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Zhang Z, Lao J, Liu M, Zheng S, Zhao M, Zhang M. Symptom cluster among cancer survivors from a nationally representative survey: a network analysis. Support Care Cancer 2024; 32:333. [PMID: 38713314 DOI: 10.1007/s00520-024-08531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To identify the symptom cluster among cancer survivors and examine their subgroup differences via network analysis based on nationally representative data. METHODS This cross-sectional study included 2966 survivors participating in the 2020 National Health Interview Survey (NHIS). Participants self-reported the presence of 14 symptoms capturing four clusters (physical, somatic, sleep, and psychologic problems). Network analysis models were used to reveal the relationships between symptoms and those interactions. Network comparison tests were applied to compare subgroups. RESULTS The core symptoms of the symptom cluster were fatigue (Bet = 33, Clo = 0.0067, Str = 0.9397), pain (Bet = 11, Clo = 0.0060, Str = 0.9226), wake up well rested (Bet = 25, Clo = 0.0057, Str = 0.8491), and anxiety (Bet = 5, Clo = 0.0043, Str = 0.9697) among cancer survivors. The core symptoms, network structure, and global strength were invariant between time since diagnoses (< 2 years vs. ≥ 2 years) or between numbers of cancers (1 vs. ≥ 2), yet varied between the comorbidity group and non-comorbidity group (≥ 1 vs. 0). CONCLUSIONS Fatigue would be a potential target for alleviating other symptoms through a negative feedback loop of other related symptoms of cancer survivors. In particular, cancer survivors with other chronic diseases should be the focus of attention and strengthen targeted intervention.
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Affiliation(s)
- Zhen Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Jiahui Lao
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Mingming Liu
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Shenglong Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Ming Zhao
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Min Zhang
- Department of Nursing, Qilu Hospital, Shandong University, Jinan, China.
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Morse L, Cooper BA, Ritchie CS, Wong ML, Kober KM, Harris C, Shin J, Oppegaard K, Hammer MJ, Schimmel AC, Paul SM, Conley YP, Levine JD, Miaskowski C. Stability and consistency of symptom clusters in younger versus older patients receiving chemotherapy. BMC Geriatr 2024; 24:164. [PMID: 38365584 PMCID: PMC10870638 DOI: 10.1186/s12877-024-04755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/28/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND By 2035, the number of newly diagnosed cancer cases will double and over 50% will be in older adults. Given this rapidly growing demographic, a need exists to understand how age influences oncology patients' symptom burden. The study purposes were to evaluate for differences in the occurrence, severity, and distress of 38 symptoms in younger (< 60 years) versus older (≥ 60 years) oncology patients undergoing chemotherapy and to evaluate for differences in the stability and consistency of symptom clusters across the two age groups. METHODS A total of 1329 patients were dichotomized into the younger and older groups. Patients completed demographic and clinical questionnaires prior to the initiation of their second or third cycle of chemotherapy. A modified version of Memorial Symptom Assessment Scale was used to evaluate the occurrence, severity, and distress of 38 common symptoms associated with cancer and its treatment. Differences between the two age groups in demographic and clinical characteristics and ratings of occurrence, severity, and distress for the 38 symptoms were evaluated using parametric and nonparametric tests. Exploratory factor analyses were done within each age group to identify symptom clusters using symptom occurrence rates. RESULTS Compared to the younger group (14.8 (± 7.0)), older adults reported a lower mean number of symptoms (12.9 (± 7.2)). Older patients experienced lower occurrence rates for almost 50% of the symptoms. Regarding symptom clusters, an eight-factor solution was selected for both age groups. Across the two age groups, the eight symptom clusters (i.e., physical and cognitive fatigue, respiratory, psychological, hormonal, chemotherapy-related toxicity, weight gain, gastrointestinal, epithelial) were stable. However, symptoms within the physical and cognitive, chemotherapy-related toxicity, and gastrointestinal clusters were not consistent across the age groups. CONCLUSIONS To be able to provide tailored and effective symptom management interventions to older oncology patients, routine assessments of the core symptoms unique to the symptom clusters identified for this group warrants consideration. The underlying mechanism(s) for these inconsistencies in symptom burden is an important focus for future studies.
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Affiliation(s)
- Lisa Morse
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital Morgan Institute, Boston, MA, USA
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Medical Group, Oakland, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Carolyn Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joosun Shin
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, CA, USA.
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way- N631Y, 94143-0610, San Francisco, CA, USA.
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Shin J, Hammer M, Cooley ME, Cooper BA, Paul SM, Cartwright F, Kober KM, Conley YP, Levine JD, Miaskowski C. Common and distinct risk factors that influence more severe and distressing shortness of breath profiles in oncology outpatients. Cancer Med 2024; 13:e7013. [PMID: 38400684 PMCID: PMC10891479 DOI: 10.1002/cam4.7013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Shortness of breath occurs in 10%-70% of oncology patients. Very little is known about interindividual variability in its severity and distress and associated risk factors. Using latent profile analyses (LPAs), purpose was to identify subgroups of patients with distinct severity and distress profiles for shortness of breath as single symptom dimensions. In addition, a joint LPA was done using patients' severity AND distress ratings. For each of the three LPAs, differences among the shortness of breath classes in demographic, clinical, symptom, stress, and resilience characteristics were evaluated. METHODS Patients completed ratings of severity and distress from shortness of breath a total of six times over two cycles of chemotherapy. All of the other measures were completed at enrollment (i.e., prior to the second or third cycle of chemotherapy). Separate LPAs were done using ratings of severity and distress, as well as a joint analysis using severity AND distress ratings. Differences among the latent classes were evaluated using parametric and nonparametric tests. RESULTS For severity, two classes were identified (Slight to Moderate [91.6%] and Moderate to Severe [8.4%]). For distress, two classes were identified (A Little Bit to Somewhat [83.9%] and Somewhat to Quite a Bit [16.1%]). For the joint LPA, two classes were identified (Lower Severity and Distress [79.9%] and Higher Severity and Distress [20.1%]). While distinct risk factors were associated with each of the LPAs, across the three LPAs, the common risk factors associated with membership in the worse class included: a past or current history of smoking, poorer functional status, and higher comorbidity burden. In addition, these patients had a higher symptom burden and higher levels of cancer-specific stress. CONCLUSIONS Clinicians can use the information provided in this study to identify high-risk patients and develop individualized interventions.
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Affiliation(s)
- Joosun Shin
- Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | - Bruce A. Cooper
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Steven M. Paul
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Kord M. Kober
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yvette P. Conley
- School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jon D. Levine
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Christine Miaskowski
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Harris CS, Kober K, Cooper B, Conley YP, Hammer MJ, Dhruva AA, Cartwright F, Paul S, Levine J, Miaskowski C. Symptom clusters in oncology outpatients: stability and consistency across a cycle of chemotherapy. BMJ Support Palliat Care 2024; 13:e1198-e1211. [PMID: 36446517 PMCID: PMC10225477 DOI: 10.1136/spcare-2022-003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Improved understanding of the stability and consistency of symptom clusters across time, symptom dimensions and cancer diagnoses will lead to refinements in symptom assessments and management, and provide direction for mechanistic studies. Study purposes were to describe the occurrence, severity and distress of 38 symptoms; evaluate the stability and consistency of symptom clusters across a cycle of chemotherapy, three symptom dimensions and four distinct cancer types; and identify common and distinct symptom clusters. METHODS Oncology outpatients (n=1329) completed the Memorial Symptom Assessment Scale prior to their next cycle of chemotherapy (T1), 1 week after chemotherapy (T2) and 2 weeks after chemotherapy (T3). Symptom clusters were identified using exploratory factor analysis using unweighted least squares. GEOMIN rotated factor loadings with absolute values ≥0.40 were considered meaningful. Clusters were stable if they were identified across each time point and/or dimension. Clusters were consistent if the same two or three symptoms with the highest factor loadings were identified across each time point and/or dimension. RESULTS Patients reported 13.9 (±7.2) symptoms at T1, 14.0 (±7.0) at T2 and 12.2 (±6.8) at T3. Psychological, weight gain, gastrointestinal and respiratory clusters were stable across time and dimensions. Only the psychological, weight gain and respiratory clusters were consistent across time and dimensions. CONCLUSION Given the stability of the psychological, weight gain and gastrointestinal clusters across cancer diagnoses, symptoms within these clusters need to be routinely assessed. However, respiratory and hormonal clusters are unique to specific cancer types and the symptoms within these clusters are variable.
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Affiliation(s)
- Carolyn S Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Anand A Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | - Frances Cartwright
- Department of Nursing, Mount Sinai Medical Center, New York, New York, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Jon Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing and School of Medicine, University of California, San Francisco, CA, USA
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Storey S, Luo X, Ren J, Huang K, Von Ah D. Symptom clusters in breast cancer survivors with and without type 2 diabetes over the cancer trajectory. Asia Pac J Oncol Nurs 2024; 11:100343. [PMID: 38222966 PMCID: PMC10784674 DOI: 10.1016/j.apjon.2023.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/10/2023] [Indexed: 01/16/2024] Open
Abstract
Objective This study aimed to investigate symptoms and symptom clusters in breast cancer survivors (BCS) with and without type 2 diabetes across three crucial periods during the cancer trajectory (0-6 months, 12-18 months, and 24-30 months) post-initial chemotherapy. Methods Eight common symptoms in both BCS and individuals with diabetes were identified through natural language processing of electronic health records from January 2007 to December 2018. Exploratory factor analysis was employed to discern symptom clusters, evaluating their stability, consistency, and clinical relevance. Results Among the 4601 BCS in the study, 20% (n = 905) had a diabetes diagnosis. Gastrointestinal symptoms and fatigue were prevalent in both groups. While BCS in both groups exhibited an equal number of clusters, the composition of these clusters differed. Symptom clusters varied over time between BCS with and without diabetes. BCS with diabetes demonstrated less stability (repeated clusters) and consistency (same individual symptoms comprising clusters) than their counterparts without diabetes. This suggests that BCS with diabetes may experience distinct symptom clusters at pivotal points in the cancer treatment trajectory. Conclusions Healthcare providers must be attentive to BCS with diabetes throughout the cancer trajectory, considering intensified and/or unique profiles of symptoms and symptom clusters. Interdisciplinary cancer survivorship models are essential for effective diabetes management in BCS. Implementing a comprehensive diabetes management program throughout the cancer trajectory could alleviate symptoms and symptom clusters, ultimately enhancing health outcomes and potentially reducing healthcare resource utilization.
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Affiliation(s)
- Susan Storey
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Xiao Luo
- Department of Management Science and Information Systems, School of Business, Oklahoma State University, OK, USA
| | - Jie Ren
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine Indianapolis, IN, USA
| | - Kun Huang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine; Regenstrief Institute, Indianapolis, IN, USA
| | - Diane Von Ah
- College of Nursing, Cancer Research, Center for Healthy Aging, Self-Management and Complex Care, The Ohio State University, Columbus, OH, USA
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Wang Y, Tian L, Liu X, Zhang H, Tang Y, Zhang H, Nie W, Wang L. Multidimensional Predictors of Cancer-Related Fatigue Based on the Predisposing, Precipitating, and Perpetuating (3P) Model: A Systematic Review. Cancers (Basel) 2023; 15:5879. [PMID: 38136423 PMCID: PMC10741552 DOI: 10.3390/cancers15245879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/22/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Cancer-related fatigue (CRF) is a widespread symptom with high prevalence in cancer patients, seriously affecting their quality of life. In the context of precision care, constructing machine learning-based prediction models for early screening and assessment of CRF is beneficial to this situation. To further understand the predictors of CRF for model construction, we conducted a comprehensive search in PubMed, Web of Science, Embase, and Scopus databases, combining CRF with predictor-related terms. A total of 27 papers met the inclusion criteria. We evaluated the above studies into three subgroups following the predisposing, precipitating, and perpetuating (3P) factor model. (1) Predisposing factors-baseline fatigue, demographic characteristics, clinical characteristics, psychosocial traits and physical symptoms. (2) Precipitating factors-type and stage of chemotherapy, inflammatory factors, laboratory indicators and metabolic changes. (3) Perpetuating factors-a low level of physical activity and poorer nutritional status. Future research should prioritize large-scale prospective studies with emerging technologies to identify accurate predictors of CRF. The assessment and management of CRF should also focus on the above factors, especially the controllable precipitating factors, to improve the quality of life of cancer survivors.
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Affiliation(s)
- Yiming Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, China; (Y.W.); (L.T.)
| | - Lv Tian
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, China; (Y.W.); (L.T.)
| | - Xia Liu
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China; (X.L.); (Y.T.); (H.Z.)
| | - Hao Zhang
- Yanda Medical Research Institute, Hebei Yanda Hospital, Sanhe 065201, China;
| | - Yongchun Tang
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China; (X.L.); (Y.T.); (H.Z.)
| | - Hong Zhang
- Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China; (X.L.); (Y.T.); (H.Z.)
| | - Wenbo Nie
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, China; (Y.W.); (L.T.)
| | - Lisheng Wang
- School of Nursing, Jilin University, No. 965 Xinjiang Street, Changchun 130021, China; (Y.W.); (L.T.)
- Yanda Medical Research Institute, Hebei Yanda Hospital, Sanhe 065201, China;
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Johannessen MS, Miaskowski C, Kleven AG, Ritchie CS, Paul SM, Grov EK, Hareide M, Gaudernack H, Utne I. Age-related differences in the occurrence, severity, and distress of symptoms in older patients at the initiation of chemotherapy. BMC Geriatr 2023; 23:481. [PMID: 37558973 PMCID: PMC10413597 DOI: 10.1186/s12877-023-04198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Evaluate for differences in occurrence, severity, and distress ratings for 32 symptoms between younger older adults (YOA, < 70 years) and older adults (OA, ≥ 70 years) at initiation of chemotherapy. METHODS Patients (n = 125) were recruited prior to the initiation of chemotherapy and completed the Memorial Symptom Assessment Scale. Differences in occurrence, severity, and distress ratings were evaluated using Independent sample t-tests and Chi-square or Fisher's exact tests. RESULTS On average, the older patients reported ten concurrent symptoms that equates with a moderate symptom burden. Symptoms with the highest occurrence rates were not always the most severe and/or the most distressing. Few age-related differences were found in patients' symptom experiences. When age-related differences were identified, OA reported lower occurrence, severity, and distress ratings. Nine of the ten symptoms with highest occurrence rates were common for both age groups. For severity and distress, only half of the symptoms were common. In terms of severity and distress, all of the top ten ranked symptoms were in the moderate to severe range. CONCLUSIONS Both YOA and OA reported a moderate symptom burden and severity and distress scores in the moderate to severe range. The symptoms with the highest occurrence rates were not always the most severe/or the most distressing. Our findings suggest that different dimensions of the symptom experience (i.e., occurrence, severity, and distress) warrant evaluation in older oncology patients.
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Affiliation(s)
- Marlen Sunde Johannessen
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | | | - Anne Grethe Kleven
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Ellen Karine Grov
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Martine Hareide
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Henrik Gaudernack
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Inger Utne
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway.
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Harris CS, Miaskowski CA, Conley YP, Hammer MJ, Dunn LB, Dhruva AA, Levine JD, Olshen AB, Kober KM. Epigenetic Regulation of Inflammatory Mechanisms and a Psychological Symptom Cluster in Patients Receiving Chemotherapy. Nurs Res 2023; 72:200-210. [PMID: 36929768 PMCID: PMC10121746 DOI: 10.1097/nnr.0000000000000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND A psychological symptom cluster is the most common cluster identified in oncology patients. Although inflammatory mechanisms are hypothesized to underlie this cluster, epigenetic contributions are unknown. OBJECTIVES This study's purpose was to evaluate associations between the occurrence of a psychological symptom cluster and levels of DNA methylation for inflammatory genes in a heterogeneous sample of patients with cancer receiving chemotherapy. METHODS Prior to their second or third cycle of chemotherapy, 1,071 patients reported the occurrence of 38 symptoms using the Memorial Symptom Assessment Scale. A psychological cluster was identified using exploratory factor analysis. Differential methylation analyses were performed in two independent samples using Illumina Infinium 450K and EPIC microarrays. Expression-associated CpG (eCpG) loci in the promoter region of 114 inflammatory genes on the 450K and 112 genes on the EPIC microarray were evaluated for associations with the psychological cluster. Robust rank aggregation was used to identify differentially methylated genes across both samples. Significance was assessed using a false discovery rate of 0.05 under the Benjamini-Hochberg procedure. RESULTS Cluster of differentiation 40 ( CD40 ) was differentially methylated across both samples. All six promoter eCpGs for CD40 that were identified across both samples were hypomethylated in the psychological cluster group. CONCLUSIONS This study is the first to suggest associations between a psychological symptom cluster and differential DNA methylation of a gene involved in tissue inflammation and cell-mediated immunity. Our findings suggest that increased CD40 expression through hypomethylation of promoter eCpG loci is involved in the occurrence of a psychological symptom cluster in patients receiving chemotherapy. These findings suggest a direction for mechanistic studies.
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Harris CS, Miaskowski CA, Conley YP, Hammer MJ, Dhruva AA, Levine JD, Olshen AB, Kober KM. Gastrointestinal Symptom Cluster is Associated With Epigenetic Regulation of Lymphotoxin Beta in Oncology Patients Receiving Chemotherapy. Biol Res Nurs 2023; 25:51-64. [PMID: 35929442 PMCID: PMC9900252 DOI: 10.1177/10998004221115863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES While the gastrointestinal symptom cluster (GISC) is common in patients receiving chemotherapy, limited information is available on its underlying mechanism(s). Emerging evidence suggests a role for inflammatory processes through the actions of the nuclear factor kappa B (NF-κB) signaling pathway. This study evaluated for associations between a GISC and levels of DNA methylation for genes within this pathway. METHODS Prior to their second or third cycle of chemotherapy, 1071 outpatients reported symptom occurrence using the Memorial Symptom Assessment Scale. A GISC was identified using exploratory factor analysis. Differential methylation analyses were performed in two independent samples using EPIC (n = 925) and 450K (n = 146) microarrays. Trans expression-associated CpG (eCpG) loci for 56 NF-κB signaling pathway genes were evaluated. Loci significance were assessed using an exploratory false discovery rate (FDR) of 25% for the EPIC sample. For the validation assessment using the 450K sample, significance was assessed at an unadjusted p-value of 0.05. RESULTS For the EPIC sample, the GISC was associated with increased expression of lymphotoxin beta (LTB) at one differentially methylated trans eCpG locus (cg03171795; FDR = 0.168). This association was not validated in the 450K sample. CONCLUSIONS This study is the first to identify an association between a GISC and epigenetic regulation of a gene that is involved in the initiation of gastrointestinal immune responses. Findings suggest that increased LTB expression by hypermethylation of a trans eCpG locus is involved in the occurrence of this cluster in patients receiving chemotherapy. LTB may be a potential therapeutic target for this common cluster.
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Affiliation(s)
| | - Christine A. Miaskowski
- School of Nursing, University of
California, San Francisco, CA, USA
- School of Medicine, University of
California, San Francisco, CA, USA
| | - Yvette P. Conley
- School of Nursing, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Marilyn J. Hammer
- The Phyllis F. Cantor Center for
Research in Nursing and Patient Care Services, Dana-Farber Cancer
Institute, Boston, MA, USA
| | - Anand A. Dhruva
- School of Medicine, University of
California, San Francisco, CA, USA
| | - Jon D. Levine
- School of Medicine, University of
California, San Francisco, CA, USA
| | - Adam B. Olshen
- School of Medicine, University of
California, San Francisco, CA, USA
| | - Kord M. Kober
- School of Nursing, University of
California, San Francisco, CA, USA
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Lin L, Zuo S, Wang Z. Nurse-guided non-pharmacological multi-component symptom cluster management intervention: A good attempt at exploring effective symptom cluster relief strategies for lung cancer. Asia Pac J Oncol Nurs 2022; 9:100150. [DOI: 10.1016/j.apjon.2022.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/02/2022] Open
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