Higher stress and symptom severity are associated with worse depressive symptom profiles in patients receiving chemotherapy

The Use of Biomarkers in Precision Health Symptom Science-Opportunities and Challenges

OBJECTIVES

Precision health symptom science applies person-centered approaches to elucidate interindividual differences in patients' symptom experiences and incorporates omics methods with social, societal, and environmental determinants of health to develop symptom management strategies. By filling scientific gaps related to patients' symptom experiences and their underlying mechanisms, interventions can be developed to improve quality of life and outcomes. The purposes of this article are to describe symptom phenotype development; review analytical approaches to identify a symptom phenotype; and discuss common and emerging methods for biomarker discovery and their implications in precision health symptom science.

METHODS

Peer-reviewed research studies, review articles, and scientific expertise were synthesized to provide a broad overview of several methods of biomarker discovery and their implications for precision health symptom science.

RESULTS

Approaches to symptom phenotype development and analytical methods for phenotype identification were reviewed. Common (ie, genomic, epigenomic, transcriptomic, proteomic, metabolomic, microbiome) and emerging (ie, polygenic risk scores, microRNA, epigenetic clocks, allostatic load, wearables) methods for biomarker discovery were described. Each method provides unique information to improve our understanding of the complex biological processes that underlie symptoms and may be used for risk prediction, screening, surveillance, and treatment response.

CONCLUSIONS

While the exemplar approaches to conducting precision health symptom science were shared through an oncology lens, they are generalizable across acute and chronic conditions.

IMPLICATIONS FOR NURSING PRACTICE

Symptom biomarker identification is inherently complex and the methods for biomarker collection, processing, measurement, and analysis are continually evolving. Therefore, symptom scientists need to form transdisciplinary teams with experts in omics methodologies and bioinformatics. Despite the challenges, symptom scientists are well suited to lead the way in precision health symptom science to reduce symptom burden and improve quality of life among patients with various chronic conditions.

Greater Symptom Burden and Poorer Quality of Life Outcomes Are Associated With The Co-Occurrence of Anxiety and Depression During Cancer Chemotherapy

OBJECTIVES

Anxiety and depression are common symptoms in oncology patients undergoing chemotherapy. Study purpose was to evaluate for differences in severity of common symptoms (ie, fatigue, energy, sleep disturbance, cognitive function, pain) and quality of life (QOL) outcomes among three subgroups of oncology outpatients with distinct joint anxiety and depression profiles.

METHODS

Oncology outpatients (N = 1328) completed measures of state anxiety and depression, six times over two cycles of chemotherapy. Latent profile analysis was done to identify subgroups of patients with distinct joint state anxiety AND depression profiles. Patients completed measures of trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain, as well as generic and disease-specific measures of QOL at enrollment. Differences among the classes in symptom severity scores and QOL scores were evaluated using parametric and non-parametric tests.

RESULTS

Three distinct joint anxiety AND depression profiles were identified and named: Low Anxiety and Low Depression (57.5%, Both Low), Moderate Anxiety and Moderate Depression (33.7%, Both Moderate), and High Anxiety and High Depression (8.8%, Both High). All of the symptom severity scores showed a "dose-response effect" (ie, as the joint anxiety AND depression profiles worsened, the severity of all of the symptoms increased). Likewise, for both the general and disease-specific QOL (except spiritual well-being) measures, all of the scores decreased as the joint anxiety AND depression profiles worsened. Compared to the Both Low classes, the other two classes reported lower scores for the spiritual well-being domain.

CONCLUSIONS

More than 40% of patients receiving chemotherapy experience moderate to high levels of both anxiety AND depression. These patients report an extremely high symptom burden and significant decrements in all domains of QOL.

IMPLICATIONS FOR NURSING PRACTICE

Clinicians need to perform comprehensive assessments of depression and anxiety and other common symptoms and QOL outcomes during chemotherapy. In addition, referrals for targeted interventions are needed to manage multiple symptoms and improve patients' QOL.

Psychological Symptom Cluster Severity Profiles Are Associated With Higher Levels of Stress and Worse Quality of Life in Postmenopausal Women With Breast Cancer

BACKGROUND

Although common, the severity of the psychological symptom cluster (PSC) (ie, co-occurrence of anxiety, depression, fatigue, sleep disturbance) varies among women with breast cancer. In addition, the impact of various types of stress and other risk factors on its severity are understudied, and the influence of the PSC on quality of life (QOL) outcomes remains poorly characterized.

OBJECTIVE

To identify subgroups of postmenopausal women with breast cancer with distinct PSC severity profiles following surgery and evaluate whether these subgroups differed in terms of demographic and clinical characteristics, symptoms, social and posttraumatic stress, and QOL.

METHODS

Following surgery, 159 postmenopausal women with early-stage, hormone receptor-positive breast cancer completed assessments of anxiety, depression, fatigue, sleep disturbance, cognitive function, physical symptoms, stress, and QOL. Latent profile analysis was used to identify subgroups of women based on the severity of the prespecified PSC. Parametric and nonparametric tests were used to evaluate for subgroup differences.

RESULTS

Three distinct PSC severity subgroups were identified (ie, Lower [71.7%], Moderate [23.9%], Higher [4.4%]). Compared with the Lower subgroup, the Moderate subgroup was less likely to have received prior radiation, and the Moderate and Higher subgroups had worse perceived cognitive function, higher symptom burden, higher posttraumatic stress, and lower QOL. Clinically relevant sleep disturbance was common across PSC subgroups.

CONCLUSIONS

PSC severity is associated with higher posttraumatic stress and poorer QOL following breast surgery. Sleep disturbance is a common problem and may be undertreated.

IMPLICATIONS FOR PRACTICE

Assessments of posttraumatic stress and sleep disturbance are needed for timely intervention.

Worse Morning Energy Profiles Are Associated with Significant Levels of Stress and Decrements in Resilience in Patients Receiving Chemotherapy

OBJECTIVES

Evidence suggests that lower levels of morning energy are associated with higher levels of stress and lower levels of resilience in patients receiving chemotherapy. Study purposes were to identify subgroups of patients with distinct morning energy profiles; evaluate for differences among the profiles in demographic and clinical characteristics, as well as measures of stress, resilience, and coping.

METHODS

A total of 1,343 outpatients receiving chemotherapy completed a demographic questionnaire and measures of global, cancer-related, and cumulative life stress, and resilience at study enrollment. Morning energy was assessed using the Lee Fatigue Scale at six time points over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct morning energy profiles. Differences among the subgroups were evaluated using parametric and nonparametric tests.

RESULTS

Three morning energy profiles were identified (i.e., High (17.3%), Low (60.3%), Very Low (22.4%)). Compared to High class, the other two morning energy classes were less likely to be employed; had a lower functional status and a higher comorbidity burden; and were more likely to self-report depression and back pain. For all three types of stress, significant differences were found among the three classes with scores that demonstrated a dose response effect (i.e., High < Low < Very Low; as decrements in morning energy increased, stress scores increased). Compared to High class, Very Low class reported higher rates of physical and sexual abuse. The resilience scores exhibited a dose response effect as well (i.e., High > Low > Very Low). Patients with the two worst energy profiles reported a higher use of disengagement coping strategies.

CONCLUSIONS

Findings highlight the complex relationships among decrements in morning energy, various types of stress, resilience, and coping in patients undergoing chemotherapy.

IMPLICATIONS FOR NURSING PRACTICE

Clinicians need to assess for stress and adverse childhood experiences to develop individualized management plans to increase patients' energy levels.

Trajectories of Depressive Symptoms Among Patients Undergoing Chemotherapy for Breast, Gastrointestinal, Gynecological, or Lung Cancer

BACKGROUND

Individuals who undergo chemotherapy for cancer are at elevated risk of developing depressive symptoms, yet substantial interindividual variation exists in trajectories of these symptoms.

OBJECTIVE

To examine interindividual variations in trajectories of depressive symptoms during 2 cycles of chemotherapy and to evaluate associations between demographic and clinical characteristics, symptom severity scores, psychological adjustment characteristics (eg, stress and coping), and initial levels and trajectories of depressive symptoms.

METHODS

Patients (n = 1323) diagnosed with breast, gynecologic, lung, or gastrointestinal cancer completed the Center for Epidemiological Studies-Depression Scale 6 times, over 2 cycles of chemotherapy. At enrollment, patients provided demographic information and completed a broad range of symptom, stress, and coping measures. Hierarchical linear modeling was used to identify characteristics associated with initial levels and trajectories of depressive symptoms.

RESULTS

Interindividual differences in initial levels of depressive symptoms were associated with marital status, functional status, level of comorbidity, chemotherapy toxicity, sleep disturbance, morning fatigue, cognitive function, global and cancer-related stress, and coping characteristics (ie, sense of coherence, venting, behavioral disengagement, and self-blame). Interindividual differences in depression trajectories were associated with education, cancer type, chemotherapy toxicity, sleep disturbance, evening energy, evening fatigue, cognitive function, global and cancer-related stress, and self-blame.

CONCLUSIONS

We present new findings concerning the trajectories and predictors of depressive symptoms during chemotherapy.

IMPLICATIONS FOR PRACTICE

Modifiable risk factors (eg, stress and coping) are important targets for intervening to address depressive symptoms in oncology patients.

Increases in stress and adverse childhood experiences are associated with the co-occurrence of anxiety and depression in oncology patients

PURPOSE

Identify subgroups of patients with distinct joint anxiety AND depression profiles and evaluate for differences in demographic and clinical characteristics, as well as stress, resilience, and coping.

DESIGN

Longitudinal study.

PARTICIPANTS

Patients (n = 1328) receiving chemotherapy.

METHODS

Measures of state anxiety and depression were done six times over two cycles of chemotherapy. All of the other measures were completed prior to second or third cycle of chemotherapy. Latent profile analysis was used to identify the distinct joint anxiety and depression profiles.

FINDINGS

Three classes were identified (i.e. Low Anxiety and Low Depression (57.5%); Moderate Anxiety and Moderate Depression (33.7%), High Anxiety and High Depression (8.8%)). For all of the stress measures, a dose response effect was seen among the profiles. Two worst profiles reported higher occurrence rates for a number of adverse childhood experiences.

IMPLICATIONS FOR PROVIDERS

Patients need referrals for stress reduction techniques and mental health and social services.

Chemotherapy-related symptom networks in distinct subgroups of Chinese patients with gastric cancer

Objective

This study aims to identify distinct subgroups among gastric cancer patients undergoing chemotherapy (CTX), delineate associated symptom networks, and ascertain the clinical and sociodemographic variables contributing to diverse symptom patterns.

Methods

Conducted in eastern China, our investigation involved gastric cancer patients receiving CTX. We gathered data using the M.D. Anderson Symptom Inventory Gastrointestinal Cancer Module along with clinical and sociodemographic variables. Subgroups were discerned based on symptom severity through latent profile analysis, and subsequent comparisons were made regarding the symptom networks in different subgroups.

Results

The analysis encompassed 677 eligible gastric cancer patients, revealing three profiles: "Profile 1: low class" (n = 354, 52.3%), "Profile 2: moderate class" (n = 222, 32.8%), and "Profile 3: all high class" (n = 101, 14.9%). Nausea-vomiting exhibited robust associations in the symptom networks of all subgroups, whereas sadness-distress, and taste change-lack of appetite were notably linked with Profile 1 and Profile 2. Distress emerged as a core symptom in Profile 1, lack of appetite dominated the symptom network in Profile 2, and fatigue attained the highest strength in Profile 3. Distinct symptom profiles were influenced by variables such as education level, CTX combined with surgical or herbal treatment, psychological resilience, and social support.

Conclusions

Patients within different subgroups manifest individualized patterns of symptom profiles. Analyzing demographics, disease characteristics, and psychosocial information among diverse subgroups facilitates healthcare providers in devising more personalized and targeted symptom management strategies, thereby alleviating the symptom burden on patients.

The association between inflammation-related biomarkers and the subtypes of cancer-related cognitive impairment in colorectal cancer patients: A latent profile analysis

PURPOSE

Cancer-related cognitive impairment (CRCI) has garnered considerable attention, yet limited research has delved into nuanced distinctions among varying degrees of CRCI in colorectal cancer survivors. This study aimed to identify distinct subgroups based on the patterns of CRCI, assess the heterogeneity among different subgroups, and investigate the potential correlations between the subgroups of CRCI and inflammation-related biomarkers.

METHODS

268 colorectal cancer patients were enrolled in this cross-sectional study, followed by the Functional Assessment of Cancer Therapy-Cognitive Function. The determination of CRCI subgroups was accomplished by the latent profile analysis (LPA). The effects of inflammation-related biomarkers on CRCI were examined using the binary logistic regression analysis. The receiver operating characteristic (ROC) curves assessed the diagnostic efficacy of inflammation-related biomarkers.

RESULTS

Two latent profiles were identified: CRCI (n = 64, 23.88%) and non-CRCI (n = 204, 76.12%). Independent factors for CRCI in colorectal cancer patients were SIRI (OR = 3.248, 95%CI [1.197-8.807], P = 0.021) and ALI (OR = 0.962, 95%CI [0.937-0.989], P = 0.005). The areas under the curve (AUCs) for SIRI and ALI in predicting CRCI were 0.781 and 0.774, with the optimal cut-off values being 0.70 and 37.04, respectively.

CONCLUSIONS

Colorectal cancer patients exhibited divergent cognitive performance profiles, categorized into two subgroups based on LPA. SIRI and ALI were identified as independent factors for CRCI, demonstrating strong diagnostic accuracy. These two inflammation-related biomarkers may potentially be novel indicators to identify and manage the development of CRCI among colorectal cancer patients.