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Liu Y, Yan Q, Zhou J, Yao X, Ye X, Chen W, Cai J, Jiang H, Li H. Identification of distinct symptom profiles in prostate cancer patients with cancer-related cognitive impairment undergoing androgen deprivation therapy: A latent class analysis. Asia Pac J Oncol Nurs 2024; 11:100497. [PMID: 38845748 PMCID: PMC11153053 DOI: 10.1016/j.apjon.2024.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 06/09/2024] Open
Abstract
Objective To identify latent classes of cognitive impairment and co-occurring symptoms (fatigue, pain, sleep disturbance, depression) as clusters in patients with prostate cancer undergoing androgen deprivation therapy and to explore the predictors among distinct latent classes. Methods A total of 228 patients with prostate cancer were recruited in this cross-sectional study. The assessment instrument included the Perceived Cognitive Impairment Scale, the Fatigue Severity Scale, the Athens Insomnia Scale, the Brief Pain Inventory, the Patient Health Questionnaire-9, the UCLA Loneliness Scale, the International Physical Activity Questionnaire - Short Form, the Charlson comorbidity index, and General Information questionnaire. The identification of different patient subgroups was done by the latent class analysis. Results The study identified three distinct latent classes: all low symptoms (class 1, 32%), high depression symptoms (class 2, 37.7%), and high physical symptoms (fatigue, sleep disturbance, and pain) with high cognitive impairment (class 3, 30.3%). Patients who had higher Charlson comorbidity index (P = 0.003) scores were more likely to be classified in class 3. Patients with higher loneliness scores (P < 0.001; P < 0.001) were significantly more likely to fall into class two or three than in class 1. However, having a higher level of physical activity (P = 0.014; P < 0.001) increased the likelihood of being in class 1. Conclusions This study exhibited the inter-individual variability of symptom experience in prostate cancer patients with cognitive impairment undergoing androgen deprivation therapy. The result suggests that more emphasis should be placed on screening for fatigue, sleep disturbance, and pain, and future interventions should focus on loneliness and physical activity.
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Affiliation(s)
- Yongcai Liu
- Department of Urology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qinqing Yan
- Department of Urology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jieru Zhou
- Department of Urology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin Yao
- Department of Urology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiangxiang Ye
- Department of Urology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Chen
- Department of Urology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian Cai
- Department of Urology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haihong Jiang
- Department of Urology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiyan Li
- Department of Urology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Wu S, Li K, Zhang Y, Wang L, Zhu B, Wang W. Men's symptom experience throughout androgen deprivation therapy for prostate cancer: A systematic review and meta-aggregation. Int J Nurs Stud 2024; 157:104796. [PMID: 38824718 DOI: 10.1016/j.ijnurstu.2024.104796] [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: 12/26/2023] [Revised: 03/20/2024] [Accepted: 05/02/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Androgen deprivation therapy is a common treatment for men with advanced prostate cancer. They have experienced many complex symptoms that affect their quality of life. However, qualitative reviews that synthesize the symptom experience for men with prostate cancer are lacking. OBJECTIVE To explore the men's symptom experience throughout androgen deprivation therapy for prostate cancer. DESIGN A qualitative evidence synthesis using meta-aggregation. DATA RESOURCES Published and unpublished literature between January 2001 and August 2023 were identified from PubMed, Embase (Ovid), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, ProQuest, Google Scholar, China National Knowledge Infrastructure (CNKI), Wang Fang, and VIP. REVIEW METHODS Two reviewers independently conducted screening, study selection and data extraction, and quality appraisal was performed using the Joanna Briggs Institutes Critical Appraisal Checklist for Qualitative Research. Data synthesis was conducted using meta-aggregative approach. RESULTS 24 articles of moderate to high methodological quality were included. A total of 98 findings were extracted with 59 unequivocal or equivocal findings eligible for meta-aggregation, aggregated into nine categories, and developed four synthesized findings: (1) production of symptoms: unrecognized and underestimated, (2) perception of symptoms: varied and complicated, (3) meaning of symptoms: threatened and affected, and (4) response to symptoms: push and pull. CONCLUSIONS Men throughout androgen deprivation for prostate cancer experience the four crisis-packed stages in their symptomatic journey. Health care provider need to understand the men's thoughts whether in the process of shared decision-making or in the course of the chosen therapy. Future research should develop individual suitable interventions and offer practical strategies for managing symptom. PROSPERO registration: CRD42023449129.
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Affiliation(s)
- Siyuan Wu
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kun Li
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Zhang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lijuan Wang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Binbin Zhu
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; Department of Nursing, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Wang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Kim HJ, Moon JH, Chung SW, Abraham I. The role of cytokines and Indolamine-2.3 dioxygenase in experiencing a psycho-neurological symptom cluster in hematological cancer patients: IL-1alpha, IL-1beta, IL-4, IL-6, TNF-alpha, kynurenine, and tryptophan. J Psychosom Res 2023; 173:111455. [PMID: 37586292 DOI: 10.1016/j.jpsychores.2023.111455] [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: 03/23/2023] [Revised: 07/07/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE This study examined (a) whether there are a subgroup of cancer patients experiencing the selected psycho-neurological symptoms as a cluster (depression, cognitive impairment, fatigue, sleep disturbance, and pain); (b) whether demographic and clinical characteristics and pro-inflammatory cytokines (IL-1α, IL-1β, IL-4, IL-6, TNF-alpha) are associated with subgroup membership; and (c) whether the activity of indolamine-2.3 dioxygenase(IDO) is associated with pro-inflammatory cytokine activity and psycho-neurological symptom cluster experience. METHODS This was a prospective cohort study where 149 hematologic patients were recruited from a university hospital and 65 healthy volunteers provided control data. Latent profile analyses were conducted to identify subgroups at two time points: the last day of chemotherapy and 1 week after chemotherapy completion. Influencing factors of subgroup membership were examined by logistic regression. RESULTS A substantial number of patients (33%, 34% at each time point) experienced the selected psycho-neurological symptoms as a cluster. Older age and elevated IL-1α and IL-6 were associated with experiencing the psycho-neurological symptom cluster. IDO activity was higher in the patients experiencing psycho-neurological symptom cluster; and was positively associated with IL-6. Symptom severity, IL-1α, IL-6, and IDO activity were all significantly higher in cancer patients than in the healthy controls. The findings were preserved across time points. CONCLUSIONS The activation of pro-inflammatory cytokines and their cross-talk with IDO may be a common biological mechanism, underlying a psycho-neurological symptom cluster experience. The novel approaches for symptom assessment and management can be developed by assessing multiple psycho-neurological symptoms as a cluster and by targeting their common biological pathway.
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Affiliation(s)
- Hee-Ju Kim
- College of Nursing, The Catholic University of Korea, Seoul, South Korea.
| | - Joon Ho Moon
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Deagu, South Korea
| | - Su Wol Chung
- Department of Biological Sciences, College of Natural Sciences, University of Ulsan, Ulsan, South Korea
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research and Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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Extracellular vesicle isolation, purification and evaluation in cancer diagnosis. Expert Rev Mol Med 2022; 24:e41. [PMID: 36268744 DOI: 10.1017/erm.2022.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Strategies for non-invasive biomarker discovery in early detection of cancer are an urgent need. Extracellular vesicles (EVs) have generated increasing attention from the scientific community and are under intensive investigations due to their unique biological profiles and their non-invasive nature. EVs are membrane-enclosed vesicles with variable sizes and function. Such vesicles are actively secreted from multiple cell types and are considered as key vehicles for inter-cellular communications and signalling. The stability and potential to easily cross biological barriers enable EVs for exerting durable effects on target cells. These along with easy access to such vesicles, the consistent secretion from tumour during all stages of tumorigenesis and their content providing a reservoir of molecules as well as mirroring the identity of the cell of origin are virtues that have made EVs appealing to be assessed in liquid biopsy approaches and for using as a promising resource of biomarkers in cancer diagnosis and therapy and monitoring targeted cancer therapy. Early detection of EVs will guide time-scheduled personalised therapy. Surveying reliable and sensitive methods for rapid isolation of EVs from biofluids, the purity of isolated vesicles and their molecular profiling and marker specification for clinical translation in patients with cancer are issues in the area and the hot topics of many recent studies. Here, the focus is over methods for EV isolation and stratification for digging more information about liquid biopsy-based diagnosis. Extending knowledge regarding EV-based strategies is a key to validate independent patient follow-up for cancer diagnosis at early stages and inspecting the efficacy of therapeutics.
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Sass D, Fitzgerald W, Wolff BS, Torres I, Pagan-Mercado G, Armstrong TS, Miaskowski C, Margolis L, Saligan L, Kober KM. Differences in Circulating Extracellular Vesicle and Soluble Cytokines in Older Versus Younger Breast Cancer Patients With Distinct Symptom Profiles. Front Genet 2022; 13:869044. [PMID: 35547250 PMCID: PMC9081604 DOI: 10.3389/fgene.2022.869044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022] Open
Abstract
Because extracellular vesicle (EV)-associated cytokines, both encapsulated and surface bound, have been associated with symptom severity, and may vary over the lifespan, they may be potential biomarkers to uncover underlying mechanisms of various conditions. This study evaluated the associations of soluble and EV-associated cytokine concentrations with distinct symptom profiles reported by 290 women with breast cancer prior to surgery. Patients were classified into older (≥60 years, n = 93) and younger (< 60 years, n = 197) cohorts within two previously identified distinct symptom severity profiles, that included pain, depressive symptoms, sleep disturbance, and fatigue (i.e., High Fatigue Low Pain and All Low). EVs were extracted using ExoQuick. Cytokine concentrations were determined using Luminex multiplex assay. Mann Whitney U test evaluated the differences in EV and soluble cytokine levels between symptom classes and between and within the older and younger cohorts adjusting for Karnofsky Performance Status (KPS) score, body mass index (BMI), and stage of disease. Partial correlation analyses were run between symptom severity scores and cytokine concentrations. Results of this study suggest that levels of cytokine concentrations differ between EV and soluble fractions. Several EV and soluble pro-inflammatory cytokines had positive associations with depressive symptoms and fatigue within both age cohorts and symptom profiles. In addition, in the older cohort with High Fatigue Low Pain symptom profile, EV GM-CSF concentrations were higher compared to the All Low symptom profile (p < 0.05). Albeit limited by a small sample size, these exploratory analyses provide new information on the association between cytokines and symptom profiles of older and younger cohorts. Of note, unique EV-associated cytokines were found in older patients and in specific symptom classes. These results suggest that EVs may be potential biomarker discovery tools. Understanding the mechanisms that underlie distinct symptom class profiles categorized by age may inform intervention trials and offer precision medicine approaches.
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Affiliation(s)
- Dilorom Sass
- National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Wendy Fitzgerald
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Brian S Wolff
- National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Isaias Torres
- National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Glorivee Pagan-Mercado
- National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Leonid Margolis
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Leorey Saligan
- National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, San Francisco, CA, United States
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