapse
Affiliation(s)
- Alberto Recio
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Cristina Linares
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - José Ramón Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain
| | - Julio Díaz
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
31
|
Renzi C, Whitaker KL, Winstanley K, Cromme S, Wardle J. Unintended consequences of an 'all-clear' diagnosis for potential cancer symptoms: a nested qualitative interview study with primary care patients. Br J Gen Pract 2016; 66:e158-70. [PMID: 26852794 PMCID: PMC4758495 DOI: 10.3399/bjgp16x683845] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/30/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nine out of 10 patients undergoing urgent cancer investigations receive an 'all-clear' diagnosis. AIM A qualitative approach was used to evaluate the impact of investigations that did not result in cancer diagnosis on subsequent symptom attribution and help seeking for recurrent or new possible cancer symptoms. DESIGN AND SETTING A survey of symptoms, help seeking, and past investigations was sent to 4913 individuals aged ≥50 years from four UK general practices. Of 2042 responders, 62 participants were recruited still reporting at least one cancer 'alarm' symptom in a 3-month follow-up survey for a nested in-depth interview study (ensuring variation in sociodemographic characteristics). METHOD Framework analysis was used to examine the in-depth semi-structured interviews and identify themes related to previous health investigations. RESULTS Interviewees were on average 65 years old, and 90% reported investigations within the previous 2 years. Most often they reported gastrointestinal, urinary, and respiratory symptoms, and 42% had waited ≥3 months before help seeking. Reassurance from a previous non-cancer diagnosis explained delays in help seeking even if symptoms persisted or new symptoms developed months or years later. Others were worried about appearing hypochondriacal or that they would not be taken seriously if they returned to the doctor. CONCLUSION An all-clear diagnosis can influence help seeking for months or even years in case of new or recurrent alarm symptoms. Considering the increasing number of people undergoing investigations and receiving an all-clear, it is paramount to limit unintended consequences by providing appropriate information and support. Specific issues are identified that could be addressed.
Collapse
Affiliation(s)
- Cristina Renzi
- Health Behaviour Research Centre, University College London, London
| | | | - Kelly Winstanley
- Health Behaviour Research Centre, University College London, London
| | - Susanne Cromme
- Health Behaviour Research Centre, University College London, London
| | - Jane Wardle
- Health Behaviour Research Centre, University College London, London
| |
Collapse
|
32
|
Lou Z, Li Y, Yang Y, Wang L, Yang J. Affects of Anxiety and Depression on Health-Related Quality of Life among Patients with Benign Breast Lumps Diagnosed via Ultrasonography in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10587-601. [PMID: 26343700 PMCID: PMC4586630 DOI: 10.3390/ijerph120910587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 01/06/2023]
Abstract
There is a high incidence of benign breast lumps among women, and these lumps may lead to physical and psychological problems. This study aims to evaluate anxiety and depressive symptoms among patients with benign breast lumps diagnosed via ultrasonography and investigate their impacts on health-related quality of life (HRQOL). A cross-sectional survey was conducted in Shenyang, China, from January to November 2013. Data were collected with self-administered questionnaires, including the Zung Self-Rating Anxiety Scale (SAS), the Center for Epidemiologic Studies Depression Scale (CES-D), and the 36-item Short-Form Health Survey (SF-36), together with demographic characteristics, from patients of the Department of Breast Surgery of the First Affiliated Hospital of China Medical University. Hierarchical multiple regression analysis (HMR) was performed to explore the effects of anxiety and depression on HRQOL. The overall prevalences of anxiety (SAS score ≥ 40) and depression (CES-D scores ≥ 16) were 40.2% and 62.0%, respectively, and 37.5% of the participants had both of these psychological symptoms. The means and standard deviations of PCS and MCS were 75.42 (15.22) and 68.70 (17.71), respectively. Anxiety and depressive symptoms were significantly negatively associated with the HRQOL of patients with benign breast lumps diagnosed via ultrasonography. Women with benign breast lumps diagnosed via ultrasonography in China experienced relatively high levels of anxiety and depressive symptoms. Anxiety and depressive symptoms had significant negative impacts on both the mental and physical quality of life (QOL) of women with benign breast lumps. Beyond the necessary clinical treatment procedures, psychological guidance and detailed explanations of the disease should be offered to alleviate the anxiety and depressive symptoms and enhance the HRQOL of patients with benign breast lumps.
Collapse
Affiliation(s)
- Zhe Lou
- Department of Cardiovascular Ultrasonic Diagnosis, the First Affiliated Hospital of China Medical University, No.155 Nanjingbei Road, Heping District, Shenyang 110001, China.
| | - Yinyan Li
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, No. 155 Nanjingbei Road, Heping District, Shenyang 110001, China.
| | - Yilong Yang
- Department of Social Medicine, School of Public health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang 110013, China.
| | - Lie Wang
- Department of Social Medicine, School of Public health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang 110013, China.
| | - Jun Yang
- Department of Cardiovascular Ultrasonic Diagnosis, the First Affiliated Hospital of China Medical University, No.155 Nanjingbei Road, Heping District, Shenyang 110001, China.
| |
Collapse
|
33
|
Cash E, Sephton SE, Chagpar AB, Spiegel D, Rebholz WN, Zimmaro LA, Tillie JM, Dhabhar FS. Circadian disruption and biomarkers of tumor progression in breast cancer patients awaiting surgery. Brain Behav Immun 2015; 48:102-14. [PMID: 25728235 DOI: 10.1016/j.bbi.2015.02.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 02/09/2015] [Accepted: 02/20/2015] [Indexed: 02/08/2023] Open
Abstract
Psychological distress, which can begin with cancer diagnosis and continue with treatment, is linked with circadian and endocrine disruption. In turn, circadian/endocrine factors are potent modulators of cancer progression. We hypothesized that circadian rest-activity rhythm disruption, distress, and diurnal cortisol rhythms would be associated with biomarkers of tumor progression in the peripheral blood of women awaiting breast cancer surgery. Breast cancer patients (n=43) provided actigraphic data on rest-activity rhythm, cancer-specific distress (IES, POMS), saliva samples for assessment of diurnal cortisol rhythm, cortisol awakening response (CAR), and diurnal mean. Ten potential markers of tumor progression were quantified in serum samples and grouped by exploratory factor analysis. Analyses yielded three factors, which appear to include biomarkers reflecting different aspects of tumor progression. Elevated factor scores indicate both high levels and strong clustering among serum signals. Factor 1 included VEGF, MMP-9, and TGF-β; suggesting tumor invasion/immunosuppression. Factor 2 included IL-1β, TNF-α, IL-6R, MCP-1; suggesting inflammation/chemotaxis. Factor 3 included IL-6, IL-12, IFN-γ; suggesting inflammation/TH1-type immunity. Hierarchical regressions adjusting age, stage and socioeconomic status examined associations of circadian, distress, and endocrine variables with these three factor scores. Patients with poor circadian coordination as measured by rest-activity rhythms had higher Factor 1 scores (R(2)=.160, p=.038). Patients with elevated CAR also had higher Factor 1 scores (R(2)=.293, p=.020). These relationships appeared to be driven largely by VEGF concentrations. Distress was not related to tumor-relevant biomarkers, and no other significant relationships emerged. Women with strong circadian activity rhythms showed less evidence of tumor promotion and/or progression as indicated by peripheral blood biomarkers. The study was not equipped to discern the cause of these associations. Circadian/endocrine aberrations may be a manifestation of systemic effects of aggressive tumors. Alternatively, these results raise the possibility that, among patients with active breast tumors, disruption of circadian activity rhythms and elevated CAR may facilitate tumor promotion and progression.
Collapse
Affiliation(s)
- E Cash
- Department of Surgery, Division of Otolaryngology-HNS, University of Louisville School of Medicine, Louisville, KY, United States; Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States
| | - S E Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States.
| | - A B Chagpar
- The Breast Center - Smilow Cancer Hospital at Yale-New Haven, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - D Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - W N Rebholz
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States
| | - L A Zimmaro
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States
| | - J M Tillie
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - F S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States; Institute for Immunity, Transplantation, and Infection, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States.
| |
Collapse
|
34
|
Hulett JM, Armer JM, Stewart BR, Wanchai A. Perspectives of the Breast Cancer Survivorship Continuum: Diagnosis through 30 Months Post-Treatment. J Pers Med 2015; 5:174-90. [PMID: 26030800 PMCID: PMC4493495 DOI: 10.3390/jpm5020174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/12/2015] [Accepted: 05/22/2015] [Indexed: 11/24/2022] Open
Abstract
This study explored breast cancer survivors' perspectives regarding their experiences of the survivorship continuum from diagnosis through 30 months post-treatment. The sample included women (N = 379) with newly-diagnosed breast cancer undergoing treatment at a Midwestern university-affiliated cancer center. Semi-structured interviews were conducted using the Lymphedema and Breast Cancer Questionnaire at time of diagnosis, post-operatively, quarterly during the first year, and then semi-annually thereafter through 30 months post-treatment. A mixed-methodology was used to analyze participants' comments. Themes central to long-term survivorship experiences included social support, positive worldviews, breast cancer and lymphedema health literacy, religious/spiritual beliefs, self-empowerment, and recovery expectations. These themes were consistent with a psychoneuroimmunological model of health in which psychosocial variables mediate stress and influence health outcomes. Qualitative data showed that social support and positive worldviews were the two themes with the most significant impact on long-term breast cancer survivorship experiences. Survivors expressed a need to advance their health care literacy in order to share ownership of breast cancer and lymphedema treatment decisions. Since breast cancer is an immune-mediated disease, long-term survivorship planning should address psychosocial factors that influence the long-term psychological distress associated with immune dysfunction.
Collapse
Affiliation(s)
- Jennifer M Hulett
- Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri-Columbia, DC 116.05 Suite 408 Mizzou North, University of Missouri, Columbia, MO 65211, USA.
| | - Jane M Armer
- Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri-Columbia, DC 116.05 Suite 408 Mizzou North, University of Missouri, Columbia, MO 65211, USA.
| | - Bob R Stewart
- Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri-Columbia, DC 116.05 Suite 408 Mizzou North, University of Missouri, Columbia, MO 65211, USA.
| | - Ausanee Wanchai
- Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri-Columbia, DC 116.05 Suite 408 Mizzou North, University of Missouri, Columbia, MO 65211, USA.
- Boromarajonani College of Nursing Buddhachinaraj, Muang, Phitsanulok 65000, Thailand.
| |
Collapse
|
35
|
Huang HP, He M, Wang HY, Zhou M. A meta-analysis of the benefits of mindfulness-based stress reduction (MBSR) on psychological function among breast cancer (BC) survivors. Breast Cancer 2015; 23:568-76. [PMID: 25820148 DOI: 10.1007/s12282-015-0604-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/15/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Psychological issue is the most common co-morbidity of women with breast cancer (BC) after receiving treatment. Effective coping with this problem is significant importance. The aim of this meta-analysis is to evaluate the benefits of mindfulness-based stress reduction (MBSR) on psychological distress among breast cancer survivors. METHODS PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched from their inception to June 30, 2014. Two reviewers independently reviewed and extracted the data. The primary outcomes of interest were psychological domains. Review Manager 5.3 was used to pool collected data. RESULTS Nine articles involving 964 participants were identified. Compared with those in control group, patients in MBSR group have a significant improvement on psychological domains: depression [mean difference (MD), 5.09; 95 % confidence interval (CI), 3.63-6.55; P < 0.00001], anxiety (MD, 2.79; 95 % CI, 1.62-3.96; P < 0.00001), stress (MD, 4.10; 95 % CI, 2.46-5.74; P < 0.00001). MBSR can also improve the overall quality of life (QOL) (MD, -1.16; 95 % CI, -2.21 to -0.12; P = 0.03). CONCLUSIONS On the basis of our findings, MBSR shows a positive effect on psychological function and QOL of breast cancer survivors. This approach can be recommended to breast cancer patients as a part of their rehabilitation.
Collapse
Affiliation(s)
- Hua-Ping Huang
- Department of Nursing Administration, Mianyang Central Hospital, No. 12, Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China.
| | - Mei He
- Department of Nursing Administration, Mianyang Central Hospital, No. 12, Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Hai-Yan Wang
- Department of Nursing Administration, Mianyang Central Hospital, No. 12, Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Mengjun Zhou
- Department of Statistic, Mianyang Central Hospital, Mianyang, China
| |
Collapse
|
36
|
Renzi C, Whitaker KL, Wardle J. Over-reassurance and undersupport after a 'false alarm': a systematic review of the impact on subsequent cancer symptom attribution and help seeking. BMJ Open 2015; 5:e007002. [PMID: 25652803 PMCID: PMC4322204 DOI: 10.1136/bmjopen-2014-007002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES This literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom attribution and delays in help seeking for subsequent possible cancer symptoms. DESIGN AND SETTING The comprehensive literature review included original research based on quantitative, qualitative and mixed data collection methods. We used a combination of search strategies, including in-depth searches of electronic databases (PubMed, EMBASE, PsychInfo), searching key authors and articles listed as 'related' in PubMed, and reference lists. We performed a narrative synthesis of key themes shared across studies. PARTICIPANTS The review included studies published after 1990 and before February 2014 reporting information on adult patients having experienced a false alarm following symptomatic presentation. We excluded false alarms in the context of screening. PRIMARY AND SECONDARY OUTCOME MEASURES We evaluated the effect of a 'false alarm' on symptom attribution and help seeking for new or recurrent possible cancer symptoms. RESULTS Overall, 1442 papers were screened and 121 retrieved for full-text evaluation. Among them, 19 reported on false alarms and subsequent symptom attribution or help seeking. They used qualitative (n=14), quantitative (n=3) and mixed methods (n=2). Breast (n=7), gynaecological (n=3), colorectal (n=2), testicular (n=2), and head and neck cancers (n=2) were the most studied. Two broad themes emerged underlying delays in help seeking: (1) over-reassurance from the previous 'all-clear' diagnosis leading to subsequent symptoms being interpreted as benign, and (2) unsupportive healthcare experiences in which symptoms were dismissed, leaving patients concerned about appearing hypochondriacal or uncertain about the appropriate next actions. The evidence suggested that the effect of a false alarm can persist for months and even years. CONCLUSIONS In conclusion, over-reassurance and undersupport of patients after a false alarm can undermine help seeking in the case of new or recurrent potential cancer symptoms, highlighting the need for appropriate patient information when investigations rule out cancer.
Collapse
Affiliation(s)
- Cristina Renzi
- Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK
| | - Katriina L Whitaker
- Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, Health Behaviour Research Centre, London, UK
| |
Collapse
|
37
|
Women's experiences of the breast cancer diagnostic process: A thematic evaluation of the literature; Recall & biopsy. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
38
|
Sarkar DK. Fetal alcohol exposure increases susceptibility to carcinogenesis and promotes tumor progression in prostate gland. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 815:389-402. [PMID: 25427920 DOI: 10.1007/978-3-319-09614-8_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The idea that exposure to adverse environmental conditions and lifestyle choices during pregnancy can result in fetal programming that underlies disease susceptibility in adulthood is now widely accepted. Fetal alcohol exposed offspring displays many behavioral and physiological abnormalities including neuroendocrine-immune functions, which often carry over into their adult life. Since the neuroendocrine-immune system plays an important role in controlling tumor surveillance, fetal alcohol exposed offspring can be vulnerable to develop cancer. Animal studies have recently showed increased cancer growth and progression in various tissues of fetal alcohol exposed offspring. I will detail in this chapter the recent evidence for increased prostate carcinogenesis in fetal alcohol exposed rats. I will also provide evidence for a role of excessive estrogenization during prostatic development in the increased incidence of prostatic carcinoma in these animals. Furthermore, I will discuss the additional possibility of the involvement of impaired stress regulation and resulting immune incompetence in the increased prostatic neoplasia in the fetal alcohol exposed offspring.
Collapse
Affiliation(s)
- Dipak K Sarkar
- Endocrinology Program and Department of Animal Sciences, Rutgers, The State University of New Jersey, 67 Poultry Farm Road, New Brunswick, NJ, 08901, USA,
| |
Collapse
|
39
|
Johnson JM, Johnson AK, O'Meara ES, Miglioretti DL, Geller BM, Hotaling EN, Herschorn SD. Breast cancer detection with short-interval follow-up compared with return to annual screening in patients with benign stereotactic or US-guided breast biopsy results. Radiology 2014; 275:54-60. [PMID: 25423143 DOI: 10.1148/radiol.14140036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the cancer detection rate and stage after benign stereotactic or ultrasonography (US)-guided core breast biopsy between patients with short-interval follow-up (SIFU) and those who return to annual screening. MATERIALS AND METHODS The Breast Cancer Surveillance Consortium (BCSC) registry and the BCSC Statistical Coordinating Center received institutional review board approval for active and passive consent processes and a waiver of consent. All procedures were HIPAA compliant. BCSC data for 1994-2010 were used to compare ipsilateral breast cancer detection rates and tumor characteristics for diagnoses within 3 months after SIFU (3-8 months) versus return to annual screening (RTAS) mammography (9-18 months) after receiving a benign pathology result from image-guided breast biopsy. RESULTS In total, 17 631 biopsies with benign findings were identified with SIFU or RTAS imaging. In the SIFU group, 27 ipsilateral breast cancers were diagnosed in 10 715 mammographic examinations (2.5 cancers per 1000 examinations) compared with 16 cancers in 6916 mammographic examinations in the RTAS group (2.3 cancers per 1000 examinations) (P = .88). Sixteen cancers after SIFU (59%; 95% confidence interval [CI]: 39%, 78%) were invasive versus 12 after RTAS (75%; 95% CI: 48%, 93%). The invasive cancer rate was 1.5 per 1000 examinations after SIFU (95% CI: 0.9, 2.4) and 1.7 per 1000 examinations (95% CI: 0.9, 3.0) after RTAS (P = .70). Among invasive cancers, 25% were late stage (stage 2B, 3, or 4) in the SIFU group (95% CI: 7%, 52%) versus 27% in the RTAS group (95% CI: 6%, 61%). Positive lymph nodes were found in seven (44%; 95% CI: 20%, 70%) invasive cancers after SIFU and in three (25%; 95% CI: 5%, 57%) invasive cancers after RTAS. CONCLUSION Similar rates of cancer detection were found between SIFU and RTAS after benign breast biopsy with no significant differences in stage, tumor size, or nodal status, although the present study was limited by sample size. These findings suggest that patients with benign radiologic-pathologic-concordant percutaneous breast biopsy results could return to annual screening.
Collapse
Affiliation(s)
- Jason M Johnson
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (J.M.J.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.K.J.); Group Health Research Institute, Seattle, Wash (E.S.O., D.L.M.); and Division of Breast Imaging, Department of Radiology, Fletcher Allen Health Care, Burlington, Vt (B.M.G., E.N.H., S.D.H.)
| | | | | | | | | | | | | |
Collapse
|
40
|
Glucocorticoids regulate natural killer cell function epigenetically. Cell Immunol 2014; 290:120-30. [PMID: 24978612 DOI: 10.1016/j.cellimm.2014.05.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/08/2014] [Accepted: 05/31/2014] [Indexed: 12/21/2022]
Abstract
Although glucocorticoids are well known for their capacity to suppress the immune response, glucocorticoids can also promote immune responsiveness. It was the purpose of this investigation to evaluate the molecular basis for this apparent dichotomous immunologic effect. Glucocorticoid treatment of natural killer cells (NK) was shown to reduce NK cell cytolytic activity by reduction of histone promoter acetylation for perforin and granzyme B, which corresponded with reduced mRNA and protein for each. In contrast, glucocorticoid treatment increased histone acetylation at regulatory regions for interferon gamma and IL-6, as well as chromatin accessibility for each. This increase in histone acetylation was associated with increased proinflammatory cytokine mRNA and protein production upon cellular stimulation. These immunologic effects were evident at the level of the individual cell and demonstrate glucocorticoids to epigenetically reduce NK cell cytolytic activity while at the same time to prime NK cells for proinflammatory cytokine production.
Collapse
|
41
|
Tan ML, Idris DB, Teo LW, Loh SY, Seow GC, Chia YY, Tin AS. Validation of EORTC QLQ-C30 and QLQ-BR23 questionnaires in the measurement of quality of life of breast cancer patients in Singapore. Asia Pac J Oncol Nurs 2014; 1:22-32. [PMID: 27981079 PMCID: PMC5123455 DOI: 10.4103/2347-5625.135817] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: To validate EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires and to measure the health-related quality of life (HRQOL) of women with breast cancer in Singapore during their first 4 years of post-diagnosis and treatments. Methods: A quantitative and cross-descriptive sectional study. All of 170 subjects were recruited in a Singapore tertiary cancer center. The European Organization for Research and Treatment-QOL questionnaire and breast cancer specific module (EORTC QLQ-C30 and QLQ-BR23) were used to measure the HRQOL among women with breast cancer. All statistical tests were performed using SPSS Version 18. The reliability of the EORTC QLQ-C30 and QLQ-BR23 questionnaires was examined using Cronbach's alpha test. EORTC QLQ-C30 was validated against EuroQol Group's 5-domain questionnaires (EQ5D) by examining its concurrent validity using Pearson Product Moment Correlation to calculate the total scores. Results: The Cronbach's alpha coefficient results for EORTC QLQ-C30 and QLQ BR-23 were 0.846 and 0.873 respectively which suggested relatively good internal consistency. The correlation between EORTC QLQ-C30 and EQ5D QOL instruments demonstrated a modest linear relationship (r=0.597; P<0.001) that indicated a moderately strong correlation between the two measures. The study showed that Singaporean women with breast cancer had enjoyed high levels of HRQOL during their first 4 years of survivorship but they had significant concern over the financial impact of breast cancer. One of the key findings was younger women had experienced more physical and psychosocial concerns than older women. Conclusion: The EORTC QLQ-C30 and QLQ-BR23 questionnaires are feasible and promising instruments to measure the levels of HRQOL in Singaporean women with breast cancer in future studies.
Collapse
Affiliation(s)
- May Leng Tan
- Department of Nursing, National Cancer Centre Singapore, Singapore
| | | | - Lee Wah Teo
- Department of Nursing, National Heart Centre Singapore, Singapore
| | - Soon Yue Loh
- Department of Nursing, National Cancer Centre Singapore, Singapore
| | - Gek Ching Seow
- Division of Nursing, Singapore General Hospital, Singapore
| | - Yen Yen Chia
- Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Aung Soe Tin
- Department of Health Services Research, Eastern Health Alliance, Singapore
| |
Collapse
|
42
|
Denieffe S, Cowman S, Gooney M. Symptoms, clusters and quality of life prior to surgery for breast cancer. J Clin Nurs 2013; 23:2491-502. [PMID: 24329603 DOI: 10.1111/jocn.12430] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES To examine the pretreatment symptoms and symptom clusters that women awaiting breast cancer surgery are experiencing and the impact of these symptoms on their quality of life. BACKGROUND Most women diagnosed with breast cancer will have surgery as a first-line treatment. The presence of presurgery symptoms may be significant in contributing to distress and impaired quality of life. While it seems that women with breast cancer may experience the symptoms of fatigue, pain, depression and sleep disturbance as a cluster, this has not yet been confirmed by empirical research in the presurgery time period. DESIGN A multiple-point prospective longitudinal cohort panel design is used. METHODS Presurgery symptoms and quality of life were assessed using the Hospital Anxiety and Depression Scale, Insomnia Severity Index, Functional Assessment of Cancer Therapy-Fatigue, Brief Pain Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(3). RESULTS Participants (n = 94, age range 30-92) experienced symptoms prior to surgery, with pain being a more prevalent symptom (35%) than fatigue (32%), sleep disturbances (25·5%) or depression (11%). global quality of life was significantly impacted on by fatigue and showed a moderate correlation with emotional functioning and a weak correlation with physical and social functioning. Hierarchical cluster analysis identified the presence of five clusters with symptoms present in differing intensities in each cluster. CONCLUSION In this cohort of women, healthy other than having a diagnosis of breast cancer, symptoms were impacting on quality of life. It is evident that clusters of symptoms are present presurgery that must be assessed and managed. RELEVANCE TO PRACTICE Healthcare delivery systems must ensure that early symptoms are addressed effectively in the presurgery period to improve quality of life and reduce adverse outcomes postsurgery.
Collapse
Affiliation(s)
- Suzanne Denieffe
- Department of Nursing, Waterford Institute of Technology, Waterford, Ireland
| | | | | |
Collapse
|
43
|
Keyzer-Dekker CMG, de Vries J, Mertens MC, Roukema JA, van der Steeg AFW. The impact of diagnosis and trait anxiety on psychological distress in women with early stage breast cancer: A prospective study. Br J Health Psychol 2013; 19:783-94. [DOI: 10.1111/bjhp.12076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 09/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Claudia M. G. Keyzer-Dekker
- Department of Paediatric Surgery; Paediatric Surgical Centre of Amsterdam; Emma Children's Hospital AMC and VU University Medical Centre; Amsterdam The Netherlands
- Department of Paediatric Surgery; Beatrix Children's Hospital; University Medical Centre Groningen; The Netherlands
| | - Jolanda de Vries
- Centre of Research on Psychology in Somatic Disease (CoRPS); Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Department of Medical Psychology; St Elisabeth Hospital; Tilburg The Netherlands
| | - Marlies C. Mertens
- Centre of Research on Psychology in Somatic Disease (CoRPS); Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Department of Medical Psychology; Jeroen Bosch Hospital; ‘s-Hertogenbosch The Netherlands
| | - Jan A. Roukema
- Centre of Research on Psychology in Somatic Disease (CoRPS); Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Department of Surgery; St Elisabeth Hospital; Tilburg The Netherlands
| | - Alida F. W. van der Steeg
- Department of Paediatric Surgery; Paediatric Surgical Centre of Amsterdam; Emma Children's Hospital AMC and VU University Medical Centre; Amsterdam The Netherlands
- Centre of Research on Psychology in Somatic Disease (CoRPS); Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Department of Surgery; St Elisabeth Hospital; Tilburg The Netherlands
| |
Collapse
|
44
|
Positive and negative meanings are simultaneously ascribed to colorectal cancer: relationship to quality of life and psychosocial adjustment. Palliat Support Care 2013; 12:277-86. [PMID: 24128421 DOI: 10.1017/s1478951513000151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Experiencing cancer can give rise to existential concerns causing great distress, and consequently drive individuals to make sense of what cancer may mean to their lives. To date, meaning-based research in the context of cancer has largely focused on one possible outcome of this process, the emergence of positive meanings (e.g. post-traumatic growth). However, negative meanings may also be ascribed to cancer, simultaneously with positive meanings. This study focused on the nature of the co-existence of positive and negative meanings in a sample of individuals diagnosed with colorectal cancer to find out whether negative meaning had an impact on quality of life and psychosocial adjustment above and beyond positive meaning. METHODS Participants were given questionnaires measuring meaning-made, quality of life, and psychological distress. Semi structured interviews were conducted with a subgroup from the original sample. RESULTS Hierarchical multiple regression analyses revealed that negative meaning-made (i.e. helplessness) was a significant predictor of poor quality of life and increased levels of depression/anxiety above and beyond positive meaning-made (i.e. life meaningfulness, acceptance, and perceived benefits). Correlational analyses and interview data revealed that negative meaning-made was mainly associated with physical and functional disability, while positive meaning-made was mostly related to emotional and psychological well-being. SIGNIFICANCE OF RESULTS Meanings of varying valence may simultaneously be ascribed to cancer as it impacts different life dimensions, and they may independently influence quality of life and psychosocial adjustment. The presence of positive meaning was not enough to prevent the detrimental effects of negative meaning on psychosocial adjustment and quality of life among individuals taking part in this study. Future attention to negative meaning is warranted, as it may be at least as important as positive meaning in predicting psychosocial adjustment and quality of life following a cancer diagnosis.
Collapse
|
45
|
Armer JM, Hulett JM, Bernas M, Ostby P, Stewart BR, Cormier JN. Best Practice Guidelines in Assessment, Risk Reduction, Management, and Surveillance for Post-Breast Cancer Lymphedema. CURRENT BREAST CANCER REPORTS 2013; 5:134-144. [PMID: 26246870 DOI: 10.1007/s12609-013-0105-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Breast cancer-related lymphedema (LE) is a progressive, chronic disease that affects millions of cancer survivors and primarily results from surgical lymphatic vessel/node removal and radiation therapy. Patient education and support for importance of early detection is essential in helping health care providers detect lymphedema early, when there is the best chance to prevent progression. Improved imaging and surgical techniques have decreased the incidence of LE; however, effective risk-reduction and treatment have historically lacked the level of evidence necessary to standardize effective treatment. The purpose of this article is to report an extensive review of literature, including highlighted multidisciplinary studies within the past three years, in order to update best practice guidelines in assessment, risk reduction, management, and surveillance for post-breast cancer lymphedema.
Collapse
Affiliation(s)
- Jane M Armer
- Sinclair School of Nursing Director, Nursing Research, Ellis Fischel Cancer Center Director, American Lymphedema Framework Project DC 116.05 Suite 415 EFCC University of Missouri-Columbia Columbia, MO 62011
| | | | | | - Pam Ostby
- Sinclair School of Nursing University of Missouri-Columbia
| | - Bob R Stewart
- College of Education and Sinclair School of Nursing University of Missouri-Columbia
| | - Janice N Cormier
- Departments of Surgical Oncology and Biostatistics The University of Texas MD Anderson Cancer Center Houston, TX
| |
Collapse
|
46
|
Witek Janusek L, Tell D, Albuquerque K, Mathews HL. Childhood adversity increases vulnerability for behavioral symptoms and immune dysregulation in women with breast cancer. Brain Behav Immun 2013; 30 Suppl:S149-62. [PMID: 22659062 PMCID: PMC3492527 DOI: 10.1016/j.bbi.2012.05.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 04/24/2012] [Accepted: 05/22/2012] [Indexed: 10/28/2022] Open
Abstract
Women respond differentially to the stress-associated with breast cancer diagnosis and treatment, with some women experiencing more intense and/or sustained behavioral symptoms and immune dysregulation than others. Childhood adversity has been identified to produce long-term dysregulation of stress response systems, increasing reactivity to stressors encountered during adulthood. This study determined whether childhood adversity increased vulnerability for more intense and sustained behavioral symptoms (fatigue, perceived stress, and depressive symptoms), poorer quality of life, and greater immune dysregulation in women (N=40) with breast cancer. Evaluation was after breast surgery and through early survivorship. Hierarchical linear modeling was used to examine intra-individual and inter-individual differences with respect to initial status and to the pattern of change (i.e. trajectory) of outcomes. At initial assessment, women exposed to childhood emotional neglect/abuse had greater perceived stress, fatigue, depressive symptoms and poorer quality of life, as well as lower natural killer cell activity (NKCA). Although these outcomes improved over time, women with greater childhood emotional neglect/abuse exhibited worse outcomes through early survivorship. No effect was observed on the pattern of change for these outcomes. In contrast, childhood physical neglect predicted sustained trajectories of greater perceived stress, worse quality of life, and elevated plasma IL-6; with no effect observed at initial assessment. Thus, childhood adversity leaves an enduring imprint, increasing vulnerability for behavioral symptoms, poor quality of life, and elevations in IL-6 in women with breast cancer. Further, childhood adversity predisposes to lower NKCA at a critical time when this immune-effector mechanism is most effective at halting nascent tumor seeding.
Collapse
Affiliation(s)
- Linda Witek Janusek
- Marcella Niehoff School of Nursing, Loyola University Chicago, Health Science Division, Maywood, IL 60153, USA.
| | - Dina Tell
- Marcella Niehoff School of Nursing, Loyola University Chicago, Health Science Division, Maywood, IL 60153
| | - Kevin Albuquerque
- Stritch School of Medicine, Loyola University Chicago, Health Science Division, Maywood, IL 60153
| | - Herbert L. Mathews
- Stritch School of Medicine, Loyola University Chicago, Health Science Division, Maywood, IL 60153
| |
Collapse
|
47
|
Harding MM, McCrone S. Experiences of non-navigated women undergoing breast diagnostic evaluation. Clin J Oncol Nurs 2013; 17:E8-E12. [PMID: 23372108 DOI: 10.1188/13.cjon.e8-e12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During the diagnostic period, women need appropriate, timely information regarding tests and procedures. Nurse navigator programs were developed to combat the negative effects on survival that are caused by delays in the diagnosis of breast cancer and lack of support from the healthcare team. Nurse navigators decreased barriers to care, increased patient satisfaction, and lowered anxiety in women undergoing diagnostic evaluation. However, although patient navigation programs have become a presence in oncology centers, those programs and the accompanying support are not offered at every facility that provides components of diagnostic evaluation. Therefore, the purpose of the current study was to explore the experiences of women who underwent a breast diagnostic evaluation without any accompanying navigation services.
Collapse
Affiliation(s)
- Mariann M Harding
- Department of Nursing, Kent State University at Tuscarawas, New Philadelphia, OH, USA.
| | | |
Collapse
|
48
|
Beta-Endorphin Neuron Regulates Stress Response and Innate Immunity to Prevent Breast Cancer Growth and Progression. VITAMINS & HORMONES 2013; 93:263-76. [PMID: 23810011 DOI: 10.1016/b978-0-12-416673-8.00011-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Body and mind interact extensively with each other to control health. Emerging evidence suggests that chronic neurobehavioral stress can promote various tumor growth and progression. The biological reaction to stress involves a chemical cascade initiated within the central nervous system and extends to the periphery, encompassing the immune, endocrine, and autonomic systems. Activation of sympathetic nervous system, such as what happens in the "fight or flight" response, downregulates tumor-suppressive genes, inhibits immune function, and promotes tumor growth. On the other hand, an optimistic attitude or psychological intervention helps cancer patients to survive longer via increase in β-endorphin neuronal suppression of stress hormone levels and sympathetic outflows and activation of parasympathetic control of tumor suppressor gene and innate immune cells to destroy and clear tumor cells.
Collapse
|
49
|
Health care utilization one year following the diagnosis benign breast disease or breast cancer. Breast 2012; 21:746-50. [DOI: 10.1016/j.breast.2012.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 01/25/2012] [Accepted: 01/29/2012] [Indexed: 11/18/2022] Open
|
50
|
Brocken P, Prins JB, Dekhuijzen PNR, van der Heijden HFM. The faster the better?—A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways. Psychooncology 2012; 21:1-10. [PMID: 22905349 DOI: 10.1002/pon.1929] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To perform a systematic review of articles published in the last 25 years on prevalence and course of distress and quality of life surrounding the diagnostic process of suspected cancer, and the influence of rapid diagnostic programs. METHODS Twenty-three articles were identified via Pubmed, PsycINFO, and reference lists of articles. Except for three randomized clinical trials and one case control study all studies were uncontrolled cohort studies. RESULTS Most studies involved patients with suspected breast cancer and therefore had a sex selection bias. Four studies on the effect of rapid outpatient diagnostic programs were found.Studies showed very high prevalence of anxiety, decreasing in case of a benign diagnosis but increasing or sustaining in patients waiting for results or after cancer diagnosis though not significantly more in rapid programs. Quality of life was low and showed varying patterns. CONCLUSIONS Distress in the diagnostic phase of cancer is a major problem and the rapid decrease of anxiety in patients eventually not diagnosed with cancer suggests a benefit of rapid diagnostic programs. The available evidence however is limited and shows some inconsistencies. Studies differ in subjects, objective and are limited by quality and quantity. Conflicting results prohibit a conclusion on patients ultimately diagnosed with cancer.
Collapse
Affiliation(s)
- Pepijn Brocken
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | |
Collapse
|