Stress Reactivity, Health Behaviors, and Compliance to Medical Care in Breast Cancer Survivors

The relationships between stress, coping strategies, and quality of life among gynecologic cancer survivors

Many studies have reported that gynecologic cancer diagnosis, surgery, adjuvant therapy, and survivorship can be extremely stressful for many people during their cancer journey, and most cancer survivors have experienced stress after cancer, which impacts their quality of life. Importantly, healthy stress management will assist patients in overcoming obstacles in their lives and enhance both the quality of life and the cancer adjustment process. This study aimed to investigate the relationships between stress, coping strategies, and quality of life among gynecologic cancer survivors and to assess the mediating effects of coping on the relationship between quality of life and stress. A series of regression models and Sobel test were conducted to investigate whether coping strategies mediated the relationship between stress and quality of life. Stress was a predictor of quality of life. Acceptance was the mediator between stress and quality of life. Tailored programs that foster coping strategies, such as the strategy of acceptance, to reduce stress and maintain quality of life in this vulnerable group need to be developed.

Nighttime salivary cortisol as a biomarker of stress and an indicator of worsening quality of life in patients with head and neck cancer: A cross‐sectional study

Background

Aim

Methods

Results

Conclusion

A laboratory medical anamnesis interview elicits psychological and physiological arousal

Since medical communication can be perceived as stressful, the assessment of patients' physiological arousal and behavior during anamnesis interviews may lead to a better understanding of doctor-patient interactions. Therefore, the aim of this study was to test physiological arousal and word use in a laboratory anamnesis interview. In total, sixty-five participants with a mean age of 25.0 years were randomly assigned either to an experimental group (n = 35, 65.7% women) in which they underwent an anamnesis interview or to a control group (n = 30, 73.3% women). Physiological arousal was assessed by salivary cortisol, salivary alpha-amylase (sAA), heart rate (HR) and heart rate variability (HRV). Psychological arousal was assessed using the Positive and Negative Affect Schedule (PANAS). Anamnesis interviews were analyzed using the Linguistic Inquiry and Word Count text analysis tool (LIWC). Participants of the experimental group showed an increase of sAA, HR and negative affect (p's ≤.0.05). Moreover, higher cortisol area under the curve with respect to ground (AUCg) was associated with lesser use of positive emotion words during the interview and subsequent higher negative affect (p's <.05). These results indicate that talking about one's own and family's medical history in anamnesis interview induces physiological arousal. Our findings suggest that anamnesis interviews could not only induce higher negative affect, but also induce physiological arousal, underscoring the importance of good doctor-patient communication.

Association of Short-Term Heart Rate Variability With Breast Tumor Stage

Cardiac autonomic modulation, assessed by heart rate variability (HRV), is associated with tumor pathogenesis and development as well as invasion and metastasis. This study aimed to examine this association in breast cancer (BC) patients. A total of 133 patients (average age 49.2years) with BC or benign breast tumors were divided into three groups: benign group, early-stage group, and advanced-stage group. About 5-min resting ECG was collected for the analysis of linear and nonlinear HRV parameters. Multiple logistic regression models were performed to test the independent contribution of HRV to breast tumor stage. The advanced-stage group had significantly reduced HRV compared to the benign and early-stage groups. In particular, for each 1-SD increase in SD2, SD of normal-to-normal intervals, very-low frequency, total power, and low frequency, the odds of having advanced staging decreased by 69.3, 64.3, 58.3, 53.3, and 65.9%, respectively. These associations were independent of age, body mass index, mean heart rate (HR), and respiratory rate (RR). These findings suggest an association between HRV and breast tumor stage, and HRV parameters may help construct an effective early diagnostic and clinical prognostic model.

Stress and worry in the 2020 coronavirus pandemic: relationships to trust and compliance with preventive measures across 48 countries in the COVIDiSTRESS global survey

The COVIDiSTRESS global survey collects data on early human responses to the 2020 COVID-19 pandemic from 173 429 respondents in 48 countries. The open science study was co-designed by an international consortium of researchers to investigate how psychological responses differ across countries and cultures, and how this has impacted behaviour, coping and trust in government efforts to slow the spread of the virus. Starting in March 2020, COVIDiSTRESS leveraged the convenience of unpaid online recruitment to generate public data. The objective of the present analysis is to understand relationships between psychological responses in the early months of global coronavirus restrictions and help understand how different government measures succeed or fail in changing public behaviour. There were variations between and within countries. Although Western Europeans registered as more concerned over COVID-19, more stressed, and having slightly more trust in the governments' efforts, there was no clear geographical pattern in compliance with behavioural measures. Detailed plots illustrating between-countries differences are provided. Using both traditional and Bayesian analyses, we found that individuals who worried about getting sick worked harder to protect themselves and others. However, concern about the coronavirus itself did not account for all of the variances in experienced stress during the early months of COVID-19 restrictions. More alarmingly, such stress was associated with less compliance. Further, those most concerned over the coronavirus trusted in government measures primarily where policies were strict. While concern over a disease is a source of mental distress, other factors including strictness of protective measures, social support and personal lockdown conditions must also be taken into consideration to fully appreciate the psychological impact of COVID-19 and to understand why some people fail to follow behavioural guidelines intended to protect themselves and others from infection. The Stage 1 manuscript associated with this submission received in-principle acceptance (IPA) on 18 May 2020. Following IPA, the accepted Stage 1 version of the manuscript was preregistered on the Open Science Framework at https://osf.io/g2t3b. This preregistration was performed prior to data analysis.

COVIDiSTRESS Global Survey dataset on psychological and behavioural consequences of the COVID-19 outbreak

This N = 173,426 social science dataset was collected through the collaborative COVIDiSTRESS Global Survey - an open science effort to improve understanding of the human experiences of the 2020 COVID-19 pandemic between 30th March and 30th May, 2020. The dataset allows a cross-cultural study of psychological and behavioural responses to the Coronavirus pandemic and associated government measures like cancellation of public functions and stay at home orders implemented in many countries. The dataset contains demographic background variables as well as measures of Asian Disease Problem, perceived stress (PSS-10), availability of social provisions (SPS-10), trust in various authorities, trust in governmental measures to contain the virus (OECD trust), personality traits (BFF-15), information behaviours, agreement with the level of government intervention, and compliance with preventive measures, along with a rich pool of exploratory variables and written experiences. A global consortium from 39 countries and regions worked together to build and translate a survey with variables of shared interests, and recruited participants in 47 languages and dialects. Raw plus cleaned data and dynamic visualizations are available.

Music, heart rate variability, and symptom clusters: a comparative study

PURPOSE

This study aimed to explore the possible range of change of a single-session music intervention (SMI) on symptom clusters and neurological reactivity for women with breast cancer undergoing chemotherapy.

METHODS

A parallel and randomized, controlled study with repeated measures design was used. A total of 100 women with breast cancer were randomly assigned to the SMI or a control group. The outcome measurements of symptom cluster were collected using the Multidimensional Fatigue Symptom Inventory, Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and the neurological reactivity with heart rate variability at four time points: before commencement of the intervention (T0), immediately afterward (T1), 1 week later (T2), and 3 weeks after the intervention (T3).

RESULTS

Of the 50 women in each group, 46 in the SMI and 48 in the control group completed the post-test at T3. Multivariate analysis of variance indicated that the SMI group had a medium effect in change of symptom clusters compared to the control group at T2. Moreover, after adjusting for baseline between normal and higher levels of sympathetic tone activity, significant differences existed in fatigue and depression at T2 and sleep disturbance at T3.

CONCLUSIONS

A single-session music intervention can be effectively used to reduce symptom clusters for women with breast cancer. Targeting those who have a higher level of sympathetic tone activity is recommended.

Racial disparities, cancer and response to oxidative stress

At the intersection of genetics, biochemistry and behavioral sciences, there is a largely untapped opportunity to consider how ethnic and racial disparities contribute to individual sensitivity to reactive oxygen species and how these might influence susceptibility to various cancers and/or response to classical cancer treatment regimens that pervasively result in the formation of such chemical species. This chapter begins to explore these connections and builds a platform from which to consider how the disciplines can be strengthened further.

Heart Rate Variability as a Prognostic Factor for Cancer Survival - A Systematic Review

An increasing cancer incidence affecting any age and social class is putting serious strain on populations and health care systems around the world. This systematic literature search aims (i) to examine the correlation of heart rate variability (HRV) and cancer patients' prognosis, (ii) to examine the relationship of HRV and clinicopathological features, and (iii) to compare HRV between different patient groups, and between patient and control groups. We conducted a systematic literature review following the PRISMA Statement. We searched the PubMed and EMBASE databases for publications released by December 2017. The search terms were: "cancer" AND "heart rate variability" AND "human" NOT "animal" NOT "review." A total of 19 studies were finally included in this review. Most publications were high-quality observational studies. The studies showed that higher HRV correlated positively with patients' progression of disease and outcome. Thus, we conclude that individuals with higher HRV and advanced coping mechanisms seem to have a better prognosis in cancer progression. HRV appears to be a useful aspect to access the general health status of cancer patients.

Sexual well-being and diurnal cortisol after prostate cancer treatment

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.

Depressive symptoms and inflammation are independent risk factors of fatigue in breast cancer survivors

BACKGROUND

Psychosocial and inflammatory factors have been associated with fatigue in breast cancer survivors. Nevertheless, the relative contribution and/or interaction of these factors with cancer-related fatigue have not been well documented.

METHOD

This cross-sectional study enrolled 111 stage 0-III breast cancer patients treated with breast surgery followed by whole breast radiotherapy. Fatigue was measured by the total score of the Multidimensional Fatigue Inventory-20. Potential risk factors included inflammatory markers (plasma cytokines and their receptors and C-reactive protein; CRP), depressive symptoms (as assessed by the Inventory of Depressive Symptomatology-Self Reported), sleep (as assessed by the Pittsburgh Sleep Quality Index) and perceived stress (as assessed by the Perceived Stress Scale) as well as age, race, marital status, smoking history, menopause status, endocrine treatment, chemotherapy and cancer stage. Linear regression modeling was employed to examine risk factors of fatigue. Only risk factors with a significance level <0.10 were included in the initial regression model. A post-hoc mediation model using PROCESS SPSS was conducted to examine the association among depressive symptoms, sleep problems, stress, inflammation and fatigue.

RESULTS

At 1 year post-radiotherapy, depressive symptoms (p<0.0001) and inflammatory markers (CRP: p = 0.015; interleukin-1 receptor antagonist: p = 0.014; soluble tumor necrosis factor receptor-2: p = 0.009 in separate models) were independent risk factors of fatigue. Mediation analysis showed that depressive symptoms also mediated the associations of fatigue with sleep and stress.

CONCLUSIONS

Depressive symptoms and inflammation were independent risk factors for cancer-related fatigue at 1 year post-radiotherapy, and thus represent independent treatment targets for this debilitating symptom.

A Comprehensive Lifestyle Randomized Clinical Trial: Design and Initial Patient Experience

Background: Although epidemiological research demonstrates that there is an association between lifestyle factors and risk of breast cancer recurrence, progression of disease, and mortality, no comprehensive lifestyle change clinical trials have been conducted to determine if changing multiple risk factors leads to changes in biobehavioral processes and clinical outcomes in women with breast cancer. This article describes the design, feasibility, adherence to the intervention and data collection, and patient experience of a comprehensive lifestyle change clinical trial (CompLife). Methods: CompLife is a randomized, controlled trial of a multiple-behavior intervention focusing on diet, exercise, and mind-body practice along with behavioral counseling to support change. The initial exposure to the intervention takes place during the 4 to 6 weeks of radiotherapy (XRT) for women with stage III breast cancer and then across the subsequent 12 months. The intervention group will have 42 hours of in-person lifestyle counseling during XRT (7-10 hours a week) followed by up to 30 hours of counseling via video connection for the subsequent 12 months (weekly sessions for 6 months and then monthly for 6 months). The primary outcome is disease-free survival. Multiple secondary outcomes are being evaluated, including: (1) biological pathways; (2) overall survival; (3) patient-reported outcomes; (4) dietary patterns/fitness levels, anthropometrics, and body composition; and (5) economic outcomes. Qualitative data of the patient experience in the trial is collected from exit interviews, concluding remarks, direct email correspondences, and web postings from patients. Results: Fifty-five patients have been recruited and randomized to the trial to date. Accrual of eligible patients is high (72%) and dropout rates extremely low (5%). Attendance to the in-person sessions is high (95% attending greater than 80% of sessions) as well as to the 30 hours of video counseling (88% attending more than 70% of sessions). Adherence to components of the behavior change intervention is high and compliance with the intensive amount of data collection is exceptional. Qualitative data collected from the participants reveals testimonials supporting the importance of the comprehensive nature of intervention, especially the mind-body/mindfulness component and social support, and meaningful lifestyle transformations. Conclusion: Conducting a comprehensive, multicomponent, lifestyle change clinical trial for women with breast was feasible and collection of biobehavioral outcomes successful. Adherence to behavior change was high and patient experience was overwhelmingly positive.

Heart rate variability measure in breast cancer patients and survivors: A systematic review

PURPOSE

In the current study, we aimed to review literature findings showing the clinical importance of cardiac autonomic modulation assessed by heart rate variability analysis in breast cancer (BC) patients and survivors.

METHODS

We conducted a systematic review according to The PRISMA Statement in Medline, Scopus and Web of Science (_-2015) databases. The search was limited to articles in English language, published in peer-reviewed journals, and with adult age samples only (e.g., women, patients, or survivors, diagnosed with BC in any stage). We included observational studies and randomized trials. Detailed heart rate variability analysis (instruments, data collection protocol, and analysis methods) was required. Search terms included autonomic nervous system, heart rate variability, sympathetic and parasympathetic nervous system, autonomic dysfunction, vagal nervous and breast neoplasms, breast cancer and breast tumor.

RESULTS

Twelve studies were included in this review. The clinical importance of cardiac autonomic modulation assessed by heart rate variability analysis in BC patients and survivors is demonstrated by association with effects of BC surgery, and treatments, and the adverse effects of surgery and treatments on survivors (e.g., cardiotoxicity, fatigue, and stress).

LIMITATIONS

The strength of evidence of included studies is low: small samples size and heterogeneity, presence of confounders, and observational studies design.

CONCLUSIONS

The heart rate variability analysis could be used as a complementary non-invasive tool for the early diagnosis and better prognosis of autonomic dysfunction, and survival in BC patients. There are many potential clinical applications of heart rate variability analysis in BC patients, and the employment of such approaches could lead to lower impairment of autonomic function in this individuals.

Decreased Cortisol and Pain in Breast Cancer: Biofield Therapy Potential

Breast cancer is one of the leading causes of cancer death among women of all races. Pain is a common symptom associated with cancer; 75–90% of cancer patients experience pain during their illness and up to 50% of that pain is undertreated. Unrelieved pain leads to increased levels of the stress hormone cortisol. The purpose of this study was to examine the impact of bioenergy on fecal cortisol levels for mice injected with murine mammary carcinoma 4T1 in two separate pilot studies. Using a multiple experimental group design, six to eight week old female BALB/c mice were injected with tumor and randomly assigned, in groups of 10, to daily treatment, every other day treatment, and no treatment groups. Five days after tumor cell injection, bioenergy interventions were begun for a period of ten consecutive days. Fecal samples were collected for each study and ELISA analysis was conducted at the end of both studies. For both studies, cortisol levels were decreased in the every other day treatment groups but remained high in the no treatment groups. Future studies utilizing bioenergy therapies on cortisol levels in a murine breast cancer model can begin to describe pain outcomes and therapeutic dose.

Higher vagal activity as related to survival in patients with advanced breast cancer: an analysis of autonomic dysregulation

OBJECTIVE

High levels of high-frequency heart rate variability (HF-HRV), related to parasympathetic-nervous-system functioning, have been associated with longer survival in patients with myocardial infarction and acute trauma and in patients undergoing palliative care. From animal studies linking higher vagal activity with better immune system functioning and reduced metastases, we hypothesized that higher HF-HRV would predict longer survival in patients with metastatic or recurrent breast cancer (MRBC).

METHODS

Eighty-seven patients with MRBC participated in a laboratory task including a 5-minute resting baseline electrocardiogram. HF-HRV was computed as the natural logarithm of the summed power spectral density of R-R intervals (0.15-0.50 Hz). In this secondary analysis of a study testing whether diurnal cortisol slope predicted survival, we tested the association between resting baseline HF-HRV on survival using Cox proportional hazards models.

RESULTS

A total of 50 patients died during a median follow-up of 7.99 years. Higher baseline HF-HRV predicted significantly longer survival, with a hazard ratio of 0.75 (95% confidence interval = 0.60-0.92, p = .006). Visceral metastasis status and baseline heart rate were related to both HF-HRV and survival. However, a combination of HF-HRV and heart rate further improved survival prediction, with a hazard ratio of 0.64 (95% confidence interval = 0.48-0.85, p = .002).

CONCLUSIONS

Vagal activity of patients with MRBC strongly predicted their survival, extending the known predictive window of HF-HRV in cancer beyond palliative care. Vagal activity can be altered by behavioral, pharmacological, and surgical interventions and may be a promising target for extending life expectancy in patients with metastasizing cancer.

Patients Experience High Levels of Anxiety 2 Years Following Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE

To explore anxiety levels during the first 2 years after rupture of aneurysmal subarachnoid hemorrhage.

METHODS

A consecutive sample of patients with aneurysmal subarachnoid hemorrhage (aSAH) (n = 88, 84.6% of eligible) from a Swedish neurosurgical clinic were followed-up with a prospective cohort design at 3 time points; 6 months, 1 year, and 2 years after the onset. Data were collected by postal questionnaires and telephone interviews: State trait anxiety inventory, Hospital anxiety and depression scales, Barthel index, Telephone interview for cognitive status, and a set of study-specific questions.

RESULTS

Most of the respondents scored above the State trait anxiety inventory Swedish norm value on anxiety levels at all 3 follow-up time points. About 59% (n = 52) of respondents scored above the cutoff value for clinical significant level of anxiety in at least 1 time point during the first 2 years after rupture of aSAH. There were no significant differences in levels of anxiety versus the observational period and the 3 follow-up time points. The most significant explanatory variable to high levels of anxiety at all 3 follow-up time points was low perceived recovery.

CONCLUSIONS

Levels of anxiety remained high and stable throughout the first 2 years after rupture of aSAH. High levels of anxiety may reduce health-related quality of life substantially. Identification of individuals with high levels of anxiety and supportive care could therefore potentially improve long-term outcome.