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The Association Between Sleep Disturbance and Proinflammatory Markers in Patients With Cancer: A Meta-analysis. Cancer Nurs 2023; 46:E91-E98. [PMID: 35728010 DOI: 10.1097/ncc.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sleep disturbance is one of the symptoms with high incidence and negative influence in patients with cancer. A better understanding of the biological factors associated with sleep disturbance is critical to predict, treat, and manage this condition. OBJECTIVE The aim of this study was to determine the correlation between sleep disturbance and proinflammatory markers in adult patients with cancer. METHODS A systematic search was conducted in 7 databases from inception to March 1, 2020, for this meta-analysis. Two reviewers independently screened the studies, extracted data, and appraised the quality of the studies. Meta-analyses were conducted using Stata 12.0 software. RESULTS Sixteen studies were included. Results indicated that sleep disturbance was associated with higher levels of the overall proinflammatory markers and that the effect size was small yet significant. Further subgroup analyses suggested that sleep disturbance was significantly associated with interleukin-6 and C-reactive protein, but not with interleukin-1β or tumor necrosis factor-α. Meta-regression results indicated that only the sample source affected the association between sleep disturbance and proinflammatory markers. CONCLUSION There was a positive relationship between sleep disturbance and selected proinflammatory markers in adult patients with cancer. IMPLICATION FOR PRACTICE This review provides empirical support for the association between sleep disturbance and certain proinflammatory markers. Healthcare providers can further explore specific biomarkers to precisely identify the individuals at risk of sleep disturbance and develop targeted strategies for therapeutic and clinical interventions.
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Barandouzi ZA, Rowcliffe C, Schrogin J, Meador R, Bruner DW. Exploring the links among inflammation and gut microbiome with psychoneurological symptoms and gastrointestinal toxicities in gynecologic cancers: a systematic review. Support Care Cancer 2022; 30:6497-6513. [PMID: 35396962 DOI: 10.1007/s00520-022-07027-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Emerging evidence highlights the roles the gut microbiome and the immune system, integral parts of the gut-brain axis, play in developing various symptoms in cancer patients. The purpose of this systematic review was to describe the roles of inflammatory markers and the gut microbiome, as well as to describe their associations with psychoneurological symptoms and gastrointestinal toxicities in women with gynecologic cancers. METHODS A comprehensive literature search was conducted in PubMed, Embase, and Web of Science from January 2000 to February 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were utilized to screen the found articles. The quality of the included studies was assessed using the Mixed Method Assessment Tool. In the included studies, various inflammatory markers and gut microbiome diversity and patterns were measured. RESULTS Sixteen studies met the eligibility criteria and were included in this systematic review. While there were discrepancies in the associations between various inflammatory markers and symptoms, most of the studies showed positive correlations between interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) and cancer-related psychoneurological symptoms and gastrointestinal toxicities in gynecologic cancer patients. Although there was no consensus in alpha diversity, studies showed significant dissimilarity in the microbial communities (beta diversity) in patients with gastrointestinal toxicities compared with patients without symptoms or healthy controls. Studies also reported inconsistent findings in the abundance of bacteria at different taxonomic levels. Radiation enteritis-derived microbiota could stimulate TNF-α and interleukin 1 beta (IL-1β) secretion. CONCLUSIONS Alteration of inflammatory markers, the gut microbiome, and their associations show emerging evidence in the development of psychoneurological symptoms and gastrointestinal toxicities in women with gynecologic cancers. More studies on the interactions between the immune system and the gut microbiome, two integral parts of the gut-brain axis, are required to shed light on the roles they play in symptom development.
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Affiliation(s)
| | - Claire Rowcliffe
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Julia Schrogin
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 30322, USA
| | - Rebecca Meador
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 30322, USA
| | - Deborah Watkins Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 30322, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
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Zhao C, Grubbs A, Barber EL. Sleep and gynecological cancer outcomes: opportunities to improve quality of life and survival. Int J Gynecol Cancer 2022; 32:669-675. [PMID: 35331996 PMCID: PMC9064983 DOI: 10.1136/ijgc-2022-003404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sleep is important for immune function, metabolic function and physical repair. Sleep is more commonly disrupted in women compared with men and is disrupted by surgery, chemotherapy, and cancer itself, making gynecological oncology patients at higher risk of insomnia and sleep disruption. Insomnia and sleep disruption are linked to increased pain, poorer quality of life, depression, and anxiety which can all negatively affect patient outcomes. A number of environmental, behavioral, and pharmacological interventions have been investigated to improve patient sleep and aid in the recovery process. It is vital to understand and address patient sleep quality in order to give patients the highest quality care and improve outcomes.
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Affiliation(s)
- Caroline Zhao
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Allison Grubbs
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emma L Barber
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA .,Institute for Public Health in Medicine, Chicago, Illinois, USA
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Wang SS, Zhong C, Epeldegui M, Nunes S, Magpantay L, DeHart JC, Hurley S, Goldberg D, Martinez E, Lacey JV, Martinez-Maza O, Reynolds P. Host characteristics associated with serologic inflammatory biomarkers in women. Cytokine 2022; 149:155726. [PMID: 34666235 PMCID: PMC8680201 DOI: 10.1016/j.cyto.2021.155726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is growing evidence that exposure to low-grade inflammation may be associated with adverse health outcomes. METHODS We conducted a cross-sectional study within the California Teachers Study prospective cohort, among female participants who had completed a questionnaire that asked about their health behaviors (e.g., diabetes, physical activity, body mass index, medication use) and who had donated blood within a year of their questionnaire. 822 women with stored serum were evaluated for 16 immune biomarkers. In addition, four immune pathways were constructed: Th1, pro-inflammatory/macrophage activation, B-cell activation, and T-cell activation. Odds ratios (ORs) and 95% confidence intervals (CI) for the association between host characteristics and immune biomarkers were assessed using logistic regression models. RESULT Compared to women of a normal BMI, obese women (>30 kg/m2) were positively associated with sTNFR2, CD27, IL6, CXCL13, sIL-2Rα, and IL6Ra levels above the median, with odds ratios ranging from 1.5 to 6.0. The pro-inflammatory/macrophage activation pathway was positively associated with diabetes (OR = 2.12, 95% CI = 1.14-3.95), fueled by individual associations between diabetes and sTNF-R2, TNFα and sCD27. Physical activity was inversely associated with sTNF-R2, TNFα, CXCL13, IL6, IL10, and IFN-γ levels, particularly for the highest category of activity (5.88+ hours/week) (ORs = 0.32-0.69). In pathway-based analyses, the Th1 pathway which includes decreased levels of IL4 and IL10 was positively associated with elevated physical activity (OR = 1.5). In contrast, the pro-inflammatory, B- and T-cell activation pathways were positively associated with higher BMI (OR ranging from 1.6 to 3) and inversely associated with increasing levels of physical activity. CONCLUSIONS Several host characteristics were associated with circulating levels of immune biomarkers, including markers of inflammation. Further understanding of associations between immune marker profiles with human disease are warranted.
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Affiliation(s)
- Sophia S Wang
- Division of Health Analytics, City of Hope, Duarte, CA, USA.
| | - Charlie Zhong
- Eugene and Ruth Roberts Academy, City of Hope, Duarte, CA, USA
| | | | - Sarah Nunes
- Eugene and Ruth Roberts Academy, City of Hope, Duarte, CA, USA; Chapman University, Orange, CA, USA
| | | | | | - Susan Hurley
- University of California San Francisco, CA, USA; Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, CA, USA
| | | | | | - James V Lacey
- Division of Health Analytics, City of Hope, Duarte, CA, USA
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Pozzar RA, Hammer MJ, Paul SM, Cooper BA, Kober KM, Conley YP, Levine JD, Miaskowski C. Distinct sleep disturbance profiles among patients with gynecologic cancer receiving chemotherapy. Gynecol Oncol 2021; 163:419-426. [PMID: 34521555 DOI: 10.1016/j.ygyno.2021.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In a sample of patients with gynecologic cancer receiving chemotherapy, we sought to identify subgroups of patients with distinct sleep disturbance profiles and assess for differences in patient characteristics and the severity of co-occurring symptoms among these subgroups. METHODS Adults with gynecologic cancer (n = 232) completed questionnaires six times over two chemotherapy cycles. Sleep disturbance was assessed using the General Sleep Disturbance Scale (GSDS). Clinically meaningful sleep disturbance was defined as a GSDS total score of ≥43. Subgroups of patients with distinct sleep disturbance profiles were identified using latent profile analysis. Differences in patient characteristics and co-occurring symptoms were assessed using Chi-square, Kruskal Wallis, and one-way analysis of variance. RESULTS Four distinct sleep disturbance profiles were identified: Low (18.5%), Moderate (43.6%), High (29.3%), and Very High (8.6%). Compared to the Low class, patients in the other three classes had lower functional status scores and higher levels of depressive symptoms, trait anxiety, and morning and evening fatigue. Compared to the Low class, patients in the Very High class were younger, had a higher body mass index, and were more likely to report a diagnosis of depression or back pain. CONCLUSIONS Over 80% of the patients with gynecologic cancer reported sleep disturbance that persisted over two cycles of chemotherapy. Patients in the Very High class experienced problems with both sleep initiation and maintenance. Clinicians should routinely assess sleep disturbance alongside depression, anxiety, and fatigue. Interventions that target the underlying mechanisms of these co-occurring symptoms are warranted.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, United States of America
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, United States of America
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, United States of America
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, United States of America
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, United States of America; School of Medicine, University of California, San Francisco, CA, United States of America.
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