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Fraterman I, Reijers ILM, Dimitriadis P, Broeks A, Gonzalez M, Menzies AMM, Lopez-Yurda M, Kapiteijn E, van der Veldt AAM, Suijkerbuijk KPM, Hospers GAP, Long GV, Blank CU, van de Poll-Franse LV. Association between pretreatment emotional distress and neoadjuvant immune checkpoint blockade response in melanoma. Nat Med 2023; 29:3090-3099. [PMID: 37957378 DOI: 10.1038/s41591-023-02631-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023]
Abstract
Neoadjuvant immune checkpoint blockade (ICB) outperforms adjuvant ICB for treatment of stage IIIB-D melanoma, but potential biomarkers of response, such as interferon-gamma (IFNγ) signature and tumor mutational burden (TMB), are insufficient. Preclinical studies suggest that emotional distress (ED) can negatively affect antitumor immune responses via β-adrenergic or glucocorticoid signaling. We performed a post hoc analysis evaluating the association between pretreatment ED and clinical responses after neoadjuvant ICB treatment in patients with stage IIIB-D melanoma in the phase 2 PRADO trial ( NCT02977052 ). The European Organisation for Research and Treatment of Cancer scale for emotional functioning was used to identify patients with ED (n = 28) versus those without (n = 60). Pretreatment ED was significantly associated with reduced major pathologic responses (46% versus 65%, adjusted odds ratio 0.20, P = 0.038) after adjusting for IFNγ signature and TMB, reduced 2-year relapse-free survival (74% versus 91%, adjusted hazard ratio 3.81, P = 0.034) and reduced 2-year distant metastasis-free survival (78% versus 95%, adjusted hazard ratio 4.33, P = 0.040) after adjusting for IFNγ signature. RNA sequencing analyses of baseline patient samples could not identify clear β-adrenergic- or glucocorticoid-driven mechanisms associated with these reduced outcomes. Pretreatment ED may be a marker associated with clinical responses after neoadjuvant ICB in melanoma and warrants further investigation. ClinicalTrials.gov registration: NCT02977052 .
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Affiliation(s)
- Itske Fraterman
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Irene L M Reijers
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Petros Dimitriadis
- Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annegien Broeks
- Core Facility and Molecular Pathology & Biobanking Department, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M Gonzalez
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - A M M Menzies
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Marta Lopez-Yurda
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Astrid A M van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Geke A P Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Georgina V Long
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands.
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2
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Hathaway CA, Townsend MK, Conejo-Garcia JR, Fridley BL, Moran Segura C, Nguyen JV, Armaiz-Pena GN, Sasamoto N, Saeed-Vafa D, Terry KL, Kubzansky LD, Tworoger SS. The relationship of lifetime history of depression on the ovarian tumor immune microenvironment. Brain Behav Immun 2023; 114:52-60. [PMID: 37557966 PMCID: PMC10592154 DOI: 10.1016/j.bbi.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Depression is associated with a higher ovarian cancer risk. Prior work suggests that depression can lead to systemic immune suppression, which could potentially alter the anti-tumor immune response. METHODS We evaluated the association of pre-diagnosis depression with features of the anti-tumor immune response, including T and B cells and immunoglobulins, among women with ovarian tumor tissue collected in three studies, the Nurses' Health Study (NHS; n = 237), NHSII (n = 137) and New England Case-Control Study (NECC; n = 215). Women reporting depressive symptoms above a clinically relevant cut-point, antidepressant use, or physician diagnosis of depression at any time prior to diagnosis of ovarian cancer were considered to have pre-diagnosis depression. Multiplex immunofluorescence was performed on tumor tissue microarrays to measure immune cell infiltration. In pooled analyses, we estimated odds ratios (OR) and 95% confidence intervals (CI) for the positivity of tumor immune cells using a beta-binomial model comparing those with and without depression. We used Bonferroni corrections to adjust for multiple comparisons. RESULTS We observed no statistically significant association between depression status and any immune markers at the Bonferroni corrected p-value of 0.0045; however, several immune markers were significant at a nominal p-value of 0.05. Specifically, there were increased odds of having recently activated cytotoxic (CD3+CD8+CD69+) and exhausted-like T cells (CD3+Lag3+) in tumors of women with vs. without depression (OR = 1.36, 95 %CI = 1.09-1.69 and OR = 1.24, 95 %CI = 1.01-1.53, respectively). Associations were comparable when considering high grade serous tumors only (comparable ORs = 1.33, 95 %CI = 1.05-1.69 and OR = 1.25, 95 %CI = 0.99-1.58, respectively). There were decreased odds of having tumor infiltrating plasma cells (CD138+) in women with vs. without depression (OR = 0.54, 95 %CI = 0.33-0.90), which was similar among high grade serous carcinomas, although not statistically significant. Depression was also related to decreased odds of having naïve and memory B cells (CD20+: OR = 0.54, 95 %CI = 0.30-0.98) and increased odds of IgG (OR = 1.22, 95 %CI = 0.97-1.53) in high grade serous carcinomas. CONCLUSION Our results provide suggestive evidence that depression may influence ovarian cancer outcomes through changes in the tumor immune microenvironment, including increasing T cell activation and exhaustion and reducing antibody-producing B cells. Further studies with clinical measures of depression and larger samples are needed to confirm these results.
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Affiliation(s)
| | - Mary K Townsend
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Carlos Moran Segura
- Advanced Analytical and Digital Laboratory, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan V Nguyen
- Advanced Analytical and Digital Laboratory, Moffitt Cancer Center, Tampa, FL, USA
| | - Guillermo N Armaiz-Pena
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Naoko Sasamoto
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Daryoush Saeed-Vafa
- Advanced Analytical and Digital Laboratory, Moffitt Cancer Center, Tampa, FL, USA; Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA
| | - Kathryn L Terry
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA.
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3
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Lempesis IG, Georgakopoulou VE, Papalexis P, Chrousos GP, Spandidos DA. Role of stress in the pathogenesis of cancer (Review). Int J Oncol 2023; 63:124. [PMID: 37711028 PMCID: PMC10552722 DOI: 10.3892/ijo.2023.5572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
Stress is a state of disrupted homeostasis, triggered by intrinsic or extrinsic factors, the stressors, which are counteracted by various physiological and behavioural adaptive responses. Stress has been linked to cancer development and incidence for decades; however, epidemiological studies and clinical trials have yielded contradictory results. The present review discusses the effects of stress on cancer development and the various underlying mechanisms. Animal studies have revealed a clear link between stress and cancer progression, revealing molecular, cellular and endocrine processes that are implicated in these effects. Thus, stress hormones, their receptor systems and their intracellular molecular pathways mediate the effects of stress on cancer initiation, progression and the development of metastases. The mechanisms linking stress and cancer progression can either be indirect, mediated by changes in the cancer microenvironment or immune system dysregulation, or direct, through the binding of neuroendocrine stress‑related signalling molecules to cancer cell receptors. Stress affects numerous anti‑ and pro‑cancer immune system components, including host resistance to metastasis, tumour retention and/or immune suppression. Chronic psychological stress through the elevation of catecholamine levels may increase cancer cell death resistance. On the whole, stress is linked to cancer development and incidence, with psychological stressors playing a crucial role. Animal studies have revealed a better link than human ones, with stress‑related hormones influencing tumour development, migration, invasion and cell proliferation. Randomized controlled trials are required to further evaluate the long‑term cancer outcomes of stress and its management.
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Affiliation(s)
- Ioannis G. Lempesis
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vasiliki Epameinondas Georgakopoulou
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Georgios P. Chrousos
- Clinical, Translational and Experimental Surgery Research Centre, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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Berk M, Köhler-Forsberg O, Turner M, Penninx BWJH, Wrobel A, Firth J, Loughman A, Reavley NJ, McGrath JJ, Momen NC, Plana-Ripoll O, O'Neil A, Siskind D, Williams LJ, Carvalho AF, Schmaal L, Walker AJ, Dean O, Walder K, Berk L, Dodd S, Yung AR, Marx W. Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management. World Psychiatry 2023; 22:366-387. [PMID: 37713568 PMCID: PMC10503929 DOI: 10.1002/wps.21110] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.
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Affiliation(s)
- Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Megan Turner
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anna Wrobel
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Loughman
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - John J McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - Natalie C Momen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Andre F Carvalho
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lianne Schmaal
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Adam J Walker
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Olivia Dean
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ken Walder
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lesley Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Seetal Dodd
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Wolfgang Marx
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
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Aquino-Acevedo AN, Knochenhauer H, Castillo-Ocampo Y, Ortiz-León M, Rivera-López YA, Morales-López C, Cruz-Robles ME, Hernández-Cordero ER, Russell S, Whitaker R, Bonilla-Claudio M, Chen DT, Dutil J, Gaillard SL, Yi JS, Previs RA, Armaiz-Pena GN. Stress hormones are associated with inflammatory cytokines and attenuation of T-cell function in the ascites from patients with high grade serous ovarian cancer. Brain Behav Immun Health 2022; 26:100558. [PMID: 36439058 PMCID: PMC9694096 DOI: 10.1016/j.bbih.2022.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/18/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Mounting evidence suggests that chronic stress and subsequent distress can promote ovarian cancer progression. These altered psychological states have been linked to sustained release of stress hormones, activation of the β-adrenergic receptors in ovarian cancer cells, and induction of pro-tumoral signaling pathways. In addition, data suggest that chronic stress promotes an inflammatory landscape highlighted by increased infiltration of tumor-associated macrophages into the ovarian tumor microenvironment (TME). In ovarian cancer, ascites is a unique TME comprised of tumor, and immune cells, which secrete pro-tumoral cytokines and chemokines that modulate tumor-associated immunity. However, our knowledge about how stress hormones impact the ascites TME remains limited. We hypothesized that the ascites harbors measurable levels of stress hormones, and accumulation of these in the ascites generates a pro-tumorigenic, inflammatory, and immunosuppressive TME. We evaluated ascites samples from 49 patients with high grade serous ovarian cancer (HGSOC) and quantified cortisol and stress hormones metabolites, metanephrine (MN), and normetanephrine (NMN) in all samples. We also measured 38 individual cytokines in the ascites, including several pro-inflammatory cytokines, such as IL-6, which were positively correlated to MN or NMN levels of those samples. Conversely, we found cortisol levels were negatively correlated to several pro-inflammatory cytokines. As T-cells are integral to the TME and our analyses identified cytokines in the ascites known to modulate T-cell function, we characterized ascites-derived T-cells and assessed the impact of stress hormones on the T-cell phenotype. Our data show an altered CD4+/CD8+ T-cell ratio and a heterogeneous expression of exhaustion markers in T-cells from the ascites, while ascites-derived CD8+ T-cells exposed to epinephrine had decreased co-expression CD38 and Granzyme B. To extend these findings to animal models, we subjected ovarian cancer-bearing mice to daily restraint stress, which resulted in increased tumor growth in two models. Congruent with our human analyses, we detected corticosterone, MN, and NMN in the ascites from tumor-bearing mice, and these stress hormones correlated with several inflammatory cytokines. Moreover, daily restraint stress leads to increased CD4+PD-1+/CD8+PD-1+ T-cell ratio in the ovarian tumor microenvironment. Overall, these data highlight a role of stress hormones in the ascites TME as a driver of tumor-associated inflammation, T-cell suppression, and disease progression.
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Affiliation(s)
- Alexandra N. Aquino-Acevedo
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Hope Knochenhauer
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, School of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Yesenia Castillo-Ocampo
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Melanie Ortiz-León
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Yadiel A. Rivera-López
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Camily Morales-López
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Melanie E. Cruz-Robles
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Elvin R. Hernández-Cordero
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Shonagh Russell
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, School of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Regina Whitaker
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, School of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Margarita Bonilla-Claudio
- School of Dental Medicine, Ponce Health Sciences University, Ponce, PR, USA
- Division of Cancer Biology, Ponce Research Institute, Ponce, PR, USA
| | - Dung-Tsa Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julie Dutil
- Department of Basic Sciences, Division of Biochemistry, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
- Division of Cancer Biology, Ponce Research Institute, Ponce, PR, USA
- Division of Women's Health, Ponce Research Institute, Ponce, PR, USA
| | - Stephanie L. Gaillard
- Departments of Oncology and Gynecology and Obstetrics, John Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medicine, Division of Medical Oncology, School of Medicine, Duke University, Durham, NC, USA
| | - John S. Yi
- Department of Surgery, Division of Surgical Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Rebecca A. Previs
- Department of Obstetrics and Gynecology, Division of Gynecology Oncology, School of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Guillermo N. Armaiz-Pena
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
- Division of Cancer Biology, Ponce Research Institute, Ponce, PR, USA
- Division of Women's Health, Ponce Research Institute, Ponce, PR, USA
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Liu Y, Tian S, Ning B, Huang T, Li Y, Wei Y. Stress and cancer: The mechanisms of immune dysregulation and management. Front Immunol 2022; 13:1032294. [PMID: 36275706 PMCID: PMC9579304 DOI: 10.3389/fimmu.2022.1032294] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Advances in the understanding of psychoneuroimmunology in the past decade have emphasized the notion that stress and cancer are interlinked closely. Durable chronic stress accelerated tumorigenesis and progression, which is unfavorable for clinical outcomes of cancer patients. Available evidence has provided unprecedented knowledge about the role and mechanisms of chronic stress in carcinogenesis, the most well-known one is dysfunction of the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). With abnormal activation of neuroendocrine system, stress-related hormones contribute to increased oncogenes expression, exacerbated chronic inflammation and impaired immunologic function. In addition, accumulating studies have demonstrated that diverse stress interventions including pharmacological approaches, physical exercises and psychological relaxation have been administered to assist in mental disorders reduction and life quality improvement in cancer patients. In this review, we systematically summarize the connection and mechanisms in the stress-immune-cancer axis identified by animal and clinical studies, as well as conclude the effectiveness and deficiencies of existing stress management strategies.
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Affiliation(s)
- Yixin Liu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Sheng Tian
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Biao Ning
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Tianhe Huang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yi Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yongchang Wei
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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7
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Barandouzi ZA, Rowcliffe C, Schrogin J, Meador R, Bruner DW. Exploring the links among inflammation and gut microbiome with psychoneurological symptoms and gastrointestinal toxicities in gynecologic cancers: a systematic review. Support Care Cancer 2022; 30:6497-6513. [PMID: 35396962 DOI: 10.1007/s00520-022-07027-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Emerging evidence highlights the roles the gut microbiome and the immune system, integral parts of the gut-brain axis, play in developing various symptoms in cancer patients. The purpose of this systematic review was to describe the roles of inflammatory markers and the gut microbiome, as well as to describe their associations with psychoneurological symptoms and gastrointestinal toxicities in women with gynecologic cancers. METHODS A comprehensive literature search was conducted in PubMed, Embase, and Web of Science from January 2000 to February 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were utilized to screen the found articles. The quality of the included studies was assessed using the Mixed Method Assessment Tool. In the included studies, various inflammatory markers and gut microbiome diversity and patterns were measured. RESULTS Sixteen studies met the eligibility criteria and were included in this systematic review. While there were discrepancies in the associations between various inflammatory markers and symptoms, most of the studies showed positive correlations between interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) and cancer-related psychoneurological symptoms and gastrointestinal toxicities in gynecologic cancer patients. Although there was no consensus in alpha diversity, studies showed significant dissimilarity in the microbial communities (beta diversity) in patients with gastrointestinal toxicities compared with patients without symptoms or healthy controls. Studies also reported inconsistent findings in the abundance of bacteria at different taxonomic levels. Radiation enteritis-derived microbiota could stimulate TNF-α and interleukin 1 beta (IL-1β) secretion. CONCLUSIONS Alteration of inflammatory markers, the gut microbiome, and their associations show emerging evidence in the development of psychoneurological symptoms and gastrointestinal toxicities in women with gynecologic cancers. More studies on the interactions between the immune system and the gut microbiome, two integral parts of the gut-brain axis, are required to shed light on the roles they play in symptom development.
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Affiliation(s)
| | - Claire Rowcliffe
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Julia Schrogin
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 30322, USA
| | - Rebecca Meador
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 30322, USA
| | - Deborah Watkins Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, 30322, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
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8
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Chang A, Sloan EK, Antoni MH, Knight JM, Telles R, Lutgendorf SK. Biobehavioral Pathways and Cancer Progression: Insights for Improving Well-Being and Cancer Outcomes. Integr Cancer Ther 2022; 21:15347354221096081. [PMID: 35579197 PMCID: PMC9118395 DOI: 10.1177/15347354221096081] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.
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Affiliation(s)
- Aeson Chang
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia
| | - Erica K Sloan
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology, Monash University, Parkville, VIC, Australia.,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.,Peter MacCallum Cancer Centre, Division of Surgery, Melbourne, VIC, Australia
| | - Michael H Antoni
- Departments of Psychology, Psychiatry, and Behavioral Sciences, and Cancer Control Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Jennifer M Knight
- Department of Psychiatry and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Telles
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Susan K Lutgendorf
- Departments of Psychological and Brain Sciences, Obstetrics and Gynecology, and Urology, and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
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9
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Standish LJ, Sweet E, Kim E, Dowd F, McLaughlin R, Chiang P, Dale L, Gaul M, Andersen MR. Recurrence of Breast Cancer After Primary Treatment: A Matched Comparison Study of Disease-Free Survival in Women Who Do and Do Not Receive Adjunctive Naturopathic Oncology Care. Integr Cancer Ther 2021; 20:15347354211058404. [PMID: 34894812 PMCID: PMC8671681 DOI: 10.1177/15347354211058404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: To compare disease free survival experienced by women who received usual
oncologic care compared to a cohort of women who received naturopathic
oncology care in addition to usual care. Methods: Women with breast cancer who received naturopathic oncology (NO) care in
Western Washington State (WA) (N = 176) were recruited to a prospective
study of clinical health-related quality of life outcomes and then matched
to women who received usual care (UC) only (N = 334). Results: Among 510 women with breast cancer stages 1 to 3, a total of 50 women (10%)
experienced a disease-free survival (DFS) ending event within the
observation period; 23 (6.8% of those in the UC cohort, and 27 (15.3% of
those in the NO cohort (P < .05). Although, women in the
2 cohorts received similar surgical, chemotherapy, and radiation treatment,
women with breast cancer who received naturopathic oncology adjunctive care
were less likely to use anti-estrogen therapy, and experienced poorer DFS
(logrank test, P < .05). However, differences in DFS
could not be shown to be due to cohort differences in anti-estrogen therapy,
baseline HRQOL, or naturopathic oncology therapies prescribed. The stage 3
women in the naturopathic oncology group had more advanced disease at
diagnosis. They were more likely to have 5 or more metastatic lymph nodes at
baseline (18.5%) compared to their usual care matched control group (13%).
Women in the naturopathic oncology group also had higher grade tumors at
diagnosis. Conclusions: Results show that recurrence of breast cancer was associated with more
advanced malignant lymph node involvement; and that naturopathic oncology
services provided in 2009-2015 did not improve disease-free survival in
these high-risk breast cancer patients.
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Affiliation(s)
- L J Standish
- Bastyr University, Kenmore, WA, USA.,University of Washington, Seattle, WA, USA
| | - E Sweet
- Bastyr University, Kenmore, WA, USA
| | | | - F Dowd
- Bastyr University, Kenmore, WA, USA
| | | | - P Chiang
- Bastyr University, Kenmore, WA, USA
| | - L Dale
- Bastyr University, Kenmore, WA, USA
| | - M Gaul
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M R Andersen
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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10
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Eckerling A, Ricon-Becker I, Sorski L, Sandbank E, Ben-Eliyahu S. Stress and cancer: mechanisms, significance and future directions. Nat Rev Cancer 2021; 21:767-785. [PMID: 34508247 DOI: 10.1038/s41568-021-00395-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/08/2023]
Abstract
The notion that stress and cancer are interlinked has dominated lay discourse for decades. More recent animal studies indicate that stress can substantially facilitate cancer progression through modulating most hallmarks of cancer, and molecular and systemic mechanisms mediating these effects have been elucidated. However, available clinical evidence for such deleterious effects is inconsistent, as epidemiological and stress-reducing clinical interventions have yielded mixed effects on cancer mortality. In this Review, we describe and discuss specific mediating mechanisms identified by preclinical research, and parallel clinical findings. We explain the discrepancy between preclinical and clinical outcomes, through pointing to experimental strengths leveraged by animal studies and through discussing methodological and conceptual obstacles that prevent clinical studies from reflecting the impacts of stress. We suggest approaches to circumvent such obstacles, based on targeting critical phases of cancer progression that are more likely to be stress-sensitive; pharmacologically limiting adrenergic-inflammatory responses triggered by medical procedures; and focusing on more vulnerable populations, employing personalized pharmacological and psychosocial approaches. Recent clinical trials support our hypothesis that psychological and/or pharmacological inhibition of excess adrenergic and/or inflammatory stress signalling, especially alongside cancer treatments, could save lives.
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Affiliation(s)
- Anabel Eckerling
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Itay Ricon-Becker
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Liat Sorski
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Elad Sandbank
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shamgar Ben-Eliyahu
- Sagol School of Neuroscience and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
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11
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Pan S, Yin K, Tang Z, Wang S, Chen Z, Wang Y, Zhu H, Han Y, Liu M, Jiang M, Xu N, Zhang G. Stimulation of hypothalamic oxytocin neurons suppresses colorectal cancer progression in mice. eLife 2021; 10:e67535. [PMID: 34528509 PMCID: PMC8536257 DOI: 10.7554/elife.67535] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 09/12/2021] [Indexed: 01/05/2023] Open
Abstract
Emerging evidence suggests that the nervous system is involved in tumor development in the periphery, however, the role of the central nervous system remains largely unknown. Here, by combining genetic, chemogenetic, pharmacological, and electrophysiological approaches, we show that hypothalamic oxytocin (Oxt)-producing neurons modulate colitis-associated cancer (CAC) progression in mice. Depletion or activation of Oxt neurons could augment or suppress CAC progression. Importantly, brain treatment with celastrol, a pentacyclic triterpenoid, excites Oxt neurons and inhibits CAC progression, and this anti-tumor effect was significantly attenuated in Oxt neuron-lesioned mice. Furthermore, brain treatment with celastrol suppresses sympathetic neuronal activity in the celiac-superior mesenteric ganglion (CG-SMG), and activation of β2 adrenergic receptor abolishes the anti-tumor effect of Oxt neuron activation or centrally administered celastrol. Taken together, these findings demonstrate that hypothalamic Oxt neurons regulate CAC progression by modulating the neuronal activity in the CG-SMG. Stimulation of Oxt neurons using chemicals, for example, celastrol, might be a novel strategy for colorectal cancer treatment.
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Affiliation(s)
- Susu Pan
- Key Laboratory of Environmental Health, Ministry of Education, Department of Toxicology, School of Public Health, Tongji Medical CollegeWuhanChina
- Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and TechnologyWuhanChina
| | - Kaili Yin
- Key Laboratory of Environmental Health, Ministry of Education, Department of Toxicology, School of Public Health, Tongji Medical CollegeWuhanChina
- Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and TechnologyWuhanChina
| | - Zhiwei Tang
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Shuren Wang
- Laboratory of Cell and Molecular Biology, State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhuo Chen
- Key Laboratory of Environmental Health, Ministry of Education, Department of Toxicology, School of Public Health, Tongji Medical CollegeWuhanChina
- Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and TechnologyWuhanChina
| | - Yirong Wang
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Hongxia Zhu
- Laboratory of Cell and Molecular Biology, State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yunyun Han
- Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and TechnologyWuhanChina
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Mei Liu
- Laboratory of Cell and Molecular Biology, State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Man Jiang
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Ningzhi Xu
- Laboratory of Cell and Molecular Biology, State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Guo Zhang
- Key Laboratory of Environmental Health, Ministry of Education, Department of Toxicology, School of Public Health, Tongji Medical CollegeWuhanChina
- Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and TechnologyWuhanChina
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12
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Cui B, Peng F, Lu J, He B, Su Q, Luo H, Deng Z, Jiang T, Su K, Huang Y, Ud Din Z, Lam EWF, Kelley KW, Liu Q. Cancer and stress: NextGen strategies. Brain Behav Immun 2021; 93:368-383. [PMID: 33160090 DOI: 10.1016/j.bbi.2020.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/17/2020] [Accepted: 11/01/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic stress is well-known to cause physiological distress that leads to body balance perturbations by altering signaling pathways in the neuroendocrine and sympathetic nervous systems. This increases allostatic load, which is the cost of physiological fluctuations that are required to cope with psychological challenges as well as changes in the physical environment. Recent studies have enriched our knowledge about the role of chronic stress in disease development, especially carcinogenesis. Stress stimulates the hypothalamic-pituitaryadrenal (HPA) axis and the sympathetic nervous system (SNS), resulting in an abnormal release of hormones. These activate signaling pathways that elevate expression of downstream oncogenes. This occurs by activation of specific receptors that promote numerous cancer biological processes, including proliferation, genomic instability, angiogenesis, metastasis, immune evasion and metabolic disorders. Moreover, accumulating evidence has revealed that β-adrenergic receptor (ADRB) antagonists and downstream target inhibitors exhibit remarkable anti-tumor effects. Psychosomatic behavioral interventions (PBI) and traditional Chinese medicine (TCM) also effectively relieve the impact of stress in cancer patients. In this review, we discuss recent advances in the underlying mechanisms that are responsible for stress in promoting malignancies. Collectively, these data provide approaches for NextGen pharmacological therapies, PBI and TCM to reduce the burden of tumorigenesis.
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Affiliation(s)
- Bai Cui
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China; State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, 651 Dongfeng East Road, Guangzhou, Guangdong Province 510060, China
| | - Fei Peng
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Jinxin Lu
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Bin He
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Qitong Su
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Huandong Luo
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Ziqian Deng
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Tonghui Jiang
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Keyu Su
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Yanping Huang
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Zaheer Ud Din
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China
| | - Eric W-F Lam
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK
| | - Keith W Kelley
- Department of Pathology, College of Medicine and Department of Animal Sciences, College of ACES, University of Illinois at Urbana-Champaign, 212 Edward R. Madigan Laboratory, 1201 West Gregory Drive, Urbana, Il 61801, USA.
| | - Quentin Liu
- Institute of Cancer Stem Cell, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province 116044, China; State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, 651 Dongfeng East Road, Guangzhou, Guangdong Province 510060, China.
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13
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Tucker JA, Osann K, Hsieh S, Wahi A, Monk BJ, Wenzel L, Nelson EL. Longitudinal Changes in Sleep: Associations with Shifts in Circulating Cytokines and Emotional Distress in a Cancer Survivor Population. Int J Behav Med 2021; 28:140-150. [PMID: 33598780 PMCID: PMC7925505 DOI: 10.1007/s12529-020-09950-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sleep disturbances are associated with numerous mood disorders. Similarly, anxiety and depression are associated with modulation of the psychoneuroimmune (PNI) axis. This study hypothesized that changes in both monitored and self-reported measures of sleep would relate to changes in circulating cytokine levels in an emotionally distressed population of cervical cancer survivors. METHODS Biospecimens, patient-reported outcome (PRO) measures, and actigraphy were collected from cervical cancer survivors enrolled in a biobehavioral clinical trial. Longitudinal changes over a 4-month period were examined. Sleep time measured by actigraphy and PRO were analyzed for correlative changes with emotional distress and serum cytokines (n = 71). RESULTS Longitudinal change in the actigraph measure of sleep time was inversely associated with changes in depression and anxiety (test for linear trend, p = 0.02 and p = 0.05 respectively), as well as acute-phase response/pro-inflammatory cytokines (test for linear trend, p = 0.003, interleukin (IL)-2; 0.022, IL-1β; 0.0002, IL-6; and 0.049, tumor necrosis factor α). Conversely, changes in self-reported sleep problems were related to an increase in depression and anxiety (p = 0.001 and p = 0.01 respectively), the T helper 2 (Th2) cytokine IL-5 (p = 0.027), and the counter-regulatory cytokine IL-10 (0.016). CONCLUSION This study showed that an increase in sleep time or decrease in sleep problems corresponded with a reduction in self-reported emotional distress and attenuation of pro-inflammatory, Th2, and counter-regulatory cytokines. Our results support sleep measurement as a meaningful biobehavioral variable in cancer survivorship. This study also indicates that sleep investigators should be aware that choice of methodology might influence concordance with different classes of immune parameters.
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Affiliation(s)
- Jo A. Tucker
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, CA USA
| | - Kathryn Osann
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, CA USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA USA
| | - Susie Hsieh
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine, CA USA
| | - Aditi Wahi
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine, CA USA
| | - Bradley J. Monk
- Arizona Oncology, US Oncology Network, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ USA
| | - Lari Wenzel
- Chao Family Comprehensive Cancer Center, University of California, Irvine, CA USA
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine, CA USA
- Program in Public Health, University of California, Irvine, CA USA
| | - Edward L. Nelson
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, CA USA
- Department of Medicine, Division of General Internal Medicine, University of California, Irvine, CA USA
- Institute for Immunology, University of California, Irvine, CA 92617 USA
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14
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Zhang L, Pan J, Chen W, Jiang J, Huang J. Chronic stress-induced immune dysregulation in cancer: implications for initiation, progression, metastasis, and treatment. Am J Cancer Res 2020; 10:1294-1307. [PMID: 32509380 PMCID: PMC7269780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023] Open
Abstract
Psychological stress is a well-accepted risk factor in cancer initiation and progression. The explosive growth of psychoneuroimmunology research in the past decade has yielded an unprecedented wealth of information about the critical role of chronic stress in the immune dysfunction that influences tumor behaviors, which presents insights to mitigate distress and improve prognosis in cancer patients. Chronic stress exacerbates inflammation and causes a metabolism disorder, making it difficult for the organisms to maintain homeostasis and increasing its susceptibility to cancer. The shifted differentiation and redistribution of the immune system induced by chronic stress fail to combat cancer efficiently. Chronic stress increases the tumor-educated immune suppressive cells and impairs the cytotoxicity of cellular immunity, thereby promoting lymphatic metastasis and hematogenous metastasis. In addition, the efficacy of existing cancer therapies is undermined because chronic stress prevents the immune system from responding properly. Emerging stress-reduction measures have been administered to assist cancer patients to cope with the adverse effects of chronic stress. Here we systematically review the current molecular, cellular, physiological mechanisms about stress-mediated immune responses in the enhancement of tumor initiation and progression, remodeling of tumor microenvironment and impairment of anti-tumor treatment. We also summarize the potential clinically applicable stress-oriented strategies towards cancer and discuss briefly where important knowledge gaps remain.
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Affiliation(s)
- Leyi Zhang
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
- Cancer Institute (Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education; Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province), Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
| | - Jun Pan
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
- Cancer Institute (Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education; Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province), Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
| | - Wuzhen Chen
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
- Cancer Institute (Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education; Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province), Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
| | - Jinxin Jiang
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
- Cancer Institute (Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education; Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province), Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
| | - Jian Huang
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
- Cancer Institute (Key Laboratory of Cancer Prevention & Intervention, National Ministry of Education; Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province), Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou 310009, P. R. China
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15
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Munshi S, Loh MK, Ferrara N, DeJoseph MR, Ritger A, Padival M, Record MJ, Urban JH, Rosenkranz JA. Repeated stress induces a pro-inflammatory state, increases amygdala neuronal and microglial activation, and causes anxiety in adult male rats. Brain Behav Immun 2020; 84:180-199. [PMID: 31785394 PMCID: PMC7010555 DOI: 10.1016/j.bbi.2019.11.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022] Open
Abstract
A link exists between immune function and psychiatric conditions, particularly depressive and anxiety disorders. Psychological stress is a powerful trigger for these disorders and stress influences immune state. However, the nature of peripheral immune changes after stress conflicts across studies, perhaps due to the focus on few measures of pro-inflammatory or anti-inflammatory processes. The basolateral amygdala (BLA) is critical for emotion, and plays an important role in the effects of stress on anxiety. As such, it may be a primary central nervous system (CNS) mediator for the effects of peripheral immune changes on anxiety after stress. Therefore, this study aimed to delineate the influence of stress on peripheral pro-inflammatory and anti-inflammatory aspects, BLA immune activation, and its impact on BLA neuronal activity. To produce a more encompassing view of peripheral immune changes, this study used a less restrictive approach to categorize and group peripheral immune changes. We found that repeated social defeat stress in adult male Sprague-Dawley rats increased the frequencies of mature T-cells positive for intracellular type 2-like cytokine and serum pro-inflammatory cytokines. Principal component analysis and hierarchical clustering was used to guide grouping of T-cells and cytokines, producing unique profiles. Stress shifted the balance towards a specific set that included mostly type 2-like T-cells and pro-inflammatory cytokines. Within the CNS component, repeated stress caused an increase of activated microglia in the BLA, increased anxiety-like behaviors across several assays, and increased BLA neuronal firing in vivo that was prevented by blockade of microglia activation. Because repeated stress can trigger anxiety states by actions in the BLA, and altered immune function can trigger anxiety, these results suggest that repeated stress may trigger anxiety-like behaviors by inducing a pro-inflammatory state in the periphery and the BLA. These results begin to uncover how stress may recruit the immune system to alter the function of brain regions critical to emotion.
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Affiliation(s)
- Soumyabrata Munshi
- Department of Foundational Sciences and Humanities, Cellular and Molecular Pharmacology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.,Department of Foundational Sciences and Humanities, Neuroscience, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Maxine K. Loh
- Department of Foundational Sciences and Humanities, Cellular and Molecular Pharmacology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.,Center for Neurobiology of Stress Resilience and Psychiatric Disorders, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Nicole Ferrara
- Department of Foundational Sciences and Humanities, Cellular and Molecular Pharmacology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.,Center for Neurobiology of Stress Resilience and Psychiatric Disorders, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - M. Regina DeJoseph
- Department of Foundational Sciences and Humanities, Physiology and Biophysics, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.,Center for Neurobiology of Stress Resilience and Psychiatric Disorders, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Alexandra Ritger
- Department of Foundational Sciences and Humanities, Neuroscience, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.,Center for Neurobiology of Stress Resilience and Psychiatric Disorders, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Mallika Padival
- Department of Foundational Sciences and Humanities, Cellular and Molecular Pharmacology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.,Center for Neurobiology of Stress Resilience and Psychiatric Disorders, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Matthew J. Record
- Department of Foundational Sciences and Humanities, Cellular and Molecular Pharmacology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Janice H. Urban
- Department of Foundational Sciences and Humanities, Physiology and Biophysics, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.,Center for Neurobiology of Stress Resilience and Psychiatric Disorders, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - J. Amiel Rosenkranz
- Department of Foundational Sciences and Humanities, Cellular and Molecular Pharmacology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.,Center for Neurobiology of Stress Resilience and Psychiatric Disorders, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA.,Corresponding Author: J. Amiel Rosenkranz, Ph.D., Center for Neurobiology of Stress Resilience and Psychiatric Disorders, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064, USA., Telephone: 847-578-8680; Fax: 847-578-3268,
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16
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Colon-Echevarria CB, Lamboy-Caraballo R, Aquino-Acevedo AN, Armaiz-Pena GN. Neuroendocrine Regulation of Tumor-Associated Immune Cells. Front Oncol 2019; 9:1077. [PMID: 31737559 PMCID: PMC6828842 DOI: 10.3389/fonc.2019.01077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022] Open
Abstract
Mounting preclinical and clinical evidence continues to support a role for the neuroendocrine system in the modulation of tumor biology and progression. Several studies have shown data supporting a link between chronic stress and cancer progression. Dysregulation of the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in promoting angiogenesis, tumor cell proliferation and survival, alteration of the immune response and exacerbating inflammatory networks in the tumor microenvironment. Here, we review how SNS and HPA dysregulation contributes to disturbances in immune cell populations, modifies cancer biology, and impacts immunotherapy response. We also highlight several interventions aimed at circumventing the adverse effects stress has on cancer patients.
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Affiliation(s)
- Claudia B Colon-Echevarria
- Division of Pharmacology, Department of Basic Sciences, School of Medicine, Ponce Health Sciences University, Ponce, PR, United States
| | - Rocio Lamboy-Caraballo
- Division of Pharmacology, Department of Basic Sciences, School of Medicine, Ponce Health Sciences University, Ponce, PR, United States
| | - Alexandra N Aquino-Acevedo
- Division of Pharmacology, Department of Basic Sciences, School of Medicine, Ponce Health Sciences University, Ponce, PR, United States
| | - Guillermo N Armaiz-Pena
- Division of Pharmacology, Department of Basic Sciences, School of Medicine, Ponce Health Sciences University, Ponce, PR, United States.,Divisions of Cancer Biology and Women's Health, Ponce Research Institute, Ponce, PR, United States
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17
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Cheng L, Meiser B. The relationship between psychosocial factors and biomarkers in cancer patients: A systematic review of the literature. Eur J Oncol Nurs 2019; 41:88-96. [DOI: 10.1016/j.ejon.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 02/06/2023]
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18
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Lu D, Andrae B, Valdimarsdóttir U, Sundström K, Fall K, Sparén P, Fang F. Psychological distress is associated with cancer-specific mortality among patients with cervical cancer. Cancer Res 2019; 79:3965-3972. [PMID: 31253667 DOI: 10.1158/0008-5472.can-19-0116] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/08/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022]
Abstract
Emerging evidence suggests a role of psychological factors in the progression of different cancer types. However, it is unclear whether psychological distress around the time of diagnosis of invasive cervical cancer places patients at a higher risk of cancer-specific mortality, independently of tumor characteristics and treatment modalities. We conducted a nationwide cohort study, including 4,245 patients with newly diagnosed cervical cancer during 2002-2011 in Sweden. Psychological distress was indicated by a clinical diagnosis of depression, anxiety, or stress reaction and adjustment disorders, or the experience of a stressful life event, including death or severe illness of a family member, divorce, or between jobs, from one year before cancer diagnosis and onwards. We calculated the hazard ratios (HRs) of cancer-specific mortality among the patients exposed to psychological distress, compared to unexposed patients, controlling for socioeconomic characteristics and other known prognostic indicators such as tumor and treatment characteristics. We found that patients exposed to psychological distress had an increased risk of cancer-specific mortality (HR 1.33, 95% CI 1.14 to 1.54). The association was primarily driven by distress experienced within one year before or after diagnosis (HR 1.30, 95% CI 1.11 to 1.52), but not thereafter (HR 1.12, 95% CI 0.84 to 1.49). In summary, our study shows that psychiatric disorders and stressful life events around cancer diagnosis are associated with increased cancer-specific mortality among patients with cervical cancer, independent of tumor characteristics and treatment modality.
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Affiliation(s)
- Donghao Lu
- Department of Medical Epidemiology & Biostatistics, Karolinska Institute
| | - Bengt Andrae
- Dept of Medical Epidemiology and Biostatistics, Karolinska Institute
| | - Unnur Valdimarsdóttir
- Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland
| | | | | | - Pär Sparén
- Department of Medical Epidemiology & Biostatistics, Karolinska Institute
| | - Fang Fang
- Department of Medical Epidemiology & Biostatistics, Karolinska Institute
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19
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Liu Y, Zhang H, Wang Z, Wu P, Gong W. 5-Hydroxytryptamine1a receptors on tumour cells induce immune evasion in lung adenocarcinoma patients with depression via autophagy/pSTAT3. Eur J Cancer 2019; 114:8-24. [PMID: 31009821 DOI: 10.1016/j.ejca.2019.03.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/13/2019] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cancer patients frequently suffer from fatigue and depression. Dysregulation of the immune system, tumour recurrence and metastasis are more common in cancer patients with depression. 5-Hydroxytryptamine (5-HT), a neurotransmitter, contributes to immune evasion in lung adenocarcinoma patients by activating 5-HTRs, but the mechanism for this phenomenon is still unclear. In this study, we examined the function of 5-HT1a receptors (5-HT1aRs) in immune evasion in a mouse model and in samples from lung adenocarcinomas patients. EXPERIMENTAL DESIGN Sixty-four human lung adenocarcinoma patients with depression and 64 lung adenocarcinoma patients without depression were recruited for this study. The expression of 5-HT receptors on lung adenocarcinoma cells from tumour tissues were detected by using immunohistochemistry (IHC) and fluorescence-activated cell sorting (FACS). The depression models were established in vitro and in vivo. The effects of immunosuppression were evaluated by testing the function of cytotoxic lymphocyte (CTLs) and Tregs, measuring tumour weight or volume, assessing the survival of mice and staining of tissues by IHC. Changes in the expression of immunoregulatory factor genes were assessed to elucidate the mechanism of immune evasion induced by the 5- hydroxytryptamine receptor (HTRs). RESULTS Higher levels of 5-HT, increased expression of 5-HT1Rs and decreased overall survival were observed in lung adenocarcinomas patients with depression compared with those without depression. Moreover, 5-HT1aR, a critical factor for increasing the number of CD4+CD25+Foxp3+ Treg cells and decreasing the ratio of Th1/Th2 cells, which suggested immune system dysregulation. In addition, expression of 5-HT1aR on tumour cells was also negatively associated with CTL activity in both peripheral blood and tumour infiltrating lymphocytes. In a depressive state, 5-HT1aR activates p-signal transducer and activator of transcription 3 (STAT3) and autophagy, and programmed death ligand-1, a downstream gene of autophagy/p-STAT3 signalling, mediates an immunosuppressive environment. Moreover, in both the mouse model and lung adenocarcinoma patients, the activation of 5HT1aR and the elevated tumour autophagy/p-STAT3 axis were associated with reduced overall survival. CONCLUSIONS The 5-HT1aR/autophagy/p-STAT3 axis influences both tumour cells and immune cells, resulting in immunosuppression in lung adenocarcinomas patients with depression.
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Affiliation(s)
- Yi Liu
- Department of Medicinal Chemistry, School of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Hao Zhang
- Department of Cardiothoracic Surgery, XiangYang Central Hospital, Hubei University of Arts and Science, XiangYang 441021, China
| | - ZhiYong Wang
- Department of Neurosurgery, XiangYang Central Hospital, Hubei University of Arts and Science, XiangYang 441021, China
| | - Pin Wu
- Department of Medicinal Chemistry, School of Pharmacy, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Wei Gong
- Department of Oncology, XiangYang Central Hospital, Hubei University of Arts and Science, XiangYang 441021, China.
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20
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Antoni MH, Dhabhar FS. The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer 2019; 125:1417-1431. [PMID: 30768779 DOI: 10.1002/cncr.31943] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/22/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
Abstract
The range of psychosocial stress factors/processes (eg, chronic stress, distress states, coping, social adversity) were reviewed as they relate to immune variables in cancer along with studies of psychosocial interventions on these stress processes and immune measures in cancer populations. The review includes molecular, cellular, and clinical research specifically examining the effects of stress processes and stress-management interventions on immune variables (eg, cellular immune function, inflammation), which may or may not be changing directly in response to the cancer or its treatment. Basic psychoneuroimmunologic research on stress processes (using animal or cellular/tumor models) provides leads for investigating biobehavioral processes that may underlie the associations reported to date. The development of theoretically driven and empirically supported stress-management interventions may provide important adjuncts to clinical cancer care going forward.
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Affiliation(s)
- Michael H Antoni
- Department of Psychology, University of Miami and Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
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21
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Halim L, Romano M, McGregor R, Correa I, Pavlidis P, Grageda N, Hoong SJ, Yuksel M, Jassem W, Hannen RF, Ong M, Mckinney O, Hayee B, Karagiannis SN, Powell N, Lechler RI, Nova-Lamperti E, Lombardi G. An Atlas of Human Regulatory T Helper-like Cells Reveals Features of Th2-like Tregs that Support a Tumorigenic Environment. Cell Rep 2018; 20:757-770. [PMID: 28723576 PMCID: PMC5529316 DOI: 10.1016/j.celrep.2017.06.079] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/16/2017] [Accepted: 06/26/2017] [Indexed: 02/07/2023] Open
Abstract
Regulatory T cells (Tregs) play a pivotal role in maintaining immunological tolerance, but they can also play a detrimental role by preventing antitumor responses. Here, we characterized T helper (Th)-like Treg subsets to further delineate their biological function and tissue distribution, focusing on their possible contribution to disease states. RNA sequencing and functional assays revealed that Th2-like Tregs displayed higher viability and autocrine interleukin-2 (IL-2)-mediated activation than other subsets. Th2-like Tregs were preferentially found in tissues rather than circulation and exhibited the highest migratory capacity toward chemokines enriched at tumor sites. These cellular responses led us to hypothesize that this subset could play a role in maintaining a tumorigenic environment. Concurrently, Th2-like Tregs were enriched specifically in malignant tissues from patients with melanoma and colorectal cancer compared to healthy tissue. Overall, our results suggest that Th2-like Tregs may contribute to a tumorigenic environment due to their increased cell survival, higher migratory capacity, and selective T-effector suppressive ability. Memory Tregs can be classified as T helper-like Tregs (Th2, Th17, Th1, and Th1/17) Human Th2-like Tregs exhibit the highest viability and IL-2-mediated activation Th2-like Tregs are the subset with the highest chemotaxis toward CCL17/22 Th2-like Tregs are enriched at tumor sites in melanoma and colorectal cancer
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Affiliation(s)
- Leena Halim
- MRC Centre for Transplantation, King's College London, Guy's Hospital, SE1 9RT London, UK
| | - Marco Romano
- MRC Centre for Transplantation, King's College London, Guy's Hospital, SE1 9RT London, UK
| | - Reuben McGregor
- MRC Centre for Transplantation, King's College London, Guy's Hospital, SE1 9RT London, UK
| | - Isabel Correa
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, SE1 9RT London, UK
| | - Polychronis Pavlidis
- MRC Centre for Transplantation, King's College London, Guy's Hospital, SE1 9RT London, UK
| | - Nathali Grageda
- MRC Centre for Transplantation, King's College London, Guy's Hospital, SE1 9RT London, UK
| | - Sec-Julie Hoong
- MRC Centre for Transplantation, King's College London, Guy's Hospital, SE1 9RT London, UK
| | - Muhammed Yuksel
- Institute of Liver Studies and Transplantation, King's College London, King's College Hospital, SE5 9RS London, UK
| | - Wayel Jassem
- Institute of Liver Studies and Transplantation, King's College London, King's College Hospital, SE5 9RS London, UK
| | - Rosalind F Hannen
- Centre for Cell Biology and Cutaneous Research, The Blizard Institute, Barts and the London School of Medicine and Dentistry, E1 2AT London, UK
| | - Mark Ong
- Histology/Histopathology Laboratory, King's College Hospital, SE5 9RS London, UK
| | - Olivia Mckinney
- Histology/Histopathology Laboratory, King's College Hospital, SE5 9RS London, UK
| | - Bu'Hussain Hayee
- Department of Gastroenterology, King's College Hospital, SE5 9RS London, UK
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, SE1 9RT London, UK
| | - Nicholas Powell
- MRC Centre for Transplantation, King's College London, Guy's Hospital, SE1 9RT London, UK
| | - Robert I Lechler
- MRC Centre for Transplantation, King's College London, Guy's Hospital, SE1 9RT London, UK; King's Health Partners, SE1 9RT London, UK
| | | | - Giovanna Lombardi
- MRC Centre for Transplantation, King's College London, Guy's Hospital, SE1 9RT London, UK.
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22
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Cassedy HF, Tucker C, Hynan LS, Phillips R, Adams C, Zimmerman MR, Pitts S, Miltenberger P, Stringer CA. Frequency of psychological distress in gynecologic cancer patients seen in a large urban medical center. Proc (Bayl Univ Med Cent) 2018; 31:161-164. [PMID: 29706807 DOI: 10.1080/08998280.2018.1440857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 01/06/2023] Open
Abstract
Psychological distress in cancer is a well-documented phenomenon, but additional information is needed about demographic and disease correlates in diverse populations with different forms of cancer. This study focused on gynecologic cancers. Using the Distress Thermometer and the Hospital Anxiety and Depression Scale, this study examined distress levels in 94 women with gynecologic cancer who were being treated as outpatients at a large urban medical center. The distress levels in this sample were lower than in comparable studies, raising questions about openness to reporting distress. Those who reported higher levels of distress were more likely to also report a mental health diagnosis or psychiatric medication. This suggests that an alternate form for distress screening may involve inquiring about mental health treatment. In this sample, younger women and those with higher educational achievement or private health insurance had higher levels of distress. Conversely, there were no relations between distress levels and disease characteristics, indicating that, for example, women with early stage disease have just as much risk of distress as those with later-stage disease.
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Affiliation(s)
- Hannah F Cassedy
- Department of Obstetrics/Gynecology, Baylor University Medical Center, Dallas, Texas
| | - Christy Tucker
- Department of Obstetrics/Gynecology, Baylor University Medical Center, Dallas, Texas
| | - Linda S Hynan
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Renee Phillips
- Department of Emotional Wellness, The Episcopal School of Dallas, Dallas, Texas
| | | | | | - Sandra Pitts
- Department of Obstetrics/Gynecology, Baylor University Medical Center, Dallas, Texas
| | | | - C Allen Stringer
- Department of Obstetrics/Gynecology, Baylor University Medical Center, Dallas, Texas
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23
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Jacobs JM, Traeger L, Eusebio J, Simon NM, Sequist LV, Greer JA, Temel JS, Pirl WF. Depression, inflammation, and epidermal growth factor receptor (EGFR) status in metastatic non-small cell lung cancer: A pilot study. J Psychosom Res 2017; 99:28-33. [PMID: 28712427 DOI: 10.1016/j.jpsychores.2017.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with stage IV non-small cell lung cancer (NSCLC) have high risk for depressive symptoms and major depressive disorder (MDD); however, those with epidermal growth factor receptor (EGFR) mutations may have decreased risk. The biological underpinning of this relationship is unknown. We examined differences in depression severity and MDD in patients with newly diagnosed stage IV NSCLC based on EGFR mutation status, and examined proinflammatory cytokines and growth factors known to play a role in cancer progression and depression. METHODS Fifty-five patients with newly diagnosed stage IV NSCLC completed self-report and clinician-administered depression assessments prior to receiving results of tumor genotyping. We measured serum levels of circulating biological markers of inflammation: IL-1β, IL-6, TGF-α, and TNF-α. We examined differences in depression severity, MDD, and inflammatory biomarkers in patients with and without EGFR mutations. RESULTS Patients with EGFR mutations (n=10) had lower depression severity (t[43]=2.38, p=0.03) than those without EGFR mutations (n=38) and fewer patients with EGFR mutations had concurrent MDD (2.08%) relative to those without mutations (27.08%). Patients with MDD had higher levels of TNF-α than those without MDD (t[40]=2.95, p=0.005). Those with EGFR mutations exhibited higher levels of TNF-α relative to those without EGFR mutations (t[35]=2.17, p=0.04). CONCLUSIONS Patients with stage IV NSCLC harboring an EGFR mutation exhibited elevated proinflammatory marker TNF-α, yet had lower depression severity than patients without EGFR mutations. More work is warranted to examine the interaction between tumor genotyping and inflammatory cytokines in the context of depression.
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Affiliation(s)
- Jamie M Jacobs
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States.
| | - Lara Traeger
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States
| | - Justin Eusebio
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States
| | - Naomi M Simon
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 6th floor, Boston, MA 02114, United States
| | - Lecia V Sequist
- Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 7B, Boston, MA 02114, United States
| | - Joseph A Greer
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States
| | - Jennifer S Temel
- Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 7B, Boston, MA 02114, United States
| | - William F Pirl
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital Cancer Center/Harvard Medical School, 55 Fruit St., Yawkey Center for Outpatient Care, Suite 10B, Boston, MA 02114, United States
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24
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Budiu RA, Vlad AM, Nazario L, Bathula C, Cooper KL, Edmed J, Thaker PH, Urban J, Kalinski P, Lee AV, Elishaev EL, Conrads TP, Flint MS. Restraint and Social Isolation Stressors Differentially Regulate Adaptive Immunity and Tumor Angiogenesis in a Breast Cancer Mouse Model. CANCER AND CLINICAL ONCOLOGY 2017; 6:12-24. [PMID: 28603578 PMCID: PMC5464739 DOI: 10.5539/cco.v6n1p12] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The ability of stress to induce immune suppression is widely recognized, but the mechanisms underlying the effects of stress on the adaptive immune system during tumor progression are not completely understood. To study the effect of stress on the immune system in vivo, we used a preclinical immunocompetent mouse model bearing 4T1 mammary adenocarcinoma cells. Mice were randomized into 4 groups, including social isolation (SI), acute restraint stress (aRRS), chronic restraint stress (cRRS), or no stress (NS). We found that SI significantly decreased the number of tumor-bearing mice still alive at the end of protocol (28 days), compared to NS mice. Although we did not detect significant changes in primary tumor volume, we observed a significant increase in the endothelial marker CD31 in primary tumors of SI mice and in lung metastases in SI and RRS mice. Survival decline in SI mice was associated with significant decreases in splenic CD8 cells and in activated T cells. From a mechanistic standpoint, RRS increased expression of FOXP3, CXCL-10, and granzyme B in mouse tumors, and the effects were reversed by propranolol. Our data demonstrate that various forms of stress differentially impact adaptive immunity and tumor angiogenesis, and negatively impact survival.
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Affiliation(s)
- Raluca A Budiu
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Magee Womens Research Institute, Pittsburgh, PA, 15213, USA
| | - Anda M Vlad
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Magee Womens Research Institute, Pittsburgh, PA, 15213, USA
| | - Linda Nazario
- Magee Womens Research Institute, Pittsburgh, PA, 15213, USA
| | - Chandra Bathula
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Kristine L Cooper
- Biostatistics Facility Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, 15213, USA
| | - Jessica Edmed
- University of Brighton, School of Pharmacy & Biomolecular Sciences, Brighton, BN2 4GJ, UK
| | - Premal H Thaker
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St Louis, MO, 63110, USA
| | - Julie Urban
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Pawel Kalinski
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Adrian V Lee
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, 15213, USA
| | - Esther L Elishaev
- Magee Womens Research Institute, Pittsburgh, PA, 15213, USA
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, 15213, USA
| | - Thomas P Conrads
- Women's Health Integrated Research Center at Inova Health System, Annandale, VA, 22003, USA
| | - Melanie S Flint
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, 15213, USA
- University of Brighton, School of Pharmacy & Biomolecular Sciences, Brighton, BN2 4GJ, UK
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25
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Lutgendorf SK, Andersen BL. Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions. ACTA ACUST UNITED AC 2016; 70:186-97. [PMID: 25730724 DOI: 10.1037/a0035730] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the last decade, there have been groundbreaking strides in our understanding of the multiple biological pathways by which psychosocial and behavioral factors can affect cancer progression. It is now clear that biobehavioral factors not only affect cellular immunity but both directly and indirectly modulate fundamental processes in cancer growth, including inflammation, angiogenesis, invasion, and metastasis. There is also an emerging understanding of how psychological and behavioral factors used in interventions can impact these physiological processes. This review outlines our current understanding of the physiological mechanisms by which psychological, social, and behavioral processes can affect cancer progression. The intervention literature is discussed, along with recommendations for future research to move the field of biobehavioral oncology forward.
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26
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Cash E, Sephton SE, Chagpar AB, Spiegel D, Rebholz WN, Zimmaro LA, Tillie JM, Dhabhar FS. Circadian disruption and biomarkers of tumor progression in breast cancer patients awaiting surgery. Brain Behav Immun 2015; 48:102-14. [PMID: 25728235 DOI: 10.1016/j.bbi.2015.02.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 02/09/2015] [Accepted: 02/20/2015] [Indexed: 02/08/2023] Open
Abstract
Psychological distress, which can begin with cancer diagnosis and continue with treatment, is linked with circadian and endocrine disruption. In turn, circadian/endocrine factors are potent modulators of cancer progression. We hypothesized that circadian rest-activity rhythm disruption, distress, and diurnal cortisol rhythms would be associated with biomarkers of tumor progression in the peripheral blood of women awaiting breast cancer surgery. Breast cancer patients (n=43) provided actigraphic data on rest-activity rhythm, cancer-specific distress (IES, POMS), saliva samples for assessment of diurnal cortisol rhythm, cortisol awakening response (CAR), and diurnal mean. Ten potential markers of tumor progression were quantified in serum samples and grouped by exploratory factor analysis. Analyses yielded three factors, which appear to include biomarkers reflecting different aspects of tumor progression. Elevated factor scores indicate both high levels and strong clustering among serum signals. Factor 1 included VEGF, MMP-9, and TGF-β; suggesting tumor invasion/immunosuppression. Factor 2 included IL-1β, TNF-α, IL-6R, MCP-1; suggesting inflammation/chemotaxis. Factor 3 included IL-6, IL-12, IFN-γ; suggesting inflammation/TH1-type immunity. Hierarchical regressions adjusting age, stage and socioeconomic status examined associations of circadian, distress, and endocrine variables with these three factor scores. Patients with poor circadian coordination as measured by rest-activity rhythms had higher Factor 1 scores (R(2)=.160, p=.038). Patients with elevated CAR also had higher Factor 1 scores (R(2)=.293, p=.020). These relationships appeared to be driven largely by VEGF concentrations. Distress was not related to tumor-relevant biomarkers, and no other significant relationships emerged. Women with strong circadian activity rhythms showed less evidence of tumor promotion and/or progression as indicated by peripheral blood biomarkers. The study was not equipped to discern the cause of these associations. Circadian/endocrine aberrations may be a manifestation of systemic effects of aggressive tumors. Alternatively, these results raise the possibility that, among patients with active breast tumors, disruption of circadian activity rhythms and elevated CAR may facilitate tumor promotion and progression.
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Affiliation(s)
- E Cash
- Department of Surgery, Division of Otolaryngology-HNS, University of Louisville School of Medicine, Louisville, KY, United States; Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States
| | - S E Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States.
| | - A B Chagpar
- The Breast Center - Smilow Cancer Hospital at Yale-New Haven, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - D Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - W N Rebholz
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States
| | - L A Zimmaro
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States
| | - J M Tillie
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - F S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States; Institute for Immunity, Transplantation, and Infection, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States.
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27
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Davis LZ, Slavich GM, Thaker PH, Goodheart MJ, Bender DP, Dahmoush L, Farley DM, Markon KE, Penedo FJ, Lubaroff DM, Cole SW, Sood AK, Lutgendorf SK. Eudaimonic well-being and tumor norepinephrine in patients with epithelial ovarian cancer. Cancer 2015; 121:3543-50. [PMID: 26096769 DOI: 10.1002/cncr.29516] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/01/2015] [Accepted: 05/18/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND The impact of psychological well-being on the physiologic processes involved in cancer progression remains unclear. Prior research has implicated adrenergic signaling in tumor growth and metastasis. Given that adrenergic signaling is influenced by both positive and negative factors, the authors examined how 2 different aspects of well-being (eudaimonic and positive affect) and psychological distress were associated with tumor norepinephrine (NE) in patients with ovarian cancer. METHODS A total of 365 women with suspected ovarian cancer completed psychosocial assessments before surgery and clinical information was obtained from medical records. Study inclusion was confirmed after histological diagnosis. Tumor NE was measured in frozen tissue samples using high-performance liquid chromatography with electrochemical detection. Confirmatory factor analysis was used to model eudaimonic well-being, positive affect, and psychological distress, and structural equation modeling was used to examine associations between these factors and tumor NE. RESULTS Eudaimonic well-being, positive affect, and psychological distress, modeled as distinct but correlated constructs, best fit the data (ie, compared with unitary or 2-factor models) (root mean square error of approximation, 0.048; comparative fit index, 0.982; and standardized root-mean-squared residual, 0.035). Structural equation modeling analysis that included physical well-being, stage of disease, histology, psychological treatment history, beta-blocker use, and caffeine use as covariates was found to have good model fit (root mean square error of approximation, 0.052; comparative fit index, 0.955; and standardized root-mean-squared residual, 0.036) and demonstrated that eudaimonic well-being was related to lower tumor NE (β = -.24 [P = .045]). In contrast, no effects were found for positive affect or psychological distress. CONCLUSIONS Eudaimonic well-being was found to be associated with lower tumor NE, independent of positive affect and psychological distress. Because adrenergic signaling is implicated in tumor progression, increasing eudaimonic well-being may improve both psychological and physiologic resilience in patients with ovarian cancer.
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Affiliation(s)
- Lauren Z Davis
- Department of Psychology, University of Iowa, Iowa City, Iowa
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael J Goodheart
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
| | - David P Bender
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
| | - Laila Dahmoush
- Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Donna M Farley
- College of Pharmacy, University of Iowa, Iowa City, Iowa
| | | | - Frank J Penedo
- Department of Medical and Social Sciences, Northwestern University, Evanston, Illinois.,Department of Psychology, Northwestern University, Evanston, Illinois.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, Illinois
| | - David M Lubaroff
- Department of Urology, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.,Department of Microbiology, University of Iowa, Iowa City, Iowa
| | - Steve W Cole
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California.,Division of Hematology/Oncology, Jonsson Comprehensive Cancer Center, University of California at Los Angeles School of Medicine, Los Angeles, California.,University of California at Los Angeles Molecular Biology Institute, Los Angeles, California
| | - Anil K Sood
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan K Lutgendorf
- Department of Psychology, University of Iowa, Iowa City, Iowa.,Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.,Department of Urology, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
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Smith HR. Depression in cancer patients: Pathogenesis, implications and treatment (Review). Oncol Lett 2015; 9:1509-1514. [PMID: 25788991 PMCID: PMC4356432 DOI: 10.3892/ol.2015.2944] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 02/02/2015] [Indexed: 12/14/2022] Open
Abstract
Depression is a common comorbidity in cancer cases, affecting >10% of patients. A cancer diagnosis is life-changing, and is a source of considerable psychological and emotional stress. Non-pathological sadness may be a normal response to a cancer diagnosis, however, stress beyond the coping mechanisms of patients may result in major depressive disorder. The current review, in addition to the obvious psychosocial elements of depression, explores its biological mechanisms, including tissue damage, inflammatory mediators and the chronic stress response, and how these immune and endocrine pathways may underlie depression in cancer. Possible iatrogenic causes of depression in cancer are also explored. There is a strong need to identify and treat depression in cancer patients in order to increase quality of life and reduce mortality. The most popular clinical and potential future biochemical screening tools for depression in cancer are briefly discussed. The interventions used will vary for every patient, but may include psychosocial therapies or pharmacotherapy; however, a paucity of research on the most effective management of depression in cancer means the optimal combination of therapies is unknown. Selection of antidepressants should be carefully considered, given the common side effects of chemotherapy (such as nausea), and the necessity to avoid serious interactions, including reducing the effectiveness of chemotherapeutic drugs. The possible link between the chronic stress response, which may predispose patients to depression, and the risk of mortality from cancer is also explored. The complex interactions between the endocrine, nervous and immune systems, which continue to be elucidated, may offer the opportunity for the development of more rapid and efficacious treatments for depression in cancer in the future.
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Affiliation(s)
- Hamish R Smith
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811, Australia
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Kim J, Lee SJ, Roh JK, Shin SJ. Association of Depression and Survival in Patients with Cancer over 10 Years. ASIAN ONCOLOGY NURSING 2015. [DOI: 10.5388/aon.2015.15.1.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joohyung Kim
- Department of Public Administration, Korea University, Seoul, Korea
| | - Suk Jeong Lee
- Red Cross College of Nursing, Chung-Ang University, CAU Healthcare System, Seoul, Korea
| | - Jae-Kyung Roh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Jun Shin
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Meyer F, Fletcher K, Prigerson HG, Braun IM, Maciejewski PK. Advanced cancer as a risk for major depressive episodes. Psychooncology 2014; 24:1080-7. [PMID: 25389107 DOI: 10.1002/pon.3722] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/10/2014] [Accepted: 10/15/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Major depression adversely affects health communication, quality of life, and survival in patients with advanced cancer. Prior research provides limited insight into how patients with advanced cancer differ from the general population in risk for developing a major depressive episode (MDE). This study aims to determine whether advanced cancer poses distinct risks for initial and recurrent MDEs. METHODS Advanced cancer patients (N = 628) from Coping with Cancer were compared with propensity-weighted general population controls (N = 9282) from the National Comorbidity Survey Replication. RESULTS Patients with advanced cancer were more likely than comparisons to have an initial MDE [OR = 27.3, 95% CI = (14.8-50.4); p < 0.001] but no more likely than comparisons to have a recurrent MDE [OR = 1.5, 95% CI = (0.9-2.6); p = 0.160]. Nearly two thirds (64.4%) of current MDEs in patients were initial onset; the vast majority (91.8%) of current MDEs in comparisons were recurrent. CONCLUSIONS Advanced cancer increases risk of an initial MDE but appears not to enhance risk of a recurrent MDE. This suggests the importance of screening widely for depression in patients with advanced cancer as opposed to targeting screening to presumably high-risk subgroups of those with psychiatric histories.
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Affiliation(s)
- Fremonta Meyer
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kalen Fletcher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Holly G Prigerson
- Center for Research on End of Life Care, Departments of Medicine and Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Ilana M Braun
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul K Maciejewski
- Center for Research on End of Life Care, Departments of Medicine and Radiology, Weill Cornell Medical College, New York, NY, USA
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Guintivano J, Arad M, Gould TD, Payne JL, Kaminsky ZA. Antenatal prediction of postpartum depression with blood DNA methylation biomarkers. Mol Psychiatry 2014; 19:560-7. [PMID: 23689534 PMCID: PMC7039252 DOI: 10.1038/mp.2013.62] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/02/2013] [Indexed: 01/06/2023]
Abstract
Postpartum depression (PPD) affects ∼10-18% of women in the general population and results in serious consequences to both the mother and offspring. We hypothesized that predisposition to PPD risk is due to an altered sensitivity to estrogen-mediated epigenetic changes that act in a cell autonomous manner detectable in the blood. We investigated estrogen-mediated epigenetic reprogramming events in the hippocampus and risk to PPD using a cross-species translational design. DNA methylation profiles were generated using methylation microarrays in a prospective sample of the blood from the antenatal period of pregnant mood disorder patients who would and would not develop depression postpartum. These profiles were cross-referenced with syntenic locations exhibiting hippocampal DNA methylation changes in the mouse responsive to long-term treatment with 17β-estradiol (E2). DNA methylation associated with PPD risk correlated significantly with E2-induced DNA methylation change, suggesting an enhanced sensitivity to estrogen-based DNA methylation reprogramming exists in those at risk for PPD. Using the combined mouse and human data, we identified two biomarker loci at the HP1BP3 and TTC9B genes that predicted PPD with an area under the receiver operator characteristic (ROC) curve (area under the curve (AUC)) of 0.87 in antenatally euthymic women and 0.12 in a replication sample of antenatally depressed women. Incorporation of blood count data into the model accounted for the discrepancy and produced an AUC of 0.96 across both prepartum depressed and euthymic women. Pathway analyses demonstrated that DNA methylation patterns related to hippocampal synaptic plasticity may be of etiological importance to PPD.
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Affiliation(s)
- J Guintivano
- The Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M Arad
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - TD Gould
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA;,Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA,Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - JL Payne
- The Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - ZA Kaminsky
- The Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kaminsky Z, Payne J. Seeing the future: epigenetic biomarkers of postpartum depression. Neuropsychopharmacology 2014; 39:233-4. [PMID: 24317310 PMCID: PMC3857665 DOI: 10.1038/npp.2013.238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Zachary Kaminsky
- The Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Payne
- The Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,E-mail:
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Children with both asthma and depression are at risk for heightened inflammation. J Pediatr 2013; 163:1443-7. [PMID: 23919906 PMCID: PMC3967500 DOI: 10.1016/j.jpeds.2013.06.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 06/06/2013] [Accepted: 06/21/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To test whether children and adolescents with co-occurring asthma and depression are at risk for elevated inflammation-concurrently and at the next assessment. STUDY DESIGN Up to 6 yearly assessments per person from the prospective, population-based Great Smoky Mountains Study (N = 1420) were used, covering children in the community aged 10-16 years old. High-sensitivity C-reactive protein (CRP) was assayed from annual bloodspot collections and provided indicators of elevated inflammation at CRP > 1, CRP > 2, and CRP > 3 mg/L. Depression was assessed with the Child and Adolescent Psychiatric Assessment. Asthma was assessed using a form adapted from the Centers for Disease Control and Prevention National Health Interview Survey. RESULTS Controlling common covariates of CRP, the co-occurrence of asthma and depression predicted heightened CRP-concurrently and at the next assessment. In turn, elevated CRP was relatively stable from one assessment to the next. CONCLUSIONS The co-occurrence of asthma and depression in childhood poses a risk for substantially elevated inflammation concurrently and over time, which could contribute to pathophysiological processes involved in the development of additional chronic diseases and also to asthma--related morbidity and mortality.
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Armaiz-Pena GN, Cole SW, Lutgendorf SK, Sood AK. Neuroendocrine influences on cancer progression. Brain Behav Immun 2013; 30 Suppl:S19-25. [PMID: 22728325 PMCID: PMC3467346 DOI: 10.1016/j.bbi.2012.06.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/14/2012] [Accepted: 06/14/2012] [Indexed: 01/11/2023] Open
Abstract
During the past decade, new studies have continued to shed light on the role of neuroendocrine regulation of downstream physiological and biological pathways relevant to cancer growth and progression. More specifically, our knowledge of the effects of the sympathetic nervous system (SNS) on cancer biology has been greatly expanded by new data demonstrating how the cellular immune response, inflammatory processes, tumor-associated angiogenesis, and tumor cell invasion and survival converge to promote tumor growth. This review will summarize these studies, while synthesizing clinical, cellular and molecular research that has continued to unearth the biological events mediating the interplay between SNS-related processes and cancer progression.
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Affiliation(s)
- Guillermo N. Armaiz-Pena
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston Texas
| | - Steve W. Cole
- Department of Medicine, Division of Hematology–Oncology, UCLA School of Medicine, Los Angeles, California
| | - Susan K. Lutgendorf
- Departments of Psychology, Urology, Obstetrics and Gynecology, and the Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Anil K. Sood
- Departments of Gynecologic Oncology, Cancer Biology and Center for RNA Interference and Non-coding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas
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35
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Thaker PH, Melhem-Bertrandt A, Sood AK, Ramondetta LM. Importance of adrenergic pathways in women's cancers. Cancer Biomark 2013; 13:145-54. [PMID: 23912486 PMCID: PMC4144752 DOI: 10.3233/cbm-130324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The importance of adrenergic pathways in cancer has long been suspected, but now there is mounting epidemiological, preclinical, and clinical evidence of its importance in gynecologic cancers. To date, most of these effects are mediated primarily through the beta 2 adrenergic receptor activation of the tumor cell cyclic AMP-protein kinase A signaling pathway. This review will discuss the current knowledge about the neuroendocrine stress response in gynecologic tumor biology.
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Affiliation(s)
- Premal H. Thaker
- Premal H. Thaker, M.D. Assistant Professor in Gynecologic Oncology Washington University School of Medicine 4911 Barnes Jewish Hospital Plaza 4 Floor Maternity Building, Campus Box 8064 St. Louis, MO 63110 Phone: 314-747-3604 Fax: 314-362-2893
| | - Amal Melhem-Bertrandt
- Amal Melhem-Bertrandt, M.D. Assistant Professor in Department of Breast Medical Oncology M.D. Anderson Cancer Center 1155 Herman Pressler Unit 1354 Houston, TX 77030 Phone: 713-792-2817 Fax: 713-794-4385
| | - Anil K. Sood
- Anil K., Sood, M.D. Professor and Vice Chair, Departments of Gynecologic Oncology and Cancer Biology Co-Director, Center for RNA Interference and Non-Coding RNA M.D. Anderson Cancer Center 1155 Herman Pressler Unit 1362 Houston, TX 77030 Phone: 713-745-5266 Fax: 713-792-7586
| | - Lois M. Ramondetta
- Anil K., Sood, M.D. Professor and Vice Chair, Departments of Gynecologic Oncology and Cancer Biology Co-Director, Center for RNA Interference and Non-Coding RNA M.D. Anderson Cancer Center 1155 Herman Pressler Unit 1362 Houston, TX 77030 Phone: 713-745-5266 Fax: 713-792-7586
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Pineda MJ, Singh DK. What is integrative oncology and can it help my patients? Obstet Gynecol Clin North Am 2012; 39:285-312. [PMID: 22640716 DOI: 10.1016/j.ogc.2012.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Integrative oncology lends itself to the comprehensive practice of gynecologic oncology with multiple tools and interventions that can impact on QoL and survival. However, there remains a paucity of well-designed, well-powered randomized control trials on various CAM modalities for gynecologic cancer patients. The reasons for the lack of level 1 evidence include the nascent state of integrative medicine as a science, the limitations on CAM funding, the relative lack of integration of CAM practitioners into the oncology community, and absence of strict regulation of herbs and supplements by the US FDA. The use of CAM as adjunctive therapies will likely continue given the patient-driven trends to date, and given the evidence for at least safety and potentially efficacy, our patients deserve our willingness to use all possible approaches to improving their outcomes. Continued evolution of our ability to specifically measure and describe QoL will further our ability to hone in on domains most important to patients and their survival and allow practitioners to make patient-specific recommendations. Multimodal programs that include physical activity, stress management, and diet have the potential to address demonstrated deficits in PWB and FWB in ovarian cancer patients which suggests a model of collaborative gynecologic oncology care). Integrative oncology represents a holistic approach to patient care whose goal is maximization of patient quantity and quality of life. Patients can achieve this optimal outcome through the synergy of conventional care, integrative modalities, lifestyle modifications, and supportive care. Refer to Table 4 for a listing of integrated medicine Internet resources.
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Affiliation(s)
- Mario Javier Pineda
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Fagundes CP, Glaser R, Johnson SL, Andridge RR, Yang EV, Di Gregorio MP, Chen M, Lambert DR, Jewell SD, Bechtel MA, Hearne DW, Herron JB, Kiecolt-Glaser JK. Basal cell carcinoma: stressful life events and the tumor environment. ACTA ACUST UNITED AC 2012; 69:618-26. [PMID: 22664550 DOI: 10.1001/archgenpsychiatry.2011.1535] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Child emotional maltreatment can result in lasting immune dysregulation that may be heightened in the context of more recent life stress. Basal cell carcinoma (BCC) is the most common skin cancer, and the immune system plays a prominent role in tumor appearance and progression. OBJECTIVE To address associations among recent severe life events, childhood parental emotional maltreatment, depression, and messenger RNA (mRNA) coding for immune markers associated with BCC tumor progression and regression. DESIGN We collected information about early parent-child experiences, severe life events in the past year as assessed by the Life Events and Difficulties Schedule, depression, and mRNA for immune markers associated with BCC tumor progression and regression from patients with BCC tumors. SETTING University medical center. PARTICIPANTS Ninety-one patients with BCC (ages, 23-92 years) who had a previous BCC tumor. MAIN OUTCOME MEASURES The expression of 4 BCC tumor mRNA markers (CD25, CD3ε, intercellular adhesion molecule 1, and CD68) that have been linked to BCC tumor progression and regression were assessed in BCC tumor biopsy specimens. RESULTS Both maternal and paternal emotional maltreatment interacted with the occurrence of severe life events to predict the local immune response to the tumor (adjusted P = .009 and P = .03, respectively). Among BCC patients who had experienced a severe life event within the past year, those who were emotionally maltreated by their mothers (P = .007) or fathers (P = .02) as children had a poorer immune response to the BCC tumor. Emotional maltreatment was unrelated to BCC immune responses among those who did not experience a severe life event. Depressive symptoms were not associated with the local tumor immune response. CONCLUSIONS Troubled early parent-child relationships, in combination with a severe life event in the past year, predicted immune responses to a BCC tumor. The immunoreactivity observed in BCCs and the surrounding stroma reflects an anti-tumor-specific immune response that can be altered by stress.
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Affiliation(s)
- Christopher P Fagundes
- Institute for Behavioral Medicine Research, The Ohio State University Medical Center, Columbus, OH 43210, USA
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Kim SY, Kim JM, Kim SW, Shin IS, Park MH, Yoon JH, Choi C, Yoon JS. Associations between plasma cytokines and depressive mood in patients with breast cancer. Int J Psychiatry Med 2012; 43:1-17. [PMID: 22641927 DOI: 10.2190/pm.43.1.a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The few studies on the associations between cytokines and depressive mood in patients with cancer have produced conflicting results. This study investigated the associations between plasma cytokines and depressive mood in patients with breast cancer using a large panel of pro-inflammatory, anti-inflammatory, and immune-modulating cytokines. METHODS We recruited 273 hospitalized patients with breast cancer awaiting surgery. Preoperative plasma samples were obtained for cytokine analysis, including pro-inflammatory (interleukin [IL]-2, IL-12, interferon [IFN]-gamma, and tumor necrosis factor [TNF-alpha]), anti-inflammatory (IL-4, IL-5, IL-10, and IL-13), and immune-modulating (granulocyte/macrophage colony-stimulating factor [GM-CSF]) cytokines. Depressive mood was measured using the Montgomery-Asberg Depression Rating Scale (MADRS) at 2-5 days postoperatively, when the patients could cooperate. Covariates included various demographic and clinical characteristics. The association between the MADRS score and each cytokine level was estimated using linear regression models. RESULTS Cytokine levels were significantly inter-correlated. Depressive mood was associated with lower levels of pro-inflammatory (IL-2, IL-12, and TNF-alpha), anti-inflammatory (IL-5, IL-10, and IL-13), and immune-modulating (GM-CSF) cytokines independent of potential covariates such as living area or functional level. CONCLUSIONS The findings suggest that depressive mood is associated with a generally decreased inflammatory reaction or immune function in patients with breast cancer.
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Dhabhar FS, Saul AN, Holmes TH, Daugherty C, Neri E, Tillie JM, Kusewitt D, Oberyszyn TM. High-anxious individuals show increased chronic stress burden, decreased protective immunity, and increased cancer progression in a mouse model of squamous cell carcinoma. PLoS One 2012; 7:e33069. [PMID: 22558071 PMCID: PMC3338811 DOI: 10.1371/journal.pone.0033069] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/03/2012] [Indexed: 12/30/2022] Open
Abstract
In spite of widespread anecdotal and scientific evidence much remains to be understood about the long-suspected connection between psychological factors and susceptibility to cancer. The skin is the most common site of cancer, accounting for nearly half of all cancers in the US, with approximately 2-3 million cases of non-melanoma cancers occurring each year worldwide. We hypothesized that a high-anxious, stress-prone behavioral phenotype would result in a higher chronic stress burden, lower protective-immunity, and increased progression of the immuno-responsive skin cancer, squamous cell carcinoma. SKH1 mice were phenotyped as high- or low-anxious at baseline, and subsequently exposed to ultraviolet-B light (1 minimal erythemal dose (MED), 3 times/week, 10-weeks). The significant strengths of this cancer model are that it uses a normal, immunocompetent, outbred strain, without surgery/injection of exogenous tumor cells/cell lines, and produces lesions that resemble human tumors. Tumors were counted weekly (primary outcome), and tissues collected during early and late phases of tumor development. Chemokine/cytokine gene-expression was quantified by PCR, tumor-infiltrating helper (Th), cytolytic (CTL), and regulatory (Treg) T cells by immunohistochemistry, lymph node T and B cells by flow cytometry, adrenal and plasma corticosterone and tissue vascular-endothelial-growth-factor (VEGF) by ELISA. High-anxious mice showed a higher tumor burden during all phases of tumor development. They also showed: higher corticosterone levels (indicating greater chronic stress burden), increased CCL22 expression and Treg infiltration (increased tumor-recruited immuno-suppression), lower CTACK/CCL27, IL-12, and IFN-γ gene-expression and lower numbers of tumor infiltrating Th and CTLs (suppressed protective immunity), and higher VEGF concentrations (increased tumor angiogenesis/invasion/metastasis). These results suggest that the deleterious effects of high trait anxiety could be: exacerbated by life-stressors, accentuated by the stress of cancer diagnosis/treatment, and mediate increased tumor progression and/or metastasis. Therefore, it may be beneficial to investigate the use of chemotherapy-compatible anxiolytic treatments immediately following cancer diagnosis, and during cancer treatment/survivorship.
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Affiliation(s)
- Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, United States of America.
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Carmack CL, Basen-Engquist K, Gritz ER. Survivors at higher risk for adverse late outcomes due to psychosocial and behavioral risk factors. Cancer Epidemiol Biomarkers Prev 2012; 20:2068-77. [PMID: 21980014 DOI: 10.1158/1055-9965.epi-11-0627] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cancer survivors face significant morbidity and mortality associated with their disease and treatment regimens, some of which can be improved through modifying behavioral and psychosocial risk factors. This article examines risk factors for adverse late effects that contribute to morbidity and mortality in cancer survivors, provides a literature review on interventions to modify these risks factors, and summarizes the national recommendations and associated current practices for identifying and managing these risk factors. Finally, future directions for research and clinical practice are discussed.
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Affiliation(s)
- Cindy L Carmack
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA.
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Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:460419. [PMID: 22778932 PMCID: PMC3384942 DOI: 10.1155/2012/460419] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 03/06/2012] [Indexed: 12/27/2022]
Abstract
This paper (1) reviews the physical and religious barriers to CBT that disabled medically ill-depressed patients face, (2) discusses research on the relationship between religion and depression-induced physiological changes, (3) describes an ongoing randomized clinical trial of religious versus secular CBT in chronically ill patients with mild-to-moderate major depression designed to (a) overcome physical and religious barriers to CBT and (b) compare the efficacy of religious versus secular CBT in relieving depression and improving immune and endocrine functions, and (4) presents preliminary results that illustrate the technical difficulties that have been encountered in implementing this trial. CBT is being delivered remotely via instant messaging, telephone, or Skype, and Christian, Jewish, Muslim, Buddhist, and Hindu versions of religious CBT are being developed. The preliminary results described here are particular to the technologies employed in this study and are not results from the CBT clinical trial whose findings will be published in the future after the study ends and data are analyzed. The ultimate goal is to determine if a psychotherapy delivered remotely that integrates patients' religious resources improves depression more quickly than a therapy that ignores them, and whether religious CBT is more effective than conventional CBT in reversing depression-induced physiological changes.
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Salim S, Chugh G, Asghar M. Inflammation in Anxiety. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY VOLUME 88 2012; 88:1-25. [DOI: 10.1016/b978-0-12-398314-5.00001-5] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hou R, Baldwin DS. A neuroimmunological perspective on anxiety disorders. Hum Psychopharmacol 2012; 27:6-14. [PMID: 22213434 DOI: 10.1002/hup.1259] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 11/18/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Research into psychoneuroimmunology has led to substantial advances in our understanding of the reciprocal interactions between the central nervous system and the immune system in neuropsychiatric disorders. To date, the presence of inflammatory responses and the crucial role of cytokines in major depression have been addressed in numerous studies. However, neuroinflammatory hypotheses in anxiety disorders have been studied less extensively than in major depression. There is a high research need for better understanding of both the heterogeneous role of specific cytokines in the control of anxious states and in different anxiety disorders and of the immunomodulating effects of antidepressants on anxiety. METHODS Relevant literature was identified through a search of MEDLINE via PubMed. We discuss recent research on neuroimmunology in anxiety and make methodological recommendations for future investigation of neuroinflammatory hypotheses in anxiety disorders. RESULTS Some accumulating evidence has indicated modulatory effects of cytokines on neuronal communication and anxiety; however, research has not revealed consistent reproducible findings. CONCLUSIONS The availability of inflammatory biomarkers may provide an opportunity to identify patients via specific pathophysiological processes and to monitor therapeutic responses within relevant pathways. Further understanding of the neuroimmunological mechanisms to untangle the reciprocal associations between inflammation and anxiety is warranted.
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Affiliation(s)
- Ruihua Hou
- University Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK.
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Pirl WF, Traeger L, Greer JA, Bemis H, Gallagher E, Lennes I, Sequist L, Heist R, Temel JS. Tumor epidermal growth factor receptor genotype and depression in stage IV non-small cell lung cancer. Oncologist 2011; 16:1299-306. [PMID: 21807767 DOI: 10.1634/theoncologist.2011-0116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Depression appears to be associated with worse survival from cancer, but underlying mechanisms for this association are unknown. In the present study, we explored the degree to which tumor genotype may be associated with depression in patients with non-small cell lung cancer (NSCLC). We examined differences in depression severity and rates of positive screens for major depressive disorder among newly diagnosed patients with stage IV NSCLC and known epidermal growth factor receptor (EGFR) genotype. METHODS Newly diagnosed patients (n = 53) with metastatic NSCLC attending an initial thoracic oncology consultation completed self-report questionnaires regarding demographics, smoking behavior, and depression before meeting with their oncologist. Biopsy samples were subsequently genotyped, including screening for EGFR mutations. We conducted a retrospective chart review to obtain clinical data, including tumor stage, performance status, and EGFR genotype. RESULTS Twelve patients (22.6%) tested positive for EGFR mutation. No EGFR mutation-positive cases met the screening criteria for major depressive disorder, in comparison with 29.3% of patients with wild-type EGFR (p = .03). Mutations of EGFR were also associated with lower depression severity than with wild-type EGFR, independent of gender, performance status, and smoking history (p < .05). This finding persisted for both the cognitive-affective and somatic domains of depression symptoms. CONCLUSIONS EGFR mutations were associated with lower depression severity and lower rates of probable major depressive disorder in patients with metastatic NSCLC, based on mood screening performed before results of genotyping were known. Findings support further work to explore the directionality of the associations and potential biological pathways to depression.
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Affiliation(s)
- William F Pirl
- M.P.H., Massachusetts General Hospital Cancer Center, Yawkey 9A, 55 Fruit Street, Boston, Massachusetts 02114. USA.
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Costanzo ES, Sood AK, Lutgendorf SK. Biobehavioral influences on cancer progression. Immunol Allergy Clin North Am 2011; 31:109-32. [PMID: 21094927 DOI: 10.1016/j.iac.2010.09.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This review focuses on the contributions of stress-related behavioral factors to cancer growth and metastasis and the biobehavioral mechanisms underlying these relationships. Behavioral factors that are important in modulation of the stress response and the pivotal role of neuroendocrine regulation in the downstream alteration of physiologic pathways relevant to cancer control, including the cellular immune response, inflammation, and tumor angiogenesis, invasion, and cell signaling pathways are described. Consequences for cancer progression and metastasis, as well as quality of life, are delineated. Behavioral and pharmacologic interventions with the potential to alter these biobehavioral pathways for patients with cancer are discussed.
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Affiliation(s)
- Erin S Costanzo
- Department of Psychiatry, Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, 6001 Research Park Boulevard, Madison, WI 53719, USA.
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Moreno-Smith M, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncol 2011; 6:1863-81. [PMID: 21142861 DOI: 10.2217/fon.10.142] [Citation(s) in RCA: 269] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The influence of psychosocial factors on the development and progression of cancer has been a longstanding hypothesis since ancient times. In fact, epidemiological and clinical studies over the past 30 years have provided strong evidence for links between chronic stress, depression and social isolation and cancer progression. By contrast, there is only limited evidence for the role of these behavioral factors in cancer initiation. Recent cellular and molecular studies have identified specific signaling pathways that impact cancer growth and metastasis. This article provides an overview of the relationship between psychosocial factors, specifically chronic stress, and cancer progression.
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Affiliation(s)
- Myrthala Moreno-Smith
- Department of Gynecologic Oncology, UTMD Anderson Cancer Center, 1155 Herman Pressler, Houston, TX 77030, USA
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Capuron L, Miller AH. Immune system to brain signaling: neuropsychopharmacological implications. Pharmacol Ther 2011; 130:226-38. [PMID: 21334376 DOI: 10.1016/j.pharmthera.2011.01.014] [Citation(s) in RCA: 761] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 01/28/2011] [Indexed: 02/06/2023]
Abstract
There has been an explosion in our knowledge of the pathways and mechanisms by which the immune system can influence the brain and behavior. In the context of inflammation, pro-inflammatory cytokines can access the central nervous system and interact with a cytokine network in the brain to influence virtually every aspect of brain function relevant to behavior including neurotransmitter metabolism, neuroendocrine function, synaptic plasticity, and neurocircuits that regulate mood, motor activity, motivation, anxiety and alarm. Behavioral consequences of these effects of the immune system on the brain include depression, anxiety, fatigue, psychomotor slowing, anorexia, cognitive dysfunction and sleep impairment; symptoms that overlap with those which characterize neuropsychiatric disorders, especially depression. Pathways that appear to be especially important in immune system effects on the brain include the cytokine signaling molecules, p38 mitogen-activated protein kinase and nuclear factor kappa B; indoleamine 2,3 dioxygenase and its downstream metabolites, kynurenine, quinolinic acid and kynurenic acid; the neurotransmitters, serotonin, dopamine and glutamate; and neurocircuits involving the basal ganglia and anterior cingulate cortex. A series of vulnerability factors including aging and obesity as well as chronic stress also appears to interact with immune to brain signaling to exacerbate immunologic contributions to neuropsychiatric disease. The elucidation of the mechanisms by which the immune system influences behavior yields a host of targets for potential therapeutic development as well as informing strategies for the prevention of neuropsychiatric disease in at risk populations.
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Affiliation(s)
- Lucile Capuron
- Laboratory of Nutrition and Integrative Neurobiology, NutriNeuro, INRA UMR 1286, University Victor Segalen Bordeaux 2, Bordeaux, France.
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Abstract
Epidemiologic evidence increasingly has supported the role of biobehavioral risk factors such as social adversity, depression, and stress in cancer progression. This review describes in vitro, in vivo, and clinical studies demonstrating relationships between such processes and pathways involved in cancer progression. These include effects on the cellular immune response, angiogenesis, invasion, anoikis, and inflammation. Biobehavioral factors have been shown to contribute to the cross talk between tumor and host cells in the tumor microenvironment, and stress effects on host cells such as macrophages seem to be critical for many pathways involved in tumor progression. Some effects are bidirectional in that tumor-derived inflammation seems to affect central nervous system processes, giving rise to vegetative symptoms and contributing to dysregulation of the hypothalamic-pituitary-adrenal axis with downstream effects on inflammatory control. Findings to date are reviewed, and fruitful areas for future research are discussed.
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Giese-Davis J, Collie K, Rancourt KMS, Neri E, Kraemer HC, Spiegel D. Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol 2010; 29:413-20. [PMID: 21149651 DOI: 10.1200/jco.2010.28.4455] [Citation(s) in RCA: 314] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Numerous studies have examined the comorbidity of depression with cancer, and some have indicated that depression may be associated with cancer progression or survival. However, few studies have assessed whether changes in depression symptoms are associated with survival. METHODS In a secondary analysis of a randomized trial of supportive-expressive group therapy, 125 women with metastatic breast cancer (MBC) completed a depression symptom measure (Center for Epidemiologic Studies-Depression Scale [CES-D]) at baseline and were randomly assigned to a treatment group or to a control group that received educational materials. At baseline and three follow-up points, 101 of 125 women completed a depression symptom measure. We used these data in a Cox proportional hazards analysis to examine whether decreasing depression symptoms over the first year of the study (the length of the intervention) would be associated with longer survival. RESULTS Median survival time was 53.6 months for women with decreasing CES-D scores over 1 year and 25.1 months for women with increasing CES-D scores. There was a significant effect of change in CES-D over the first year on survival out to 14 years (P = .007) but no significant interaction between treatment condition and CES-D change on survival. Neither demographic nor medical variables explained this association. CONCLUSION Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with MBC in this sample. Further research is necessary to confirm this hypothesis in other samples, and causation cannot be assumed based on this analysis.
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Abstract
BACKGROUND There are few studies of QoL among long-term gynecologic cancer survivors; available data suggest significant sequelae of disease and treatment. Research clarifying circumstances that improve difficult survivorship trajectories is lacking. PURPOSE The present study examines whether social support moderates the relationship between physical functioning and psychological outcomes by testing the stress-buffering hypothesis. METHODS Participants (N = 260) were gynecologic cancer survivors (cervical, n = 47; endometrial, n = 133; ovarian, n = 69; vulvar, n = 11). Compromised physical health was conceptualized as multidimensional. Social support (SNI, PSS-Fa, PSS-Fr, ISEL) was tested as a buffer of adverse psychological outcomes (IES-R, CES-D). RESULTS Results for traumatic stress provided evidence for buffering; whereas social support was of general benefit for depressive symptoms. Effects varied by source and type of support. CONCLUSIONS These results suggest that circumstances for gynecologic cancer survivors burdened with physical symptoms may be worse for those with fewer support resources, providing needed insight into a common target of psychosocial interventions for cancer survivors.
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