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Tsai TC, Mitchell HR, Zeitzer J, Ting A, Laurenceau JP, Spiegel D, Kim Y. Dyadic Investigation of Posttraumatic Stress Symptoms and Daily Sleep Health in Patients With Cancer and Their Caregivers. Psychosom Med 2024; 86:234-243. [PMID: 38345316 PMCID: PMC11081839 DOI: 10.1097/psy.0000000000001283] [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] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Cancer can be a traumatic experience affecting multidimensional aspects of sleep among patients and caregivers. This study examined the differential associations of cancer-related posttraumatic stress symptoms (PTSS) with various sleep markers in this population. METHODS Patients newly diagnosed with colorectal cancer ( n = 138, mean age = 56.93 years, 31.88% female, 60.14% Hispanic, 6.53 months after diagnosis) and their sleep-partner caregivers ( n = 138, mean age = 55.32 years, 68.12% female, 57.97% Hispanic) completed questionnaires assessing the four PTSS clusters (intrusion, avoidance, alterations in arousal and reactivity, negative alterations in cognitions and mood). Participants also completed daily sleep diaries for 14 consecutive days, from which sleep onset latency (SOL), wake after sleep onset (WASO), and sleep duration were derived. RESULTS Actor-partner interdependence model revealed that caregivers' greater alterations in arousal and reactivity were associated with their own longer SOL ( b = 15.59, p < .001) and their patients' longer sleep duration ( b = 0.61, p = .014), whereas patients' arousal and reactivity were associated with their caregivers' shorter SOL ( b = -8.47, p = .050). Patients' and caregivers' greater negative alterations in cognitions and mood were associated with patients' longer SOL ( b = 9.15, p = .014) and shorter sleep duration ( b = -0.41, p = .050), respectively. Caregivers' greater intrusion was related to their own shorter SOL ( b = -10.14, p = .004). CONCLUSIONS The four PTSS clusters, particularly arousal and reactivity and negative cognitions and mood, have distinct associations with sleep markers individually and dyadically in patients and caregivers affected by cancer. Investigations of psychosocial and biobehavioral pathways underlying these relations are warranted. Tailored trauma treatments and sleep interventions may improve the well-being of this population.
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Affiliation(s)
- Thomas C. Tsai
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33146, United States
| | | | - Jamie Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University
- Department of Psychiatry and Sleep Medicine, Palo Alto VA Medical Center
| | - Amanda Ting
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33146, United States
| | | | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | - Youngmee Kim
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33146, United States
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Guo K, Zhao X, Luo J, Ren Y, Liu Y, Yang J. Relationship of sleep with diurnal cortisol rhythm considering sleep measurement and cortisol sampling schemes. Psychoneuroendocrinology 2024; 162:106952. [PMID: 38232528 DOI: 10.1016/j.psyneuen.2023.106952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
Information on the relationships between the previous night's sleep and the next-day diurnal cortisol rhythm is inconsistent due to confounding factors such as sleep measurements (trait/state sleep and objective/subjective sleep) and cortisol sampling schemes. Therefore, this study aimed to investigate these relationships, considering the confounding factors. College students (n = 79) wore actigraphy for 3 days to undergo an evaluation of previous night-time sleep objectively and reported their subjective sleep parameters in a sleep diary. In addition, participants provided six salivary cortisol samples daily. Furthermore, six cortisol sampling schemes were created to reflect diurnal cortisol rhythms, and two different methods were used to calculate the index of diurnal cortisol slope (DCS). A multilevel model was created to examine the impact of both trait and state sleep on next-day diurnal cortisol rhythm. The results revealed that higher objective state sleep efficiency and longer objective state total sleep time were associated with a higher cortisol awakening response (CAR). Moreover, higher objective trait sleep efficiency and longer objective trait total sleep time were associated with higher waking cortisol levels and steeper DCS. In addition, a minimum of four saliva samples were required at different time points, including upon waking, 30 min after waking, 1 h after waking, and at bedtime, to explore the relationship of sleep efficiency/total sleep time with waking cortisol, CAR, and DCS. Furthermore, the index of the peak-to-bed slope was appropriately employed to examine the relationship between sleep efficiency and DCS, whereas the wake-to-bed slope was effective for examining the relationship between total sleep time and DCS. In summary, this study clarified the relationship between sleep and next-day diurnal cortisol rhythm and suggested a cost-effective cortisol sampling schedule and calculation methods.
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Affiliation(s)
- Kaige Guo
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality, Southwest University, Chongqing 400715, China
| | - Xiaolin Zhao
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality, Southwest University, Chongqing 400715, China
| | - Jiahao Luo
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality, Southwest University, Chongqing 400715, China
| | - Yipeng Ren
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality, Southwest University, Chongqing 400715, China
| | - Yuan Liu
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality, Southwest University, Chongqing 400715, China.
| | - Juan Yang
- Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality, Southwest University, Chongqing 400715, China.
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Low SLK, Ho GF, Liu B, Koh ES, Fei Y, Teo CS, Zhu X. Exploring Guolin Qigong (Mind-Body Exercise) for Improving Cancer Related Fatigue in Cancer Survivors: A Mixed Method Randomized Controlled Trial Protocol. Integr Cancer Ther 2024; 23:15347354241252698. [PMID: 38757745 PMCID: PMC11102686 DOI: 10.1177/15347354241252698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/05/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Cancer-related fatigue and its associated symptoms of sleep disorder and depression are prevalent in cancer survivors especially among breast, lung, and colorectal cancer survivors. While there is no gold standard for treating cancer-related fatigue currently, studies of mind-body exercises such as Qigong have reported promise in reducing symptoms. This study was designed to evaluate the feasibility and effect of Guolin Qigong on cancer-related fatigue and other symptoms in breast, lung and colorectal cancer survivors while exploring their perceptions and experiences of Guolin Qigong intervention. METHODS This is an open-label randomized controlled trial with 60 participants divided into 2 study groups in a 1:1 ratio. The intervention group will receive 12 weeks of Guolin Qigong intervention with a 4-week follow-up while control will receive usual care under waitlist. The primary outcome will be feasibility measured based on recruitment and retention rates, class attendance, home practice adherence, nature, and quantum of missing data as well as safety. The secondary subjective outcomes of fatigue, sleep quality and depression will be measured at Week-1 (baseline), Week-6 (mid-intervention), Week-12 (post-intervention), and Week-16 (4 weeks post-intervention) while an objective 24-hour urine cortisol will be measured at Week-1 (baseline) and Week-12 (post-intervention). We will conduct a semi-structured interview individually with participants within 3 months after Week-16 (4 weeks post-intervention) to obtain a more comprehensive view of practice adherence. DISCUSSION This is the first mixed-method study to investigate the feasibility and effect of Guolin Qigong on breast, lung, and colorectal cancer survivors to provide a comprehensive understanding of Guolin Qigong's intervention impact and participants' perspectives. The interdisciplinary collaboration between Western Medicine and Chinese Medicine expertise of this study ensures robust study design, enhanced participant care, rigorous data analysis, and meaningful interpretation of results. This innovative research contributes to the field of oncology and may guide future evidence-based mind-body interventions to improve cancer survivorship. TRIAL REGISTRATION This study has been registered with ANZCTR (ACTRN12622000688785p), was approved by Medical Research Ethic Committee of University Malaya Medical Centre (MREC ID NO: 2022323-11092) and recognized by Western Sydney University Human Research Ethics Committee (RH15124).
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Affiliation(s)
- Sara L. K. Low
- Western Sydney University, Penrith South, NSW, Australia
| | - Gwo Fuang Ho
- University Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Eng-Siew Koh
- University of New South Wales, Liverpool, NSW, Australia
| | - Yutong Fei
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Xiaoshu Zhu
- Western Sydney University, Penrith South, NSW, Australia
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Zhu W, Li W, Gao J, Wang L, Guo J, Yang H. Factors associated with the sleep disturbances of people with breast cancer during chemotherapy in China: A cross-sectional study. Nurs Open 2023. [PMID: 37099665 DOI: 10.1002/nop2.1784] [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: 09/27/2022] [Revised: 03/10/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
AIM The aim of the study was to investigate the incidence of sleep disturbance and its relationship with anxiety and depression symptoms, social support and hope in breast cancer patients in China during chemotherapy. DESIGN A single-centre cross-sectional study. METHODS A total of 329 breast cancer patients were selected via convenience sampling method before they began chemotherapy (n = 115), before the 5th week of chemotherapy (n = 117) or 1 month after chemotherapy ended (n = 97) and administered paper-and-pencil questionnaires to evaluate sleep quality, depression and anxiety symptoms, social support and hope. Risk factors significantly associated with sleep disturbance during bivariate were incorporated in the multivariate analysis. Bivariate analyses showed that age, menopausal status, depression and anxiety symptoms, emotional/informational support, tangible support, affectionate support, positive social interaction and total support were predictors of sleep disturbance. RESULTS Sleep disturbance was prevalent in breast cancer patients before (27.0%), during (32.5%) and after (39.2%) chemotherapy, with 37.4%, 41.9% and 52.6% of participants, respectively, reporting sleeping below the recommended 7 h. Only 8.6%-15.5% of patients reported taking sedative-hypnotic drugs during the chemotherapy. Multivariate analyses found that participants reporting clinically significant anxiety (HADS > 8) were 3.5 times more likely to report sleep disturbance (PSQI > 8) than participants without clinically significant anxiety, and each increment in emotional/informational support was associated with a 9.04% reduced risk of sleep disturbance. Moreover, age was an independent predictor of sleep disturbance during multivariate modelling.
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Affiliation(s)
- Wenjuan Zhu
- Shanxi Medical University, Taiyuan, China
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Wanling Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Jinnan Gao
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Linying Wang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Jun Guo
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui Yang
- Shanxi Medical University, Taiyuan, China
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5
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Amidi A, Wu LM. Circadian disruption and cancer- and treatment-related symptoms. Front Oncol 2022; 12:1009064. [PMID: 36387255 PMCID: PMC9650229 DOI: 10.3389/fonc.2022.1009064] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 07/27/2023] Open
Abstract
Cancer patients experience a number of co-occurring side- and late-effects due to cancer and its treatment including fatigue, sleep difficulties, depressive symptoms, and cognitive impairment. These symptoms can impair quality of life and may persist long after treatment completion. Furthermore, they may exacerbate each other's intensity and development over time. The co-occurrence and interdependent nature of these symptoms suggests a possible shared underlying mechanism. Thus far, hypothesized mechanisms that have been purported to underlie these symptoms include disruptions to the immune and endocrine systems. Recently circadian rhythm disruption has emerged as a related pathophysiological mechanism underlying cancer- and cancer-treatment related symptoms. Circadian rhythms are endogenous biobehavioral cycles lasting approximately 24 hours in humans and generated by the circadian master clock - the hypothalamic suprachiasmatic nucleus. The suprachiasmatic nucleus orchestrates rhythmicity in a wide range of bodily functions including hormone levels, body temperature, immune response, and rest-activity behaviors. In this review, we describe four common approaches to the measurement of circadian rhythms, highlight key research findings on the presence of circadian disruption in cancer patients, and provide a review of the literature on associations between circadian rhythm disruption and cancer- and treatment-related symptoms. Implications for future research and interventions will be discussed.
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Affiliation(s)
- Ali Amidi
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Sleep and Circadian Psychology Research Group, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lisa M. Wu
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Sleep and Circadian Psychology Research Group, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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6
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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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7
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Lin CH, Lin YH, Tzeng IS, Kuo CY. An Association Rule Analysis of the Acupressure Effect on Sleep Quality. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:1399258. [PMID: 34630604 PMCID: PMC8494578 DOI: 10.1155/2021/1399258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/09/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sleep is recognized as an all-important physiological process, which also contributes to maintaining several bodily functions and systems. According to the Pittsburgh Sleep Quality Index (PSQI), also known as the most widely used tool in the field of subjective assessment of self-perceived sleep quality, a combination of acupoints could be more effective than single acupoint treatment in improving sleep quality. METHODS The present study was based on the extracted eligible studies rooted in a previous meta-analysis that worked on the basis of association rule mining and examined the potential kernel acupoint combinations for improving sleep quality. RESULTS Depending on the Apriori algorithm, we summarized 26 acupoints as binary data from the 32 eligible studies based on a previous meta-analysis and analyzed them. The top 10 most frequently selected acupoints were HT7, SP6, PC6, KI1, GV20, EM5, EX-HN3, EX-HN16, KI3, and MA-TF1. Furthermore, as deduced from 21 association rules, the primary relevant rules in the combination of acupoints are (EX-HN3, EX-HN16)=>(GV20) and (HT7, KI1)=>(PC6). CONCLUSIONS In order to use acupuncture to improve sleep quality, integrating (EX-HN3, EX-HN16, GV20) with (HT7, KI1, PC6) acupoints could be deemed as the kernel acupoint combination.
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Affiliation(s)
- Chih-Hung Lin
- Respiratory Care and Chest Medicine, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Ya-Hsuan Lin
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Statistics, National Taipei University, Taipei, Taiwan
| | - Chan-Yen Kuo
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Nursing, Cardinal Tien College of Healthcare and Management, New Taipei, Taiwan
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Lu Q, Warmoth K, Chen L, Wu CS, Chu Q, Li Y, Gallagher MW, Stanton AL, Kagawa Singer M, Young L, Loh A. A Culturally Sensitive Social Support Intervention for Chinese American Breast Cancer Survivors (Joy Luck Academy): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30950. [PMID: 34550088 PMCID: PMC8495571 DOI: 10.2196/30950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Breast cancer is the most prevalent type of cancer among Asian American women. Chinese American immigrant breast cancer survivors face unique challenges because of cultural and socioecological factors. They report emotional distress and the need for social, emotional, and spiritual support. However, culturally and linguistically appropriate information for managing survivorship health care is often unavailable. Objective To improve the health outcomes for this underserved and understudied population, we developed, designed, and launched a randomized controlled trial to test the health benefits of a culturally sensitive social support intervention (Joy Luck Academy). In this paper, we describe the research protocol. Methods This randomized controlled trial will enroll Chinese-speaking, stage 0 to 3 breast cancer survivors who have completed treatment within the previous 36 months using a community-based participatory research approach. We will randomly assign 168 participants to the intervention or control group. The intervention arm will attend 7 weekly 3.5-hour peer mentor and educational sessions. The control group will receive the educational information. We will assess health outcomes at baseline, immediately after the Joy Luck Academy, and at 1- and 4-month follow-ups. The primary outcome is quality of life, as measured by the Functional Assessment of Cancer Therapy scale. Secondary outcomes include depressive symptoms, positive affect, fatigue, and perceived stress. We will also explore how the intervention influences cortisol levels. To identify how and to whom the program is effective, we will measure social and personal resources and theorized mechanisms and perform qualitative interviews with a subsample of participants to enhance the interpretation of quantitative data. Results Recruitment began in February 2015, and data collection was completed in February 2019. We expect to complete data management by August 2021 and publish results in 2022. Conclusions If the Joy Luck Academy is demonstrated to be effective, it may be easily disseminated as an intervention for other groups of Asian American immigrant breast cancer survivors. Furthermore, similar programs could be integrated into other diverse communities. Trial Registration ClinicalTrials.gov NCT02946697; http://clinicaltrials.gov/ct2/show/NCT02946697. International Registered Report Identifier (IRRID) DERR1-10.2196/30950
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Affiliation(s)
- Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Psychology, University of Houston, Houston, TX, United States
| | - Krystal Warmoth
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Lingjun Chen
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Christine S Wu
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Qiao Chu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Annette L Stanton
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Marjorie Kagawa Singer
- Department of Community Health Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Lucy Young
- Herald Cancer Association, San Gabriel, CA, United States
| | - Alice Loh
- Herald Cancer Association, San Gabriel, CA, United States
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9
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Rural-Urban Differences in Neuroimmune Biomarkers and Health Status Among Women Living With Breast Cancer. Cancer Nurs 2021; 44:323-332. [PMID: 32195710 DOI: 10.1097/ncc.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of chronic emotional and psychosocial stressors following breast cancer (BC) treatment, BC survivors are at risk of neuroimmune dysfunction in survivorship. Rural BC survivors experience more health disparities than urban BC survivors. Rural-urban residence as a variable on neuroimmune activity in extended BC survivorship continuum has not been explored. OBJECTIVE To report the feasibility of studying relationships between neuroimmune activity and perceived health in rural and urban BC survivors. METHODS Data from a pilot study of BC survivors (n = 41) were analyzed. Participants were rural (n = 16) and urban (n = 25). Participants completed Medical Outcomes Study Short-Form Version 2 Health Survey questionnaires and provided salivary specimens for analysis of salivary α-amylase (sAA), cortisol, and interleukin 6 (IL-6). Rural-Urban Commuting Area Codes were used to determine rural or urban residence. RESULTS Differences in immune activity were observed between rural and urban BC survivors (U = 34, P < .05). No rural-urban group differences in neuroendocrine activity were observed. Relationships were observed between perceptions of mental health and sAA (P < .05) in rural BC survivors and between perceptions of mental health and IL-6 (P < .05) in urban BC survivors. Interleukin 6 was positively associated with perceptions of physical health (P < .05) in rural BC survivors. CONCLUSION Pilot data suggest rural-urban residence may be a factor in relationships between neuroimmune function (ie, sAA and IL-6) and perceived health status, particularly social functioning in women with BC. Additional studies with powered designs are indicated. IMPLICATIONS FOR PRACTICE Although evidence is limited, data support the feasibility of studying relationships between sAA and IL-6 and perceptions of health in women with BC.
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10
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Effects of a light therapy intervention on diurnal salivary cortisol in fatigued cancer survivors: A secondary analysis of a randomized controlled trial. J Psychosom Res 2020; 139:110266. [PMID: 33070045 DOI: 10.1016/j.jpsychores.2020.110266] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/13/2020] [Accepted: 10/02/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Altered diurnal cortisol rhythms are a potential mechanism through which symptoms of fatigue are maintained in post-treatment cancer survivors. Exposure to early morning bright light may target this underlying dysregulation, resulting in improved diurnal cortisol patterns, subsequently improving symptoms of fatigue. This research investigates the effects of a 4-week light therapy intervention on the diurnal cortisol slopes and output in fatigued cancer survivors. METHODS Post-treatment adult cancer survivors who met diagnostic criteria for cancer-related fatigue were randomly assigned to receive either a bright white light (BWL) or dim red light (DRL) device, used daily for 30 min over four consecutive weeks. Assessments of fatigue and salivary cortisol were collected at baseline and post-intervention. Cortisol was sampled four times per day (waking, noon, 5 pm, bedtime) for three days at each timepoint. Diurnal cortisol slopes and total cortisol output were calculated at baseline and post-intervention. Linear mixed models were used to analyze the data. RESULTS Seventy-seven participants were included in this analysis (BWL n = 40; DRL n = 37). Participants in both groups displayed increased steepness in cortisol slope (B = -0.02, p = .01, Cohen's d = 0.57) and increased total cortisol output (B = 9.58, p = .03, Cohen's d = 0.49) from baseline to post-intervention, indicating only a moderate effect of time. Neither diurnal cortisol slopes nor total cortisol output mediated the relationship between the light therapy intervention and fatigue levels. CONCLUSION Though the results of this trial are promising for light therapy as an effective intervention to reduce fatigue in cancer survivors, this does not appear to be achieved through alterations in neuroendocrine function. ClinicalTrials.gov registration #: NCT01780623.
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11
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Ho RTH, Fong TCT, Chan WC, Kwan JSK, Chiu PKC, Yau JCY, Lam LCW. Psychophysiological Effects of Dance Movement Therapy and Physical Exercise on Older Adults With Mild Dementia: A Randomized Controlled Trial. J Gerontol B Psychol Sci Soc Sci 2020; 75:560-570. [PMID: 30496547 DOI: 10.1093/geronb/gby145] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Dementia interferes with older adults' functioning in cognitive, daily, psychosocial, and neuroendocrine domains. The present study examined the psychophysiological effects of dance movement therapy (DMT) and physical exercise for older adults with dementia. METHODS This randomized controlled trial recruited 204 older adults diagnosed with mild dementia into the DMT, exercise, or waitlist control group. Both DMT and exercise interventions had similar intensity and comprised 24 hr of intervention that spanned over 12 weeks. All participants completed self-report questionnaires on psychosocial well-being, daily functioning, neurocognitive assessments, and salivary cortisol measures at baseline and 3 follow-up measurements more than 1 year. RESULTS The DMT group showed significant decreases in depression, loneliness, and negative mood (d = 0.33-0.42, p < .05) and improved daily functioning (d = 0.40, p < .01) and diurnal cortisol slope (d = 0.30, p < .01). The effects on daily functioning and cortisol slope remained at 1-year follow-up. The exercise group of matched intensity showed no significant effects on the outcomes. DISCUSSION The study findings support the potential utility of DMT as a multifaceted intervention for improving various aspects of functioning in older adults with declining cognitive abilities. The lack of beneficial effects for our exercise intervention and long-term DMT effects highlights the need to maintain persistent levels of exercise with adequate intensity and duration.
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Affiliation(s)
- Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong.,Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong.,Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Joseph S K Kwan
- Department of Medicine, The University of Hong Kong, Hong Kong
| | | | - Joshua C Y Yau
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
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12
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Ho RTH, Lo HHM, Fong TCT, Choi CW. Effects of a Mindfulness-based Intervention on diurnal cortisol pattern in disadvantaged families: A randomized controlled trial. Psychoneuroendocrinology 2020; 117:104696. [PMID: 32353816 DOI: 10.1016/j.psyneuen.2020.104696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 03/10/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The present study examined the psychophysiological effects of Family-based Mindfulness Intervention (FBMI) on children and parents from disadvantaged families. METHODS This randomized controlled trial recruited parents and their children from 51 disadvantaged families in Hong Kong and randomized them into FBMI (n = 26) and waitlist control (n = 25) groups. The parent intervention included 6 sessions and the child intervention included 8 sessions with 2 half-hour joint programs. Both interventions lasted 9 hours in total each. All participants completed four salivary cortisol measures after wakeup, before lunchtime, late-afternoon, and before sleep at baseline and end of the intervention. The diurnal cortisol pattern was summarized by the morning cortisol, evening cortisol, mean cortisol, and diurnal cortisol slope. RESULTS Compared to the control group, children in the FBMI group showed significant increases in morning cortisol (d = 0.50, p = 0.03) and significant decreases in diurnal cortisol slopes (d = 0.50, p = 0.04) at the end of intervention. Parents in the FBMI group displayed significant decreases in evening cortisol (d = 0.50, p = 0.04) compared to the control group at the end of intervention. No significant treatment effects were found on the mean cortisol. DISCUSSION The present findings suggest that FBMI could improve the diurnal cortisol slope and cortisol levels of the children and parents from disadvantaged families, respectively. Future studies should elucidate its potential benefits on neuroendocrine functioning.
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Affiliation(s)
- Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong; Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Herman H M Lo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong; Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - C W Choi
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong
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13
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Fong TCT, Ho RTH. Mindfulness facets predict quality of life and sleep disturbance via physical and emotional distresses in Chinese cancer patients: A moderated mediation analysis. Psychooncology 2020; 29:894-901. [PMID: 32065693 DOI: 10.1002/pon.5363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Colorectal cancer survivors are at risk of symptom burden and emotional distress. Dispositional mindfulness has been linked with better sleep quality and quality of life (QoL) in these patients. This longitudinal study aimed to examine the associations among mindfulness facets, symptom burden, emotional distress, and functional outcomes. METHODS Study sample of this three-wave, 2-month survey was 127 Chinese colorectal cancer survivors. The participants completed the Five Facet Mindfulness Questionnaire, Memorial Symptom Assessment Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and SF-12 health survey. Moderated mediation analyses examined the direct and indirect effects of mindfulness facets on QoLs and sleep quality via symptom burden and emotional distress, using acting with awareness as a moderator. RESULTS The mindfulness facets had no significant direct effects on functional outcomes 2 months later. Awareness and nonreacting showed significant and positive indirect effects on physical and mental QoL via symptom burden and emotional distress 1 month later, respectively. Awareness, nonjudging, and nonreacting significantly predicted better sleep quality indirectly via emotional distress. Nonreacting showed stronger indirect effects on the functional outcomes among patients with greater awareness. CONCLUSIONS This study demonstrates longitudinal linkages between dispositional mindfulness and functioning in cancer survivors via symptom burden and emotional distress. Acting with awareness and nonreacting are the two facets that displayed clinical relevance in predicting better sleep quality and QoL.
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Affiliation(s)
- Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong.,Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
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14
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Ho RTH, Fong TCT, Yau JCY, Chan WC, Kwan JSK, Chiu PKC, Lam LCW. Diurnal Cortisol Slope Mediates the Association Between Affect and Memory Retrieval in Older Adults With Mild Cognitive Impairment: A Path-Analytical Study. Front Aging Neurosci 2020; 12:35. [PMID: 32153385 PMCID: PMC7047326 DOI: 10.3389/fnagi.2020.00035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 02/04/2020] [Indexed: 12/28/2022] Open
Abstract
Background Memory deficits are linked to dysfunctional HPA axis activity and negative affect in older adults. This study evaluated the mediating effect of the diurnal cortisol pattern on the relationship between affect and memory in older people with mild cognitive impairment (MCI). Methods This longitudinal study recruited 189 Chinese older adults with MCI from elderly centers in Hong Kong. The participants completed assessments of affect, salivary cortisol, and digit spans at baseline; neurocognitive assessments on verbal fluency, memory retrieval, and digit spans at 6-month follow-up; and instrumental activities of daily living (IADL) at 1-year follow-up. Structural equation modeling examined the direct and indirect effects of negative affect on memory and IADL via diurnal cortisol pattern. Results Controlling for covariates, negative affect significantly predicted flattened diurnal cortisol slopes (β = 0.17, p < 0.05) but not memory or IADL (p = 0.23 – 0.91) directly. Diurnal cortisol slopes negatively predicted memory retrieval (β = −0.20, p < 0.05), which in turn positively predicted IADL (β = 0.22, p < 0.01). The indirect effect from negative affect to IADL via cortisol slope and memory retrieval was significant and negative (αβγ = −0.05, 95% bootstrapped CI = −0.248 to −0.001). Discussion The present study established certain temporal linkages among affect and cortisol slopes at baseline, memory retrieval at 6 months, and functional decline 1 year later in older adults with MCI. Flattened diurnal cortisol slopes might mediate the detrimental effects of negative affect on memory retrieval and functioning across 1 year.
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Affiliation(s)
- Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Joshua C Y Yau
- Centre on Behavioral Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Joseph S K Kwan
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.,Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Patrick K C Chiu
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
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15
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Sun GW, Yang YL, Yang XB, Wang YY, Cui XJ, Liu Y, Xing CZ. Preoperative insomnia and its association with psychological factors, pain and anxiety in Chinese colorectal cancer patients. Support Care Cancer 2019; 28:2911-2919. [PMID: 31758321 DOI: 10.1007/s00520-019-05151-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/24/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Sleep disturbances are common in cancer patients, but little is known about preoperative insomnia and its associated factors in colorectal cancer (CRC) patients. The aim of this study was to clarify the relationship between preoperative insomnia and its associated factors (i.e., pain, anxiety, self-esteem, and coping styles) in CRC patients. METHODS A cross-sectional study was conducted in consecutive CRC inpatients (N = 434), who were required to complete the questionnaires about insomnia, pain, anxiety, self-esteem, and coping styles (acceptance/resignation, confrontation, avoidance) before the day of surgery. Hierarchical regression analyses were conducted to explore the relationships between preoperative anxiety and its associated factors. RESULTS Based on the cutoff value of Athens Insomnia Scale (scores ≥ 6) in Chinese cancer patients, the prevalence of insomnia was 38.2% before surgery. Pain (β = 0.087, p = 0.015) and anxiety (β = 0.372, p < 0.001) were positively associated with preoperative insomnia, while self-esteem (β = - 0.479, p < 0.001) and confrontation coping (β = - 0.124, p = 0.003) showed protective effects on preoperative insomnia when putting them together into hierarchical regression. The associated factors together accounted for an additional variance of preoperative insomnia (47.6%). CONCLUSIONS In line with previous findings, the detrimental effects of pain and anxiety on preoperative insomnia were also observed in our study. More importantly, our main new findings were that self-esteem and confrontation coping played important roles in alleviating preoperative insomnia among CRC patients. Clinicians should take these results into account when developing cancer care management to relieve preoperative insomnia.
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Affiliation(s)
- Guang-Wei Sun
- Department of Anorectal, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yi-Long Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Xue-Bin Yang
- Dalian Seventh People's Hospital, Dalian, Liaoning, PR China
| | - Yin-Yin Wang
- Dalian Seventh People's Hospital, Dalian, Liaoning, PR China
| | - Xue-Jiao Cui
- Psychological Clinic, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Ying Liu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
| | - Cheng-Zhong Xing
- Department of Anorectal, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
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Huang TW, Cheung DST, Xu X, Loh EW, Lai JH, Su WW, Wu SS, Lin CC. Relationship Between Diurnal Cortisol Profile and Sleep Quality in Patients With Hepatocellular Carcinoma. Biol Res Nurs 2019; 22:139-147. [DOI: 10.1177/1099800419881195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose:Hepatocellular carcinoma (HCC) is the second leading cause of cancer mortality worldwide. Sleep problems are common in HCC patients and may be attributable to disturbances in the circadian rhythm. Research into the role of circadian rhythms in sleep quality among HCC patients is lacking, however. This study investigated the relationship between the diurnal cortisol profile and sleep quality among HCC patients. We aimed to identify alterations in the diurnal cortisol profile in patients with HCC compared to healthy controls and investigate whether they were associated with poor sleep quality among HCC patients.Methods:Participants comprised 75 HCC patients and 33 healthy individuals. The Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-T) was administered to assess sleep quality. Saliva samples were collected on 3 consecutive days at five time points daily to measure diurnal cortisol levels.Results:In the HCC group, 89.3% of individuals were poor sleepers (PSQI-T > 5), whereas among healthy individuals, 30.3% were poor sleepers. While the healthy participants’ diurnal cortisol profile followed a typical pattern that peaked 30 min after waking and declined gradually throughout the day, the cortisol level in the HCC patients rebounded at bedtime. Higher cortisol levels were marginally correlated with poor sleep quality ( OR = 1.00007, p < .05).Conclusions:Our study suggests a potential association between disturbed circadian rhythm and poor sleep quality in HCC patients. Further investigation of the causal relationship between sleep and circadian rhythm is warranted.
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Affiliation(s)
- Tsai-Wei Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Xinyi Xu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - El-Wui Loh
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, Zhonghe District, New Taipei City, Taiwan
- Shared Decision Making Resource Center, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jun-Hung Lai
- Department of Internal Medicine, Erlin Christian Hospital, Changhua, Taiwan
| | - Wei-Wen Su
- Department of Gastroenterology, Changhua Christian Medical Center, Changhua, Taiwan
| | - Shun-Sheng Wu
- Department of Gastroenterology, Changhua Christian Medical Center, Changhua, Taiwan
| | - Chia-Chin Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Pok Fu Lam, Hong Kong
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Perez‐Tejada J, Labaka A, Pascual‐Sagastizabal E, Garmendia L, Iruretagoyena A, Arregi A. Predictors of psychological distress in breast cancer survivors: A biopsychosocial approach. Eur J Cancer Care (Engl) 2019; 28:e13166. [DOI: 10.1111/ecc.13166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ainitze Labaka
- Department of Basic Psychological Processes and their Development University of The Basque Country San Sebastián Spain
| | - Eider Pascual‐Sagastizabal
- Department of Basic Psychological Processes and their Development University of The Basque Country San Sebastián Spain
| | - Larraitz Garmendia
- Department of Basic Psychological Processes and their Development University of The Basque Country San Sebastián Spain
| | | | - Amaia Arregi
- Department of Basic Psychological Processes and their Development University of The Basque Country San Sebastián Spain
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18
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Sullivan KA, Bever SR, McKim DB, Godbout JP, Sheridan JF, Obrietan K, Pyter LM. Mammary tumors compromise time-of-day differences in hypothalamic gene expression and circadian behavior and physiology in mice. Brain Behav Immun 2019; 80:805-817. [PMID: 31108169 PMCID: PMC6664435 DOI: 10.1016/j.bbi.2019.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/26/2019] [Accepted: 05/16/2019] [Indexed: 01/11/2023] Open
Abstract
Circadian rhythms influence various aspects of biology, including hormonal, immunological, and behavioral processes. These 24-hour oscillations are necessary to optimize cellular functions and to synchronize these processes with the environment. Breast cancer patients and survivors frequently report disruptions in circadian oscillations that adversely affect quality-of-life, including fragmented sleep-wake cycles and flattened cortisol rhythms, which are associated with negative behavioral comorbidities (e.g., fatigue). However, the potential causal role of tumor biology in circadian dysregulation has not been investigated. Here, we examined the extent to which sham surgery, non-metastatic mammary tumors, or mammary tumor removal in mice disrupts circadian rhythms in brain clock gene expression, locomotor behavior (free-running and entrained), and physiological rhythms that have been associated with cancer behavioral comorbidities. Tumors and tumor resection altered time-of-day differences in hypothalamic expression of eight circadian-regulated genes. The onset of activity in entrained running behavior was advanced in tumor-bearing mice, and the amplitude of free-running rhythms was increased in tumor-resected mice. Tumors flattened rhythms in circulating corticosterone and Ly6cHi monocytes which were largely restored by surgical tumor resection. This work implies that tumors alone may directly impact central and/or peripheral circadian rhythmicity in breast cancer patients, and that these effects may persist in cancer survivors, potentially contributing to behavioral comorbidities.
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Affiliation(s)
- Kyle A Sullivan
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, Ohio State University, Columbus, OH, USA
| | - Savannah R Bever
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel B McKim
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, Ohio State University, Columbus, OH, USA
| | - Jonathan P Godbout
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, Ohio State University, Columbus, OH, USA
| | - John F Sheridan
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, Ohio State University, Columbus, OH, USA; Department of Biosciences, College of Dentistry, Ohio State University, Columbus, OH, USA
| | - Karl Obrietan
- Department of Neuroscience, Ohio State University, Columbus, OH, USA
| | - Leah M Pyter
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, Ohio State University, Columbus, OH, USA; Departments of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA; James Comprehensive Cancer Center and Solove Research Institute, Ohio State University, Columbus, OH, USA.
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Hulett JM, Fessele KL, Clayton MF, Eaton LH. Rigor and Reproducibility: A Systematic Review of Salivary Cortisol Sampling and Reporting Parameters Used in Cancer Survivorship Research. Biol Res Nurs 2019; 21:318-334. [PMID: 30857393 DOI: 10.1177/1099800419835321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Salivary cortisol is a commonly used biomarker in cancer survivorship research; however, variations in sampling protocols and parameter reporting limit comparisons across studies. Standardized practices to provide rigor and reproducibility of diurnal salivary cortisol sampling and reporting are not well established. Previous systematic reviews examining relationships between diurnal salivary cortisol and clinical outcomes have resulted in mixed findings. It remains unclear which sampling protocols and reporting parameters offer the greatest utility for clinical research. This review examines diurnal salivary cortisol sampling protocols and reporting parameters to evaluate whether a standardized approach is recommended. A comprehensive search of intervention studies among adult cancer survivors including diurnal salivary cortisol resulted in 30 articles for review. Sampling protocols ranged from 1 to 4 days with the majority of studies sampling cortisol for 2 days. Sampling instances ranged from 2 to 7 times per day, with the majority collecting at 4 time points per day. Diurnal cortisol slope and cortisol awakening response (CAR) were the most commonly reported parameters associated with clinical outcomes. Flattened cortisol slopes, blunted CARs, and elevated evening cortisol concentrations were associated with poorer psychosocial and physiological outcomes. Based on our review, we propose that a rigorous, standardized diurnal salivary cortisol sampling protocol should include sampling at key diurnal times across ≥3 consecutive days to report diurnal cortisol parameters (i.e., CAR and slope) and objective measures of participant protocol adherence. Diminishing budgetary resources and efforts to minimize participant burden dictate the importance of standardized cortisol sampling protocols and reporting parameters.
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Affiliation(s)
- Jennifer M Hulett
- 1 College of Nursing, University of South Carolina, Columbia, SC, USA
| | | | | | - Linda H Eaton
- 4 School of Nursing & Health Studies, University of Washington, Bothell, Bothell, WA, USA
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Wan C, Boileau K, D'Amico D, Huang V, Fiocco AJ, Clément R, Bielajew C. A cross-cultural analysis of salivary cortisol patterns in breast cancer survivors. BREAST CANCER MANAGEMENT 2019. [DOI: 10.2217/bmt-2019-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: In this study, we examined whether Chinese and White women with and without a history of breast cancer exhibit differences in physiological and psychological stress profiles. Methods: Diurnal and reactive salivary cortisol profiles and psychological stress patterns of 41 breast cancer survivors and 58 healthy women were assessed. Results: Breast cancer survivors displayed a blunted acute cortisol response but there was no main effect of ethnocultural membership. Subjective appraisals of stress during the acute stressor revealed a significant interaction between ethnocultural group, health status and time (p = 0.032). Conclusion: Our results support the existing literature though suggest group differences in the appraisal of stress; thus, underscoring the importance of cultural sensitivity and awareness among clinicians and existing programs.
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Affiliation(s)
- Cynthia Wan
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Kayla Boileau
- School of Psychology, University of Ottawa, Ottawa, Canada
| | | | - Vivian Huang
- Department of Psychology, Ryerson University, Toronto, Canada
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Perceived stress moderates the effects of a randomized trial of dance movement therapy on diurnal cortisol slopes in breast cancer patients. Psychoneuroendocrinology 2018; 87:119-126. [PMID: 29059542 DOI: 10.1016/j.psyneuen.2017.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 12/22/2022]
Abstract
Women with breast cancer are at risk of psychosocial distress and may suffer from aberrant diurnal cortisol rhythms. Dance movement therapy (DMT), a movement-based psychotherapy that incorporates exercise and artistic components, has demonstrated stress reduction effects. This study examined the effects of DMT on the diurnal cortisol rhythms of breast cancer patients undergoing radiotherapy treatment and the role of perceived stress in producing such effects. The study sample comprised 121 Chinese breast cancer patients randomized to the DMT (n=63) and control (n=58) groups. The intervention consisted of six 1.5-h group sessions held twice weekly over the course of radiotherapy. Participants completed validated self-report measures of perceived stress, fatigue, pain, and sleep disturbance and provided five salivary cortisol samples at baseline (Time 1) and post-intervention (Time 2). Moderated mediation analysis was used to evaluate the intervention effect on Time 2 diurnal cortisol slopes. Despite the absence of a significant DMT effect on diurnal cortisol slopes (B=-0.55, 95% CI=-1.20 to 0.08, β=-0.14), baseline perceived stress significantly moderated the intervention effect (B=-0.18, 95% CI=-0.32 to -0.05, β=-0.30). At high levels of baseline perceived stress (1 SD above the mean), the DMT group showed a steeper cortisol slope (M=-7.14) than the control group (M=-5.80) at Time 2. The present findings suggest that DMT might have a beneficial effect on diurnal cortisol slopes in breast cancer patients with high levels of distress.
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Simultaneous measurement of salivary cortisol and alpha-amylase: Application and recommendations. Neurosci Biobehav Rev 2017; 83:657-677. [DOI: 10.1016/j.neubiorev.2017.08.015] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/16/2017] [Accepted: 08/21/2017] [Indexed: 01/20/2023]
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Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology 2017; 83:25-41. [PMID: 28578301 PMCID: PMC5568897 DOI: 10.1016/j.psyneuen.2017.05.018] [Citation(s) in RCA: 488] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 01/20/2023]
Abstract
Changes in levels of the stress-sensitive hormone cortisol from morning to evening are referred to as diurnal cortisol slopes. Flatter diurnal cortisol slopes have been proposed as a mediator between chronic psychosocial stress and poor mental and physical health outcomes in past theory and research. Surprisingly, neither a systematic nor a meta-analytic review of associations between diurnal cortisol slopes and health has been conducted to date, despite extensive literature on the topic. The current systematic review and meta-analysis examined associations between diurnal cortisol slopes and physical and mental health outcomes. Analyses were based on 179 associations from 80 studies for the time period up to January 31, 2015. Results indicated a significant association between flatter diurnal cortisol slopes and poorer health across all studies (average effect size, r=0.147). Further, flatter diurnal cortisol slopes were associated with poorer health in 10 out of 12 subtypes of emotional and physical health outcomes examined. Among these subtypes, the effect size was largest for immune/inflammation outcomes (r=0.288). Potential moderators of the associations between diurnal cortisol slopes and health outcomes were examined, including type of slope measure and study quality indices. The possible roles of flatter slopes as either a marker or a mechanism for disease etiology are discussed. We argue that flatter diurnal cortisol slopes may both reflect and contribute to stress-related dysregulation of central and peripheral circadian mechanisms, with corresponding downstream effects on multiple aspects of biology, behavior, and health.
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Affiliation(s)
- Emma K. Adam
- School of Education and Social Policy and Institute for Policy Research, Northwestern University, 2120 Campus Drive, Evanston, IL, 60208, USA,Corresponding author: , 847-467-2010
| | - Meghan E. Quinn
- Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, IL 60208, USA and Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood St., Chicago, IL, 60612, USA
| | - Royette Tavernier
- Department of Psychology, Wesleyan University, 207 High Street, Middletown, CT, 06459, USA.
| | - Mollie T. McQuillan
- School of Education and Social Policy and Institute for Policy Research, Northwestern University, 2120 Campus Drive, Evanston, IL, 60208, USA
| | - Katie A. Dahlke
- American Institutes for Research, 1120 E. Diehl Road, Suite 200, Naperville, IL, USA, 60563
| | - Kirsten E. Gilbert
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Parkway, Suite 2100, St. Louis, MO, USA
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Mansano-Schlosser TC, Ceolim MF. Factors associated with poor sleep quality in women with cancer. Rev Lat Am Enfermagem 2017; 25:e2858. [PMID: 28301036 PMCID: PMC5363332 DOI: 10.1590/1518-8345.1478.2858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 11/21/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives to analyze the factors associated with poor sleep quality, its characteristics and components in women with breast cancer prior to surgery for removing the tumor and throughout the follow-up. Method longitudinal study in a teaching hospital, with a sample of 102 women. The following were used: a questionnaire for sociodemographic and clinical characterization, the Pittsburgh Sleep Quality Index; the Beck Depression Inventory; and the Herth Hope Scale. Data collection covered from prior to the surgery for removal of the tumor (T0) to T1, on average 3.2 months; T2, on average 6.1 months; and T3, on average 12.4 months. Descriptive statistics and the Generalized Estimating Equations model were used. Results depression and pain contributed to the increase in the score of the Pittsburgh Sleep Quality Index, and hope, to the reduction of the score - independently - throughout follow-up. Sleep disturbances were the component with the highest score throughout follow-up. Conclusion the presence of depression and pain, prior to the surgery, contributed to the increase in the global score of the Pittsburgh Sleep Quality Index, which indicates worse quality of sleep throughout follow-up; greater hope, in its turn, influenced the reduction of the score of the Pittsburgh Sleep Quality Index.
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Affiliation(s)
- Thalyta Cristina Mansano-Schlosser
- Post-doctoral fellow, Faculdade de Enfermagem, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil. Scholarship holder from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Maria Filomena Ceolim
- Associate Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil
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25
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The influence of cancer on endocrine, immune, and behavioral stress responses. Physiol Behav 2016; 166:4-13. [DOI: 10.1016/j.physbeh.2015.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/10/2015] [Accepted: 09/30/2015] [Indexed: 12/21/2022]
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Mansano-Schlosser TC, Ceolim MF. Variação longitudinal da qualidade do sono em mulheres com câncer de mama. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Comparar a qualidade do sono, a depressão e a esperança em mulheres com câncer de mama ao longo de aproximadamente um ano. Métodos: Estudo longitudinal, com 107 mulheres, em hospital universitário. Foram utilizados os instrumentos: questionário de caracterização sociodemográfica e clínica; Índice de Qualidade do Sono de Pittsburgh; Inventário de Depressão de Beck e Escala de Esperança de Herth. Os dados foram coletados em T0, antes da cirurgia de retirada do tumor, e após a mesma em: T1, em média 3,2 meses; T2, em média 6,1 meses; em T3, em média 12,4 meses. Resultados: A má qualidade do sono persistiu ao longo do seguimento; a esperança aumentou em T1; a proporção de mulheres com depressão moderada e grave elevou-se em T3. Houve correlação significativa entre os escores indicativos de qualidade do sono, de depressão e de esperança nos quatro tempos. Conclusão: Os achados deste estudo indicam a importância do seguimento por tempo prolongado.
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The correlation between perceived social support, cortisol and brain derived neurotrophic factor levels in healthy women. Psychiatry Res 2016; 239:149-53. [PMID: 27137977 DOI: 10.1016/j.psychres.2016.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/25/2016] [Accepted: 03/07/2016] [Indexed: 11/20/2022]
Abstract
In this study, the role of brain derived neurotrophic factor (BDNF) in stress resilience was investigated. With a focus on healthy subjects, we explored whether plasma BDNF levels are correlated with the dexamethasone suppression test (DST) and subjectively perceived social support status. Moreover, we examined the possible interacting effect of DST status and perceived social support on BDNF levels. Seventy-two healthy volunteers, 44 females and 28 males, were recruited from the community and completed the perceived routine support subscale of Measurement of Support Function (PRS_MSF) questionnaire. Plasma BDNF levels and DST suppression rate with the low dose DST were measured. There was a significant positive correlation between BDNF and DST suppression rate in the female subjects. This was also true for the plasma BDNF levels and PRS_MSF in the female subjects. The positive correlation between BDNF and PRS_MSF was significant only in female subjects with low DST suppression rates. Plasma BDNF levels were associated with stress resilience in a sex-specific manner. Subjects' belief in social support might buffer the biological stress reactions. Differences in social perception and the biological stress response between men and women merits further investigation.
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Webster S, Chandrasekaran S, Vijayaragavan R, Sethu G. Impact of Emotional Support on Serum Cortisol in Breast Cancer Patients. Indian J Palliat Care 2016; 22:141-9. [PMID: 27162424 PMCID: PMC4843552 DOI: 10.4103/0973-1075.179607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
CONTEXT Breast cancer is the most commonly occurring female cancer in the world. Research gap exists regarding emotional support for breast cancer patients. AIM The main aim of this study was to compare the efficiency of Emotional Support- Focused Nurse directed Intervention on serum cortisol among arm I, II and III in breast cancer patients. METHODS The study was designed to compare the effectiveness of emotional support focused nurse directed intervention in terms of verbal, written and telephone basis on serum cortisol among breast cancer patients in Cancer Centre at Erode. Participants were randomly allocated by using Sequentially Numbered Opaque Sealed Envelope (SNOSE) method. 2 ml of blood samples were collected from 30 breast cancer patients who were selected randomly by adopting random number table, 10 in each experimental arm during evening at 18 hour; radioimmunoassay method was used to measure the level of serum cortisol before and after intervention. The intervention was given twice in a week for the duration of 30-45 minutes, in which early 20-30 minutes spares to express thoughts and feelings of the participants and subsequent 10-15 minutes for rendering informational support and later follow up session for the period of 1 month. RESULTS Emotional support was effective in reducing serum cortisol level among breast cancer patients. There was no statistically significant difference between arms on serum cortisol levels. CONCLUSIONS Marginal differences were noted between posttest mean scores of serum cortisol among verbal, written and telephone arms. Further emotional support can be rendered according to the preference of the breast cancer patients.
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Affiliation(s)
- Sampoornam Webster
- Department of Mental Health Nursing, Saveetha University, Chennai, Tamil Nadu, India
| | - Susila Chandrasekaran
- Department of Maternal Health Nursing, Billroth College of Nursing, Chennai, Tamil Nadu, India
| | - R Vijayaragavan
- Department of Research and Development, Saveetha University, Chennai, Tamil Nadu, India
| | - Gowri Sethu
- Department of Physiology, Saveetha University, Chennai, Tamil Nadu, India
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Hoyt MA, Bower JE, Irwin MR, Weierich MR, Stanton AL. Sleep quality and depressive symptoms after prostate cancer: The mechanistic role of cortisol. Behav Neurosci 2016; 130:351-6. [PMID: 26820589 DOI: 10.1037/bne0000107] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A substantial portion of men treated for prostate cancer report clinically significant sleep problems and disturbance in sleep quality constitutes significant risk for the development of depressive symptoms in survivors. Dysregulation in biological stress processes underlies the impact of poor sleep on the onset and/or progression of depressive symptoms, yet few studies have sought to identify potential neurobiological mechanisms (e.g., HPA axis activation) underlying this association in PC survivors. The present study examines the relationships between sleep disturbance, depressive symptoms, and indices of diurnal cortisol patterns among men treated for prostate cancer. In total, 66 men (84.8% White; mean age = 65.8 years, SD = 9.04) treated in the prior 2 years for localized prostate cancer were recruited. They completed questionnaires to measure sleep quality and depressive symptoms at study entry (T1) and 4 months later (T2). They also provided 4 saliva samples per day, over 3 days, at T1. Three cortisol indices were computed: diurnal slope, area under the curve (AUCg), and cortisol awakening response (CAR). Analyses indicate that, controlling for body mass index and age, worse sleep quality at T1 was significantly associated with higher levels of depressive symptoms at T2. Significant indirect effects were observed for cortisol slope (indirect effect = -.17, 95% CI [-.61, -.01]) and AUCg (indirect effect = -.14, 95% CI [-.43, -.01]), but not CAR. Results suggest that dysregulation in HPA activity acts as a neurobiological mechanism of the impact of sleep disruption on depressive symptoms in men with prostate cancer. (PsycINFO Database Record
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Affiliation(s)
- Michael A Hoyt
- Department of Psychology, Graduate Center, Hunter College, City University of New York
| | - Julienne E Bower
- Department of Psychology, Cousins Center for Psychoneuroimmunology, Semel Institute, University of California, Los Angeles
| | - Michael R Irwin
- Department of Psychology, Cousins Center for Psychoneuroimmunology, Semel Institute, University of California, Los Angeles
| | - Mariann R Weierich
- Department of Psychology, Graduate Center, Hunter College, City University of New York
| | - Annette L Stanton
- Department of Psychology, Cousins Center for Psychoneuroimmunology, Semel Institute, University of California, Los Angeles
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Habitual sleep-wake behaviors and lifestyle as predictors of diurnal cortisol patterns in young breast cancer survivors: a longitudinal study. Psychoneuroendocrinology 2015; 53:60-8. [PMID: 25591116 DOI: 10.1016/j.psyneuen.2014.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/03/2014] [Accepted: 12/19/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of changes in diurnal cortisol patterns during the 8-month follow up period for young breast cancer survivors. Among the potential predictors were tumor size, lymph node metastasis, changes in sleep problems, habitual time of awakening and bedtime, physical activity levels, body mass index (BMI), and depressive levels across 8 months. METHODS The participants were 62 breast cancer women who were aged 40 years and below, and had completed active breast cancer treatment. The longitudinal data were collected at four points: baseline assessment (T0) and three follow-ups after baseline: T1 (in the 2nd month), T2 (in the 5th month), and T3 (in the 8th month). The participants collected their salivary cortisol at home at six time points: upon waking, 30 and 45min after waking, and at 1200h, 1700h, and 2100h. They also completed several questionnaires: the Medical Outcomes Study Sleep scale; the Beck Depression Inventory-II, physical activity levels on a 10-point scale, time of going to bed, time of awakening, and total sleep hours. RESULTS This study found that the main predictors of changes toward flatter diurnal cortisol patterns during the 8-month follow ups were greater tumor sizes, increases of BMI scores, and habitually later times of awakening. CONCLUSIONS While greater tumor sizes represent biological vulnerability of disruption of cortisol circadian rhythm, maintaining an appropriate BMI and good sleep habits could be a protective factor for normal cortisol regulation, which likely helps to reduce early mortality in young breast cancer survivors.
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Andreotti C, Root JC, Ahles TA, McEwen BS, Compas BE. Cancer, coping, and cognition: a model for the role of stress reactivity in cancer-related cognitive decline. Psychooncology 2014; 24:617-23. [PMID: 25286084 DOI: 10.1002/pon.3683] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 07/15/2014] [Accepted: 08/20/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cognitive decline and accompanying neurological changes associated with non-CNS cancer diagnosis and treatment have been increasingly identified in a subset of patients. Initially believed to be because of neurotoxic effects of chemotherapy exposure, observation of cognitive decline in patients not treated with chemotherapy, cancer-diagnosed individuals prior to treatment, and patients receiving alternative treatment modalities (surgery, endocrine therapy, and radiation) has led to the investigation of additional potential etiologies and moderating factors. Stressful experiences have long been posited as a contributor to these cognitive changes. Through reciprocal connectivity with peripheral systems, the brain maintains a dynamic circuitry to adapt to stress (allostasis). However, overuse of this system leads to dysregulation and contributes to pathophysiology (allostatic load). At this time, little research has been conducted to systematically examine the role of allostatic load in cancer-related cognitive dysfunction. METHODS AND RESULTS Here, we integrate theories of stress biology, neuropsychology, and coping and propose a model through which individuals with a high level of allostatic load at diagnosis may be particularly vulnerable to the neurocognitive effects of cancer. CONCLUSIONS Opportunities for future research to test and extend proposed mechanisms are discussed in addition to points of prevention and intervention based on individual variation in stress reactivity and coping skills.
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Affiliation(s)
- Charissa Andreotti
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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Day-to-day dynamics of associations between sleep, napping, fatigue, and the cortisol diurnal rhythm in women diagnosed as having breast cancer. Psychosom Med 2014; 76:519-28. [PMID: 25186656 PMCID: PMC4163097 DOI: 10.1097/psy.0000000000000097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To examine whether day-to-day variations in sleep behaviors, ongoing sleep disturbance, and fatigue predict the cortisol diurnal rhythm in women recently diagnosed as having early-stage breast cancer. METHODS Women (N = 130, mean [standard deviation] age = 55.6 [9.4] years) collected saliva 5×/day/2 days for cortisol. Diaries were used to assess prior-day nap duration, nocturnal awakenings, sleep latency, and morning restfulness. Ongoing fatigue and sleep disturbance were measured using the Multidimensional Fatigue Symptom Inventory and the Pittsburg Sleep Quality Inventory. Data were analyzed using a multilevel growth curve modeling. RESULTS Greater ongoing fatigue (b = 0.035, p = .032), or sleep disturbance (b = 0.026, p = .006) predicted a slower cortisol decline. Greater ongoing fatigue also predicted higher awakening cortisol (b = 0.154, p = .030) and lower cortisol awakening response (CAR; b = -0.146, p = .005). Longer prior-day naps predicted higher CAR (b = 0.042, p = .050) and a steeper cortisol decline (b = -0.035, p = .003). Longer sleep latency predicted both a greater cortisol linear decline (b = -0.013, p < .001) and a greater quadratic slope curvature (b = 0.0007, p < .001). Feeling less rested in the morning predicted lower awakening cortisol (b = -0.187, p = .004), higher CAR (b = 0.124, p = .016), and a slower cortisol decline (b = 0.023, p = .042). CONCLUSIONS Both daily variations in sleep behaviors and ongoing sleep disturbance and fatigue are associated with a disrupted cortisol rhythm. In contrast, prior-day napping is associated with a more robust cortisol rhythm. These findings are particularly relevant to women with breast cancer who often experience sleep disturbance and fatigue. Additional research is needed to determine causal pathways between sleep disturbance and dysregulation of the hypothalamic-pituitary-adrenal axis in patients with breast cancer.
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