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Murali KP, Merriman JD, Yu G, Vorderstrasse A, Kelley AS, Brody AA. Complex Care Needs at the End of Life for Seriously Ill Adults With Multiple Chronic Conditions. J Hosp Palliat Nurs 2023; 25:146-155. [PMID: 37040386 PMCID: PMC10175220 DOI: 10.1097/njh.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Understanding the complex care needs of seriously ill adults with multiple chronic conditions with and without cancer is critical for the delivery of high-quality serious illness and palliative care at the end of life. The objective of this secondary data analysis of a multisite randomized clinical trial in palliative care was to elucidate the clinical profile and complex care needs of seriously ill adults with multiple chronic conditions and to highlight key differences among those with and without cancer at the end of life. Of the 213 (74.2%) older adults who met criteria for multiple chronic conditions (eg, 2 or more chronic conditions requiring regular care with limitations of daily living), 49% had a diagnosis of cancer. Hospice enrollment was operationalized as an indicator for severity of illness and allowed for the capture of complex care needs of those deemed to be nearing the end of life. Individuals with cancer had complex symptomatology with a higher prevalence of nausea, drowsiness, and poor appetite and end of life and lower hospice enrollment. Individuals with multiple chronic conditions without cancer had lower functional status, greater number of medications, and higher hospice enrollment. The care of seriously ill older adults with multiple chronic conditions requires tailored approaches to improve outcomes and quality of care across health care settings, particularly at the end of life.
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Affiliation(s)
| | | | - Gary Yu
- New York University Rory Meyers College of Nursing
| | | | - Amy S. Kelley
- Icahn School of Medicine at Mount Sinai, Geriatrics and Palliative Medicine
| | - Abraham A. Brody
- New York University Rory Meyers College of Nursing
- New York University Grossman School of Medicine
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2
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Mazor M, David D, Moorehead D, Merriman JD, Lin JJ. Community Navigation and Supportive Care Experiences of Low-Income Black and Latina Cancer Survivors: Patient and Navigator Perspectives. J Oncol Navig Surviv 2023; 14:https://www.jons-online.com/jons-categories?view=article&artid=4883:low-income-black-and-latina-cancer-survivors&catid=128. [PMID: 37293184 PMCID: PMC10249905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Little is known about the role of community-based navigation in supportive care delivery for historically marginalized cancer survivors. The purposes of this study were to evaluate supportive care experiences of low-income, Black and Latina cancer survivors and examine the care role of their community navigator. Methods Qualitative evaluation of semi-structured interviews with Black and Latina cancer survivors (n=10) and navigators (n=4) from a community-based organization for low-income women were conducted and analyzed using content analysis. Results Content analysis yielded six themes that described the supportive care experience over time and before and after navigator support. Navigating supportive care alone: a) internal and external influencers; b) alone and just surviving; c) feeling overwhelmed and distressed. Community Navigator delivered supportive care: a) establishing trust and safety; b) accepting multi-dimensional, navigator assisted supportive care management; c) distress alleviation. Conclusions Low-income Black and Latina women with cancer reported internal strength yet endured cancer care alone leading to a feeling of distress. Subsequently, community navigators provided patient-centric, supportive care and alleviate physical and emotional distress. These findings highlight the importance of increasing awareness of and linkage to community navigators who may be able to meet the supportive care needs of diverse patient populations.
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Affiliation(s)
- Melissa Mazor
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
| | - Daniel David
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
| | - Dolores Moorehead
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
| | - John D Merriman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
| | - Jenny J Lin
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Drs. Lin and Mazor); Rory Meyers College of Nursing, New York University, New York, New York (Drs. David and Merriman); Women's Cancer Resource Center, Berkeley, California (Ms. Moorehead)
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3
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Ghazal LV, Merriman JD, Santacroce SJ, Fletcher J, Wright F, Dickson VV. Profiles of Work and Quality of Life among Young Adult Cancer Survivors. West J Nurs Res 2023; 45:293-305. [PMID: 36529990 DOI: 10.1177/01939459221120742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Work ability, or the perception of one's ability to work presently and in the future, may impact quality of life (QOL) among young adult (YA) cancer survivors. Through a convergent mixed methods design, we explored work ability, work-related goals, and QOL among YA hematologic cancer survivors within five years of diagnosis. We described associations at the individual- and microsystem (work)- levels; and compared factors across low and high work ability groups. Participants (N = 40) completed a survey and interview via digital platforms. Qualitative analysis revealed self-assessed declines in work ability led to questioning work-related goals and influenced QOL. Integrated analysis led to the development of four profiles, growing our understanding of work's influence on QOL for YA cancer survivors, and identifying components YAs considered when contemplating work-related goals after a cancer diagnosis. Larger studies are needed to elucidate these profiles and identify modifiable factors to inform targeted interventions to improve QOL.
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Affiliation(s)
- Lauren V Ghazal
- School of Nursing, University of Michigan, Ann Arbor, MI, USA.,Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - John D Merriman
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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4
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Murali KP, Yu G, Merriman JD, Vorderstrasse A, Kelley AS, Brody AA. Multiple Chronic Conditions among Seriously Ill Adults Receiving Palliative Care. West J Nurs Res 2023; 45:14-24. [PMID: 34433344 PMCID: PMC9040129 DOI: 10.1177/01939459211041174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The objective of this study was to characterize multiple chronic conditions (MCCs) among seriously ill adults receiving palliative care at the end of life. A latent class analysis was conducted to identify latent subgroups of seriously ill older adults based on a baseline Charlson comorbidity index (CCI) measurement, a measure of comorbidity burden, and mortality risk. The three latent subgroups were: (1) low to moderate CCI with MCC, (2) high CCI with MCC, and (3) high CCI and metastatic cancer. The "low to moderate CCI and MCC" subgroup included older adults with chronic obstructive pulmonary disease (COPD), cardiovascular disease, congestive heart failure, myocardial infarction, dementia, diabetes, and lymphoma. A "high CCI and MCC" subgroup included individuals with severe illness including liver or renal disease among other MCCs. A "high CCI and metastatic cancer" included all participants with metastatic cancer. This study sheds light on the MCC profile of seriously ill adults receiving palliative care.
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Affiliation(s)
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - John D. Merriman
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Amy S. Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abraham A. Brody
- Rory Meyers College of Nursing, New York University, New York, NY, USA,Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, NY, USA
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5
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Ghazal LV, Merriman JD, Santacroce SJ, Fletcher J, Wright F, Dickson VV. Exploration of Relationships Between Symptoms, Work Characteristics, and Quality of Life in Young Adult Hematologic Cancer Survivors. J Adolesc Young Adult Oncol 2022; 11:530-534. [PMID: 34882016 PMCID: PMC9639603 DOI: 10.1089/jayao.2021.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study explores relationships between individual, microsystem (work) characteristics, and quality of life (QOL) among young adult (YA; ages 20-39 years at diagnosis) hematologic cancer survivors. Forty YAs who had completed cancer therapy within the past 5 years were recruited through social media and completed an online survey. Poorer QOL was associated with higher levels of depressive symptoms, fatigue, impaired cognitive function, and poorer work ability and financial health (all p < 0.05). A comprehensive understanding of work characteristics, including work ability, may lead to multilevel interventions improving QOL. Future research should include larger, more diverse samples of YA cancer survivors.
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Affiliation(s)
- Lauren V. Ghazal
- College of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - John D. Merriman
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Sheila J. Santacroce
- School of Nursing, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
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6
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Murali KP, Yu G, Merriman JD, Vorderstrasse A, Kelley AS, Brody AA. Latent Class Analysis of Symptom Burden Among Seriously Ill Adults at the End of Life. Nurs Res 2021; 70:443-454. [PMID: 34393192 PMCID: PMC8563402 DOI: 10.1097/nnr.0000000000000549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Serious illness is characterized by high symptom burden that negatively affects quality of life (QOL). Although palliative care research has highlighted symptom burden in seriously ill adults with cancer, symptom burden among those with noncancer serious illness and multiple chronic conditions has been understudied. Latent class analysis is a statistical method that can be used to better understand the relationship between severity of symptom burden and covariates, such as the presence of multiple chronic conditions. Although latent class analysis has been used to highlight subgroups of seriously ill adults with cancer based on symptom clusters, none have incorporated multiple chronic conditions. OBJECTIVES The objectives of this study were to (a) describe the demographic and baseline characteristics of seriously ill adults at the end of life in a palliative care cohort, (b) identify latent subgroups of seriously ill individuals based on severity of symptom burden, and (c) examine variables associated with latent subgroup membership, such as QOL, functional status, and the presence of multiple chronic conditions. METHODS A secondary data analysis of a palliative care clinical trial was conducted. The latent class analysis was based on the Edmonton Symptom Assessment System, which measures nine symptoms on a scale of 0-10 (e.g., pain, fatigue, nausea, depression, anxiousness, drowsiness, appetite, well-being, and shortness of breath). Clinically significant cut-points for symptom severity were used to categorize each symptom item in addition to a categorized total score. RESULTS Three latent subgroups were identified (e.g., low, moderate, and high symptom burden). Lower overall QOL was associated with membership in the moderate and high symptom burden subgroups. Multiple chronic conditions were associated with statistically significant membership in the high symptom burden latent subgroup. Older adults between 65 and 74 years had a lower likelihood of moderate or high symptom burden subgroup membership compared to the low symptom burden class. DISCUSSION Lower QOL was associated with high symptom burden. Multiple chronic conditions were associated with high symptom burden, which underlines the clinical complexity of serious illness. Palliative care at the end of life for seriously ill adults with high symptom burden must account for the presence of multiple chronic conditions.
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Murali KP, Merriman JD, Yu G, Vorderstrasse A, Kelley A, Brody AA. An Adapted Conceptual Model Integrating Palliative Care in Serious Illness and Multiple Chronic Conditions. Am J Hosp Palliat Care 2020; 37:1086-1095. [PMID: 32508110 PMCID: PMC7483852 DOI: 10.1177/1049909120928353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Seriously ill adults with multiple chronic conditions (MCC) who receive palliative care may benefit from improved symptom burden, health care utilization and cost, caregiver stress, and quality of life. To guide research involving serious illness and MCC, palliative care can be integrated into a conceptual model to develop future research studies to improve care strategies and outcomes in this population. METHODS The adapted conceptual model was developed based on a thorough review of the literature, in which current evidence and conceptual models related to serious illness, MCC, and palliative care were appraised. Factors contributing to patients' needs, services received, and service-related variables were identified. Relevant patient outcomes and evidence gaps are also highlighted. RESULTS Fifty-eight articles were synthesized to inform the development of an adapted conceptual model including serious illness, MCC, and palliative care. Concepts were organized into 4 main conceptual groups, including Factors Affecting Needs (sociodemographic and social determinants of health), Factors Affecting Services Received (health system; research, evidence base, dissemination, and health policy; community resources), Service-Related Variables (patient visits, service mix, quality of care, patient information, experience), and Outcomes (symptom burden, quality of life, function, advance care planning, goal-concordant care, utilization, cost, death, site of death, satisfaction). DISCUSSION The adapted conceptual model integrates palliative care with serious illness and multiple chronic conditions. The model is intended to guide the development of research studies involving seriously ill adults with MCC and aid researchers in addressing relevant evidence gaps.
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Affiliation(s)
| | | | - Gary Yu
- 5894NYU Rory Meyers College of Nursing, New York, NY, USA
| | - Allison Vorderstrasse
- Florence S. Downs PhD Program in Nursing Research and Theory, 5894NYU Rory Meyers College of Nursing, New York, NY, USA
| | - Amy Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 5925Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, 5894NYU Rory Meyers College of Nursing, New York, NY, USA
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8
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Knisely MR, Maserati M, Heinsberg LW, Shah LL, Li H, Zhu Y, Ma Y, Graves LY, Merriman JD, Conley YP. Symptom Science: Advocating for Inclusion of Functional Genetic Polymorphisms. Biol Res Nurs 2019; 21:349-354. [PMID: 31023072 PMCID: PMC6700869 DOI: 10.1177/1099800419846407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Incorporating biologically based data into symptom science research can contribute substantially to understanding commonly experienced symptoms across chronic conditions. The purpose of this literature review was to identify functional polymorphisms associated with common symptoms (i.e., pain, sleep disturbance, fatigue, affective and cognitive symptoms) with the goal of identifying a parsimonious list of functional genetic polymorphisms with evidence to advocate for their inclusion in symptom science research. PubMed was searched to identify genes and functional polymorphisms associated with symptoms across chronic conditions, revealing eight functional genetic polymorphisms in seven different genes that showed evidence of association with at least three or more symptoms and/or symptom clusters: BDNF rs6265, COMT rs4680, FKBP5 rs3800373, IL-6 rs1800795, NFKB2 rs1056890, SLC6A4 5-HTTLPR+rs25531, and TNFA rs1799964 and rs1800629. Of these genes, three represent protein biomarkers previously identified as common data elements for symptom science research (BDNF, IL-6, and TNFA), and the polymorphisms in these genes identified through the search are known to impact secretion or level of transcription of these protein biomarkers. Inclusion of genotype data for polymorphisms offers great potential to further advance scientific knowledge of the biological basis of individual symptoms and symptom clusters across studies. Additionally, these polymorphisms have the potential to be used as targets to optimize precision health through the identification of individuals at risk for poor symptom experiences as well as the development of symptom management interventions.
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Affiliation(s)
| | - Megan Maserati
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lisa L. Shah
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hongjin Li
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yehui Zhu
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yumi Ma
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - John D. Merriman
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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9
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Bender CM, Merriman JD, Sereika SM, Gentry AL, Casillo FE, Koleck TA, Rosenzweig MQ, Brufsky AM, McAuliffe P, Zhu Y, Conley YP. Trajectories of Cognitive Function and Associated Phenotypic and Genotypic Factors in Breast Cancer. Oncol Nurs Forum 2019; 45:308-326. [PMID: 29683114 DOI: 10.1188/18.onf.308-326] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study identified women with unique trajectories of executive function, concentration, and visual working memory before and during adjuvant therapy for breast cancer, and examined phenotypic and genotypic predictors associated with subgroups. SAMPLE & SETTING 399 postmenopausal women, of whom 288 were women with early-stage breast cancer and 111 were women without breast cancer, matched on age and years of education to the women with breast cancer, and all at an urban cancer center. METHODS & VARIABLES A repeated-measures design was used; assessments occurred before adjuvant therapy and every six months post-therapy initiation. Group-based trajectory modeling determined subgroups. Multinomial logistic regression identified phenotypic and genotypic characteristics. RESULTS Three executive function and concentration trajectory subgroups were identified. IMPLICATIONS FOR NURSING Advancing age, greater pretherapy fatigue, and poorer pretherapy cognitive function are associated with the low subgroups. DNA repair and oxidative stress mechanisms may be involved in the cognitive changes that women experience.
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Affiliation(s)
| | | | - Susan M Sereika
- Associate professors School of Nursing, University of Pittsburgh, Pennsylvania
| | - Amanda L Gentry
- Department of Health and Community Systems, School of Medicine
| | - Frances E Casillo
- Department of Acute and Tertiary Care, Office of Community Partnerships
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10
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Merriman JD, Sereika SM, Conley YP, Koleck TA, Zhu Y, Phillips ML, Bertocci MA, Brufsky AM, Bender CM. Exploratory Study of Associations Between DNA Repair and Oxidative Stress Gene Polymorphisms and Cognitive Problems Reported by Postmenopausal Women With and Without Breast Cancer. Biol Res Nurs 2018; 21:50-60. [PMID: 30213196 DOI: 10.1177/1099800418799964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Women with breast cancer report varying frequencies of cognitive problems during adjuvant systemic therapy. This variability suggests latent subgroups. Therefore, we identified latent subgroups of self-reported cognitive problems among postmenopausal women with and without breast cancer. We explored associations between membership in these subgroups and (a) demographic, clinical, and symptom characteristics and (b) variations in candidate gene polymorphisms. METHODS We evaluated frequency of cognitive problems using the Patient Assessment of Own Functioning Inventory. Growth mixture modeling identified latent subgroups over 18 months of adjuvant systemic therapy and at matched time points for women without cancer ( N = 331). We evaluated for differences among subgroups in demographic, clinical, and symptom characteristics and in 41 single nucleotide polymorphisms in 10 candidate genes involved in DNA repair and oxidative stress pathways ( n = 199). We modeled associations between genotypes and subgroup membership using multinomial logistic regression. RESULTS We identified three latent subgroups: more frequent, persistent, and almost never. Receipt of chemotherapy plus anastrozole, depressive symptoms, and baseline neuropathic symptoms increased the odds of belonging to the more frequent subgroup. Anxiety and depressive symptoms increased the odds of belonging to the persistent subgroup. With covariates controlled for, carrying the ERCC5 rs873601 G minor allele increased the odds of reporting more frequent cognitive problems. CONCLUSIONS Chemotherapy plus anastrozole, depressive symptoms, and presence of neuropathic symptoms may predict more frequent cognitive problems during systemic therapy that later resolve. Mood dysregulation before therapy may predict persistent cognitive problems during therapy. ERCC5 genotype may influence frequency of cognitive problems after controlling for these risk factors.
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Affiliation(s)
- John D Merriman
- 1 New York University Meyers College of Nursing, New York, NY, USA
| | - Susan M Sereika
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA.,3 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yvette P Conley
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA.,3 Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Yehui Zhu
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA
| | - Mary L Phillips
- 5 School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Adam M Brufsky
- 5 School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,6 University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Catherine M Bender
- 2 School of Nursing, University of Pittsburgh, Pittsburgh, USA.,6 University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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11
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Allen DH, Myers JS, Jansen CE, Merriman JD, Von Ah D. Assessment and Management of Cancer- and Cancer Treatment-Related Cognitive Impairment. J Nurse Pract 2018; 14:217-224.e5. [PMID: 30906237 DOI: 10.1016/j.nurpra.2017.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Deborah H Allen
- Duke University Health System, DUMC Box 3543, Durham NC 27710
| | - Jamie S Myers
- Research Assistant Professor, Kansas Univeristy School of Nursing, Mail Stop 2029, Kansas City, KS 66160,
| | - Catherine E Jansen
- Oncology Clinical Nurse Specialist, Kaiser Permanente, 4141 Geary Blvd., San Francisco, CA 94118,
| | - John D Merriman
- Assistant Professor, New York University Meyers College of Nursing, 433 1st Avenue, New York, NY 10010,
| | - Diane Von Ah
- Associate Professor & Chair, Dept. of Community Health Systems, Indiana University School of Nursing, 749 Chestnut St, Terre Haute, IN 47809,
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12
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Merriman JD, Sereika SM, Brufsky AM, McAuliffe PF, McGuire KP, Myers JS, Phillips ML, Ryan CM, Gentry AL, Jones LD, Bender CM. Trajectories of self-reported cognitive function in postmenopausal women during adjuvant systemic therapy for breast cancer. Psychooncology 2015; 26:44-52. [PMID: 26486371 DOI: 10.1002/pon.4009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/10/2015] [Accepted: 09/25/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE In a sample of 368 postmenopausal women, we (1) determined within-cohort and between-cohort relationships between adjuvant systemic therapy for breast cancer and self-reported cognitive function during the first 18 months of therapy and (2) evaluated the influence of co-occurring symptoms, neuropsychological function, and other covariates on relationships. METHODS We evaluated self-reported cognitive function, using the Patient Assessment of Own Functioning Inventory (PAOFI), and potential covariates (e.g., co-occurring symptom scores and neuropsychological function z-scores) in 158 women receiving aromatase inhibitor (AI) therapy alone, 104 women receiving chemotherapy followed by AI therapy, and 106 non-cancer controls. Patients were assessed before systemic therapy and then every 6 months, for a total of four assessments over 18 months. Controls were assessed at matched time points. Mixed-effects modeling was used to determine longitudinal relationships. RESULTS Controlling for covariates, patients enrolled before chemotherapy reported poorer global cognitive function (p < 0.001), memory (p < 0.001), language and communication (p < 0.001), and sensorimotor function (p = 0.002) after chemotherapy. These patients reported poorer higher-level cognitive and intellectual functions from before chemotherapy to 12 months after initiation of AI therapy (p < 0.001). Higher levels of depressive symptoms (p < 0.001), anxiety (p < 0.001), and fatigue (p = 0.040) at enrollment were predictors of poorer cognitive function over time. PAOFI total score was a predictor of executive function (p = 0.048) and visual working memory (p = 0.005) z-scores, controlling for covariates. CONCLUSIONS Findings provide further evidence of poorer self-reported cognitive function after chemotherapy and of relationships between co-occurring symptoms and cognitive changes. AI therapy alone does not have an impact on self-reported cognitive function. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- John D Merriman
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan M Sereika
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam M Brufsky
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Priscilla F McAuliffe
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Kandace P McGuire
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jamie S Myers
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary L Phillips
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Amanda L Gentry
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lindsay D Jones
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Bender CM, Merriman JD, Gentry AL, Ahrendt GM, Berga SL, Brufsky AM, Casillo FE, Dailey MM, Erickson KI, Kratofil FM, McAuliffe PF, Rosenzweig MQ, Ryan CM, Sereika SM. Patterns of change in cognitive function with anastrozole therapy. Cancer 2015; 121:2627-36. [PMID: 25906766 PMCID: PMC4512875 DOI: 10.1002/cncr.29393] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/12/2015] [Accepted: 03/04/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND The purpose of this study was to examine and compare the effects of the first 18 months of anastrozole therapy on cognitive function in women with breast cancer. METHODS This large, longitudinal cohort study was composed of postmenopausal women with early-stage breast cancer who received chemotherapy plus anastrozole (n = 114) or anastrozole alone (n = 173) and a control group (n = 110). Cognitive function was assessed before systemic therapy and 6, 12, and 18 months after therapy initiation and at comparable time points in controls. RESULTS The chemotherapy-anastrozole and anastrozole-alone groups had poorer executive function than the controls at nearly all time points (P < .0001 to P = .09). A pattern of deterioration in working memory and concentration was observed during the first 6 months of anastrozole therapy for the chemotherapy-anastrozole group (P < .0001 and P < .0009, respectively) and the anastrozole-alone group (P = .0008 and P = .0002, respectively). This was followed by improved working memory and concentration from 6 to 12 months in both groups. The anastrozole-alone group had a second decline in working memory and concentration from 12 to 18 months after the initiation of therapy (P < .0001 and P = .02, respectively). CONCLUSIONS Women with breast cancer had poorer executive functioning from the period before therapy through the entire first 18 months of therapy. A pattern of decline in working memory and concentration with initial exposure to anastrozole was observed. Women receiving anastrozole alone had a second deterioration in working memory and concentration from 12 to 18 months after therapy initiation. The longer term effects (>18 months) of anastrozole on cognitive function remain to be determined.
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Affiliation(s)
| | | | | | | | - Sarah L Berga
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Adam M Brufsky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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14
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Dunn LB, Langford DJ, Paul SM, Berman MB, Shumay DM, Kober K, Merriman JD, West C, Neuhaus JM, Miaskowski C. Trajectories of fear of recurrence in women with breast cancer. Support Care Cancer 2015; 23:2033-43. [PMID: 25524004 PMCID: PMC5469210 DOI: 10.1007/s00520-014-2513-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Although fear of recurrence (FCR) is common among cancer survivors, it remains unclear what factors predict initial levels (e.g., prior to surgery) or changes in FCR in the post-treatment period. Among women treated for breast cancer, this study evaluated the effects of demographic, clinical, symptom, and psychosocial adjustment characteristics on the initial (preoperative) levels of FCR and trajectories of FCR over 6 months following surgery. METHODS Prior to and for 6 months following breast cancer surgery, 396 women were assessed for demographic and clinical (disease and treatment) characteristics, symptoms, psychological adjustment characteristics, and quality of life (QOL). FCR was assessed using a four-item subscale from the QOL instrument. Hierarchical linear modeling was used to examine changes in FCR scores and to identify predictors of inter-individual differences in preoperative FCR levels and trajectories over 6 months. RESULTS From before surgery to 6 months post-operatively, women with breast cancer showed a high degree of inter-individual variability in FCR. Preoperatively, women who lived with someone, experienced greater changes in spiritual life, had higher state anxiety, had more difficulty coping, or experienced more distress due to diagnosis or distress to family members reported higher FCR scores. Patients who reported better overall physical health and higher FCR scores at enrollment demonstrated a steeper decrease in FCR scores over time. CONCLUSIONS These findings highlight inter-individual heterogeneity in initial levels and changes in FCR over time among women undergoing breast cancer surgery. Further work is needed to identify and provide interventions for women experiencing FCR during and after breast cancer treatment.
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Affiliation(s)
- Laura B Dunn
- School of Medicine, University of California, San Francisco, CA, USA,
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15
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Merriman JD, Aouizerat BE, Cataldo JK, Dunn LB, Kober K, Langford DJ, West C, Cooper BA, Paul SM, Miaskowski C. Associations between catecholaminergic, GABAergic, and serotonergic genes and self-reported attentional function in oncology patients and their family caregivers. Eur J Oncol Nurs 2014; 19:251-9. [PMID: 25524657 DOI: 10.1016/j.ejon.2014.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 11/19/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE OF THE RESEARCH Evaluate for associations between variations in genes involved in catecholaminergic, gamma-aminobutyric acid (GABA)-ergic, and serotonergic mechanisms of neurotransmission and attentional function latent classes. PATIENTS AND METHODS This descriptive, longitudinal study was conducted at two radiation therapy departments. The sample included three latent classes of individuals with distinct trajectories of self-reported attentional function during radiation therapy, who were previously identified using growth mixture modeling among 167 oncology patients and 85 of their family caregivers. Multivariable models were used to evaluate for genotypic associations of neurotransmission genes with attentional function latent class membership, after controlling for covariates. RESULTS Variations in catecholaminergic (i.e., ADRA1D rs4815675, SLC6A3 rs37022), GABAergic (i.e., SLC6A1 rs2697138), and serotonergic (i.e., HTR2A rs2296972, rs9534496) neurotransmission genes were significant predictors of latent class membership in multivariable models. CONCLUSIONS Findings suggest that variations in genes that encode for three distinct but related neurotransmission systems are involved in alterations in attentional function. Knowledge of both phenotypic and genetic markers associated with alterations in attentional function can be used by clinicians to identify patients and family caregivers who are at higher risk for this symptom. Increased understanding of the genetic markers associated with alterations in attentional function may provide insights into the underlying mechanisms for this significant clinical problem.
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Affiliation(s)
- John D Merriman
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA.
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA; Institute for Human Genetics, University of California, San Francisco, 513 Parnassus Avenue, Box 0794, San Francisco, CA 94143-0794, USA.
| | - Janine K Cataldo
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA.
| | - Laura B Dunn
- School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0410, San Francisco, CA 94143-0410, USA.
| | - Kord Kober
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA.
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA.
| | - Claudia West
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA.
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA.
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA.
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143-0610, USA.
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Doong SH, Dhruva A, Dunn LB, West C, Paul SM, Cooper BA, Elboim C, Abrams G, Merriman JD, Langford DJ, Leutwyler H, Baggott C, Kober K, Aouizerat BE, Miaskowski C. Associations between cytokine genes and a symptom cluster of pain, fatigue, sleep disturbance, and depression in patients prior to breast cancer surgery. Biol Res Nurs 2014; 17:237-47. [PMID: 25304131 DOI: 10.1177/1099800414550394] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pain, fatigue, sleep disturbance, and depression are common and frequently co-occurring symptoms in oncology patients. This symptom cluster is often attributed to the release of proinflammatory cytokines. The purposes of this study were to determine whether distinct latent classes of patients with breast cancer (n = 398) could be identified based on their experience with this symptom cluster, whether patients in these latent classes differed on demographic and clinical characteristics and whether variations in cytokine genes were associated with latent class membership. Three distinct latent classes were identified: "all low" (61.0%), "low pain and high fatigue" (31.6%), "all high" (7.1%). Compared to patients in the all low class, patients in the all high class were significantly younger, had less education, were more likely to be non-White, had a lower annual income, were more likely to live alone, had a lower functional status, had a higher comorbidity score, and had more advanced disease. Significant associations were found between interleukin 6 (IL6) rs2069845, IL13 rs1295686, and tumor necrosis factor alpha rs18800610 and latent class membership. Findings suggest that variations in pro- and anti-inflammatory cytokine genes are associated with this symptom cluster in breast cancer patients.
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Affiliation(s)
- Sy-Huey Doong
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | - Laura B Dunn
- School of Medicine, University of California, San Francisco, CA, USA
| | - Claudia West
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- Schools of Nursing, University of California, San Francisco, CA, USA
| | | | - Gary Abrams
- School of Medicine, University of California, San Francisco, CA, USA
| | - John D Merriman
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Dale J Langford
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Heather Leutwyler
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Christina Baggott
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Kord Kober
- Schools of Nursing, University of California, San Francisco, CA, USA
| | - Bradley E Aouizerat
- Schools of Nursing, University of California, San Francisco, CA, USA Institute for Human Genetics, University of California, San Francisco, CA, USA
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17
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Miaskowski C, Cataldo JK, Baggott CR, West C, Dunn LB, Dhruva A, Merriman JD, Langford DJ, Kober KM, Paul SM, Cooper BA, Aouizerat BE. Cytokine gene variations associated with trait and state anxiety in oncology patients and their family caregivers. Support Care Cancer 2014; 23:953-65. [PMID: 25249351 DOI: 10.1007/s00520-014-2443-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 09/14/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE Anxiety is common among cancer patients and their family caregivers (FCs) and is associated with poorer outcomes. Recently, associations between inflammation and anxiety were identified. However, the relationship between variations in cytokine genes and anxiety warrants investigation. Therefore, phenotypic and genotypic characteristics associated with trait and state anxiety were evaluated in a sample of 167 oncology patients with breast, prostate, lung, or brain cancer and 85 of their FCs. METHODS Using multiple regression analyses, the associations between participants' demographic and clinical characteristics as well as variations in cytokine genes and trait and state anxiety were evaluated. RESULTS In the bivariate analyses, a number of phenotypic characteristics were associated with both trait and state anxiety (e.g., age, functional status). However, some associations were specific only to trait anxiety (e.g., number of comorbid conditions) or state anxiety (e.g., participation with a FC). Variations in three cytokine genes (i.e., interleukin (IL) 1 beta, IL1 receptor 2 (IL1R2), nuclear factor kappa beta 2 (NFKB2)) were associated with trait anxiety, and variations in two genes (i.e., IL1R2, tumor necrosis factor alpha (TNFA)) were associated with state anxiety. CONCLUSIONS These findings suggest that both trait and state anxiety need to be assessed in oncology patients and their FCs. Furthermore, variations in cytokine genes may contribute to higher levels of anxiety in oncology patients and their FCs.
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18
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Bender CM, Merriman JD. Cancer- and treatment-related cognitive changes: what can we do now? What lies ahead? Oncology (Williston Park) 2014; 28:806-808. [PMID: 25224482 PMCID: PMC4261918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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19
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Saad S, Dunn LB, Koetters T, Dhruva A, Langford DJ, Merriman JD, West C, Paul SM, Cooper B, Cataldo J, Hamolsky D, Elboim C, Aouizerat BE, Miaskowski C. Cytokine gene variations associated with subsyndromal depressive symptoms in patients with breast cancer. Eur J Oncol Nurs 2014; 18:397-404. [PMID: 24726621 PMCID: PMC4074554 DOI: 10.1016/j.ejon.2014.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE This study explored the relationships between variations in cytokines genes and depressive symptoms in a sample of patients who were assessed prior to and for six months following breast cancer surgery. Phenotypic differences between Resilient (n = 155) and Subsyndromal (n = 180) depressive symptom classes, as well as variations in cytokine genes were evaluated. METHOD Patients were recruited prior to surgery and followed for six months. Growth mixture modeling was used to identify distinct latent classes based on Center for Epidemiological Studies Depression (CES-D) Scale scores. Eighty-two single nucleotide polymorphisms and 35 haplotypes among 15 candidate cytokine genes were evaluated. RESULTS Patients in the Subsyndromal class were significantly younger, more likely to be married or partnered, and reported a significantly lower functional status. Variation in three cytokine genes (i.e., interferon gamma receptor 1 (IFNGR1 rs9376268), interleukin 6 (IL6 rs2069840), tumor necrosis factor alpha (TNFA rs1799964)), as well as age and functional status predicted membership in the Subsyndromal versus the Resilient class. CONCLUSIONS A variation in TNFA that was associated with Subsyndromal depressive symptoms in a sample of patients and their family caregivers was confirmed in this sample. Variations in cytokine genes may place these patients at higher risk for the development of Subsyndromal levels of depressive symptoms.
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Affiliation(s)
- Shanwell Saad
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA
| | - Laura B Dunn
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Theresa Koetters
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA
| | - Anand Dhruva
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Dale J Langford
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA
| | - John D Merriman
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA
| | - Claudia West
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA
| | - Steven M Paul
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA
| | - Bruce Cooper
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Janine Cataldo
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA
| | - Deborah Hamolsky
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA
| | | | - Bradley E Aouizerat
- Department of Physiological Nursing and the Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
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Abstract
OBJECTIVES To review the proposed mechanisms of cognitive changes associated with non-central nervous system cancers and cancer treatment. DATA SOURCES Review and synthesis of databased publications and review articles. CONCLUSION Proposed mechanisms include cytokine upregulation, hormonal changes, neurotransmitter dysregulation, attentional fatigue, genetic predisposition, and comorbid symptoms. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses need to understand the multiple mechanisms that may contribute to the development of cancer- and treatment-related cognitive changes so that they can identify patients at high risk and help patients understand why these changes occur.
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21
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Dhruva A, Aouizerat BE, Cooper B, Paul SM, Dodd M, West C, Wara W, Lee K, Dunn LB, Langford DJ, Merriman JD, Baggott C, Cataldo J, Ritchie C, Kober KM, Leutwyler H, Miaskowski C. Cytokine gene associations with self-report ratings of morning and evening fatigue in oncology patients and their family caregivers. Biol Res Nurs 2014; 17:175-84. [PMID: 24872120 DOI: 10.1177/1099800414534313] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to evaluate for differences in variations in pro- and anti-inflammatory cytokine genes between participants who were classified as having low and high levels of morning and evening fatigue and to evaluate for differences in phenotypic characteristics between these two groups. In a sample of 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 of their family caregivers, growth mixture modeling was used to identify latent classes of individuals based on ratings of morning and evening fatigue obtained prior to, during, and for 4 months following completion of radiation therapy. Differences in single nucleotide polymorphisms and haplotypes in 15 cytokine genes were evaluated between the latent classes. Multiple logistic regression was used to assess the effect of phenotypic and genotypic characteristics on morning and evening fatigue class membership. Associations were found between morning fatigue and number of comorbidities as well as variations in tumor necrosis factor alpha (TNFA) rs1800629 and rs3093662. Evening fatigue was associated with caring for children at home and variations in interleukin 4 (IL4) rs2243248 and TNFA rs2229094. Younger age and lower performance status were associated with both morning and evening fatigue. These findings suggest that inflammatory mediators are associated with the development of morning and evening fatigue. However, because different phenotypic characteristics and genomic markers are associated with diurnal variations in fatigue, morning and evening fatigue may be distinct but related symptoms.
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Affiliation(s)
- Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, CA, USA Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Marylin Dodd
- School of Nursing, University of California, San Francisco, CA, USA
| | - Claudia West
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Kathryn Lee
- School of Nursing, University of California, San Francisco, CA, USA
| | - Laura B Dunn
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, CA, USA
| | - John D Merriman
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Janine Cataldo
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
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22
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Ritchie C, Dunn LB, Paul SM, Cooper BA, Skerman H, Merriman JD, Aouizerat B, Alexander K, Yates P, Cataldo J, Miaskowski C. Differences in the symptom experience of older oncology outpatients. J Pain Symptom Manage 2014; 47:697-709. [PMID: 23916681 PMCID: PMC3833968 DOI: 10.1016/j.jpainsymman.2013.05.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/19/2013] [Accepted: 05/22/2013] [Indexed: 11/24/2022]
Abstract
CONTEXT The relatively low number of older patients in cancer trials limits knowledge of how older adults experience symptoms associated with cancer and its treatment. OBJECTIVES This study evaluated for differences in the symptom experience across four older age groups (60-64, 65-69, 70-74, ≥75 years). METHODS Demographic, clinical, and symptom data from 330 patients aged >60 years who participated in one Australian and two U.S. studies were evaluated. The Memorial Symptom Assessment Scale was used to evaluate the occurrence, severity, frequency, and distress of 32 symptoms commonly associated with cancer and its treatment. RESULTS On average, regardless of the age group, patients reported 10 concurrent symptoms. The most prevalent symptoms were physical in nature. Worrying was the most common psychological symptom. For 28 (87.5%) of the 32 Memorial Symptom Assessment Scale symptoms, no age-related differences were found in symptom occurrence rates. For symptom severity ratings, an age-related trend was found for difficulty swallowing. As age increased, severity of difficulty swallowing decreased. For symptom frequency, age-related trends were found for feeling irritable and diarrhea, with both decreasing in frequency as age increased. For symptom distress, age-related trends were found for lack of energy, shortness of breath, feeling bloated, and difficulty swallowing. As age increased, these symptoms received lower average distress ratings. CONCLUSION Additional research is warranted to examine how age differences in symptom experience are influenced by treatment differences, aging-related changes in biological or psychological processes, or age-related response shift.
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Affiliation(s)
- Christine Ritchie
- School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Laura B Dunn
- School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Helen Skerman
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - John D Merriman
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Bradley Aouizerat
- School of Nursing, University of California at San Francisco, San Francisco, California, USA; Institute for Human Genetics, University of California at San Francisco, San Francisco, California, USA
| | - Kimberly Alexander
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Janine Cataldo
- School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing, University of California at San Francisco, San Francisco, California, USA.
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23
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Leung G, Baggott C, West C, Elboim C, Paul SM, Cooper BA, Abrams G, Dhruva A, Schmidt BL, Kober K, Merriman JD, Leutwyler H, Neuhaus J, Langford D, Smoot BJ, Aouizerat BE, Miaskowski C. Cytokine candidate genes predict the development of secondary lymphedema following breast cancer surgery. Lymphat Res Biol 2014; 12:10-22. [PMID: 24502445 PMCID: PMC3961780 DOI: 10.1089/lrb.2013.0024] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lymphedema (LE) is a frequent complication following breast cancer treatment. While progress is being made in the identification of phenotypic risk factors for the development of LE, little information is available on the molecular characterization of LE. The purpose of this study was to determine if variations in pro- and anti-inflammatory cytokine genes were associated with LE following breast cancer treatment. METHODS AND RESULTS Breast cancer patients completed a number of self-report questionnaires. LE was evaluated using bioimpedance spectroscopy. Genotyping was done using a custom genotyping array. No differences were found between patients with (n=155) and without LE (n=387) for the majority of the demographic and clinical characteristics. Patients with LE had a significantly higher body mass index, more advanced disease, and a higher number of lymph nodes removed. Genetic associations were identified for three genes (i.e., interleukin (IL4) 4 (rs2227284), IL 10 (rs1518111), and nuclear kappa factor beta 2 (NFKB2 (rs1056890)) associated with inflammatory responses. CONCLUSIONS These genetic associations suggest a role for a number of pro- and anti-inflammatory genes in the development of LE following breast cancer treatment.
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Affiliation(s)
- Geraldine Leung
- 1 School of Nursing, University of California , San Francisco, California
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24
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Miaskowski C, Paul SM, Cooper B, West C, Levine JD, Elboim C, Hamolsky D, Abrams G, Luce J, Dhruva A, Langford DJ, Merriman JD, Kober K, Baggott C, Leutwyler H, Aouizerat BE. Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery. Eur J Oncol Nurs 2014; 18:242-53. [PMID: 24485012 PMCID: PMC4013216 DOI: 10.1016/j.ejon.2013.12.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/10/2013] [Accepted: 12/12/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE In this prospective, longitudinal study, we extend our findings on persistent breast pain in patients (n = 398) following breast cancer surgery and evaluate the prevalence and characteristics of persistent pain in the arm/shoulder. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the arm pain classes, were evaluated. METHODS AND SAMPLE Patients were recruited from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices. Patients were assessed prior to and monthly for six months following breast cancer surgery. RESULTS Using growth mixture modeling, patients were classified into no (41.6%), mild (23.6%), and moderate (34.8%) arm pain classes based on ratings of worst arm/shoulder pain. Compared to the no pain class, patients in the moderate pain class were significantly younger, had a higher body mass index, and were more likely to report preoperative breast pain and swelling in the affected breast. In addition, patients in the moderate pain class reported higher levels of depression, anxiety, and sleep disturbance than the no pain class. CONCLUSIONS Findings suggest that approximately 35% of women experience persistent levels of moderate arm/shoulder pain in the first six months following breast cancer surgery. Moderate arm/shoulder pain is associated with clinically meaningful decrements in functional status and quality of life.
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Affiliation(s)
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Claudia West
- School of Nursing, University of California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, CA, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, CA, USA
| | - Judith Luce
- School of Medicine, University of California, San Francisco, CA, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, CA, USA
| | - John D Merriman
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | | | | | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, CA, USA; Institute for Human Genetics, University of California, San Francisco, CA, USA
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Langford DJ, West C, Elboim C, Cooper BA, Abrams G, Paul SM, Schmidt BL, Levine JD, Merriman JD, Dhruva A, Neuhaus J, Leutwyler H, Baggott C, Sullivan CW, Aouizerat BE, Miaskowski C. Variations in potassium channel genes are associated with breast pain in women prior to breast cancer surgery. J Neurogenet 2014; 28:122-35. [PMID: 24392765 DOI: 10.3109/01677063.2013.856430] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Preoperative breast pain in women with breast cancer may result from a number of causes. Previous work from our team found that breast pain occurred in 28.2% of women (n = 398) who were about to undergo breast cancer surgery. The occurrence of preoperative breast pain was associated with a number of demographic and clinical characteristics, as well as variation in two cytokine genes. Given that ion channels regulate excitability of sensory neurons, we hypothesized that variations in potassium channel genes would be associated with preoperative breast pain in these patients. Therefore, in this study, we evaluated for associations between single-nucleotide polymorphisms and inferred haplotypes among 10 potassium channel genes and the occurrence of preoperative breast pain in patients scheduled to undergo breast cancer surgery. Multivariable logistic regression analyses were used to identify those genetic variations that were associated with the occurrence of preoperative breast pain while controlling for age and genomic estimates of and self-reported race/ethnicity. Variations in four potassium channel genes: (1) potassium voltage-gated channel, delayed rectifier, subfamily S, member 1 (KCNS1); (2) potassium inwardly rectifying channel, subfamily J, member 3 (KCNJ3); (3) KCNJ6; and (4) potassium channel, subfamily K, member 9 (KCNK9) were associated with the occurrence of breast pain. Findings from this study warrant replication in an independent sample of women who report breast pain following one or more breast biopsies.
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Merriman JD, Aouizerat BE, Cataldo JK, Dunn L, Cooper BA, West C, Paul SM, Baggott CR, Dhruva A, Kober K, Langford DJ, Leutwyler H, Ritchie CS, Abrams G, Dodd M, Elboim C, Hamolsky D, Melisko M, Miaskowski C. Association between an interleukin 1 receptor, type I promoter polymorphism and self-reported attentional function in women with breast cancer. Cytokine 2013; 65:192-201. [PMID: 24315345 DOI: 10.1016/j.cyto.2013.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 10/11/2013] [Accepted: 11/01/2013] [Indexed: 12/11/2022]
Abstract
Subgroups of patients with breast cancer may be at greater risk for cytokine-induced changes in cognitive function after diagnosis and during treatment. The purposes of this study were to identify subgroups of patients with distinct trajectories of attentional function and evaluate for phenotypic and genotypic (i.e., cytokine gene polymorphisms) predictors of subgroup membership. Self-reported attentional function was evaluated in 397 patients with breast cancer using the Attentional Function Index before surgery and for six months after surgery (i.e., seven time points). Using growth mixture modeling, three attentional function latent classes were identified: High (41.6%), Moderate (25.4%), and Low-moderate (33.0%). Patients in the Low-moderate class were significantly younger than those in the High class, with more comorbidities and lower functional status than the other two classes. No differences were found among the classes in years of education, race/ethnicity, or other clinical characteristics. DNA was recovered from 302 patients' samples. Eighty-two single nucleotide polymorphisms among 15 candidate genes were included in the genetic association analyses. After controlling for age, comorbidities, functional status, and population stratification due to race/ethnicity, IL1R1 rs949963 remained a significant genotypic predictor of class membership in the multivariable model. Carrying the rare "A" allele (i.e., GA+AA) was associated with a twofold increase in the odds of belonging to a lower attentional function class (OR: 1.98; 95% CI: 1.18, 3.30; p=.009). Findings provide evidence of subgroups of women with breast cancer who report distinct trajectories of attentional function and of a genetic association between subgroup membership and an IL1R1 promoter polymorphism.
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Affiliation(s)
- John D Merriman
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, United States.
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States; Institute for Human Genetics, University of California, San Francisco, 513 Parnassus Avenue, Box 0794, San Francisco, CA 94143, United States.
| | - Janine K Cataldo
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Laura Dunn
- School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0410, San Francisco, CA 94143, United States.
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Claudia West
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Christina R Baggott
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0410, San Francisco, CA 94143, United States.
| | - Kord Kober
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Heather Leutwyler
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Christine S Ritchie
- School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0410, San Francisco, CA 94143, United States.
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0410, San Francisco, CA 94143, United States.
| | - Marylin Dodd
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Charles Elboim
- Redwood Regional Medical Group, 121 Sotoyome Street, Santa Rosa, CA 95405, United States.
| | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
| | - Michelle Melisko
- School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Box 0410, San Francisco, CA 94143, United States.
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA 94143, United States.
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Stephens K, Cooper BA, West C, Paul SM, Baggott CR, Merriman JD, Dhruva A, Kober KM, Langford DJ, Leutwyler H, Luce JA, Schmidt BL, Abrams GM, Elboim C, Hamolsky D, Levine JD, Miaskowski C, Aouizerat BE. Associations between cytokine gene variations and severe persistent breast pain in women following breast cancer surgery. J Pain 2013; 15:169-80. [PMID: 24411993 DOI: 10.1016/j.jpain.2013.09.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 08/21/2013] [Accepted: 09/03/2013] [Indexed: 01/02/2023]
Abstract
UNLABELLED Persistent pain following breast cancer surgery is a significant clinical problem. Although immune mechanisms may play a role in the development and maintenance of persistent pain, few studies have evaluated for associations between persistent breast pain following breast cancer surgery and variations in cytokine genes. In this study, associations between previously identified extreme persistent breast pain phenotypes (ie, no pain vs severe pain) and single nucleotide polymorphisms (SNPs) spanning 15 cytokine genes were evaluated. In unadjusted analyses, the frequency of 13 SNPs and 3 haplotypes in 7 genes differed significantly between the no pain and severe pain classes. After adjustment for preoperative breast pain and the severity of average postoperative pain, 1 SNP (ie, interleukin [IL] 1 receptor 2 rs11674595) and 1 haplotype (ie, IL10 haplotype A8) were associated with pain group membership. These findings suggest a role for cytokine gene polymorphisms in the development of persistent breast pain following breast cancer surgery. PERSPECTIVE This study evaluated for associations between cytokine gene variations and the severity of persistent breast pain in women following breast cancer surgery. Variations in 2 cytokine genes were associated with severe breast pain. The results suggest that cytokines play a role in the development of persistent postsurgical pain.
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Affiliation(s)
- Kimberly Stephens
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Claudia West
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Christina R Baggott
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - John D Merriman
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Heather Leutwyler
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Judith A Luce
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Brian L Schmidt
- Department of Oral Maxillofacial Surgery, New York University College of Dentistry, New York, New York
| | - Gary M Abrams
- School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Jon D Levine
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, California
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, California
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, San Francisco, California; Institute for Human Genetics, University of California, San Francisco, San Francisco, California.
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Alfaro E, Dhruva A, Langford DJ, Koetters T, Merriman JD, West C, Dunn LB, Paul SM, Cooper B, Cataldo J, Hamolsky D, Elboim C, Kober K, Aouizerat BE, Miaskowski C. Associations between cytokine gene variations and self-reported sleep disturbance in women following breast cancer surgery. Eur J Oncol Nurs 2013; 18:85-93. [PMID: 24012192 PMCID: PMC3946647 DOI: 10.1016/j.ejon.2013.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/27/2013] [Accepted: 08/04/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE OF THE RESEARCH To attempt to replicate the associations found in our previous study of patients and family caregivers between interleukin 6 (IL6) and nuclear factor kappa beta 2 (NFKB2) and sleep disturbance and to identify additional genetic associations in a larger sample of patients with breast cancer. METHODS AND SAMPLE Patients with breast cancer (n = 398) were recruited prior to surgery and followed for six months. Patients completed a self-report measure of sleep disturbance and provided a blood sample for genomic analyses. Growth mixture modeling was used to identify distinct latent classes of patients with higher and lower levels of sleep disturbance. KEY RESULTS Patients who were younger and who had higher comorbidity and lower functional status were more likely to be in the high sustained sleep disturbance class. Variations in three cytokine genes (i.e., IL1 receptor 2 (IL1R2), IL13, NFKB2) predicted latent class membership. CONCLUSIONS Polymorphisms in cytokine genes may partially explain inter-individual variability in sleep disturbance. Determination of high risk phenotypes and associated molecular markers may allow for earlier identification of patients at higher risk for developing sleep disturbance and lead to the development of more targeted clinical interventions.
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Affiliation(s)
- Emely Alfaro
- School of Nursing, University of California, San Francisco, CA, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, CA, USA
| | - Theresa Koetters
- School of Nursing, University of California, San Francisco, CA, USA
| | - John D Merriman
- School of Nursing, University of California, San Francisco, CA, USA
| | - Claudia West
- School of Nursing, University of California, San Francisco, CA, USA
| | - Laura B Dunn
- School of Medicine, University of California, San Francisco, CA, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, CA, USA
| | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, CA, USA; Institute for Human Genetics, University of California, San Francisco, CA, USA
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Dhruva A, Aouizerat BE, Cooper B, Paul SM, Dodd M, West C, Wara W, Lee K, Dunn LB, Langford DJ, Merriman JD, Baggott C, Cataldo J, Ritchie C, Kober K, Leutwyler H, Miaskowski C. Differences in morning and evening fatigue in oncology patients and their family caregivers. Eur J Oncol Nurs 2013; 17:841-8. [PMID: 24012189 PMCID: PMC3867806 DOI: 10.1016/j.ejon.2013.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/10/2013] [Accepted: 06/21/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE OF THE RESEARCH To identify distinct latent classes of individuals based on ratings of morning and evening fatigue; evaluate for differences in phenotypic characteristics, as well as symptom and quality of life scores, among these latent classes; and evaluate for an overlap in morning and evening fatigue class membership. PATIENTS AND METHODS In a sample of 167 oncology outpatients and 85 of their FCs, growth mixture modeling was used to identify distinct latent classes based on ratings of morning and evening fatigue obtained before, during, and after radiation therapy. Analyses of variance and Chi Square analyses were used to evaluate for differences among the morning and evening fatigue latent classes. RESULTS Three distinct latent classes for morning fatigue were identified. Participants in the High Morning Fatigue class (47%) were younger and had lower functional status. Three distinct latent classes for evening fatigue were identified. Participants in the High Evening Fatigue class (61%) were younger, more likely to be female, more likely to have children at home, and more likely to be a FC. Only 10.3% of participants were classified in both the Very Low Morning and Low Evening Fatigue classes and 41.3% were classified in both the High Morning and High Evening Fatigue classes. CONCLUSIONS Different characteristics were associated with morning and evening fatigue, which suggests that morning and evening fatigue may be distinct but related symptoms. Additional research is needed to elucidate the mechanisms that may underlie diurnal variability in fatigue.
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Affiliation(s)
- Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
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Merriman JD, Aouizerat BE, Langford DJ, Cooper BA, Baggott CR, Cataldo JK, Dhruva A, Dunn L, West C, Paul SM, Ritchie CS, Swift PS, Miaskowski C. Preliminary evidence of an association between an interleukin 6 promoter polymorphism and self-reported attentional function in oncology patients and their family caregivers. Biol Res Nurs 2013; 16:152-9. [PMID: 23482714 DOI: 10.1177/1099800413479441] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subgroups of individuals may be at greater risk of cytokine-induced changes in attentional function. The purposes of this study were to identify subgroups of individuals with distinct trajectories of attentional function and evaluate for phenotypic and genotypic (i.e., cytokine gene polymorphisms) differences among these subgroups. Self-reported attentional function was evaluated in 252 participants (167 oncology patients and 85 family caregivers) using the Attentional Function Index before radiation therapy and at six additional assessments over 6 months. Three latent classes of attentional function were identified using growth mixture modeling: moderate (36.5%), moderate-to-high (48.0%), and high (15.5%) attentional function. Participants in the moderate class were significantly younger, with more comorbidities and lower functional status, than those in the other two classes. However, only functional status remained significant in multivariable models. Included in the genetic association analyses were 92 single nucleotide polymorphisms (SNPs) among 15 candidate genes. Additive, dominant, and recessive genetic models were assessed for each SNP. Controlling for functional status, only Interleukin 6 (IL6) rs1800795 remained a significant genotypic predictor of class membership in multivariable models. Each additional copy of the rare "G" allele was associated with a 4-fold increase in the odds of belonging to the lower attentional function class (95% confidence interval: [1.78, 8.92]; p = .001). Findings provide preliminary evidence of subgroups of individuals with distinct trajectories of attentional function and of a genetic association with an IL6 promoter polymorphism.
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Affiliation(s)
- John D Merriman
- 1School of Nursing, University of California, San Francisco, CA, USA
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31
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Dunn LB, Aouizerat BE, Langford DJ, Cooper BA, Dhruva A, Cataldo JK, Baggott CR, Merriman JD, Dodd M, West C, Paul SM, Miaskowski C. Cytokine gene variation is associated with depressive symptom trajectories in oncology patients and family caregivers. Eur J Oncol Nurs 2012; 17:346-53. [PMID: 23187335 PMCID: PMC4114773 DOI: 10.1016/j.ejon.2012.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/24/2012] [Accepted: 10/01/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE Depressive symptoms are common in cancer patients and their family caregivers (FCs). While these symptoms are characterized by substantial interindividual variability, the factors that predict this variability remain largely unknown. This study sought to confirm latent classes of oncology patients and FCs with distinct depressive symptom trajectories and to examine differences in phenotypic and genotypic characteristics among these classes. METHOD Among 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 of their FCs, growth mixture modeling (GMM) was used to identify latent classes of individuals based on Center for Epidemiological Studies-Depression (CES-D) scores obtained prior to, during, and for four months following completion of radiation therapy. One hundred four single nucleotide polymorphisms (SNPs) and haplotypes in 15 candidate cytokine genes were interrogated for differences between the two largest latent classes. Multivariate logistic regression analyses assessed effects of phenotypic and genotypic characteristics on class membership. RESULTS Four latent classes were confirmed: Resilient (56.3%), Subsyndromal (32.5%), Delayed (5.2%), and Peak (6.0%). Participants who were younger, female, non-white, and who reported higher baseline trait and state anxiety were more likely to be in the Subsyndromal, Delayed, or Peak groups. Variation in three cytokine genes (i.e., interleukin 1 receptor 2 [IL1R2], IL10, tumor necrosis factor alpha [TNFA]), age, and performance status predicted membership in the Resilient versus Subsyndromal classes. CONCLUSIONS Findings confirm the four latent classes of depressive symptom trajectories previously identified in a sample of breast cancer patients. Variations in cytokine genes may influence variability in depressive symptom trajectories.
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Affiliation(s)
- Laura B Dunn
- School of Medicine, University of California, San Francisco, CA, USA.
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32
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Miaskowski C, Cooper BA, Dhruva A, Dunn LB, Langford DJ, Cataldo JK, Baggott CR, Merriman JD, Dodd M, Lee K, West C, Paul SM, Aouizerat BE. Evidence of associations between cytokine genes and subjective reports of sleep disturbance in oncology patients and their family caregivers. PLoS One 2012; 7:e40560. [PMID: 22844404 PMCID: PMC3402493 DOI: 10.1371/journal.pone.0040560] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/08/2012] [Indexed: 11/18/2022] Open
Abstract
The purposes of this study were to identify distinct latent classes of individuals based on subjective reports of sleep disturbance; to examine differences in demographic, clinical, and symptom characteristics between the latent classes; and to evaluate for variations in pro- and anti-inflammatory cytokine genes between the latent classes. Among 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 of their FCs, growth mixture modeling (GMM) was used to identify latent classes of individuals based on General Sleep Disturbance Scale (GSDS) obtained prior to, during, and for four months following completion of radiation therapy. Single nucleotide polymorphisms (SNPs) and haplotypes in candidate cytokine genes were interrogated for differences between the two latent classes. Multiple logistic regression was used to assess the effect of phenotypic and genotypic characteristics on GSDS group membership. Two latent classes were identified: lower sleep disturbance (88.5%) and higher sleep disturbance (11.5%). Participants who were younger and had a lower Karnofsky Performance status score were more likely to be in the higher sleep disturbance class. Variation in two cytokine genes (i.e., IL6, NFKB) predicted latent class membership. Evidence was found for latent classes with distinct sleep disturbance trajectories. Unique genetic markers in cytokine genes may partially explain the interindividual heterogeneity characterizing these trajectories.
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Affiliation(s)
- Christine Miaskowski
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, United States of America.
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Merriman JD, Jansen C, Koetters T, West C, Dodd M, Lee K, Paul SM, Aouizerat BE, Cooper BA, Swift PS, Wara W, Miaskowski C. Predictors of the trajectories of self-reported attentional fatigue in women with breast cancer undergoing radiation therapy. Oncol Nurs Forum 2010; 37:423-32. [PMID: 20591802 DOI: 10.1188/10.onf.423-432] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine how attentional fatigue changed from the time of simulation to four months after the completion of radiation therapy and to investigate whether specific variables predicted initial levels and trajectories of attentional fatigue. DESIGN Descriptive, longitudinal study. SETTING Two radiation therapy departments. SAMPLE 73 women with breast cancer who received primary or adjuvant radiation therapy. METHODS Participants completed questionnaires prior to, during, and after radiation therapy. Descriptive statistics and hierarchical linear modeling were used for data analysis. MAIN RESEARCH VARIABLES Attentional fatigue; demographic, clinical, and symptom characteristics. FINDINGS Large amounts of interindividual variability were found in the trajectories of attentional fatigue. At baseline, higher levels of attentional fatigue were associated with younger age, not working, a higher number of comorbidities, and higher levels of trait anxiety. The trajectory of attentional fatigue improved over time for women with higher body mass index at baseline. CONCLUSIONS This study is the first to identify predictors of interindividual variability in attentional fatigue in women with breast cancer undergoing radiation therapy. The predictors should be considered in the design of future correlational and interventional studies. IMPLICATIONS FOR NURSING Nurses could use knowledge of the predictors to identify patients at risk for higher levels of attentional fatigue. In addition, nurses could use the information to educate patients about how attentional fatigue may change during and following radiation therapy for breast cancer.
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Affiliation(s)
- John D Merriman
- School of Nursing, University of California, San Francisco, USA
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