Stress, depression, the immune system, and cancer. Lancet Oncol. 2004;5:617-625. [PMID: 15465465 DOI: 10.1016/s1470-2045(04)01597-9]

Depression in women with metastatic breast cancer: a review of the literature

OBJECTIVE

The aim of this article is to review the available literature on depression in women with metastatic breast cancer in terms of prevalence, potential risk factors, and consequences, as well as pharmacological and psychological interventions.

METHOD

An extensive review of the literature was conducted.

RESULTS

The prevalence of depression appears to be especially elevated in patients with advanced cancer. Many demographic, medical, and psychosocial factors may increase the risk that women will develop depressive symptoms during the course of their illness. Despite the fact that depression appears to be associated with numerous negative consequences, this disorder remains underdiagnosed and undertreated. Both pharmacotherapy and psychotherapy have been found to treat effectively depressive symptoms in this population, but cognitive-behavioral therapy appears to be the most cost-effective approach.

SIGNIFICANCE OF RESULTS

Areas for future research are suggested.

The association between depressive symptoms and acute exacerbations of COPD

BACKGROUND

Depression is an important comorbidity for patients with chronic obstructive pulmonary disease (COPD). The association between depression and acute exacerbations of COPD is unknown. This study was designed to determine the frequency of COPD exacerbations in outpatients with and without depressive symptoms.

METHODS

In this retrospective cohort study, patients with a primary diagnosis of COPD were followed for 1 year after discharge from a pulmonary rehabilitation program and the frequency of exacerbations was recorded. Upon completion of the program, all patients were administered the Short-Form 36 Health Survey (SF-36), which contains a mental health domain. Patients were classified as having depressive symptoms based on their domain score, which was separately validated in a second population of patients.

RESULTS

Of the 194 patients with COPD who completed the pulmonary rehabilitation program, 32 (16.5%) had depressive symptoms. There were no differences in terms of age, race, pack-years, forced expiratory volume in 1 second (FEV(1)), 6-minute walk distance, body mass index, use of supplemental oxygen, use of inhaled steroids, or the Charlson Comorbidity Index between patients with and without depressive symptoms. Patients with depressive symptoms had more exacerbations in the following year (1.91 vs. 1.36; p = 0.02), were 2.8 times more likely to have ever had an exacerbation (95% confidence interval (CI), 1.1-7.3; p = 0.03), and suffered a first exacerbation earlier (148 days compared with 266 days; p = 0.04) than nondepressed patients.

CONCLUSIONS

COPD patients with depressive symptoms have a significantly higher risk for exacerbations. Early screening for depression in patients with COPD may help identify those patients at higher risk for subsequent exacerbations.

The rebirth of neuroscience in psychosomatic medicine, Part I: historical context, methods, and relevant basic science

Neuroscience was an integral part of psychosomatic medicine at its inception in the early 20th century. Since the mid-20th century, however, psychosomatic research has largely ignored the brain. The field of neuroscience has burgeoned in recent years largely because a variety of powerful new methods have become available. Many of these methods allow for the noninvasive study of the living human brain and thus are potentially available for integration into psychosomatic medicine research at this time. In this first paper we examine various methods available for human neuroscientific investigation and discuss their relative strengths and weaknesses. We next review some basic functional neuroanatomy involving structures that are increasingly being identified as relevant for psychosomatic processes. We then discuss, and provide examples of, how the brain influences end organs through "information transfer systems," including the autonomic, neuroendocrine, and immune systems. The evidence currently available suggests that neuroscience holds great promise for advancing the goal of understanding the mechanisms by which psychosocial variables influence physical disease outcomes. An increased focus on such mechanistic research in psychosomatic medicine is needed to further its acceptance into the field of medicine.

Norepinephrine upregulates VEGF, IL-8, and IL-6 expression in human melanoma tumor cell lines: implications for stress-related enhancement of tumor progression

Studies suggest that stress can be a co-factor for the initiation and progression of cancer. The catecholamine stress hormone, norepinephrine (NE), may influence tumor progression by modulating the expression of factors implicated in angiogenesis and metastasis. The goal of this study was to examine the influence of NE on the expression of VEGF, IL-8, and IL-6 by the human melanoma cell lines, C8161, 1174MEL, and Me18105. Cells were treated with NE and levels of VEGF, IL-8, and IL-6 were measured using ELISA and real-time PCR. The expression of beta-adrenergic receptors (beta-ARs) mRNA and protein were also assessed. Finally, immunohistochemistry was utilized to examine the presence of beta1- and beta2-AR in primary and metastatic human melanoma biopsies. We show that NE treatment upregulated production of VEGF, IL-8, and IL-6 in C8161 cells and to a lesser extent 1174MEL and Me18105 cells. The upregulation was associated with induced gene expression. The effect on C8161 cells was mediated by both beta1- and beta2-ARs. Furthermore, 18 of 20 melanoma biopsies examined expressed beta2-AR while 14 of 20 melanoma biopsies expressed beta1-AR. Our data support the hypothesis that NE can stimulate the aggressive potential of melanoma tumor cells, in part, by inducing the production VEGF, IL-8, and IL-6. This line of research further suggests that interventions targeting components of the activated sympathetic-adrenal medullary (SAM) axis, or the utilization of beta-AR blocking agents, may represent new strategies for slowing down the progression of malignant disease and improving cancer patients' quality of life.

Neuroendocrine modulation of cancer progression

Clinical and animal studies now support the notion that psychological factors such as stress, chronic depression, and lack of social support might promote tumor growth and progression. Recently, cellular and molecular studies have started to identify biological processes that could mediate such effects. This review provides a mechanistic understanding of the relationship between biological and behavioral influences in cancer and points to more comprehensive behavioral and pharmacological approaches for better patient outcomes.

Catecholamines can mediate stress-related effects on tumor progression

Studies have implicated behavior as a factor that can influence several aspects of health and have described the complex bidirectional interactions among the CNS, the endocrine system and the immune system that are involved. There is evidence that psychological factors can affect the incidence and progression of some cancers in humans. The hypothesis that stress could be a cofactor is supported by data obtained from animal models. Catecholamines, norepinephrine in particular, have been shown to directly affect various aspects of tumor development that is separate from the well-characterized effects on the cellular immune response to immunogenic tumors. Studies have shown that norepinephrine can directly affect tumor cell behavior and gene expression, further suggesting another mechanism for stress-related modulation of tumor progression. This line of research further suggests that interventions targeting components of the activated sympathetic-adrenal-medullary axis, or the utilization of β-adrenergic receptor-blocking agents, may represent new strategies for slowing down the progression of malignant disease and improving cancer patients' quality of life.

Analysis of chloroethane toxicity and carcinogenicity including a comparison with bromoethane

Chloroethane (CE) gas carcinogenicity is analyzed and determined from a National Toxicology Program (NTP) bioassay where an inhalation concentration of 15,000 ppm CE gas in air produced the highest incidence of an uncommon-to-rare tumor ever observed by the NTP. Persistently inhaled CE produces endometrial cancers in female mice. The first-tumor-corrected uterine endometrial incidence (I) in B6C3F1 mice is 90%, but no significant tumors occurred in F344 rats. The endometrial cancers dispersed by 1) migrating locally to the adjacent myometrium, 2) then migrating to the bloodstream by intravasation, 3) entering 17 distal organs by extravasation and adapting to the new tissue environment. Distal cancers retained sufficient endometrial cell features to be recognized at each metastatic site. CE produced one of the highest metastasis rates ever observed by NTP of 79%. Comparing CE with bromoethane (BE), a structural analogue, it was found that BE too produced rare murine endometrial cancers yielding the second highest NTP incidence rate of I = 58% with a similar high malignancy rate of 56%. Because of the historical rarity of endometrial tumors in the B6C3F1 mouse, both of these SAR haloethanes seem to be evoking a strong, related carcinogenic potential in B6C3F1 mice, but not in F344 rats. The question of whether humans are similar to mice or to rats is addressed here and in Gargas, et al., 2008. The powerful carcinogenesis caused by these halohydrocarbons may have been caused by excessive and metabolically unresolved acetaldehyde (AC) which is directly generated by Cyp2E1 in the oxidative elimination of CE. With >95% AC metabolic production, as predicted from pharmacokinetic (PK) studies depending on CE exposure, AC is the main elimination intermediate. AC is a known animal carcinogen and a strongly suspected human carcinogen. Also, CE causes incipient decreases of tissue essential glutathione pools [GSH] by Phase II conjugation metabolic elimination of CE (and BE), by glutantione transferase (GST), in most organs (except brain) exposed to high circulating CE and it metabolites. In three laboratories, an excessive stress reaction of hyperkinesis was observed only during 15,000 ppm gas exposure but not when the exposure ceased or when exposure was presented at 150 ppm. Test rodents other than the female mice did not exhibit a pattern of visible stress nor did they have a carcinogenic response to CE gas. Unremitting stress has been documented to contribute a feedback to the hypothalamus which stimulates the hypothalamic-pituitary-axis (HPA), which in turn, induces the adrenal glands. Because estrus and estrogen and progesterone levels were unaltered by CE gas, the adrenal over stimulation, causing high steroid output, may be the penultimate step in this extraordinary carcinogenic response. High adrenal production of corticosteroids could adversely promote endometrial cells to cancers in mice − a mechanism that has already been observed in humans.

Locating relationship and communication issues among stressors associated with breast cancer

This article clarifies how the social contexts in which breast cancer survivors live can contribute to the stress they experience because of the disease. Guided by Solomon and Knobloch's (2004) relational turbulence model and Petronio's (2002) communication privacy management theory, this study explores personal relationship and communication boundary issues within stressors that are associated with the diagnosis, treatment, and early survivorship of breast cancer. A qualitative analysis of discourse posted on breast cancer discussion boards and weblogs using the constant comparative method and open-coding techniques revealed 12 sources of stress. Using axial coding methods and probing these topics for underlying relationship and communication issues yielded 5 themes. The discussion highlights the implications of the findings for the theories that guided this investigation and for breast cancer survivorship more generally.

Sex dimorphism in antitumor response of chemotherapeutic drug cisplatin in a murine host-bearing a T-cell lymphoma

Previously we have demonstrated that in-vivo growth of a murine T-cell lymphoma of spontaneous origin designated as Dalton's lymphoma (DL) shows sex dimorphism (J Rep Immunol 2005; 65:17-32). It remained unclear, however, if DL growth in female and male tumor-bearing hosts also shows a sex-dependent differential susceptibility to the antitumor action of cancer chemotherapeutic drugs. In this study we have demonstrated that in-vivo administration of anticancer drugs: cisplatin or doxorubicin to the DL-bearing host results in a sex-dependent different antitumor activity of the drugs, causing a sex dimorphism in the antitumor response of the drugs with respect to tumor growth inhibition. The antitumor effect of both drugs was found to be better in male tumor-bearing hosts compared with female tumor-bearing hosts. The study also shows that DL cells obtained from male and female tumor-bearing hosts display a differential growth response to following treatment with cisplatin in vitro. Cell growth regulatory proteins: interleukin-2, interferon-gamma, tumor growth factor-beta, p53, caspase-activated DNase, vascular endothelial growth factor, and interleukin-2 receptor were found to be involved in the observed sex-specific response of DL cells to the antitumor action of cisplatin. Moreover, gonadal hormones: androgen, estrogen, and their specific antagonists flutamide and tamoxifen were found to directly modulate the cytotoxicity of cisplatin against DL cells in vitro. This study, therefore, suggests for the first time that the efficacy of cancer chemotherapeutic may vary in a sex-specific manner in a host-bearing a T-cell lymphoma.

Association of preoperative depression and survival after resection of malignant brain astrocytoma

BACKGROUND

Clinical depression has been shown to negatively influence the morbidity and mortality of multiple disease states. It remains unclear if clinical depression affects survival after surgical management of malignant brain astrocytoma. We set out to determine whether patients with a diagnosis of clinical depression before surgery experienced decreased survival independent of treatment modality or degree of disability.

METHODS

One thousand fifty-two patients undergoing surgical management for malignant brain astrocytoma (WHO grade 3 or 4) performed at a single institution from 1995 to 2006 were retrospectively reviewed. The independent association of depression prior to surgery and subsequent survival was assessed via multivariate proportional hazards regression analysis.

RESULTS

Surgical management consisted of primary resection in 605 (58%) patients, secondary resection in 410 (39%), and biopsy in 37 patients (3.5%). Pathology was WHO grade IV in 829 (79%) and grade III in 223 (21%). Forty-nine patients (5%) carried the diagnosis of depression at the time of surgery. Mean age and KPS on admission was 51 +/- 16 and 80 +/- 10 years, respectively. Two hundred ninety patients (28%) received Gliadel (BCNU MGI Pharma, Inc., Bloomington, MN, USA) wafer implantation and 274 (26%) received postoperative temozolomide (concomitant in 102, delayed adjuvant in 172 patients). Subsequent resection was performed at the time of recurrence in 135 (13%) patients a mean of 10 +/- 6 months after surgery. Adjusting for all variables associated with survival in this model, age (P < .001), KPS (P < .001), WHO grade III vs IV (P < .001), primary versus secondary resection (P < .001), gross-total resection (P < .001), Gliadel wafer implantation (P = .048), postoperative temozolomide therapy (P < .001), and subsequent resection at time of recurrence (P < .001); preoperative depression was independently associated with decreased survival (relative risk [95% CI]: 1.41 [1.1-1.96], P < .05). The difference in percent survival between the depression and nondepression cohorts was most notable at 12 months (15% vs 41%) and 20 months (0% vs 21%) after surgery.

CONCLUSION

In our experience, patients who are actively depressed at the time of surgery were associated with decreased survival after surgical management of malignant astrocytoma, independent of degree of disability, tumor grade, or subsequent treatment modalities. In our opinion, the presence of an association between preoperative depression and survival warrants further investigation.

Therapeutic Actions of Melatonin in Cancer: Possible Mechanisms

Melatonin is a phylogenetically well-preserved molecule with diverse physiological functions. In addition to its well-known regulatory control of the sleep/wake cycle, as well as circadian rhythms generally, melatonin is involved in immunomodulation, hematopoiesis, and antioxidative processes. Recent human and animal studies have now shown that melatonin also has important oncostatic properties. Both at physiological and pharmacological doses melatonin exerts growth inhibitory effects on breast cancer cell lines. In hepatomas, through its activation of MT 1 and MT2 receptors, melatonin inhibits linoleic acid uptake, thereby preventing the formation of the mitogenic metabolite 1,3-hydroxyoctadecadienoic acid. In animal model studies, melatonin has been shown to have preventative action against nitrosodiethylamine (NDEA)-induced liver cancer. Melatonin also inhibits the growth of prostate tumors via activation of MT1 receptors thereby inducing translocation of the androgen receptor to the cytoplasm and inhibition of the effect of endogenous androgens. There is abundant evidence indicating that melatonin is involved in preventing tumor initiation, promotion, and progression. The anticarcinogenic effect of melatonin on neoplastic cells relies on its antioxidant, immunostimulating, and apoptotic properties. Melatonin's oncostatic actions include the direct augmentation of natural killer (NK) cell activity, which increases immunosurveillance, as well as the stimulation of cytokine production, for example, of interleukin (IL)-2, IL-6, IL-12, and interferon (IFN)-γ. In addition to its direct oncostatic action, melatonin protects hematopoietic precursors from the toxic effect of anticancer chemotherapeutic drugs. Melatonin secretion is impaired in patients suffering from breast cancer, endometrial cancer, or colorectal cancer. The increased incidence of breast cancer and colorectal cancer seen in nurses and other night shift workers suggests a possible link between diminished secretion of melatonin and increased exposure to light during nighttime. The physiological surge of melatonin at night is thus considered a “natural restraint” on tumor initiation, promotion, and progression.

Perceived stress and cause-specific mortality among men and women: results from a prospective cohort study

The authors assessed the effect of psychological stress on total and cause-specific mortality among men and women. In 1981-1983, the 12,128 Danish participants in the Copenhagen City Heart Study were asked two questions on stress intensity and frequency and were followed in a nationwide registry until 2004, with <0.1% loss to follow-up. Sex differences were found in the relations between stress and mortality (p = 0.02). After adjustments, men with high stress versus low stress had higher all-cause mortality (hazard ratio (HR) = 1.32, 95% confidence interval (CI): 1.15, 1.52). This finding was most pronounced for deaths due to respiratory diseases (high vs. low stress: HR = 1.79, 95% CI: 1.10, 2.91), external causes (HR = 3.07, 95% CI: 1.65, 5.71), and suicide (HR = 5.91, 95% CI: 2.47, 14.16). High stress was related to a 2.59 (95% CI: 1.20, 5.61) higher risk of ischemic heart disease mortality for younger, but not older, men. In general, the effects of stress were most pronounced among younger and healthier men. No associations were found between stress and mortality among women, except among younger women with high stress, who experienced lower cancer mortality (HR = 0.51, 95% CI: 0.28, 0.92). Future preventive strategies may be targeted toward stress as a risk factor for premature death among middle-aged, presumably healthy men.

Depression and cancer: an unexplored and unresolved emergent issue in elderly patients

Despite the high prevalence of depressive disorders in cancer patients and elderly people, the topic of depression in elderly cancer patients still remains unexplored. This emerges from a systematic review of the literature conducted to investigate issues of depression, diagnosis, pathogenesis, treatment and their complex neuroimmunobiological interactions. Indeed, it becomes apparent that depression in elderly patients with cancer may have a peculiar phenomenology. In addition, the moderate rate of major depressive disorder and the high rate of minor depressive disorder are accompanied by subthreshold forms of depression that are at risk to be underrecognized and untreated. Immune dysfunction may represent a common pathogenic ground of depression, cancer and aging. This may have important implications for treatment. In the near future, we need to develop validated mood disorder diagnoses and verify antidepressant treatment efficacy for elderly cancer patients with depression in order to improve their clinical outcome and quality of life.

Depressed and anxious mood and T-cell cytokine expressing populations in ovarian cancer patients

The adaptive immune response of ovarian cancer patients has been linked to survival, and is known to be impaired in the tumor microenvironment. Little is known about relationships between biobehavioral factors such as depressed mood and anxiety and the adaptive immune response in ovarian cancer. Thirty-seven patients with epithelial ovarian cancer and 14 patients with benign ovarian neoplasms completed psychosocial questionnaires pre-surgery. Lymphocytes from peripheral blood, tumor, and ascites (fluid around the tumor), were obtained on the day of surgery. Expression of the Type-1 cytokine interferon-gamma (IFN gamma), and the Type-2 cytokine interleukin-4 (IL-4) by T-helper (CD4(+)) and T-cytotoxic (CD8(+)) cells was measured under autologous tumor-stimulated, polyclonally-stimulated, or unstimulated conditions. Links with mood were examined. Among cancer patients, marked elevations in unstimulated and tumor-stimulated Type-2 responses were seen, particularly in ascites and tumor-infiltrating lymphocytes (P values<0.01). With polyclonal stimulation, lymphocytes from all compartments expressed elevated Type-1 cytokines (P values<0.014). Depressed and anxious mood were both associated with significantly lower ratios of polyclonally-stimulated CD4(+) cells producing IFN gamma (TH(1) cells) vs. IL-4 (TH(2) cells) in all compartments (depressed mood: P=0.012; anxiety: P=0.038) and depressed mood was also related to lower ratios of polyclonally-stimulated CD8(+) cells producing IFN gamma (TC(1)) vs. IL-4 (TC(2)) (P=0.035). Although effects of polyclonal stimulation should be generalized with caution to the in vivo immune response, findings suggest that depressed and anxious mood are associated with greater impairment of adaptive immunity in peripheral blood and in the tumor microenvironment among ovarian cancer patients.

Interdisciplinarity and systems science to improve population health: a view from the NIH Office of Behavioral and Social Sciences Research

Fueled by the rapid pace of discovery, humankind's ability to understand the ultimate causes of preventable common disease burdens and to identify solutions is now reaching a revolutionary tipping point. Achieving optimal health and well-being for all members of society lies as much in the understanding of the factors identified by the behavioral, social, and public health sciences as by the biological ones. Accumulating advances in mathematical modeling, informatics, imaging, sensor technology, and communication tools have stimulated several converging trends in science: an emerging understanding of epigenomic regulation; dramatic successes in achieving population health-behavior changes; and improved scientific rigor in behavioral, social, and economic sciences. Fostering stronger interdisciplinary partnerships to bring together the behavioral-social-ecologic models of multilevel "causes of the causes" and the molecular, cellular, and, ultimately, physiological bases of health and disease will facilitate breakthroughs to improve the public's health. The strategic vision of the Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health (NIH) is rooted in a collaborative approach to addressing the complex and multidimensional issues that challenge the public's health. This paper describes OBSSR's four key programmatic directions (next-generation basic science, interdisciplinary research, systems science, and a problem-based focus for population impact) to illustrate how interdisciplinary and transdisciplinary perspectives can foster the vertical integration of research among biological, behavioral, social, and population levels of analysis over the lifespan and across generations. Interdisciplinary and multilevel approaches are critical both to the OBSSR's mission of integrating behavioral and social sciences more fully into the NIH scientific enterprise and to the overall NIH mission of utilizing science in the pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability.

Restraint stress induces lymphocyte reduction through p53 and PI3K/NF-kappaB pathways

Restraint stress, either physical or psychological, can modulate immune function. However, the mechanisms associated with stress-induced lymphocyte reduction remains to be elucidated. We have previously shown that chronic stress induces Fas-mediated lymphocyte reduction. Here, we investigated the mechanisms by which restraint stress modulates lymphocyte reduction. Our data have shown that inhibition of p53 by the p53 inhibitor PFT-alpha attenuates stress-induced reduction in lymphocyte numbers. These results were verified using p53 knockout mice, suggesting a pivotal role of p53 in this process. In addition our data have indicated that PI3K/nuclear factor kappa B (NF-kappaB) signaling pathway plays an important role in the stress-induced lymphocyte reduction. Our study thus demonstrates that restraint stress promotes lymphocyte reduction through p53 and PI3K/NF-kappaB pathways.

Stress, immunity, and cervical cancer: biobehavioral outcomes of a randomized clinical trial [corrected]

PURPOSE

Cancer diagnosis and treatment imparts chronic stressors affecting quality of life (QOL) and basic physiology. However, the capacity to increase survival by improving QOL is controversial. Patients with cervical cancer, in particular, have severely compromised QOL, providing a population well-suited for the evaluation of novel psychosocial interventions and the exploration of mechanisms by which modulation of the psychoneuroimmune axis might result in improved clinical outcomes.

EXPERIMENTAL DESIGN

A randomized clinical trial was conducted in cervical cancer survivors that were enrolled at >or=13 and <22 months after diagnosis (n=50), comparing a unique psychosocial telephone counseling (PTC) intervention to usual care. QOL and biological specimens (saliva and blood) were collected at baseline and 4 months post-enrollment.

RESULTS

The PTC intervention yielded significantly improved QOL (P=0.011). Changes in QOL were significantly associated with a shift of immune system T helper type 1 and 2 (Th1/Th2) bias, as measured by IFN-gamma/interleukin-5 ELISpot T lymphocyte precursor frequency; improved QOL being associated with increased Th1 bias (P=0.012). Serum interleukin-10 and the neuroendocrine variables of cortisol and dehydroepiandrosterone revealed trends supporting this shift in immunologic stance and suggested a PTC-mediated decrease of the subject's chronic stress response.

CONCLUSIONS

This study documents the utility of a unique PTC intervention and an association between changes in QOL and adaptive immunity (T helper class). These data support the integration of the chronic stress response into biobehavioral models of cancer survivorship and suggests a novel mechanistic hypotheses by which interventions leading to enhanced QOL could result in improved clinical outcome including survival.

Neuroendocrine influences on cancer biology

Over the past 25 years, epidemiological and clinical studies have linked psychological factors such as stress, chronic depression, and lack of social support to the incidence and progression of cancer. Although the mechanisms underlying these observations are not completely understood, recent molecular and animal studies have begun to identify specific signaling pathways that could explain the impact of neuroendocrine effects on tumor growth and metastasis. This review will highlight the importance of known clinical, molecular, and cellular processes with regard to the neuroendocrine stress effects on tumor biology and discuss possible behavioral and pharmacological interventions to ameliorate these effects and ultimately improve cancer outcomes.

Early life stress enhances the vulnerability to chronic psychosocial stress and experimental colitis in adult mice

Early life stress enhances the vulnerability to both mood and chronic inflammatory disorders, suggesting a link between these stress-related disorders. To study this, we exposed male C57BL/6 mice to early life stress [maternal separation (MS), 3 h/d, d 1-14] and to adult chronic psychosocial stress [chronic subordinate colony housing (CSC)] and measured changes in neuroendocrine parameters and in the severity of a chemically induced colitis. In both unseparated and MS mice, 19 d of CSC exposure resulted in a transient decrease in body weight gain, increased anxiety-related behavior, and decreased vasopressin mRNA expression in the hypothalamic paraventricular nucleus compared with respective nonstressed mice. However, only CSC-stressed MS mice showed elevated CRH mRNA expression in the paraventricular nucleus and reduced plasma corticosterone. Subsequent treatment with dextran sulfate sodium (1%, 7 d) resulted in a more severe colonic inflammation in MS compared with unseparated mice. This was indicated by an increased histological damage score and increased TNF secretion (nonstressed MS mice), more severe body weight loss and inflammatory reduction in colon length (CSC-stressed MS mice), and increased interferon-gamma secretion (nonstressed and CSC-stressed MS mice). In conclusion, early life stress and subsequent exposure to chronic psychosocial stress in adulthood induced neuroendocrine abnormalities, which likely contributed to enhanced vulnerability to chemically induced colitis. The combined use of MS and CSC represents a potential animal model providing novel (patho)physiological insights into the complex interactions between neuroendocrine and inflammatory actions upon chronic stress exposure. These findings may further help to reveal mechanisms of hypocortisolemic disorders.

Do stress-related psychosocial factors contribute to cancer incidence and survival?

A substantial body of research has investigated the associations between stress-related psychosocial factors and cancer outcomes. Previous narrative reviews have been inconclusive. In this Review, we evaluated longitudinal associations between stress and cancer using meta-analytic methods. The results of 165 studies indicate that stress-related psychosocial factors are associated with higher cancer incidence in initially healthy populations (P = 0.005); in addition, poorer survival in patients with diagnosed cancer was noted in 330 studies (P <0.001), and higher cancer mortality was seen in 53 studies (P <0.001). Subgroup meta-analyses demonstrate that stressful life experiences are related to poorer cancer survival and higher mortality but not to an increased incidence. Stress-prone personality or unfavorable coping styles and negative emotional responses or poor quality of life were related to higher cancer incidence, poorer cancer survival and higher cancer mortality. Site-specific analyses indicate that psychosocial factors are associated with a higher incidence of lung cancer and poorer survival in patients with breast, lung, head and neck, hepatobiliary, and lymphoid or hematopoietic cancers. These analyses suggest that stress-related psychosocial factors have an adverse effect on cancer incidence and survival, although there is evidence of publication bias and results should be interpreted with caution.

Psychoneuroimmunology

Psychoneuroimmunology (PNI) is a discipline that has evolved in the last 40 years to study the relationship between immunity, the endocrine system, and the central and peripheral nervous systems. In this manner, neurotransmitters, hormones, and neuropeptides have been found to regulate immune cells, and these in turn are capable of communicating with nervous tissue through the secretion of a wide variety of cytokines. Of critical importance is the effect of products of the CNS and nerves on the maintenance of the delicate balance between cell-mediated (Th1) and humoral (Th2) immune responses. A good example of how this concept operates in vivo becomes evident when analyzing the effects of stressors. Chronic stress affects significantly the function of the immune system as well as modifies the evolution of a variety of skin diseases, as psychosocial interventions have proved to be effective in their therapy.

Inscriptions of violence: societal and medical neglect of child abuse--impact on life and health

OBJECTIVE

A sickness history from General Practice will be unfolded with regard to its implicit lived meanings. This experiential matrix will be analyzed with regard to its medico-theoretical aspects.

METHOD

The analysis is grounded in a phenomenology of the body. The patient Katherine Kaplan lends a particular portrait to the dynamics that are enacted in the interface between socially silenced domestic violence and the theoretical assumptions of human health as these inform the clinical practice of health care.

RESULTS

By applying an understanding of sickness that transcends the mind-body split, a concealed and complex logic emerges. This logic is embedded in a nexus of the impact of childhood abuse experience and the medical disinterest in subjective experiences and their impact on selfhood and health. Its core is twofold: the violation of embodiment resulting from intra-familial abuse and existential threat, and the embodiment of violation resulting from social rules and the theoretically blinded medical gaze.

CONCLUSION

A considerable medical investment, apparently conducted in a correct and consistent manner as to diagnostic and therapeutic measures, results in the complete incapacitation of a young physician.

VEGF is differentially regulated in multiple myeloma-derived cell lines by norepinephrine

Evidence from human and animal studies support the hypothesis that psychological stress can be a co-factor for the initiation and progression of cancer. Recent work from our laboratory and others have shown that the catecholamine hormone, norepinephrine (NE), may influence tumor progression of some solid epithelial tumors including nasopharyngeal carcinoma (NPC) and ovarian cancer by modulating the expression of proangiogenic and pro-metastatic factors, such as vascular endothelial growth factor (VEGF). In this study, we determined whether NE can likewise modulate the expression of VEGF in a lymphoid tumor, multiple myeloma (MM), a cancer of plasma cells. Three MM-derived cell lines, NCI-H929, MM-M1, and FLAM-76, were studied. The presence of beta1- and beta2-adrenergic receptors (ARs) was assessed using Western blotting. Cells were treated with 0, 1, and 10 microM NE for 1, 3, 6, and 24h and the levels of VEGF in culture supernatants were measured by ELISA. Immunoblots of cell lysates revealed the presence of beta1- and beta2-ARs in all three MM-derived cell lines. However, these MM-derived cell lines exhibited varying degrees of NE-dependent regulation of VEGF expression with FLAM-76 (the only IL-6-dependent cell line among the three) exhibiting the most significant stimulation, followed by MM-M1 cells and then NCI-H929. The data suggest that the ability of NE to regulate the expression of VEGF is not limited to solid epithelial tumors and suggests a possible regulatory role of catecholamine stress hormones in MM progression.

Perceived stress and risk of colorectal cancer in men and women: a prospective cohort study

OBJECTIVE

We aim to assess the relationship between stress and risk of primary colorectal cancer in men and women.

DESIGN

A prospective cohort study.

SETTING

The Copenhagen City Heart Study, Denmark.

SUBJECTS

A total of 6488 women and 5426 men were included in the study. The participants were asked about intensity and frequency of stress at baseline in 1981-1983 and were followed until the end of 2000 in the Danish Cancer Registry. Less than 0.1% was lost to follow-up.

MAIN OUTCOME MEASURES

First time incidence of primary colorectal cancer.

RESULTS

During follow-up 162 women and 166 men were diagnosed with colorectal cancer. Women with moderate and high stress intensity had a hazard ratio of 0.60 (95% CI: 0.37-0.98) and 0.52 (0.23-1.14) for colorectal cancer, respectively, compared to women with no stress. For colon cancer, a one-unit increase on a seven-point stress-score was associated with an 11% lower incidence of the disease (HR = 0.89, 95% CI: 0.81-0.99) amongst women. There was no consistent evidence of an association between stress and colorectal cancer in men.

CONCLUSION

Perceived stress was associated with lower risk of particularly colon cancer in women, whilst there was no clear relationship between stress and colorectal cancer in men.

Microbial endocrinology: how stress influences susceptibility to infection

A holistic approach to understanding the mechanisms by which stress influences the pathogenesis of infectious disease has resulted in the development of the field of microbial endocrinology. This transdisciplinary field represents the intersection of microbiology with mammalian endocrinology and neurophysiology, and is based on the tenet that microorganisms have evolved systems for using neurohormones, which are widely distributed throughout nature, as environmental cues to initiate growth and pathogenic processes. This review reveals that responsiveness to human stress hormones is widespread in the microbial world and documents recent advances in microbial endocrinology.

Molecular genetics of the stress-responsive adrenocortical axis

Stress-responsive adrenocortical function is the final physiological response to the cascade of events that occurs when the interaction between individuals and their environment takes place. Glucocorticoids are produced in response to perturbance of homeostasis and are necessary for the energy required to restore this homeostasis. Genetics contributes to the individual variation in basal and stimulated plasma glucocorticoid levels and also to adrenal gland mass that increases in response to prolonged adrenal stimulation. This review briefly describes regulation of the adrenocortical axis, summarizes the linkage studies carried out so far in humans and in model organisms, and discusses the potential candidate genes that might contribute to the variation. The significance of individual variations in the glucocorticoid stress-responsiveness, with particular attention to their potential role in the recent explosion of obesity and the prevalence of metabolic syndrome X, is commented upon.

Measurement and meaning of salivary cortisol: a focus on health and disease in children

Measurement of salivary cortisol can provide important information about hypothalamic-pituitary-adrenal (HPA) axis activity under normal conditions and in response to stress. However, there are many variables relating to the measurement of cortisol in saliva which may introduce error and therefore may render difficult the comparison and interpretation of data between, and within, laboratories. This review addresses the effects of gender, age, time and location of sampling, units of measurement, assay conditions and compliance with the protocol, all of which have the potential to impact upon the precision, accuracy and reliability of salivary cortisol measurements in the literature. Some of these factors are applicable to both adults and children, but the measurement of salivary cortisol in children introduces aspects of unique variability which demand special attention. The specific focus of this review is upon the somewhat neglected area of methodological variability of salivary cortisol measurement in children. In addition to these methodological issues, the review highlights the use of salivary cortisol measurements to provide information about HPA axis dysfunction associated with psycho- and patho-physiological conditions in children. Novel applications for salivary cortisol measurements in future research into HPA axis activity in children are also discussed.

Influence of education level on cancer survival in Sweden

BACKGROUND

While cancer survival at several sites has historically been shown to vary by education level, a current comprehensive assessment of survival following a cancer diagnosis in Sweden, a country with universal health care and cancer screening, has yet to be carried out.

METHODS

Using the 2006 update of the Swedish Family-Cancer Database and Cox's proportional hazards regression methods, we calculate the adjusted hazard ratio (HR) and 95% confidence interval to estimate the influence of education level on site-specific cancer survival.

RESULTS

Significant positive associations between education level and cancer survival were observed following a diagnosis of upper aerodigestive track cancer, colon cancer, pancreatic cancer, lung cancer, kidney cancer, urinary bladder cancer, melanoma, non-Hodgkin's lymphoma, breast cancer, endometrial cancer, cervical cancer, prostate cancer, and testicular cancer. Although the HRs differed between cancer sites, compared with women and men completing <9 years of education, university graduates were associated with a significant 40% improved survival for all cancer sites combined.

CONCLUSIONS

Survival differences by education level were observed for both indolent and aggressive malignancies.

Physical exercise as adjuvant therapy for patients undergoing hematopoietic stem cell transplantation

Even when the procedures are successful, patients experience considerable physical, psychological and psychosocial stress before, during and after hematopoietic stem cell transplantation (HSCT). Physical exercise therapy constitutes a potentially promising intervention to reduce such stress within the framework of HSCT because of its multidimensional effectiveness. Up to May 2007, fifteen published studies have examined physical exercise interventions in the context of HSCT, with no study reporting any unexpected or negative effects. The most common intervention involved isolated aerobic exercise programs and occurred during or after the transplantation process; strength training programs and combined intervention strategies are being examined more rarely. Significant benefits from the exercise interventions have been predominantly reported for physical performance, quality of life and fatigue status of the patients. Several other benefits like a faster recurrence of immune cells or reduced severity of therapy-related side effects can be estimated. Future research is needed for the purpose of evidence-based medicine/therapy to provide more rigorous examinations of these interventions, to address existing methodological problems and to identify further effect levels of physical exercise therapy in the context of HSCT.

Proteomic analysis of the cortisol-mediated stress response in THP-1 monocytes using DIGE technology

The glucocorticoid (GC) cortisol, the main mediator of the hypothalamic-pituitary-adrenal axis has many implications in metabolism, stress response and the immune system. Its function is mediated via binding to the glucocorticoid receptor (GR), a member of the superfamily of ligand-activated nuclear hormone receptors. The activity of the ligated GR results from its binding as a transcription factor to glucocorticoid response elements (GREs). Two-dimensional gel electrophoresis with DIGE (fluorescence difference gel electrophoresis) technology was applied to study the effects of cortisol on the human THP-1 monocytic cell line. A total of 28 cortisol-modulated proteins were identified belonging to five functional groups: cytoskeleton (8), chaperones (9), immune response (4), metabolism (3) and transcription/translation (4). Their corresponding genes were screened for putative GREs in their + 10 kb/- 0.2 kb promoter regions including all alternative promoters available within the Database for Transcription Start Sites (DBTSS). FKBP51, known to be induced by cortisol, was identified as the strongest differentially expressed protein, and contains the highest number of strict GREs. Genomic analysis of five alternative FKBP5 promoter regions suggests GC inducibility of all transcripts. Additionally, proteomics (2D DIGE and 2D immunoblotting) revealed the existence of several FKBP51 isoforms, which were not previously described. To our knowledge this is the first proteomic study that addresses the effects of cortisol on immune cells. FKBP51 isoforms found on the gel map were linked to alternative promoter usage on the genetic level, successfully correlating both the specific proteomic and genomic findings.

Understanding the interaction between psychosocial stress and immune-related diseases: a stepwise progression

For many years, anecdotal evidence and clinical observations have suggested that exposure to psychosocial stress can affect disease outcomes in immune-related disorders such as viral infections, chronic autoimmune diseases and tumors. Experimental evidence in humans supporting these observations was, however, lacking. Studies published in the last 2 decades in Brain, Behavior and Immunity and other journals have demonstrated that acute and chronic psychological stress can induce pronounced changes in innate and adaptive immune responses and that these changes are predominantly mediated via neuroendocrine mediators from the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal axis. In addition, psychological stress has predicted disease outcomes using sophisticated models such as viral challenge, response to vaccination, tracking of herpesvirus latency, exploration of tumor metastasis and healing of experimental wounds, as well as epidemiological investigations of disease progression and mortality. These studies have contributed significantly to our understanding that the neuroendocrine-immune interaction is disturbed in many pathophysiological conditions, that stress can contribute to this disturbance, and that malfunction in these communication pathways can play a significant role in the progression of disease processes. There are, however, significant gaps in the extant literature. In the coming decade(s), it will be essential to further analyze neuroendocrine-immune communication during disease states and to define the specific pathways linking the central nervous system to the molecular events that control important disease-relevant processes. This knowledge will provide the basis for new therapeutic pharmacological and non-pharmacological behavioral approaches to the treatment of chronic diseases via specific modulation of nervous system-immune system communication.

Gene expression signature in peripheral blood cells from medical students exposed to chronic psychological stress

To assess response to chronic psychological stress, gene expression profiles in peripheral blood from 18 medical students confronting license examination were analyzed using an original microarray. Total RNA was collected from each subject 9 months before the examination and mixed to be used as a universal control. At that time, most students had normal scores on the state-trait anxiety inventory (STAI). However, STAI scores were significantly elevated at 2 months and at 2 days before the examination. Pattern of the gene expression profile was more uniform 2 days before than 2 months before the examination. We identified 24 genes that significantly and uniformly changed from the universal control 2 days before the examination. Of the 24 genes, real-time PCR validated changes in mRNA levels of 10 (PLCB2, CSF3R, ARHGEF1, DPYD, CTNNB1, PPP3CA, POLM, IRF3, TP53, and CCNI). The identified genes may be useful to assess chronic psychological stress response.

Sertraline effectiveness and safety in depressed oncological patients

GOALS OF WORK

Cancer is often burdened by psychological comorbidity, mainly represented by depression, anxiety and adjustment disorders. Efficacy and tolerability of sertraline in the treatment of depressive disorders is well known; however, its efficacy and safety in patients with cancer has been poorly studied. This study was aimed to provide evidences of effectiveness, safety, tolerability and rapidity of action of sertraline in a population of oncological outpatients affected by mood disorders and its effects on quality of life.

MATERIALS AND METHODS

Thirty-five adult cancer outpatients with mood depression, during chemotherapy, were enrolled to a 12-week trial with a flexible dose regime of sertraline. The treatment response was assessed at baseline, week 4 and week 12, with hospital anxiety and depression scale (HADS) and Montgomery Asberg depression rating scale (MADRS), to rate depression and anxiety; mini mental adjustment to cancer scale (Mini-MAC), to assess the psychological response to the diagnosis of cancer; clinical global impression (CGI) to evaluate severity of illness; dosage record and treatment emergent symptom scale (DOTES), to assess the adverse effects of the clinical treatments and their possible relation with the drug used; and QL index to rate quality of life.

MAIN RESULTS

Both mean depression scores, analysed by HADS and MADRS scales, and HADS anxiety scores significantly decreased during the 12 weeks of study. Mean MINI-MAC scores show that hopelessness and anxious preoccupation decreased significantly at T2 compared with T0. No severe adverse effects were observed.

CONCLUSION

In this preliminary study, sertraline was found to be effective and well tolerated in the treatment of depressed outpatients with cancer.

Personalidade e câncer de mama e do aparelho digestório

Como a literatura indica influência de características de personalidade na formação do câncer, este estudo objetivou verificar se elas seriam gerais ou variariam segundo o tipo de neoplasia. Foram aplicadas entrevistas psicológicas e forma reduzida do TAT em 15 mulheres entre 41 e 60 anos, distribuídas em um grupo de 10 com câncer de mama (CM) e outro de cinco com câncer do aparelho digestório (CAD). Resultados revelaram predominância de organizações de personalidade borderline no grupo CM e neurótica no CAD. Ambos os grupos apresentaram perdas e frustrações antecedendo a doença, clivagem do ego entre razão e afeto, conflitos entre pulsões agressivas e sexuais e com figura materna e predomínio do pensamento operatório, indicando dificuldade de representação psíquica das pulsões. Foram realizadas considerações relativas à importância da psicoterapia com pacientes neoplásicos, auxiliando na construção e fortalecimento da capacidade de simbolizar.

Cancer in people with depression or anxiety: record-linkage study

BACKGROUND

It has been suggested that the risk of cancer may be higher in people with psychological disorders, like depression and anxiety, than in the general population.

AIMS

To determine cancer risk in cohorts of people with depression or anxiety, compared with that in a control cohort.

METHOD

Analysis of linked statistical records of hospital admission and mortality.

RESULTS

Lung cancer was more common in those with depression (risk ratio 1.36, 95% confidence intervals 1.19-1.54) or anxiety (1.29, 1.12-1.48) than in others. Excluding lung cancer, the risk ratio for all other cancers combined was 0.98 (0.92-1.04) in the depression cohort and 1.01 (0.95-1.07) in the anxiety cohort. There was a significant association, in the short-term only, between depression, anxiety and the subsequent diagnosis of brain tumours.

CONCLUSIONS

With the exception of lung and brain tumours, cancer risk was not increased in people with depression or anxiety.

Monoaminergic agents modulate antidepressant-like effect caused by diphenyl diselenide in rats

In this study, the antidepressant-like effect caused by diphenyl diselenide on rat forced swimming test (FST) was investigated. The involvement of the monoaminergic system in the antidepressant-like effect was also evaluated. Diphenyl diselenide (0.1-30 mg/kg), given by oral route (p.o.), 30 min earlier, reduced the immobility time in the FST, without accompanying changes in ambulation when assessed in an open field. The anti-immobility effect of diphenyl diselenide (1 mg/kg, p.o.) on the FST was prevented by pretreatment of rats with p-chlorophenylalanine methyl ester (PCPA; 100 mg/kg, i.p., an inhibitor of serotonin synthesis, given once a day, for 3 consecutive days), WAY100635 (0.1 mg/kg, s.c., a selective 5-HT(1A) receptor antagonist), ketanserin (1 mg/kg, i.p., a 5-HT(2A)/(2C) receptor antagonist), ondasentron (1 mg/kg, i.p., a 5-HT(3) receptor antagonist), haloperidol (1 mg/kg, i.p., a D(1), D(2) and D(3) receptor antagonist), SCH233390 (0.05 mg/kg, s.c., a D(1) receptor antagonist), sulpiride (50 mg/kg, i.p., a D(2) receptor antagonist), prazosin (1 mg/kg, i.p., an alpha(1)-adrenoceptor antagonist), yohimbine (1 mg/kg, i.p., an alpha(2)-adrenoceptor antagonist). However, the anti-immobility effect caused by diphenyl diselenide (1 mg/kg, p.o.) on the FST was not affected by pretreatment with propanolol (2 mg/kg, i.p., a beta-adrenoceptor antagonist). Furthermore, monoamine oxidase (MAO) activity was inhibited (39%) in the animals treated with diphenyl diselenide (30 mg/kg, p.o.) when compared to the control group. Taken together these data demonstrated that the antidepressant-like effect caused by diphenyl diselenide seems to be mediated by involvement of the central monoaminergic system.

Neuroimunomodulação: sobre o diálogo entre os sistemas nervoso e imune

OBJETIVO: Trabalhos de pesquisa provenientes do campo da neuroimunomodulação vêm tornando explícitas as intrincadas relações existentes entre o sistema nervoso central e o sistema imune. Uma revisão bibliográfica foi realizada com o objetivo de descrever as bases de estudo da neuroimunomodulação. MODELOS EXPERIMENTAIS: Sabe-se, hoje, que estados emocionais como ansiedade e depressão são capazes de modificar a atividade do sistema imune como também o fazem o estresse e fármacos com ação no sistema nervoso central. COMPORTAMENTO DOENTIO: Os comportamentos apresentados por um organismo doente devem ser encarados como decorrência de estratégias homeostáticas de cada indivíduo. POSSÍVEIS MECANISMOS DE SINALIZAÇÃO DO SISTEMA IMUNE PARA O SISTEMA NERVOSO CENTRAL: Grande destaque tem sido atribuído para a participação do eixo hipotálamo-pituitária-adrenal, do sistema nervoso autônomo simpático e das citocinas nas sinalizações entre o sistema nervoso central e o sistema imune. CONCLUSÃO: O presente artigo pretende mostrar a relevância dos fenômenos de neuroimunomodulação; ele faz uma análise crítica das influências do sistema nervoso central sobre o sistema imune e vice-versa.

Versão brasileira da Escala de Estresse Percebido: tradução e validação para idosos

OBJETIVO: Traduzir a Escala de Estresse Percebido para a língua portuguesa do Brasil e verificar sua validade para mensurar o estresse percebido de idosos brasileiros. MÉTODOS: A escala foi traduzida e testada em sua versão completa, com 14 questões e na reduzida, com dez questões. A tradução obedeceu às etapas de tradução, tradução reversa e revisão por um comitê. A escala traduzida foi aplicada, por meio de entrevista, a 76 idosos com idade média de 70,04 anos (DP=6,34; mín: 60; máx: 84). A consistência interna foi verificada por meio do coeficiente alfa de Cronbach e a validade de construto, por análise fatorial exploratória com rotação ortogonal pelo método varimax. As médias das versões completa e reduzida foram analisadas comparando o estresse percebido em função da auto-avaliação da saúde, nível econômico percebido, estado civil, condições de residência, entre outras. RESULTADOS: Quanto à confiabilidade, a versão completa apresentou consistência interna semelhante (r=0,82) à reduzida (r=0,83). A análise fatorial revelou a existência de dois fatores para a completa e um para a reduzida. A questão 12 apresentou as menores cargas fatoriais. Ao analisar a possibilidade de a escala diferenciar o estresse percebido em função das variáveis, verificou-se que a versão completa obteve maiores diferenças no estresse do que a reduzida. CONCLUSÕES: A Escala de Estresse Percebido mostrou-se clara e confiável para mensurar o estresse percebido de idosos brasileiros, apresentando qualidades psicométricas adequadas.

Effects of a preincisional 14-day course of valerian on natural killer cell activity in Sprague-Dawley male rats undergoing abdominal surgery

INTRODUCTION

The American Cancer Society estimated that more than 1 million new cancer cases were diagnosed in 2005 and a majority of these patients died from metastatic spread. The standard for treating solid tumor cancer is surgical resection. However, it has been suggested that surgical resection may, in fact, promote metastasis. One of the body's natural defenses to combat metastasis is the activity of natural killer (NK) cells. NK cells serve as a vital mediator of detection during the early innate immune response and destruction of aberrant cells. It has been demonstrated that benzodiazepines may ameliorate surgery-induced suppression of NK cell activity. We examined the effect of a 14-day course of valerian, a herbal anxiolytic, on NK cell activity in Sprague-Dawley rats.

METHODS

Thirty-five rats were assigned to 1 of 3 groups: (1) surgical animals administered research grade valerian, 15 mg/kg solubilized in peanut oil; (2) surgical animals administered peanut oil (vehicle); and (3) anesthesia-only animals administered valerian. One day before the 14-day course of valerian, blood was drawn to assay baseline NK cell activity. On experimental day, all animals were administered isoflurane anesthesia. Surgical animals underwent a standard laparotomy whereas anesthesia-only rats were anesthetized for the same period of time as the surgical rats. Twenty-four hours postexperiment animals underwent a second blood draw to assay NK cell activity.

RESULTS

Analysis of covariance (ANCOVA) was used to analyze NK cell activity (measured in lytic units). Our results suggested that there was no difference (P = .9) in suppression within or between groups.

CONCLUSIONS

Clinical studies with valerian have been published but with small numbers and some ambiguity. Further research regarding valerian's effectiveness as a modulator of NK cell activity and whether dosage or route of administration is a factor in modulation is still warranted.

Stress and long-term survivors of brain cancer

INTRODUCTION

Adult brain tumor patients are joining the ranks of cancer survivors in increasing numbers in the United States. As a result, health care providers are faced with new challenges to address the need for psychosocial support in this population.

METHODS

Using the Perceived Stress Scale and the National Comprehensive Cancer Network's Distress Thermometer, levels of stress and cancer-related items of concern were assessed in adult long-term survivors of brain cancer.

RESULTS

Sixty-one percent of the sample population experienced elevated levels of stress. Scores were not significantly associated with age, gender, treatment status, or tumor grade. Long-term survivors were just as likely to report being stressed (chi(2) = 0.032, NS), while reporting fewer numbers of items of concern (5.02, SD = 3.509), compared to brain tumor patients diagnosed 18 months (M = 6.82, SD = 3.737, t = 2.467, p 0.05).

DISCUSSION/CONCLUSION

Despite their long-term survival status, long-term survivors of brain cancer continue to experience elevated levels of stress. Predictors of stress in this population are related to familial, emotional, and practical concerns. While the scientific community continues to examine the specific impact of stress on both the physical and mental outcomes of cancer patients, understanding the sources of stress within cancer populations is key in designing targeted interventions to help patients manage the stress associated with this disease. IMPLICATIONS FOR BRAIN TUMOR SURVIVORS: This study provides a better understanding of the unique needs of long-term survivors of brain cancer. An awareness of the sources and levels of stress experienced by this population could lead to the development of effective supportive care interventions to improve the quality of life of the survivor.

Depression, Immunity, and Survival in Patients With Hepatobiliary Carcinoma

Purpose

The aims of the present study were to assess the prevalence of depressive symptoms at diagnosis, test the association between depressive symptoms and survival, and preliminarily test a mediational model of depression, immunity, and survival in patients with hepatobiliary carcinoma (HBC).

Patients and Methods

One hundred one patients diagnosed with HBC were prospectively studied. Depressive symptoms were measured at diagnosis using the Center for Epidemiological Studies Depression Scale (CES-D). Sociodemographic and disease-specific data were gathered from the patients' charts. In a subsample of patients, stress; alcohol, tobacco, and drug use; sleep quality; physical activity; social support; natural killer (NK) cell number and cytotoxicity; and plasma levels of interleukin (IL) -4, IL-5, tumor necrosis factor alpha, and interferon gamma were measured. Survival was measured from date of diagnosis to death.

Results

At diagnosis, 37% of patients reported a CES-D score of ≥ 16 (clinical range). Using Cox regression analysis, sociodemographic and disease-specific variables and CES-D score significantly predicted survival (Breslow χ2= 32.4, P = .006). Only vascular invasion (P = .001) and CES-D score ≥ 16 (P = .03) were significant predictors. In a subsample of 23 patients, patients who reported a CES-D score of ≥ 16 were found to have significantly lower NK cell numbers than patients who reported a CES-D score of less than 16 (F1,21= 9.39, P = .003). A robust trend was found in which NK cell number was associated with survival. A mediational model linking depressive symptoms and survival, with NK cell number as a mediator, was preliminarily supported.

Conclusion

Secondary to the high prevalence of depressive symptoms and impact on survival, psychological and pharmacologic interventions should be designed and implemented in patients diagnosed with HBC.

Self-reported stress and risk of endometrial cancer: a prospective cohort study

OBJECTIVES

To assess a possible relationship between perceived stress and first-time incidence of primary endometrial cancer. Psychological stress may affect the synthesis and metabolism of estrogens and thereby be related to risk of endometrial cancer.

METHODS

The 6760 women participating in the Copenhagen City Heart Study were asked about their stress level at baseline from 1981 to 1983. These women were prospectively followed up in the Danish nationwide cancer registry until 2000 and <0.1% were lost to follow-up. Cox proportional hazard models were used to analyze data.

RESULTS

During follow-up, 72 women were diagnosed with endometrial cancer. For each increase in stress level on a 7-point stress scale, there was a lower risk of primary endometrial cancer (hazard ratio (HR) = 0.88; 95% confidence interval (CI), 0.76-1.01). This inverse association was particularly strong in women who received hormone therapy (HR = 0.77; 95% CI, 0.61-0.96) and in normal-weight women (HR = 0.73; 95% CI, 0.58-0.91).

CONCLUSIONS

Stress may affect gonadal synthesis of estrogens and alter the sensitivity of the uterus toward estrogen stimulation. These mechanisms may explain the lower risk of endometrial cancer observed among stressed women in this study. Despite these results, stress may still be a risk factor for a range of other diseases and should therefore not be considered a healthy response.

Sociodemographic status, stress, and risk of prostate cancer. A prospective cohort study

PURPOSE

The social gradient in prostate cancer incidence observed in several studies may be a result of differential access to prostate cancer screening. We aim to assess if socioeconomic status, stress, and marital status are associated with prostate cancer risk in a population with free access to health care.

METHODS

The 5,496 men who participated in the Copenhagen City Heart Study were asked about their income, educational level, stress level, and marital status during 1981-1983. These men were prospectively followed up in the Danish Cancer Registry until the end of 2002 and fewer than 0.1 % were lost to follow-up.

RESULTS

During follow-up, 157 men were diagnosed with prostate cancer. Neither high income (HR = 1.17, 95% confidence interval [CI]: 0.78-1.76) nor high education (HR = 1.22; 95% CI: 0.76-1.96) were associated with risk of prostate cancer. There were also no differences in prostate cancer risk according to stress (HR = 0.99; 95% CI: 0.90-1.09) or marital status.

CONCLUSION

In a racially homogeneous population of Caucasians with free access to health care, we found no evidence of a relation between sociodemographic variables or stress and subsequent risk of prostate cancer.