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Eddington HS, McLeod M, Trickey AW, Barreto N, Maturen K, Morris AM. Patient-reported distress and age-related stress biomarkers among colorectal cancer patients. Cancer Med 2021; 10:3604-3612. [PMID: 33932256 PMCID: PMC8178484 DOI: 10.1002/cam4.3914] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/03/2021] [Accepted: 04/01/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Distress among cancer patients has been broadly accepted as an important indicator of well-being but has not been well studied. We investigated patient characteristics associated with high distress levels as well as correlations among measures of patient-reported distress and "objective" stress-related biomarkers among colorectal cancer patients. METHODS In total, 238 patients with colon or rectal cancer completed surveys including the Distress Thermometer, Problem List, and the Hospital Anxiety and Depression Scale. We abstracted demographic and clinical information from patient charts and determined salivary cortisol level and imaging-based sarcopenia. We evaluated associations between patient characteristics (demographics, clinical factors, and psychosocial and physical measures) and three outcomes (patient-reported distress, cortisol, and sarcopenia) with Spearman's rank correlations and multivariable linear regression. The potential moderating effect of age was separately investigated by including an interaction term in the regression models. RESULTS Patient-reported distress was associated with gender (median: women 5.0, men 3.0, p < 0.001), partnered status (single 5.0, partnered 4.0, p = 0.018), and cancer type (rectal 5.0, colon 4.0, p = 0.026); these effects varied with patient age. Cortisol level was associated with "emotional problems" (ρ = 0.34, p = 0.030), anxiety (ρ = 0.46, p = 0.006), and depression (ρ = 0.54, p = 0.001) among younger patients. We found no significant associations between patient-reported distress, salivary cortisol, and sarcopenia. CONCLUSIONS We found that young, single patients reported high levels of distress compared to other patient groups. Salivary cortisol may have limited value as a cancer-related stress biomarker among younger patients, based on association with some psychosocial measures. Stress biomarkers may not be more clinically useful than patient-reported measures in assessing distress among colorectal cancer patients.
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Affiliation(s)
- Hyrum S. Eddington
- S‐SPIRE CenterDepartment of SurgeryStanford UniversityStanfordCaliforniaUSA
| | - Megan McLeod
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Amber W. Trickey
- S‐SPIRE CenterDepartment of SurgeryStanford UniversityStanfordCaliforniaUSA
| | - Nicolas Barreto
- S‐SPIRE CenterDepartment of SurgeryStanford UniversityStanfordCaliforniaUSA
| | - Katherine Maturen
- Department of RadiologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Arden M. Morris
- S‐SPIRE CenterDepartment of SurgeryStanford UniversityStanfordCaliforniaUSA
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2
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Groarke A, Curtis R, Skelton J, Groarke JM. Quality of life and adjustment in men with prostate cancer: Interplay of stress, threat and resilience. PLoS One 2020; 15:e0239469. [PMID: 32941547 PMCID: PMC7498057 DOI: 10.1371/journal.pone.0239469] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/04/2020] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Diagnosis and treatment of prostate cancer can generate many challenges which impact on adjustment, so understanding the psychosocial factors which contribute to individual vulnerability to poor adaptation warrants further investigation. This study investigates stress and masculine identity threat as predictors of quality of life and emotional adjustment in men with localized prostate cancer and the role of resilience as a potential protective psychological factor. METHODS Participants were invited to complete a survey study via online prostate cancer forums. Participants were 204 men ranging in age from 44-88 years (M = 65.24±7.51) and who were diagnosed with early localized prostate cancer within the previous five years. Measures used included the Perceived Stress Scale, Cancer-Related Masculine Threat Scale and the Conor-Davidson Resilience Scale. Using a cross-sectional online survey design, the extent to which perceived stress, masculine threat and psychological resilience are associated with quality of life, positive and negative affect and distress was assessed. RESULTS Hierarchical regression analysis demonstrated that perceived stress accounted for 26%-44% of variance on quality of life and adjustment indices, with high stress associated with low mood and poor quality of life. Low masculine threat and high resilience predicted better quality of life and emotional adjustment accounting for between 1-7% of the variance. Resilience moderated the relationship between stress and distress and mediated the association between masculine threat and distress and negative affect. CONCLUSION Perceived stress was the most powerful predictor in the model and findings suggest it contributes significantly to functional and affective status in survivors of prostate cancer. Psychological resilience is a protective factor which buffers the negative effect of stress and masculine identity threat on emotional adjustment. Findings indicate that men should be screened as part of the diagnostic and treatment process for high perceived stress and low resilience to identify those at risk for poor adjustment during survivorship.
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Affiliation(s)
- AnnMarie Groarke
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Ruth Curtis
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jean Skelton
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jenny M. Groarke
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
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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.
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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
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Hoyt MA, Gaffey AE, Wang AW, Litwin MS, Lawsin CJ. Sexual well-being and diurnal cortisol after prostate cancer treatment. J Health Psychol 2018; 25:1796-1801. [PMID: 29696999 DOI: 10.1177/1359105318772655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sexual dysfunction and psychological distress are common after prostate cancer. Research has not examined the role of neuroendocrine markers of stress (e.g. cortisol). This study examines whether sexual functioning or sexual bother is associated with diurnal cortisol. Men treated for prostate cancer completed the University of California-Los Angeles Prostate Cancer Index and provided saliva samples four times daily for cortisol assessment. Higher sexual bother, but not sexual functioning, was associated with steeper cortisol slope. Better sexual functioning, and not sexual bother, was significantly associated with the cortisol awakening response. Assessment of stress and stress-reducing interventions might be warranted in sexual rehabilitation after prostate cancer.
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Yang YL, Li MY, Liu L, Wang L. Perceived stress and its associated demographic-clinical characteristics and positive expectations among Chinese cervical, kidney, and bladder cancer patients. Support Care Cancer 2018; 26:2303-2312. [PMID: 29404843 DOI: 10.1007/s00520-018-4081-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/29/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Positive expectations about personal abilities and future outcomes are important in shaping human behavior and emotion, which may influence the psychological adjustment in cancer patients. We aimed to assess two basic kinds of perceived stress in Chinese cancer patients and to investigate their associations with demographic-clinical characteristics and positive expectations. METHODS A multi-center, cross-sectional study was conducted in consecutive cervical, kidney, and bladder cancer inpatients from three general hospitals in Liaoning province from February 2013 to August 2014. A total of 790 patients eligible for this study completed questionnaires on demographic-clinical variables, optimism, general self-efficacy, perceived global, and cancer-related stress anonymously. Hierarchical regression analyses were conducted to examine the relationships between optimism, general self-efficacy, and perceived stress, after controlling for possible covariates. RESULTS Mean score of perceived global stress was 17.85 (SD 4.43). Mean score of perceived cancer-related stress was 37.15 (SD 12.66); 38.1% of the sample scored 44 and above, 20.1% scored 50 and above. Education, physical activity, cancer stage, and time since diagnosis were significantly associated with perceived stress. Optimism and general self-efficacy accounted for an additional variance in perceived global (14.9%) and cancer-related stress (16.9%), and both of them were independent and protective variables of perceived stress. CONCLUSIONS This study recognized cancer patients at risk for high levels of perceived stress and extended the understanding of the association between positive expectations and perceived global and cancer-related stress. Enhancing or maintaining optimism and general self-efficacy might be potential targets for future psychosocial interventions aimed at relieving perceived stress in cancer patients.
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Affiliation(s)
- Yi-Long Yang
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Meng-Yao Li
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Li Liu
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People's Republic of China.
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The influence of cancer on endocrine, immune, and behavioral stress responses. Physiol Behav 2016; 166:4-13. [DOI: 10.1016/j.physbeh.2015.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/10/2015] [Accepted: 09/30/2015] [Indexed: 12/21/2022]
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Liu Y, Zhang R, Qiu F, Li K, Zhou Y, Shang D, Xu Y. Construction of a lncRNA-PCG bipartite network and identification of cancer-related lncRNAs: a case study in prostate cancer. MOLECULAR BIOSYSTEMS 2014; 11:384-93. [PMID: 25385343 DOI: 10.1039/c4mb00439f] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
LncRNAs are involved in a wide range of biological processes, such as chromatin remodeling, mRNA splicing, mRNA editing and translation. They can either upregulate or downregulate gene expression, and play key roles in the progression of various human cancers. However, the functional mechanisms of most lncRNAs still remain unknown at present. This paper aims to provide space for the understanding of lncRNAs by proposing a new method to obtain protein-coding genes (PCGs) regulated by lncRNAs, thus identifying candidate cancer-related lncRNAs using bioinformatics approaches. This study presents a method based on sample correlation, which is applied to the expression profiles of lncRNAs and PCGs in prostate cancer in combination with protein interaction data to build a lncRNA-PCG bipartite network. Candidate cancer-related lncRNAs were extracted from the bipartite network by using a random walk. 14 prostate cancer-related lncRNAs were acquired from the LncRNADisease database and MNDR, of which 6 lncRNAs were present in our network. As one of the seed nodes, ENSG00000234741 achieved the highest score among them. The other two cancer-related lncRNAs (ENSG00000225937 and ENSG00000236830) were ranked within the top 30. In addition, the top candidate lncRNA ENSG00000261777 shares an intron with DDX19, and interacts with IGF2 P1, indicating its involvement in prostate cancer. In this paper, we described a new method for predicting candidate lncRNA targets, and obtained candidate therapeutic targets using this method. We hope that this study will bring a new perspective in future lncRNA studies.
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Affiliation(s)
- Yongjing Liu
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China.
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Curtis R, Groarke A, Sullivan F. Stress and self-efficacy predict psychological adjustment at diagnosis of prostate cancer. Sci Rep 2014; 4:5569. [PMID: 24993798 PMCID: PMC4081888 DOI: 10.1038/srep05569] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/12/2014] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer is the most frequently non-skin cancer diagnosed among men. Diagnosis, a significant burden, generates many challenges which impact on emotional adjustment and so warrants further investigation. Most studies to date however, have been carried out at or post treatment with an emphasis on functional quality of life outcomes. Men recently diagnosed with localised prostate cancer (N = 89) attending a Rapid Access Prostate Clinic to discuss treatment options completed self report questionnaires on stress, self-efficacy, and mood. Information on age and disease status was gathered from hospital records. Self-efficacy and stress together explained more than half of the variance on anxiety and depression. Self-efficacy explained variance on all 6 emotional domains of the POMS (ranging from 5–25%) with high scores linked to good emotional adjustment. Perceived global and cancer specific stress also explained variance on the 6 emotional domains of the POMS (8–31%) with high stress linked to poor mood. These findings extend understanding of the role of efficacy beliefs and stress appraisal in predicting emotional adjustment in men at diagnosis and identify those at risk for poor adaptation at this time. Such identification may lead to more effective patient management.
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Affiliation(s)
- Ruth Curtis
- School of Psychology, National University of Ireland, Galway
| | | | - Frank Sullivan
- Prostate Cancer Institute, National University of Ireland, Galway
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Hsiao CP, Moore IMK, Insel KC, Merkle CJ. Symptom self-management strategies in patients with non-metastatic prostate cancer. J Clin Nurs 2013; 23:440-9. [PMID: 23551614 DOI: 10.1111/jocn.12178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the association between symptoms, symptom distress and symptom self-management and to identify effective strategies of symptom self-management in men with non-metastatic prostate cancer following radical prostatectomy or radiation therapy. BACKGROUND Men receiving treatments for localised prostate cancer experience symptoms of urinary incontinence, urinary obstruction/irritation, bowel difficulties and sexual dysfunction. Understanding patients' symptom experiences and identifying strategies that they use to manage these symptoms are imperative for symptom management planning. DESIGN A descriptive, cross-sectional study was conducted with a sample of 53 men, who were within three months of the initiation of their treatment. METHODS The Symptom Indexes and the Strategy and Effectiveness of Symptom Self-Management questionnaires were used to measure symptoms, symptom distress and symptom self-management. Descriptive statistics, t-tests, correlations and multiple regressions were used to analyse the data. RESULTS Symptoms were significantly correlated with symptom-related distress (r = 0·67, p < 0·01). Frequency of symptoms was significantly associated with symptom self-management strategies for urinary (β = 0·50, p < 0·01), bowel (β = 0·71, p < 0·01) and sexual problems (β = 0·28, p = 0·05). The most effective strategies were as follows: pads and doing Kegel exercise for managing urinary problems, rest and endurance for bowel symptoms, and expressing feelings and finding alternative ways to express affection for management of sexual dysfunction. CONCLUSIONS Assessing symptom self-management among men with newly diagnosed prostate cancer can help healthcare providers develop strategies that will enhance health-related quality of life. RELEVANCE TO CLINICAL PRACTICE Results provide information on effective strategies that patients with prostate cancer found to reduce their symptoms. The strategies used provide a foundation for developing and testing interventions for personalised symptom management.
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Affiliation(s)
- Chao-Pin Hsiao
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
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Gordijn MS, van Litsenburg RR, Gemke RJBJ, Bierings MB, Hoogerbrugge PM, van de Ven PM, Heijnen CJ, Kaspers GJL. Hypothalamic-pituitary-adrenal axis function in survivors of childhood acute lymphoblastic leukemia and healthy controls. Psychoneuroendocrinology 2012; 37:1448-56. [PMID: 22385687 DOI: 10.1016/j.psyneuen.2012.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 12/20/2011] [Accepted: 01/31/2012] [Indexed: 12/30/2022]
Abstract
Of all malignancies in children, acute lymphoblastic leukemia (ALL) is the most common type. Since survival significantly improves over time, treatment-related side effects become increasingly important. Glucocorticoids play an important role in the treatment of ALL, but they may suppress the hypothalamic-pituitary-adrenal (HPA) axis. The duration of HPA axis suppression is not yet well defined. The present study aimed at assessing the function of the HPA axis by determining the cortisol awakening response (CAR) and the dexamethasone (DEX) suppression test in children that were treated for childhood ALL, compared to a healthy age and sex matched reference group. In addition, questionnaires regarding sleep, fatigue, depression and quality of life were completed by the children and their parents. Fourty-three survivors who finished their treatment for childhood ALL 37 (interquartile range 22-75) months before and 57 healthy controls were included. No differences in CAR were observed between ALL survivors and the reference group, but survivors of ALL had higher morning cortisol levels and an increased cortisol suppression in response to oral dexamethasone. Higher cortisol levels in childhood ALL survivors were associated with more fatigue and poorer quality of life. We conclude that the experience of a stressful life event in the past may have caused a long-term dysregulation of the HPA axis in childhood ALL survivors, as reflected in an increased cortisol production and an enhanced negative feedback mechanism.
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Affiliation(s)
- Maartje S Gordijn
- Department of Pediatrics, Division Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands.
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