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Cruz E, Mendez A, Ting A, Spiegel D, Tsai TC, Carver CS, Kim Y. The associations of spirituality and Hispanic ethnicity with neuroendocrine biomarkers among patients with colorectal cancer. J Psychosom Res 2024; 185:111865. [PMID: 39116686 DOI: 10.1016/j.jpsychores.2024.111865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/19/2024] [Accepted: 07/21/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Dealing with cancer evokes not only physical and emotional distress, but may also promote resilience through spirituality. Patients with cancer are vulnerable to neuroendocrine dysregulation. This longitudinal observational study examined the degree to which spirituality was associated with neuroendocrine biomarkers and the moderating role of Hispanic ethnicity. METHODS Participants were adults who were recently diagnosed with colorectal cancer (n = 81, 55 years old, 66% male, 63% Hispanic, 72% advanced cancer, 7 months post-diagnosis). The domains of spirituality (faith, meaning, and peace) and ethnicity (Hispanic vs. non-Hispanic) were self-reported. Cortisol and alpha amylase (sAA) were assayed from saliva samples collected at waking and bedtime on seven consecutive days. Mean levels at waking and bedtime, and diurnal slopes over seven days were calculated. Age and cancer stage were covariates. RESULTS Overall, patients reported moderate to high levels of spirituality. General linear modeling revealed that greater faith was associated with higher levels of sAA at waking and bedtime as well as more blunted diurnal pattern of sAA only among Hispanic patients (p ≤ .045). Greater peace was associated with steeper diurnal pattern of sAA, regardless of ethnicity (B = 0.021, p = .005). Meaning and cortisol were not significantly associated with study variables. CONCLUSIONS Findings indicate that presence of peace facing a cancer diagnosis associated with neuroendocrine regulation, whereas drawing on one's faith, particularly among Hispanic patients, associated with neuroendocrine dysregulation during the first months after the diagnosis. Further investigations of psychobiobehavioral moderators and mediators for healthy neuroendocrine functioning among patients with cancer are warranted.
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Affiliation(s)
| | | | - Amanda Ting
- Department of Psychology, University of Miami, USA
| | - David Spiegel
- Department of Psychiatry & Behavioral Sciences, Stanford University, USA
| | | | | | - Youngmee Kim
- Department of Psychology, University of Miami, USA.
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2
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Boing L, Fretta TDB, Lynch BM, Dias M, Rosa LMD, Baptista F, Bergmann A, Fausto DY, Bocchi Martins JB, Guimarães ACDA. Mat Pilates and belly dance: Effects on patient-reported outcomes among breast cancer survivors receiving hormone therapy and adherence to exercise. Complement Ther Clin Pract 2023; 50:101683. [PMID: 36403344 DOI: 10.1016/j.ctcp.2022.101683] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/16/2022] [Accepted: 10/29/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Breast cancer treatment leads to several side effects. Exercise can help to reduce these side effects. However, it is unknown whether a mat Pilates or a belly dance intervention can improve the patient-reported outcomes of these women. OBJECTIVE Examine the effects of a 16-week exercise intervention (mat Pilates or belly dance) on patient reported outcomes (PROs) among breast cancer survivors, at 16 weeks, six months, and 12 months; and investigate sociodemographic and clinical predictors of intervention adherence. METHODS Seventy-four breast cancer survivors who were receiving hormone therapy were randomly allocated into mat Pilates (n = 25), belly dance (n = 25) or control group (educational sessions) (n = 24). Mat Pilates and belly dance groups received a 16-week intervention, delivered three days a week and 60 min a session. The control group received three education sessions and continue usual care. The patient reported outcomes assessed were depressive symptoms (Beck Depression Inventory), stress (Perceived Stress Scale), optimism (Life Orientation Test), fatigue (FACT-F), sleep quality (Pittsburgh Sleep Quality Index) and pain (VAS), clinical and sociodemographic characteristics, and habitual physical activity (IPAQ short). RESULTS All three groups showed a significant improvement in fatigue, and this effect was maintained during follow-up. No significant effects were found for depressive symptoms, optimism, stress, or pain. A history of exercise prior to breast cancer and be inactive after diagnosis were significant predictors of adherence to interventions. CONCLUSION Mat Pilates, belly dance and a few educational sessions can be effective in improving fatigue after 16 weeks of intervention. REGISTRATION ClinicalTrials.gov (NCT03194997).
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Affiliation(s)
- Leonessa Boing
- College of Health and Sport Science, Santa Catarina State University, Florianopolis, Brazil; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
| | | | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
| | - Mirella Dias
- College of Health and Sport Science, Santa Catarina State University, Florianopolis, Brazil.
| | - Luciana Martins da Rosa
- Nursing Department, School of Health Sciences, Federal University of Santa Catarina, Florianopolis, Brazil.
| | - Fátima Baptista
- Universidade de Lisboa Faculdade de Motricidade Humana, Exercise and Health Laboratory, Interdisciplinary Center for the Study of Human Performance, Cruz Quebrada, Lisboa, Portugal.
| | - Anke Bergmann
- Clinical Epidemiology, National Institute of Cancer, Rio de Janeiro, Brazil.
| | - Danielly Yani Fausto
- College of Health and Sport Science, Santa Catarina State University, Florianopolis, Brazil.
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Al-Bashaireh AM, Khraisat O, Alnazly EK, Aldiqs M. Inflammatory Markers, Metabolic Profile, and Psychoneurological Symptoms in Women with Breast Cancer: A Literature Review. Cureus 2021; 13:e19953. [PMID: 34976536 PMCID: PMC8713038 DOI: 10.7759/cureus.19953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
Breast cancer is one of the most prevalent cancers in women. The improvement in breast cancer treatment has significantly increased the proportion of survival rate for women with breast cancer. Despite the advancement in breast cancer treatment, a great proportion of survivors suffer from co-occurring psychoneurological symptoms which impact their quality of life. The most frequently reported psychoneurological symptoms among women with breast cancer are depressive symptoms, anxiety, fatigue, sleep disturbances, and pain. These symptoms usually appear as a cluster. Inflammatory activation and serum metabolic alterations have been associated with the etiology of cancer and with various chronic neurocognitive disorders. However, to date, no studies considered the combined effects of inflammatory markers and metabolites in the development of psychoneurological symptoms in women with breast cancer especially those who were treated with chemotherapy. Further clarification of the relationships between the inflammatory markers, serum metabolic alterations, and psychoneurological symptoms in women with breast cancer should be pursued.
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Abstract
PURPOSE OF REVIEW Depression is a prevalent comorbidity in cancer that significantly increases the risk for numerous negative health outcomes. This review updates the current evidence base for management of depression in cancer, highlighting new research directions based on the inflammatory hypothesis of depression. RECENT FINDINGS Research on pharmacotherapy and psychotherapy for depression in cancer has shown mixed efficacy partly because of methodological issues arising from the phenomenology of depression in cancer. After decades of stagnancy, more recent high-quality clinical trials are beginning to provide an evidence base to guide treatment. Inflammatory cytokine-associated depression is a subtype of depression that may have particular relevance in cancer, opening new avenues to explore therapeutic targets and biobehavioral impacts of interventions, which may improve cancer outcomes. SUMMARY The continuum of severity in cancer-related depression is important to consider in management approaches. Choice of treatment should be personalized to the patient and their symptom profile as there is currently insufficient evidence to recommend any particular medication or psychotherapy over another. Psychological interventions should be considered first line for mild-to-moderate depression, and pharmacological treatment added for more severe depression, which can be optimally delivered within a collaborative care model. VIDEO ABSTRACT http://links.lww.com/YCO/A62.
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Affiliation(s)
- Aliza A Panjwani
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
| | - Madeline Li
- Division of Psychosocial Oncology, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
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Papanastasiou A, Seliniotaki T, Rizos E, Kampoli K, Ntavatzikos A, Arkadopoulos N, Tsionou C, Spandidos DA, Koumarianou A. Role of stress, age and adjuvant therapy in the cognitive function of patients with breast cancer. Oncol Lett 2019; 18:507-517. [PMID: 31289522 PMCID: PMC6540331 DOI: 10.3892/ol.2019.10361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/10/2019] [Indexed: 02/05/2023] Open
Abstract
According to data largely obtained from retrospective studies, it has been postulated that chemotherapy exerts an aggravating effect on the cognitive function of patients with breast cancer. Potential individual factors related to the effects of chemotherapy on cognitive function have been indicated, such as age-related cognitive dysfunction and stress. Elderly patients differ from non-elderly patients as regards higher cognitive related comorbidities, such as dementia, as well as regarding lower stress levels, indicating that 'chemobrain' may differentially affect these two age groups. The aim of this review was to discuss the effects of stress and chemotherapy on cognitive dysfunction and identify any potential age-related differences in patients with breast cancer treated with adjuvant chemotherapy. For this purpose, a systematic review of the literature was carried out on the PubMed, Scopus and Web of Science databases. The inclusion criteria were original articles published in peer-reviewed journals, elderly and non-elderly patients with breast cancer, reporting on stress and at least one cognitive parameter pre- and/or post-treatment. Eight studies met the preset criteria and were further analyzed. In total, the data of 1,253 women were included, of whom 800 patients with breast cancer were treated with surgery only, systemic treatment only, or both. Although all the studies included a non-elderly breast cancer patient subpopulation, only two of the studies included patients over 65 years of age. All studies indicated a statistically significant association of stress with various domains of cognitive dysfunction in patients, as shown by either self-completed questionnaires, neuropsychological testing or both. An age over 60 years was linked to fewer cognitive difficulties mediated by lower levels of stress. Thus, the evidence supports the association of stress with cognitive deficits in patients with breast cancer, regardless of the type of cancer-related treatment. Therefore, stress should be appropriately addressed. However, further research is required to investigate the association of stress with cognitive function in elderly patients with breast cancer.
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Affiliation(s)
- Artemis Papanastasiou
- Second Department of Psychiatry, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Theodora Seliniotaki
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Katerina Kampoli
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anastasios Ntavatzikos
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Nikolaos Arkadopoulos
- Fourth Department of Surgery, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Christina Tsionou
- Department of Breast Diseases, Maternity-Health, 15232 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Correspondence to: Dr Anna Koumarianou, Hematology-Oncology Unit, Fourth Department of Internal Medicine, University General Hospital ‘ATTIKON’, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari, 12462 Athens, Greece, E-mail:
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Pilevarzadeh M, Amirshahi M, Afsargharehbagh R, Rafiemanesh H, Hashemi SM, Balouchi A. Global prevalence of depression among breast cancer patients: a systematic review and meta-analysis. Breast Cancer Res Treat 2019; 176:519-533. [PMID: 31087199 DOI: 10.1007/s10549-019-05271-3] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/04/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE Depression in patients with breast cancer imposes huge costs to patients, families, and healthcare systems. The present study aimed at evaluating the global prevalence depression among patients with breast cancer. METHODS In this meta-analysis, three electronic databases (PubMed, Web of Science, and Scopus) were searched from 1 January, 2000 until 30 March, 2019. The Hoy tool was used to evaluate the quality of the articles included in the meta-analysis. The search, screening, quality evaluation, and data extraction were carried out by two of the researchers. RESULTS Of 47,424 studies, 72 studies performed in 30 countries entered the final stage of analysis. The global prevalence of depression was 32.2%. Specifically, the prevalence of depression was highest in the Eastern Mediterranean region and twice as high in middle-income countries as compared to developed countries. CONCLUSIONS Regarding the high prevalence of depression in patients with breast cancer, it is vital to carry out screening within standard time periods and offer the necessary emotional support.
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Affiliation(s)
- Motahare Pilevarzadeh
- Department of Nursing Education, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | | | | | - Hosein Rafiemanesh
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Mehdi Hashemi
- Clinical Immunology Research Center, Department of Internal Medicine, Hematology and Medical Oncology Ward, Ali-Ebne-Abitalelb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Abbas Balouchi
- Student Research Committee, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, Iran
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7
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Li M, Kouzmina E, McCusker M, Rodin D, Boutros PC, Paige CJ, Rodin G. Cytokines and depression in cancer patients and caregivers. Neuropsychiatr Dis Treat 2017; 13:2903-2911. [PMID: 29238195 PMCID: PMC5713706 DOI: 10.2147/ndt.s144774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE A better understanding of the biobehavioral mechanisms underlying depression in cancer is required to translate biomarker findings into clinical interventions. We tested for associations between cytokines and the somatic and psychological symptoms of depression in cancer patients and their healthy caregivers. PATIENTS AND METHODS The GRID Hamilton Rating Scale for Depression (Ham-D) was administered to 61 cancer patients of mixed type and stage, 26 primary caregivers and 38 healthy controls. Concurrently, blood was drawn for multiplexed plasma assays of 15 cytokines. Multiple linear regression, adjusted for biobehavioral variables, identified cytokine associations with the psychological (Ham-Dep) and somatic (Ham-Som) subfactors of the Ham-D. RESULTS The Ham-Dep scores of cancer patients were similar to their caregivers, but their Ham-Som scores were significantly higher (twofold, p=0.016). Ham-Som was positively associated with IL-1ra (coefficient: 1.27, p≤0.001) in cancer patients, and negatively associated with IL-2 (coefficient: -0.68, p=0.018) in caregivers. Ham-Dep was negatively associated with IL-4 (coefficient: -0.67, p=0.004) in cancer patients and negatively associated with IL-17 (coefficient: -1.81, p=0.002) in caregivers. CONCLUSION The differential severity of somatic symptoms of depression in cancer patients and caregivers and the unique cytokine associations identified with each group suggests the potential for targeted interventions based on phenomenology and biology. The clinical implication is that depressive symptoms in cancer patients can arise from biological stressors, which is an important message to help destigmatize the development of depression in cancer patients.
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Affiliation(s)
- Madeline Li
- Princess Margaret Cancer Centre, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina Kouzmina
- Informatics & Biocomputing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Megan McCusker
- Princess Margaret Cancer Centre, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Paul C Boutros
- Informatics & Biocomputing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Department of Pharmacology & Toxicology, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Christopher J Paige
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Princess Margaret Cancer Centre, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Sikora MJ. Family Matters: Collaboration and Conflict Among the Steroid Receptors Raises a Need for Group Therapy. Endocrinology 2016; 157:4553-4560. [PMID: 27835038 PMCID: PMC5133350 DOI: 10.1210/en.2016-1778] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Antiestrogen therapies targeting the function of estrogen receptor (ER) have been the cornerstone of therapy for ER+ breast cancer for decades. However, as long as these therapies have been in use, it has also been evident that response to antiestrogen therapy is not based solely on ER expression but that other factors modify breast cancer antiestrogen response. Such factors may include ER's relatives in the steroid hormone receptor (HR) family, androgen receptor (AR), progesterone receptor (PR), glucocorticoid receptor (GR), and mineralocorticoid receptor (MR). A series of recent studies has demonstrated that these HRs are not bystanders in ER signaling but rather can alter ER genomic binding and subsequent control of target gene expression. For example, PR and GR may "reprogram" ER binding to DNA toward PR/GR sites; androgen receptor may reverse ER gene regulation functions or regulate ER DNA binding. Accordingly, modulation of HR function concurrently with antiestrogen therapy can either improve antiestrogen response or mediate antiestrogen resistance. This highlights the critical need to better understand how other HRs influence ER function, in particular in the context of antiestrogen therapy. This review discusses recent insights into the mechanisms by which HRs can modify ER function and antiestrogen response, as well as pharmacological implications for antiestrogen therapies and potential combined endocrine therapies.
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Affiliation(s)
- Matthew J Sikora
- Department of Pathology, University of Colorado Denver | Anschutz Medical Campus, Aurora, Colorado 80045
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9
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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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Bevans MF, Ross A, Wehrlen L, Klagholz SD, Yang L, Childs R, Flynn SL, Remaley AT, Krumlauf M, Reger RN, Wallen GR, Shamburek R, Pacak K. Documenting stress in caregivers of transplantation patients: initial evidence of HPA dysregulation. Stress 2016; 19:175-84. [PMID: 26949170 PMCID: PMC4976925 DOI: 10.3109/10253890.2016.1146670] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There is growing evidence linking caregiver stress with an increased risk for morbidity and mortality. While the emotional and practical burden experienced by caregivers is well established, the physiological changes that may affect the caregiver's health are less understood. This study sought to compare self-reported stress, anxiety and depression along with neuroendocrine and immune markers of stress among adult caregivers of allogeneic hematopoietic stem cell transplantation patients during the acute transplant recovery period to matched non-caregivers controls. Biomarkers and self-reported data were collected at three points during the patient's HSCT: (1) before transplant, (2) after initial transplantation discharge (±7 days) and (3) 6 weeks after initial transplantation discharge. Mixed linear modeling was used to examine differences by group and time. Twenty-one caregivers and 20 controls completed all study procedures. The majority of caregivers were female (57% or 57.1%) and married (95.2%), with a mean age of 52 ± 11.4 years. Caregiver perceived stress, anxiety and depression scores were significantly higher than controls (p < 0.001) with effect sizes (ES) ranging from 1.37 to 1.80 and they did not change over time (p > 0.05) for either group. Caregivers had significantly lower serum cortisol levels than controls at both discharge (p = 0.013; ES = 0.81) and 6 weeks after discharge (p = 0.028; ES = 0.72) but exhibited no significant relationship between self-reported stress and serum cortisol. In addition, caregivers showed a significant inverse relationship between stress and epinephrine levels (r(s)=-0.654, p = 0.021). These findings support the evidence of the caregiving experience being stressful. The counter-intuitive relationship between cortisol and epinephrine might suggest dysregulation of the HPA axis and central nervous system but additional research on the physiological impact of caregiving is warranted.
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Affiliation(s)
- Margaret F. Bevans
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Alyson Ross
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Leslie Wehrlen
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Stephen D. Klagholz
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Li Yang
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Richard Childs
- National Heart, Lung, and Blood Institute, 10 Center Drive, Bethesda, MD, USA
| | - Sharon L. Flynn
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Alan T. Remaley
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Robert N. Reger
- National Heart, Lung, and Blood Institute, 10 Center Drive, Bethesda, MD, USA
| | - Gwenyth R. Wallen
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, USA
| | - Robert Shamburek
- National Heart, Lung, and Blood Institute, 10 Center Drive, Bethesda, MD, USA
| | - Karel Pacak
- National Institute of Child Health and Human Development, 10 Center Drive, Bethesda, MD, USA
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Shinn EH, Valentine A, Jethanandani A, Basen-Engquist K, Fellman B, Urbauer D, Atkinson E, Yusuf SW, Lenihan D, Woods ML, Kies MS, Sood AK, Carmack C, Morrison WH, Gillenwater A, Sturgis EM, Garden AS. Depression and Oropharynx Cancer Outcome. Psychosom Med 2016; 78:38-48. [PMID: 26632757 PMCID: PMC4696911 DOI: 10.1097/psy.0000000000000256] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Studies have shown a modest relationship between depression and mortality in patients with cancer. Our study addressed methodological weaknesses in the literature by restricting the sample to patients with one cancer type, adjusting for factors known to affect outcome, and following up patients for a sufficient period. METHODS We prospectively followed patients newly diagnosed with squamous cell oropharyngeal cancer from the start of radiation therapy until death or until date of last clinical visit. All patients were optimally treated with radiation and sometimes chemotherapy. After adjusting for tumor stage, treatment, comorbidities, smoking, excessive alcohol use, and demographic factors, we assessed the effects of baseline self-reported depression on overall survival and recurrence. RESULTS One hundred thirty participants were followed for a median of 5 years. The average age was 56 years, and 83% were male. Eighteen participants died during the study and 15 experienced disease recurrence. Self-reported depression was associated with decreased overall survival duration (hazard ratio = 3.6, 95% confidence interval = 1.2-10.8) and disease recurrence (hazard ratio = 3.8, 95% confidence interval = 1.2-12.2) in multivariate analysis. In addition, smoking was associated with disease recurrence. CONCLUSIONS Patients with oropharyngeal cancer may benefit from depression screening and evidence-based treatments, if appropriate. Future studies are needed to determine whether depression is an independent prognostic factor of outcome and to elucidate biobehavioral mechanisms involved in patients with oropharyngeal cancer.
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Affiliation(s)
- Eileen H. Shinn
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center
| | - Alan Valentine
- Department of Psychiatry, University of Texas M. D. Anderson Cancer Center
| | - Amit Jethanandani
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center
| | - Karen Basen-Engquist
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center
| | - Bryan Fellman
- Department of Biostatistics, University of Texas M. D. Anderson Cancer Center
| | - Diana Urbauer
- Department of Biostatistics, University of Texas M. D. Anderson Cancer Center
| | - Emma Atkinson
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center
| | - Syed Wamique Yusuf
- Department of Cardiology, University of Texas M. D. Anderson Cancer Center
| | - Daniel Lenihan
- Department of Cardiology, Vanderbilt University Medical Center
| | - Myrshia L. Woods
- Department of Cardiology, University of Texas M. D. Anderson Cancer Center
| | - Merrill S. Kies
- Department of Thoracic Medical Oncology, University of Texas M. D. Anderson Cancer Center
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M. D. Anderson Cancer Center
| | - Cindy Carmack
- Department of Palliative Care, University of Texas M. D. Anderson Cancer Center
| | - William H. Morrison
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center
| | - Ann Gillenwater
- Department of Head and Neck Cancer Surgery, University of Texas M. D. Anderson Cancer Center
| | - Erich M. Sturgis
- Department of Head and Neck Cancer Surgery, University of Texas M. D. Anderson Cancer Center
| | - Adam S. Garden
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center
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The Mediating Role of Mental Adjustment in the Relationship between Perceived Stress and Depressive Symptoms in Hematological Cancer Patients: A Cross-Sectional Study. PLoS One 2015; 10:e0142913. [PMID: 26587991 PMCID: PMC4666411 DOI: 10.1371/journal.pone.0142913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background Depression is a particularly common psychological disorder that affects cancer patients. Diagnosed with hematological malignancies constitute a serious unpredictable and uncontrollable medical stress situation and patients are susceptible to suffer from depressive symptoms. The aims of the study were to explore the correlation between perceived stress and depressive symptoms in patients with hematological malignancies, and assess the mediating role of mental adjustment between these variables. Methods A single center, cross-sectional study was performed by convenience sampling between July 2013 and April 2014 in a hospital of China. The Center for Epidemiologic Studies Depression Scale, Perceived Stress Scale, and Mini-Mental Adjustment Scale, as well as questions about demographic and clinical factors was distributed to 300 hematological cancer patients. Completed questionnaires were received from 227 inpatients. Results The results showed that perceived stress was positively correlated with depressive symptoms. The mental adjustment significantly mediated the relationship between perceived stress and depressive symptoms. Conclusions Among hematological cancer patients perceived stress may be a risk factor for depressive symptoms, whereas positive coping style might be protective against depressive symptoms. Results showed that medical managers could support the development of mental adjustment in the patients to alleviate psychological disorders.
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13
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Aboalela N, Lyon D, Elswick RK, Kelly DL, Brumelle J, Bear HD, Jackson-Cook C. Perceived Stress Levels, Chemotherapy, Radiation Treatment and Tumor Characteristics Are Associated with a Persistent Increased Frequency of Somatic Chromosomal Instability in Women Diagnosed with Breast Cancer: A One Year Longitudinal Study. PLoS One 2015; 10:e0133380. [PMID: 26177092 PMCID: PMC4503400 DOI: 10.1371/journal.pone.0133380] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/26/2015] [Indexed: 11/18/2022] Open
Abstract
While advances in therapeutic approaches have resulted in improved survival rates for women diagnosed with breast cancer, subsets of these survivors develop persistent psychoneurological symptoms (fatigue, depression/anxiety, cognitive dysfunction) that compromise their quality of life. The biological basis for these persistent symptoms is unclear, but could reflect the acquisition of soma-wide chromosomal instability following the multiple biological/psychological exposures associated with the diagnosis/treatment of breast cancer. An essential first step toward testing this hypothesis is to determine if these cancer-related exposures are indeed associated with somatic chromosomal instability frequencies. Towards this end, we longitudinally studied 71 women (ages 23-71) with early-stage breast cancer and quantified their somatic chromosomal instability levels using a cytokinesis-blocked micronuclear/cytome assay at 4 timepoints: before chemotherapy (baseline); four weeks after chemotherapy initiation; six months after chemotherapy (at which time some women received radiotherapy); and one year following chemotherapy initiation. Overall, a significant change in instability frequencies was observed over time, with this change differing based on whether the women received radiotherapy (p=0.0052). Also, significantly higher instability values were observed one year after treatment initiation compared to baseline for the women who received: sequential taxotere/doxorubicin/cyclophosphamide (p<0.001) or taxotere/cyclophosphamide (p=0.014). Significant predictive associations for acquired micronuclear/cytome abnormality frequencies were also observed for race (p=0.0052), tumor type [luminal B tumors] (p=0.0053), and perceived stress levels (p=0.0129). The impact of perceived stress on micronuclear/cytome frequencies was detected across all visits, with the highest levels of stress being reported at baseline (p =0.0024). These findings suggest that the cancer-related exposome has an impact on both healthy somatic cells and tumor cells, and may lead to persistent chromosomal instability. In addition, stress was a significant predictor of chromosomal instability; thus, interventions that aim to reduce stress may reduce acquired soma-wide chromosomal instability for cancer survivors.
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Affiliation(s)
- Noran Aboalela
- Department of Human & Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Debra Lyon
- Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - R. K. Elswick
- Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Debra Lynch Kelly
- Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jenni Brumelle
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Harry D. Bear
- Division of Surgical Oncology, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Colleen Jackson-Cook
- Department of Human & Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, United States of America
- * E-mail:
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14
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Ouakinin S, Eusebio S, Torrado M, Silva H, Nabais I, Gonçalves G, Bacelar-Nicolau L. Stress reactivity, distress and attachment in newly diagnosed breast cancer patients. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1121491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Abstract
Depressive symptoms are common among patients with cancer, and both psychological stress and physiological factors have been implicated in the etiology of depression. Scientific progress in this area is challenged by the changing nature of psychological and physiological processes over the course of cancer diagnosis and treatment. The article by Wu and colleagues in the current issue of Psychosomatic Medicine provides an example of thoughtful consideration of the complex longitudinal relationships between psychological stress, physiology, and depressive symptoms. These findings are put into context by discussing broader challenges in this area, with a focus on the contribution of inflammatory processes caused by cancer and/or its treatment to depressive and related sickness behavior symptoms. We outline several regulatory pathways by which cortisol, inflammatory processes, and depressive symptoms may interact in the context of cancer and highlight implications of these interactions for tumor progression. Additional research is needed to delineate these pathways and advance scientific understanding of the biobehavioral mechanisms underlying depressive symptoms in the context of cancer, with important implications for the development of effective interventions for patients undergoing initial cancer treatment, as well as for long-term survivors.
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