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Amonoo HL, Guo M, Boardman AC, Acharya N, Daskalakis E, Deary EC, Waldman LP, Gudenkauf L, Lee SJ, Joffe H, Addington EL, Moskowitz JT, Huffman JC, El-Jawahri A. A Positive Psychology Intervention for Caregivers of Hematopoietic Stem Cell Transplantation Survivors (PATH-C): Initial Testing and Single-Arm Pilot Trial. Transplant Cell Ther 2024; 30:448.e1-448.e14. [PMID: 38266964 PMCID: PMC11009093 DOI: 10.1016/j.jtct.2024.01.064] [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: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
Caregivers of patients with hematologic malignancies undergoing allogeneic hematopoietic stem cell transplantation (HSCT) play a crucial role in supporting their loved ones through physical, emotional, and practical challenges. This role has been associated with high levels of psychological distress and low levels of positive psychological well-being (PPWB). Positive psychology interventions for caregivers in other disease groups (eg, breast cancer) have been associated with improved outcomes. However, positive psychology interventions that specifically address HSCT caregivers' psychological needs are currently lacking. The goal of this single-arm open-pilot trial was to determine the feasibility and acceptability of the Positive Affect in the Transplantation of Hematopoietic Stem Cells (PATH) intervention for HSCT Caregivers to identify caregiver preferences to tailor PATH for HSCT caregivers. Adult caregivers of HSCT recipients were eligible for PATH during the HSCT recipient's first 100 d post-transplant. We defined, a priori, feasibility as >60% of participants who start the intervention completing ≥6/9 intervention sessions and acceptability as weekly ratings of ease and utility of the PP exercises ≥7/10 on a 10-point Likert Scale (0 = very difficult/not helpful; 10 = very easy/very helpful). We conducted semistructured qualitative exit interviews (n = 15) to explore HSCT caregivers' perception of PATH's content, benefits of PATH, as well as facilitators and barriers to engaging with the intervention. Transcribed interviews were analyzed using framework-guided rapid analysis by 2 coders. The intervention was feasible with 83% (15/18) of caregivers who started the intervention completing ≥6/9 intervention sessions. Among caregivers who completed ≥6/9 intervention sessions, ratings of ease (mean = 8.1; 95% CI: 7.4, 8.7) and utility (mean = 8.3; 95% CI: 7.8, 8.9) also exceeded our a priori threshold of ≥7/10. Caregivers identified benefits of PATH, including identifying and responding to emotions, dedicating time to self-care, and cultivating important relationships. Sociodemographic factors (eg, being retired) and the manualized structure of PATH were cited as facilitators to intervention engagement. Barriers to PATH engagement included lack of time and competing caregiving responsibilities. Caregivers preferred remote intervention delivery within the first 100 d post HSCT. This is the first study to show a 9-wk, phone-delivered positive psychology intervention is feasible in caregivers of allogeneic HSCT recipients. Our findings also underscore the specific preferences of this population for positive psychology interventions. Larger studies are warranted to establish the efficacy of these interventions in addressing persistent unmet psychological needs for HSCT caregivers.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Michelle Guo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Nikita Acharya
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lauren P Waldman
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Lisa Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Hadine Joffe
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeff C Huffman
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Mass General Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
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Brown L, Hunter MS, Chen R, Crandall CJ, Gordon JL, Mishra GD, Rother V, Joffe H, Hickey M. Promoting good mental health over the menopause transition. Lancet 2024; 403:969-983. [PMID: 38458216 DOI: 10.1016/s0140-6736(23)02801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/01/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
The potential risk for mental health conditions over the menopause transition shapes women's expectations and informs putative physiological mechanisms regulating women's mental health. We review evidence from prospective studies reporting on associations between mental health conditions and the menopause transition. Major depressive disorder and the more prevalent subthreshold depressive symptoms are the most common conditions studied. We reviewed 12 prospective studies reporting depressive symptoms, major depressive disorder, or both over the menopause transition and found no compelling evidence for a universal increased risk for either condition. However, specific subgroups of participants, primarily defined by menopause-related risk factors (ie, vasomotor symptoms that are severe or disturb sleep, a long duration of the transition, or reproductive hormone dynamics) and psychosocial risk factors (eg, stressful life events), were vulnerable to depressive symptoms. The increased risk of major depressive disorder over the menopause transition appears predominantly in individuals with previous major depressive disorder. Greater focus on recognising risk factors in primary care is warranted. On the basis of scarce data, we found no compelling evidence that risk of anxiety, bipolar disorder, or psychosis is universally elevated over the menopause transition. Potential misattribution of psychological distress and psychiatric disorders to menopause could harm women by delaying accurate diagnosis and the initiation of effective psychotropic treatments, and by creating negative expectations for people approaching menopause. A paradigm shift is needed. We conclude with recommendations for the detection and treatment of depressive symptoms or major depressive disorder and strategies to promote good mental health over the menopause transition, while responsibly preparing and supporting those at risk.
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Affiliation(s)
- Lydia Brown
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; Academic Research Collaborative in Health, La Trobe University, Bundoora, VIC, Australia; Healthscope Hospitals, Melbourne, VIC, Australia.
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rong Chen
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | | | - Gita D Mishra
- NHMRC Centre for Research Excellence in Women and NCDs, School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Viktoria Rother
- Inner West Area Mental Health Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia
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Crespi CM, Ganz PA, Partridge AH, Wolff A, Joffe H, Irwin MR, Thure K, Petersen L, Shih YCT, Bower JE. Work Productivity Among Younger Breast Cancer Survivors: The Impact of Behavioral Interventions for Depression. Value Health 2024; 27:322-329. [PMID: 38135214 DOI: 10.1016/j.jval.2023.12.004] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES The Pathways to Wellness randomized controlled trial found that 2 behavioral interventions, mindfulness awareness practices and survivorship education, reduced depressive symptoms in younger breast cancer survivors (BCSs) compared with wait-list control. This secondary analysis examines whether the interventions led to reduced loss of work productivity among younger BCSs and whether such reductions were mediated by reductions in depressive symptoms. METHODS The Work Productivity and Activity Impairment scale was used to measure work productivity loss at 4 assessment time points. Correlates of productivity loss at enrollment were examined using multivariable linear regression. Differences in change over time in productivity loss between each intervention group and control were assessed using linear mixed models. Reduced depressive symptoms were tested as a mediator of reduced productivity loss. RESULTS Of 247 trial participants, 199 were employed and included in the analyses. At enrollment, higher productivity loss was associated with chemotherapy receipt (P = .003), younger age (P = .021), more severe cognitive problems (P = .002), higher musculoskeletal pain severity (P = .002), more depressive symptoms (P = .016), and higher fatigue severity (P = .033). The mindfulness intervention led to significantly less productivity loss compared with control at all 3 postintervention assessment points (all P < .05), with about 54% of the effect mediated by reduction in depressive symptoms. Survivorship education was not associated with reduced loss of productivity. CONCLUSIONS These findings suggest that addressing depressive symptoms through behavioral interventions, such as mindfulness, may mitigate impacts on work productivity in younger BCSs.
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Affiliation(s)
- Catherine M Crespi
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Medicine (Hematology-Oncology), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Antonio Wolff
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael R Irwin
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Katie Thure
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Ya-Chen Tina Shih
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Julienne E Bower
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA; Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Grant LK, Gooley JJ, St Hilaire MA, Joffe H, Brainard GC, Van Reen E, Rüger M, Rajaratnam SMW, Lockley SW, Czeisler CA, Rahman SA. A pilot study of light exposure as a countermeasure for menstrual phase-dependent neurobehavioral performance impairment in women. Sleep Health 2024; 10:S34-S40. [PMID: 37748973 PMCID: PMC10959759 DOI: 10.1016/j.sleh.2023.08.012] [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: 03/01/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE To examine effects of menstrual phase and nighttime light exposure on subjective sleepiness and auditory Psychomotor Vigilance Task performance. METHODS Twenty-nine premenopausal women (12 =Follicular; 17 =Luteal) completed a 6.5-hour nighttime monochromatic light exposure with varying wavelengths (420-620 nm) and irradiances (1.03-14.12 µW/cm2). Subjective sleepiness, reaction time, and attentional lapses were compared between menstrual phases in women with minimal (<33%) or substantial (≥33%) light-induced melatonin suppression. RESULTS When melatonin was not suppressed, women in the follicular phase had significantly worse reaction time (mean difference=145.1 ms, 95% CI 51.8-238.3, p < .001, Cohen's D=1.9) and lapses (mean difference=12.9 lapses, 95% CI 4.37-21.41, p < .001, Cohen's D=1.7) compared to women in the luteal phase. When melatonin was suppressed, women in the follicular phase had significantly better reaction time (mean difference=152.1 ms, 95% CI 43.88-260.3, p < .001, Cohen's D=1.7) and lapses (mean difference=12.3 lapses, 95% CI 1.14-25.6, p < .01, Cohen's D=1.6) compared to when melatonin was not suppressed, such that their performance was not different (p > .9) from women in the luteal phase. Subjective sleepiness did not differ by menstrual phase (mean difference=0.6, p > .08) or melatonin suppression (mean difference=0.2, p > .4). CONCLUSIONS Nighttime light exposure sufficient to suppress melatonin can also mitigate neurobehavioral performance deficits associated with the follicular phase. Despite the relatively small sample size, these data suggest that nighttime light may be a valuable strategy to help reduce errors and accidents in female shift workers.
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Affiliation(s)
- Leilah K Grant
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA; Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Joshua J Gooley
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A St Hilaire
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA; Department of Computer and Data Sciences, School of Science and Engineering, Merrimack College, North Andover, Massachusetts, USA
| | - Hadine Joffe
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA; Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Women's Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George C Brainard
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eliza Van Reen
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Melanie Rüger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Shantha M W Rajaratnam
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven W Lockley
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Shadab A Rahman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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5
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Oken E, Rifas-Shiman SL, Joffe H, Manson JE, Spagnolo PA, Bertisch SM, Klerman EB, Chavarro JE. Associations of adverse childhood and lifetime experiences with sleep quality and duration among women in midlife. Sleep Health 2023; 9:860-867. [PMID: 37923668 PMCID: PMC10840935 DOI: 10.1016/j.sleh.2023.09.003] [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: 05/03/2023] [Revised: 07/24/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Many women experience sleep problems during midlife. Associations of adverse lifetime experiences-more common among women-with sleep outcomes are understudied. METHODS We studied 476 women enrolled in Project Viva 1999-2002. At enrollment, participants reported any lifetime history of abuse and/or financial hardship. At midlife follow-up ∼20 years later, they reported a history of up to 10 adverse childhood experiences (ACEs); 7-day sleep quality (patient-reported outcomes measurement information system sleep disturbance and sleep-related impairment T-scores); and past month average sleep duration. We examined associations of adverse experiences with sleep outcomes, adjusted for childhood sociodemographic variables. We also explored mediation by current depression and anxiety symptoms, hot flash severity, general health, and body mass index. RESULTS ACEs were common: 301 women (63%) reported one or more. Each additional ACE was associated with higher midlife sleep disturbance (adjusted β = 0.65 points, 95% confidence interval [CI]: 0.27, 1.02) and sleep-related impairment (0.98, 95% CI: 0.54, 1.41) T-scores, and with sleep duration <6 hour/night (odds ratio 1.19, 95% CI: 1.00, 1.42), but not with continuous sleep duration (-2 minutes, 95% CI: -5, 1). Adverse experiences in adulthood were less consistently associated with sleep quality but were associated with sleep duration, for example, financial hardship during the index pregnancy was associated with 75 minutes (95% CI: -120, -29) shorter sleep duration 2 decades later. Associations of ACEs with sleep disturbance and sleep-related impairment were mediated by midlife depression anxiety and physical health but not by hot flash severity or body mass index. CONCLUSIONS Adverse lifetime experiences have deleterious associations with sleep duration and quality in midlife women.
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Affiliation(s)
- Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | | | - Hadine Joffe
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Connors Center for Women Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - JoAnn E Manson
- Connors Center for Women Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Primavera Alessandra Spagnolo
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Connors Center for Women Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Suzanne M Bertisch
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Elizabeth B Klerman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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Cohn AY, Grant LK, Nathan MD, Wiley A, Abramson M, Harder JA, Crawford S, Klerman EB, Scheer FAJL, Kaiser UB, Rahman SA, Joffe H. Effects of Sleep Fragmentation and Estradiol Decline on Cortisol in a Human Experimental Model of Menopause. J Clin Endocrinol Metab 2023; 108:e1347-e1357. [PMID: 37207451 PMCID: PMC10584010 DOI: 10.1210/clinem/dgad285] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023]
Abstract
CONTEXT Perturbations to the hypothalamic-pituitary-adrenal (HPA) axis have been hypothesized to increase postmenopausal cardiometabolic risk. Although sleep disturbance, a known risk factor for cardiometabolic disease, is prevalent during the menopause transition, it is unknown whether menopause-related sleep disturbance and estradiol decline disturb the HPA axis. OBJECTIVE We examined the effect of experimental fragmentation of sleep and suppression of estradiol as a model of menopause on cortisol levels in healthy young women. METHODS Twenty-two women completed a 5-night inpatient study during the mid-to-late follicular phase (estrogenized). A subset (n = 14) repeated the protocol after gonadotropin-releasing hormone agonist-induced estradiol suppression. Each inpatient study included 2 unfragmented sleep nights followed by 3 experimental sleep fragmentation nights. This study took place with premenopausal women at an academic medical center. Interventions included sleep fragmentation and pharmacological hypoestrogenism, and main outcome measures were serum bedtime cortisol levels and cortisol awakening response (CAR). RESULTS Bedtime cortisol increased 27% (P = .03) and CAR decreased 57% (P = .01) following sleep fragmentation compared to unfragmented sleep. Polysomnographic-derived wake after sleep-onset (WASO) was positively associated with bedtime cortisol levels (P = .047) and negatively associated with CAR (P < .01). Bedtime cortisol levels were 22% lower in the hypoestrogenized state compared to the estrogenized state (P = .02), while CAR was similar in both estradiol conditions (P = .38). CONCLUSION Estradiol suppression and modifiable menopause-related sleep fragmentation both independently perturb HPA axis activity. Sleep fragmentation, commonly seen in menopausal women, may disrupt the HPA axis, which in turn may lead to adverse health effects as women age.
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Affiliation(s)
- Aviva Y Cohn
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital (BWH), Harvard Medical School (HMS), Boston, MA 02115, USA
- Women's Hormones and Aging Research Program, Department of Psychiatry, BWH, HMS, Boston, MA 02115, USA
- Connors Center for Women's Health and Gender Biology, BWH, HMS, Boston, MA 02115, USA
| | - Leilah K Grant
- Connors Center for Women's Health and Gender Biology, BWH, HMS, Boston, MA 02115, USA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, BWH, Boston, MA 02115, USA
- Division of Sleep Medicine, HMS, Boston, MA 02115, USA
| | - Margo D Nathan
- Women's Hormones and Aging Research Program, Department of Psychiatry, BWH, HMS, Boston, MA 02115, USA
| | - Aleta Wiley
- Women's Hormones and Aging Research Program, Department of Psychiatry, BWH, HMS, Boston, MA 02115, USA
- Connors Center for Women's Health and Gender Biology, BWH, HMS, Boston, MA 02115, USA
| | - Mathena Abramson
- Women's Hormones and Aging Research Program, Department of Psychiatry, BWH, HMS, Boston, MA 02115, USA
- Connors Center for Women's Health and Gender Biology, BWH, HMS, Boston, MA 02115, USA
| | - Jessica A Harder
- Women's Hormones and Aging Research Program, Department of Psychiatry, BWH, HMS, Boston, MA 02115, USA
| | - Sybil Crawford
- Tan Chingfen Graduate School of Nursing at UMass Chan Medical School, Worcester, MA 01605, USA
| | - Elizabeth B Klerman
- Connors Center for Women's Health and Gender Biology, BWH, HMS, Boston, MA 02115, USA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, BWH, Boston, MA 02115, USA
- Division of Sleep Medicine, HMS, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, HMS, Boston, MA 02114, USA
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, BWH, Boston, MA 02115, USA
- Division of Sleep Medicine, HMS, Boston, MA 02115, USA
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital (BWH), Harvard Medical School (HMS), Boston, MA 02115, USA
| | - Shadab A Rahman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, BWH, Boston, MA 02115, USA
- Division of Sleep Medicine, HMS, Boston, MA 02115, USA
| | - Hadine Joffe
- Women's Hormones and Aging Research Program, Department of Psychiatry, BWH, HMS, Boston, MA 02115, USA
- Connors Center for Women's Health and Gender Biology, BWH, HMS, Boston, MA 02115, USA
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Nathan M, Beatty L, Coborn J, Wiley A, Srivastava A, Russell J, Joffe H. Targeting psychological and menopausal factors linked to non-adherence to anti-estrogen therapy in women with early-stage hormone-receptor positive breast cancer: A web-based feasibility study of Finding My Way. Psychooncology 2023; 32:1461-1465. [PMID: 37496178 DOI: 10.1002/pon.6195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/02/2023] [Revised: 05/26/2023] [Accepted: 07/16/2023] [Indexed: 07/28/2023]
Abstract
Key Points
Reduced adherence to anti‐estrogen therapy (AET; tamoxifen and aromatase inhibitors) in women with early‐stage hormone‐receptor‐positive (HR+) breast cancers leads to adverse clinical outcomes.
Modifiable psychological factors (e.g., depressive symptoms and anxiety) and menopausal symptoms (e.g., sleep disturbance and hot flashes) are linked with diminished adherence.
An intervention targeting psychological and menopausal symptoms has potential to improve AET adherence.
We conducted a pilot study to evaluate the feasibility of a remotely administered behavioral intervention in women with early‐stage HR+ breast cancer taking AET at‐risk for non‐adherence with psychological and menopausal symptoms.
Findings from this preliminary study show that a web‐based behavioral intervention is feasible and may be a potential method of reducing risk for AET non‐adherence in some patients.
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Affiliation(s)
- Margo Nathan
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa Beatty
- Flinders University Institute of Mental Health & Wellbeing, College of Education, Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Jamie Coborn
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aleta Wiley
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akanksha Srivastava
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julia Russell
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hadine Joffe
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology, Dana Farber Cancer Center, Boston, Massachusetts, USA
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Swanson LM, Hood MM, Hall MH, Avis NE, Joffe H, Colvin A, Ruppert K, Kravitz HM, Neal-Perry G, Derby CA, Hess R, Harlow SD. Sleep timing, sleep regularity, and psychological health in early late life women: Findings from the Study of Women's Health Across the Nation (SWAN). Sleep Health 2023; 9:203-210. [PMID: 36509657 PMCID: PMC10478033 DOI: 10.1016/j.sleh.2022.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/06/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the associations of actigraphy-assessed sleep timing and regularity with psychological health in early late life women, whose circadian rhythms may be impacted by aging. DESIGN Cross-sectional. PARTICIPANTS A racially/ethnically diverse sample of 1197 community-dwelling women (mean age 65 years) enrolled in the Study of Women's Health Across the Nation. MEASURES Actigraphy-assessed sleep measures included timing (mean midpoint from sleep onset to wake-up) and regularity (standard deviation of midpoint in hours). Psychological health measures included a composite well-being score, the Center for Epidemiological Studies Depression Scale, and the Generalized Anxiety Disorder-7 Scale. Linear and logistic regression models, adjusted for covariates (including sleep duration), tested associations between sleep and psychological health measures. RESULTS After covariate adjustment, a sleep midpoint outside of 2:00-4: 00 AM was significantly associated with depressive symptoms (β = 0.88, 95% CI = 0.06, 1.70) and scoring above the cut-point for clinically significant depressive symptoms (OR = 1.72, 95% CI = 1.15, 2.57). Sleep irregularity was significantly associated with lower psychological well-being (β = -0.18, 95% CI = -0.33, -0.03), depressive (β = 1.36, 95% CI = 0.29, 2.44) and anxiety (β = 0.93, 95% CI = 0.40, 1.46) symptoms, and scoring above the cut-point for clinically significant depressive (OR = 1.68, 95% CI = 1.01, 2.79) and anxiety (OR = 1.62, 95% CI = 1.07, 2.43) symptoms. CONCLUSION Above and beyond sleep duration, a sleep midpoint outside of 2:00-4:00 AM was associated with depressive symptoms while sleep irregularity was associated with multiple psychological health domains in late life women.
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Affiliation(s)
- Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
| | - Michelle M Hood
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia Colvin
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristine Ruppert
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Howard M Kravitz
- Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carol A Derby
- The Saul R. Korey Department of Neurology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Hess
- Department of Population Health Sciences, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Siobán D Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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9
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Simon JA, Anderson RA, Ballantyne E, Bolognese J, Caetano C, Joffe H, Kerr M, Panay N, Seitz C, Seymore S, Trower M, Zuurman L, Pawsey S. Efficacy and safety of elinzanetant, a selective neurokinin-1,3 receptor antagonist for vasomotor symptoms: a dose-finding clinical trial (SWITCH-1). Menopause 2023; 30:239-246. [PMID: 36720081 PMCID: PMC9970022 DOI: 10.1097/gme.0000000000002138] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Neurokinin (NK)-3 and NK-1 receptors have been implicated in the etiology of vasomotor symptoms (VMS) and sleep disturbances associated with menopause. This phase 2b, adaptive, dose-range finding study aimed to assess the efficacy and safety of multiple doses of elinzanetant (NT-814), a selective NK-1,3 receptor antagonist, in women experiencing VMS associated with menopause, and investigate the impact of elinzanetant on sleep and quality of life. METHODS Postmenopausal women aged 40 to 65 years who experienced seven or more moderate-to-severe VMS per day were randomized to receive elinzanetant 40, 80, 120, or 160 mg or placebo once daily using an adaptive design algorithm. Coprimary endpoints were reduction in mean frequency and severity of moderate-to-severe VMS at weeks 4 and 12. Secondary endpoints included patient-reported assessments of sleep and quality of life. RESULTS Elinzanetant 120 mg and 160 mg achieved reductions in VMS frequency versus placebo from week 1 throughout 12 weeks of treatment. Least square mean reductions were statistically significant versus placebo at both primary endpoint time points for elinzanetant 120 mg (week 4: -3.93 [SE, 1.02], P < 0.001; week 12: -2.95 [1.15], P = 0.01) and at week 4 for elinzanetant 160 mg (-2.63 [1.03]; P = 0.01). Both doses also led to clinically meaningful improvements in measures of sleep and quality of life. All doses of elinzanetant were well tolerated. CONCLUSIONS Elinzanetant is an effective and well-tolerated nonhormone treatment option for postmenopausal women with VMS and associated sleep disturbance. Elinzanetant also improves quality of life in women with VMS.
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Affiliation(s)
- James A. Simon
- From the George Washington University, IntimMedicine Specialists, Washington, DC
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | - Hadine Joffe
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mary Kerr
- NeRRe Therapeutics, Stevenage, United Kingdom
| | - Nick Panay
- Queen Charlotte's and Chelsea and Westminster Hospitals, Imperial College, London, United Kingdom
| | | | | | - Mike Trower
- NeRRe Therapeutics, Stevenage, United Kingdom
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10
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Bower JE, Partridge AH, Wolff AC, Cole SW, Irwin MR, Thorner ED, Joffe H, Petersen L, Crespi CM, Ganz PA. Improving biobehavioral health in younger breast cancer survivors: Pathways to Wellness trial secondary outcomes. J Natl Cancer Inst 2023; 115:83-92. [PMID: 36130057 PMCID: PMC9830488 DOI: 10.1093/jnci/djac180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The Pathways to Wellness trial tested the efficacy of 2 interventions for younger breast cancer survivors: mindful awareness practices (MAPs) and survivorship education (SE). This planned secondary analysis examines intervention effects on stress, positive psychological outcomes, and inflammation (Clincaltrials.gov NCT03025139). METHODS Women diagnosed with breast cancer at or before age 50 years who had completed treatment and had elevated depressive symptoms were randomly assigned to 6 weeks of MAPs, SE, or wait-list control (WLC). Assessments conducted at pre- and postintervention and at 3- and 6-month follow-up measured general stress perceptions, cancer-related intrusive thoughts and worry, positive affect, meaning and peace in life, altruism and empathy, and markers of inflammation. Analyses compared change in outcomes over time in each intervention group relative to WLC using linear mixed models. RESULTS A total 247 women were randomly assigned to MAPs (n = 85), SE (n = 81), or WLC (n = 81). MAPs statistically significantly decreased intrusive thoughts and worry at postintervention and 3-month follow-up relative to WLC (P < .027) and statistically significantly increased positive affect and meaning and peace at postintervention, with positive affect persisting at 3-month follow-up (P < .027). SE statistically significantly decreased intrusive thoughts at 3-month follow-up and statistically significantly increased positive affect at 6-month follow-up relative to WLC (P < .01). Proinflammatory gene expression increased in WLC relative to MAPs (P = .016) but did not differ from SE. There were no intervention effects on other outcomes. CONCLUSION MAPs had beneficial effects on psychological and immune outcomes in younger breast cancer survivors and is a promising approach for enhancing biobehavioral health.
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Affiliation(s)
- Julienne E Bower
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Steve W Cole
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine (Hematology-Oncology), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael R Irwin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elissa D Thorner
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Catherine M Crespi
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine (Hematology-Oncology), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
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11
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Christmas M, Janssen I, Joffe H, Upchurch D, Santoro N, Kravitz HM. Menopause hormone therapy and complementary alternative medicine, quality of life, and racial/ethnic differences: the Study of Women's Health Across the Nation (SWAN). Menopause 2022; 29:1357-1364. [PMID: 36256923 PMCID: PMC9901179 DOI: 10.1097/gme.0000000000002087] [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: 02/08/2023]
Abstract
OBJECTIVE We hypothesized that, among midlife women with vasomotor and/or genitourinary symptoms of menopause, (1) hormone therapy (HT) compared with complementary alternative medicine (CAM) will be associated with higher quality of life (QoL), and (2) race/ethnicity would modify associations of HT and CAM with QoL. METHODS Cross-sectional and longitudinal analyses of QoL in the Study of Women's Health Across the Nation participants using HT, CAM, or both. Women ( n = 2,514) completed a CAM use questionnaire and QoL assessments at baseline and every 1 to 2 years from 2002 to 2013. Associations between QoL and treatment, adjusted for covariates, and race/ethnicity-by-treatment interactions were analyzed using linear and mixed effects regression models. RESULTS During 7.8 (SD, 2.9) years of follow-up, 732 women (29%) reported HT of 2.4 (SD, 1.7) years, and 798 women (32%) reported CAM use of 2.1 (SD, 1.4) years. Overall, neither HT nor CAM was associated with QoL. However, the treatment-by-race/ethnicity interaction was significant for self-reported QoL ( P = 0.034 at baseline, P = 0.044 longitudinal). Among White women, self-reported QoL was higher in HT-only users than in those who used neither ( P = 0.030; d = 0.11; 95% confidence interval, 0.01-0.21). In contrast, Black women using HT only had lower self-reported QoL compared with Black women using neither ( P = 0.027; d = -0.21; 95% confidence interval, -0.40 to -0.02). CONCLUSION Comparisons between treatment type within each racial/ethnic group yielded significant differences in self-reported QoL. Clinicians should be aware of racial/ethnic differences in treatment preferences when counseling patients on treatment options for menopausal symptoms to provide optimal care. VIDEO SUMMARY http://links.lww.com/MENO/B33 .
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Affiliation(s)
| | | | - Hadine Joffe
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Dawn Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
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12
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NADKARNI ASHWINI, Robins H, Altman A, Steger C, Shah S, Farah S, Joffe H, Levy-Carrick NC. (142) A Pilot of Academic Coordination Enhances Faculty Learning, Career Development and Professional Equity. J Acad Consult Liaison Psychiatry 2022. [DOI: 10.1016/j.jaclp.2022.10.144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Faleschini S, Tiemeier H, Rifas-Shiman SL, Rich-Edwards J, Joffe H, Perng W, Shifren J, Chavarro JE, Hivert MF, Oken E. Longitudinal associations of psychosocial stressors with menopausal symptoms and well-being among women in midlife. Menopause 2022; 29:1247-1253. [PMID: 36099555 PMCID: PMC9613623 DOI: 10.1097/gme.0000000000002056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/04/2023]
Abstract
OBJECTIVE We examined longitudinal associations of psychosocial stressors with menopausal symptoms and well-being of women in midlife in a longitudinal cohort. METHODS This study is based on 682 women from Project Viva, a prospective cohort enrolled in 1999 to 2002 during pregnancy (median age = 33.3 y) and followed for almost two decades. In pregnancy, women self-reported psychosocial stressors (history of physical and sexual abuse and financial instability, from childhood to the current pregnancy). In 2017 to 2021 (median age, 51.6 y), they reported their menopausal symptoms (0-44 point scale) and well-being (general health [good/fair/poor vs excellent/very good], generalized anxiety symptoms, and depressive symptoms [both-more than minimal levels vs none/minimal]). We performed multivariable and logistic regression models to examine associations of psychosocial stressors with outcomes, adjusting for covariates. RESULTS History of physical abuse (reported by 37.3%) was associated with worse menopausal symptoms in the somatovegetative (odds ratio [OR], 0.46 points; 95% confidence interval [CI], 0.04-0.87 points) and psychological (OR, 0.52 points; 95% CI, 0.07-0.97 points) domains and with worse general health (OR, 1.73; 95% CI, 1.17-2.55) and greater depressive symptoms (OR, 1.74; 95% CI, 1.05-2.87). History of sexual abuse (7.7%) was associated with worse menopausal symptoms (OR, 2.81 points; 95% CI, 1.05-4.56) and worse general health (OR, 2.04; 95% CI, 1.04-4.03) but not with depressive symptoms. History of financial instability (10.8%) was associated with worse menopausal symptoms (1.92 points; 0.49 to 3.34), worse general health (OR, 2.16; 95% CI, 1.24-3.75), and greater depressive symptoms (OR, 2.68; 95% CI, 1.44-4.98). We observed no association between psychosocial stressors and generalized anxiety symptoms assessed at midlife. CONCLUSIONS Psychosocial stressors were associated with worse menopausal symptoms and well-being decades after initial report.
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Affiliation(s)
- Sabrina Faleschini
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Henning Tiemeier
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Sheryl L. Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Janet Rich-Edwards
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Hadine Joffe
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA
| | - Wei Perng
- Department of Epidemiology, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jan Shifren
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Jorge E. Chavarro
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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14
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Coborn J, de Wit A, Crawford S, Nathan M, Rahman S, Finkelstein L, Wiley A, Joffe H. Disruption of Sleep Continuity During the Perimenopause: Associations with Female Reproductive Hormone Profiles. J Clin Endocrinol Metab 2022; 107:e4144-e4153. [PMID: 35878624 PMCID: PMC9516110 DOI: 10.1210/clinem/dgac447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Nocturnal vasomotor symptoms (nVMS), depressive symptoms (DepSx), and female reproductive hormone changes contribute to perimenopause-associated disruption in sleep continuity. Hormonal changes underlie both nVMS and DepSx. However, their association with sleep continuity parameters resulting in perimenopause-associated sleep disruption remains unclear. OBJECTIVE We aimed to determine the association between female reproductive hormones and perimenopausal sleep discontinuity independent of nVMS and DepSx. METHODS Daily sleep and VMS diaries, and weekly serum assays of female reproductive hormones were obtained for 8 consecutive weeks in 45 perimenopausal women with mild DepSx but no primary sleep disorder. Generalized estimating equations were used to examine associations of estradiol, progesterone, and follicle stimulating hormone (FSH) with mean number of nightly awakenings, wakefulness after sleep onset (WASO) and sleep-onset latency (SOL) adjusting for nVMS and DepSx. RESULTS Sleep disruption was common (median 1.5 awakenings/night, WASO 24.3 and SOL 20.0 minutes). More awakenings were associated with estradiol levels in the postmenopausal range (β = 0.14; 95% CI, 0.04 to 0.24; P = 0.007), and higher FSH levels (β [1-unit increase] = 0.12; 95% CI, 0.02 to 0.22; P = 0.02), but not with progesterone (β [1-unit increase] = -0.02; 95% CI, -0.06 to 0.01; P = 0.20) in adjusted models. Female reproductive hormones were not associated with WASO or SOL. CONCLUSION Associations of more awakenings with lower estradiol and higher FSH levels provide support for a perimenopause-associated sleep discontinuity condition that is linked with female reproductive hormone changes, independent of nVMS and DepSx.
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Affiliation(s)
| | | | - Sybil Crawford
- Tan Chingfen Graduate School of Nursing at UMass Chan Medical School, Worcester, MA, 01605, United States
| | - Margo Nathan
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
| | - Shadab Rahman
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, 02115, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, United States
| | - Lauren Finkelstein
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
| | - Aleta Wiley
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, United States
| | - Hadine Joffe
- Correspondence: Hadine Joffe, MD MSc, Brigham and Women’s Hospital, Thorn 1117, 75 Francis St, Boston MA 02115-6106, USA.
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15
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Ensrud KE, Larson JC, Guthrie KA, Crandall CJ, LaCroix AZ, Reed SD, Bhasin S, Mitchell CM, Joffe H. Changes in serum endogenous estrogen concentrations are mediators of the effect of low-dose oral estradiol on vasomotor symptoms. Menopause 2022; 29:1014-1020. [PMID: 35969887 PMCID: PMC9472527 DOI: 10.1097/gme.0000000000002026] [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: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to quantify changes in serum total estradiol (E2) and estrone (E1) concentrations with initiation of low-dose oral estradiol treatment and evaluate whether changes in concentrations mediate the effect of treatment in reducing vasomotor symptom (VMS) frequency. METHODS We analyzed baseline and week 8 (W8) data from 171 perimenopausal and postmenopausal women with VMS enrolled in low-dose 17β estradiol ( n = 72) and placebo ( n = 99) groups of a randomized clinical trial. RESULTS From baseline to W8, women in the low-dose estradiol group had a fourfold increase in E2, resulting in a W8 E2 of 23 pg/mL, and a fivefold increase in E1, resulting in a W8 E1 of 110.7 pg/mL. In contrast, E2 and E1 among women in the placebo group were unchanged from baseline to W8. Changes in E2 and E1 from baseline to W8 met criteria for mediating the effect of low-dose estradiol treatment on VMS frequency. With change in estrogen concentration added to treatment assignment in a regression model predicting W8 VMS frequency, the effect of treatment with low-dose estradiol versus placebo was attenuated, with change in E2 representing a 44.1% reduction ( P = 0.03) and change in E1 representing a 69.5% reduction ( P = 0.02) in total intervention effect. CONCLUSION Among perimenopausal and postmenopausal women with VMS, treatment with low-dose oral estradiol versus placebo results in four- to fivefold increases in serum E2 and E1. The increases in serum E2 and E1 with low-dose oral estradiol treatment seem to mediate in part the effect of treatment in reducing VMS frequency.
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Affiliation(s)
- Kristine E. Ensrud
- Department of Medicine and Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN
- Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN
| | - Joseph C. Larson
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle WA
| | | | - Carolyn J. Crandall
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California – San Diego, La Jolla, CA
| | - Susan D. Reed
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Shalender Bhasin
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Caroline M. Mitchell
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA
| | - Hadine Joffe
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Connors Center For Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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16
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Grant LK, Coborn JE, Cohn A, Nathan MD, Scheer FAJL, Klerman EB, Kaiser UB, Harder J, Abramson M, Elguenaoui E, Russell JA, Wiley A, Rahman SA, Joffe H. Sleep Fragmentation and Estradiol Suppression Decrease Fat Oxidation in Premenopausal Women. J Clin Endocrinol Metab 2022; 107:e3167-e3176. [PMID: 35569055 PMCID: PMC9282266 DOI: 10.1210/clinem/dgac313] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Body fat gain associated with menopause has been attributed to estradiol (E2) withdrawal. Hypoestrogenism is unlikely to be the only contributing factor, however. OBJECTIVE Given the links between sleep and metabolic health, we examined the effects of an experimental menopausal model of sleep fragmentation on energy metabolism. METHODS Twenty premenopausal women (age 21-45 years) underwent a 5-night inpatient study during the mid-to-late follicular phase (estrogenized; n = 20) and the same protocol was repeated in a subset of the participants (n = 9) following leuprolide-induced E2 suppression (hypo-estrogenized). During each 5-night study, there were 2 nights of unfragmented sleep followed by 3 nights of fragmented sleep. Indirect calorimetry was used to assess fasted resting energy expenditure (REE) and substrate oxidation. RESULTS Sleep fragmentation in the estrogenized state increased the respiratory exchange ratio (RER) and carbohydrate oxidation while decreasing fat oxidation (all P < 0.01). Similarly, in the hypo-estrogenized state without sleep fragmentation, RER and carbohydrate oxidation increased and fat oxidation decreased (all P < 0.01); addition of sleep fragmentation to the hypo-estrogenized state did not produce further effects beyond that observed for either intervention alone (P < 0.05). There were no effects of either sleep fragmentation or E2 state on REE. CONCLUSION Sleep fragmentation and hypoestrogenism each independently alter fasting substrate oxidation in a manner that may contribute to body fat gain. These findings are important for understanding mechanisms underlying propensity to body fat gain in women across the menopause transition.
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Affiliation(s)
- Leilah K Grant
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
- Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jamie E Coborn
- Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Aviva Cohn
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Margo D Nathan
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114,USA
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Jessica Harder
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mathena Abramson
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Elkhansaa Elguenaoui
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Julia A Russell
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Aleta Wiley
- Mary Horrigan Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Hadine Joffe
- Correspondence: Dr. Hadine Joffe, MD, MSc, Brigham and Women’s Hospital Harvard Medical School, 75 Francis Street, Thorn 1111, Boston, MA 02115, USA. Email
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Kravitz HM, Colvin AB, Avis NE, Joffe H, Chen Y, Bromberger JT. Risk of high depressive symptoms after the final menstrual period: the Study of Women's Health Across the Nation (SWAN). Menopause 2022; 29:805-815. [PMID: 35796553 PMCID: PMC9268212 DOI: 10.1097/gme.0000000000001988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/28/2023]
Abstract
OBJECTIVE To examine depressive symptoms during postmenopause and the contribution of depressive symptom trajectories before the final menstrual period (FMP) and psychosocial/health factors to postmenopause depressive symptoms. METHODS Longitudinal analysis of depressive symptoms (Center for Epidemiologic Studies-Depression scale) collected every 1 to 2 years from 1996 to 2017 from 1,551 midlife women in the Study of Women's Health Across the Nation for a median follow-up of 19.0 years. Latent class growth analysis identified depression trajectories from baseline to FMP. Multivariable random effects (woman as random effect) linear or logistic regression models were conducted. RESULTS Women had higher odds of reporting high depressive symptom score (≥16) during postmenopause than when they were premenopausal (OR = 1.49, 95% CI, 1.09-2.04), but not when perimenopausal. Three pre-FMP trajectories were identified: Group 1 (47.7%), consistently low scores, Group 2 (39.9%), moderate scores below the high depressive symptom threshold, and Group 3 (12.4%), consistently high scores. Both the moderate (OR = 2.62, 95% CI, 1.89-3.66) and high score (OR = 6.88, 95% CI, 4.72-10.02) groups, compared with the consistently low group, had significantly higher postmenopausal depressive symptom scores. Other pre-FMP variables associated with high postmenopausal depressive symptoms were: higher odds of childhood trauma/maltreatment, poor role physical, high anxiety symptoms, sleep problems, high vasomotor symptoms, and lower odds for chronological aging and lower social support. CONCLUSIONS Compared with premenopause, postmenopause remains a period of increased risk for higher depressive symptoms, especially for women with pre-FMP depressive symptoms. Pre-FMP depressive symptom trajectories are highly predictive of postmenopause depressive symptoms independent of health and psychosocial factors.
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Affiliation(s)
| | - Alicia B Colvin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Yuqing Chen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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18
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Spagnolo PA, Lorell BH, Joffe H. Preface to theme issue on women's health and clinical trials. Contemp Clin Trials 2022; 119:106837. [PMID: 35728741 DOI: 10.1016/j.cct.2022.106837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Primavera A Spagnolo
- Mary Horrigan Connors Center for Women's Health and Gender Biology, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | | | - Hadine Joffe
- Mary Horrigan Connors Center for Women's Health and Gender Biology, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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19
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Santoro NF, Coons HL, El Khoudary SR, Epperson CN, Holt-Lunstad J, Joffe H, Lindsey SH, Marlatt KL, Montella P, Richard-Davis G, Rockette-Wagner B, Salive ME, Stuenkel C, Thurston RC, Woods N, Wyatt H. NAMS 2021 Utian Translational Science SymposiumSeptember 2021, Washington, DCCharting the path to health in midlife and beyond: the biology and practice of wellness. Menopause 2022; 29:504-513. [PMID: 35486944 PMCID: PMC9248978 DOI: 10.1097/gme.0000000000001995] [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: 11/26/2022]
Abstract
ABSTRACT Charting the Path to Health in Midlife and Beyond: The Biology and Practice of Wellness was a Translational Science Symposium held on Tuesday, September 21, 2021. Foundational psychosocial and behavioral approaches to promote healthy aging and strategies to disseminate this information were discussed. The following synopsis documents the conversation, describes the state of the science, and outlines a path forward for clinical practice. Wellness, in its broadest sense, prioritizes an orientation toward health, and an embrace of behaviors that will promote it. It involves a journey to improve and maintain physical and mental health and overall well-being to fully engage and live one's best life. It is more about recognizing and optimizing what one can do than what one cannot do and emphasizes the individual's agency over changing what they are able to change. Wellness is therefore not a passive state but rather an active goal to be sought continually. When viewed in this fashion, wellness is accessible to all. The conference addressed multiple aspects of wellness and embraced this philosophy throughout.
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Affiliation(s)
| | - Helen L Coons
- University of Colorado School of Medicine, Aurora, CO
| | | | | | | | - Hadine Joffe
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Cynthia Stuenkel
- University of California at San Diego School of Medicine, San Diego, CA
| | | | - Nancy Woods
- University of Washington School of Medicine, Seattle, WA
| | - Holly Wyatt
- University of Alabama at Birmingham, Birmingham, AL
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20
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Rahman SA, Nathan MD, Wiley A, Crawford S, Cohn AY, Harder JA, Grant LK, Erickson A, Srivastava A, McCormick K, Bertisch SM, Winkelman JW, Joffe H. A double-blind, randomized, placebo-controlled trial of suvorexant for the treatment of vasomotor symptom-associated insomnia disorder in midlife women. Sleep 2022; 45:6503732. [DOI: 10.1093/sleep/zsac007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study Objectives
The neuropeptide orexin promotes wakefulness, modulates thermoregulation, increases after menopause, and is normalized in women receiving estrogen therapy, suggesting a role for orexin antagonism as a treatment for the vasomotor symptom (VMS)-associated insomnia disorder. We tested the efficacy of the dual orexin receptor antagonist suvorexant for chronic insomnia related to nighttime VMS.
Methods
In a double-blind, placebo-controlled trial, 56 women with chronic insomnia associated with nighttime VMS, Insomnia Severity Index (ISI) scores ≥15, and >30 min of diary-rated wake after sleep-onset (WASO) were randomized to receive oral suvorexant 10–20 mg (n = 27) or placebo (n = 29) nightly for 4 weeks. Analysis of within-person change in ISI was adjusted for baseline ISI and race.
Results
Mean baseline ISI scores were 18.1 (95% CI, 16.8 to 19.4) and 18.3 (95% CI, 17.2 to 19.5) in the suvorexant and placebo groups, respectively (p = .81). The average 4-week ISI within-person decrease from baseline was greater on suvorexant (−8.1 [95% CI, −10.2 to −6.0]) compared to placebo (−5.6 [95% CI, −7.4 to −3.9], p = .04). Compared to placebo, nighttime diary-rated VMS frequency was significantly reduced with suvorexant (p < .01). While diary-rated WASO and total sleep time trended toward improvement on suvorexant, findings were not significant after adjustment for multiple comparisons. Daytime VMS and other sleep-related outcomes did not differ between groups. Suvorexant was well tolerated.
Conclusion
These results suggest that suvorexant is likely a well-tolerated and efficacious treatment for VMS-associated insomnia disorder and reduces nighttime VMS. Antagonism of orexin receptors could provide a novel therapeutic option for midlife women with VMS-associated chronic insomnia.
Clinical Trial Information
Efficacy of Suvorexant in the Treatment of Hot Flash-associated Insomnia, https://clinicaltrials.gov/ct2/show/NCT03034018, ClinicalTrials.gov Identifier: NCT03034018.
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Affiliation(s)
- Shadab A Rahman
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Margo D Nathan
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Aleta Wiley
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sybil Crawford
- Tan Chingfen Graduate School of Nursing, UMASS Chan Medical School, Worcester, MA, USA
| | - Aviva Y Cohn
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica A Harder
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Leilah K Grant
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Athena Erickson
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Akanksha Srivastava
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen McCormick
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Suzanne M Bertisch
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - John W Winkelman
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hadine Joffe
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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21
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Sosinsky AZ, Rich-Edwards JW, Wiley A, Wright K, Spagnolo PA, Joffe H. Enrollment of female participants in United States drug and device phase 1-3 clinical trials between 2016 and 2019. Contemp Clin Trials 2022; 115:106718. [PMID: 35247632 DOI: 10.1016/j.cct.2022.106718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/16/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Historically, females have been underrepresented in clinical trials evaluating the safety and efficacy of investigational drugs and devices. We assessed participation by sex in recent clinical trials. METHODS We extracted data over a 4-year period (2016-2019) from ClinicalTrials.gov on US-based, pharmaceutical industry or government-funded Phase 1-3 clinical trials of drugs and devices. We included trials with adult cardiovascular, psychiatric, and cancer endpoints whose protocol planned to enroll both sexes. Average proportions of females enrolled per trial were described overall and by disease area. RESULTS Across 1433 trials including 302,664 participants in our analysis, on average, 41.2% were female. Females were underrepresented compared with their proportion of the disease population in cardiovascular disease trials (41.9% female participants vs. 49% female population with cardiovascular disease). In psychiatry, where females comprise 60% of patients, the mean participation of females in clinical trials was 42.0%. Similarly, for cancer trials, where 51% of patients are female, only 41.0% of cancer clinical trial participants were female. For each therapeutic area analyzed, the participation of females in clinical trials fell short of the benchmark derived from national prevalence data. CONCLUSIONS While the participation of females in clinical trials has improved compared to previous reports, sex-based gaps still persist between trial populations and those expected to use these drugs/devices based on distributions of diseases in the population. Given potential sex-based differences in treatment responses and toxicities, adequate inclusion of females in clinical trials remains critical.
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Affiliation(s)
- Alexandra Z Sosinsky
- The Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham & Women's Hospital, Boston, MA, United States of America; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham & Women's Hospital, Boston, MA, United States of America; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Janet W Rich-Edwards
- The Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham & Women's Hospital, Boston, MA, United States of America; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; Division of Women's Health, Department of Medicine, Brigham & Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Aleta Wiley
- The Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham & Women's Hospital, Boston, MA, United States of America; Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, United States of America
| | - Kalifa Wright
- The Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham & Women's Hospital, Boston, MA, United States of America
| | - Primavera A Spagnolo
- The Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham & Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, United States of America
| | - Hadine Joffe
- The Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham & Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, United States of America.
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22
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Bove R, Anderson A, Rowles W, Rankin KA, Hills NK, Carleton M, Cooper J, Cree BA, Gelfand JM, Graves J, Henry RG, Krysko KM, Rush G, Zamvil SS, Joffe H, Chan JR, Green A. A Hormonal therapy for menopausal women with MS: A Phase Ib/IIa Randomized Controlled Trial. Mult Scler Relat Disord 2022; 61:103747. [DOI: 10.1016/j.msard.2022.103747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/17/2022] [Indexed: 12/27/2022]
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23
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Harder JA, Fichorova RN, Srivastava A, Wiley A, Burdick KE, Locascio JJ, Joffe H. Brain-derived neurotrophic factor and mood in perimenopausal depression. J Affect Disord 2022; 300:145-149. [PMID: 34954335 PMCID: PMC8935344 DOI: 10.1016/j.jad.2021.12.092] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/18/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous work implicates high pro-inflammatory biomarkers in mood disturbance and low brain-derived neurotrophic factor (BDNF) levels in major depression. However, in hormonally-sensitive premenstrual dysphoric disorder (PMDD), BDNF levels are higher when mood is worse. Perimenopausal depression has not been studied to date. We evaluated whether BDNF and inflammatory cytokines predict mood symptoms across the menstrual cycle in hormonally-sensitive perimenopausal depression symptoms. METHODS Data from 49 time points derived from mid-to-late follicular phase [M/L-FP] and peri‑menstrual assessments of 14 perimenopausal women ages 38-52 with ovulatory menstrual cycles 24-35 days long across 1-2 cycles for mood symptoms, BDNF levels, cytokines, gonadal steroids. Depression was assessed with Montgomery-Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI); irritability with Kellner Symptom Questionnaire Anger-Hostility subscale (SQ); overall psychological distress with Profile of Mood States (POMS). Mixed models were run on dependent measures of MADRS (primary endpoint) and other mood outcomes (BDI, POMS, SQ) with independent variables of interest (each biomarker, cycle phase), controlling for cycle number and participant. RESULTS After FDR adjustment, BDNF levels showed consistent significant positive relationships to MADRS (β=0.00053; p = 0.0028), POMS (β=0.00153; p = 0.0394), SQ (β=0.00053; p = 0.0067), and BDI (β=0.00039; p = 0.0231). Cycle phase did not affect this relationship. No other biomarker consistently predicted affective symptom severity. LIMITATIONS Small sample size and large number of comparisons. CONCLUSION In women with perimenopausal depression symptoms, BDNF is elevated in association with more severe mood symptomatology, resembling the pattern in hormonally-sensitive PMDD and suggesting a hormonally-sensitive mood disorder biomarker profile distinct from that of major depression.
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Affiliation(s)
- Jessica A. Harder
- Department of Psychiatry, Brigham and Women’s
Hospital, Harvard Medical School
| | - Raina N. Fichorova
- Department of Obstetrics and Gynecology, Brigham and
Women’s Hospital, Harvard Medical School
| | - Akanksha Srivastava
- Department of Psychiatry, Brigham and Women’s
Hospital, Harvard Medical School
| | - Aleta Wiley
- Department of Psychiatry, Brigham and Women’s
Hospital, Harvard Medical School
| | | | - Joseph J. Locascio
- Department of Neurology, Massachusetts General Hospital,
Harvard Medical School
| | - Hadine Joffe
- Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, United States; Connors Center for Women's Health and Gender Biology, Harvard Medical School, Brigham and Women's Hospital, United States.
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24
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Rahman SA, Mayer EL, Poort H, Schrag D, Tung SC, Zhou ES, Wiley A, Finkelstein L, Elguenaoui E, Nolan M, Joffe H. Abstract P4-09-01: Incidence of patient-reported fatigue developing in patients receiving palbociclib and endocrine therapy for advanced HR+ HER2- breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-09-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Clinician-rated adverse event data from pivotal trials of the CDK4/6 inhibitor palbociclib (palbo) in patients (pts) with HR+ HER2- metastatic breast cancer (MBC) describe fatigue as a common non-hematologic toxicity. While palbo and endocrine therapy (ET) significantly improve outcomes compared to ET alone, in a pooled analysis of the PALOMA trials, rates of incident Common Terminology Criteria for Adverse Events (CTCAE) all-grade fatigue over 4.2 years of treatment approached 39.2%, with grade 3/4 at 2.5%. As these studies included only provider-rated CTCAE toxicity, it is important to quantify pts’ ratings of fatigue severity, which may differ from clinician assessments. Methods: Eligible pts with HR+ HER2- MBC, initiating standard-dose palbo with ET (aromatase inhibitor or fulvestrant), and without clinically meaningful fatigue prior to initiation of palbo, were followed for the 6 initial treatment cycles. The absence of baseline fatigue was established using the patient-reported Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F), a 13-item scale (range 0-52, lower score = more fatigue) validated against anemia to indicate clinically meaningful fatigue if FACIT-F score <34. After screening and baseline assessments (several weeks apart), the FACIT-F was repeated during the 3rd week of 6 consecutive cycles. Pts also reported fatigue severity using the NCI Patient-Reported Outcomes for CTCAE (PRO-CTCAE; range 0-4; grade 3/4 = severe) when they completed the FACIT-F. The primary endpoint was new-onset fatigue (FACIT-F score <34) after treatment initiation; the secondary endpoint was severe fatigue on the PRO-CTCAE fatigue severity item. Incident rate of fatigue was estimated based on frequencies (dichotomized FACIT-F scores <34 vs. >=34; PRO-CTCAE fatigue severity grade 3/4 vs. <3). Rate of fatigue incidence on the FACIT-F in the presence of competing risks (e.g., disease progression or study burden) was estimated using the cumulative incidence function. Concurrently rated FACIT-F scores were compared between PRO-CTCAE severe and non-severe cases using linear mixed-models. Results: Of 115 pts enrolled (5/2018-1/2021), 88 were evaluable after excluding those not initiating palbo (n=3), without baseline data (n=13), or with clinically meaningful fatigue between screening and baseline (n=11). Mean (±SD) age was 59.4 ± 11.3, baseline FACIT-fatigue score was 44.4 ± 5.1, and follow-up duration was 5.8 ± 2.0 cycles. The majority (72%) were receiving palbo with letrozole. New-onset fatigue through the 6th treatment cycle was observed in 21 pts, translating to a fatigue incidence rate of 23.9% (95% CI 15.4% - 34.1%). The mean time to new-onset fatigue was 3.8 ± 1.7 treatment cycles. Those who withdrew early (n=26) completed data for 3.7 ± 2.1 treatment cycles; the cumulative incidence of fatigue at 4 treatment cycles was 18.2% (95% CI 10.9 - 26.9). Using the PRO-CTCAE, the incidence rate of severe fatigue was 14.8% (95% CI 8.1% - 23.9%). The mean FACIT-F score when PRO-CTCAE grade indicated severe fatigue was significantly lower (more fatigue) than when the PRO-CTCAE grade was non-severe (26.3 ± 5.1 vs. 44.8 ± 4.8, p<0.0001). Conclusion: In pts with HR+ HER2- MBC initiating palbo and ET, approximately one-quarter develop fatigue within the first 6 cycles based on the FACIT-F, which associates significantly with a PRO-CTCAE severity grade 3/4. While direct comparison cannot be made between provider-rated CTCAE and patient-reported PRO-CTCAE, it is notable that the incidence of severe fatigue with PRO-CTCAE is higher than that observed with provider-rated CTCAE. Ongoing analyses will explore potential associations of factors (e.g., hematological, sleep, activity) with treatment-emergent fatigue developing on palbo and ET therapy.
Citation Format: Shadab A Rahman, Erica L Mayer, Hanneke Poort, Deborah Schrag, Stephanie C Tung, Eric S Zhou, Aleta Wiley, Lauren Finkelstein, Elkhansaa Elguenaoui, Moira Nolan, Hadine Joffe. Incidence of patient-reported fatigue developing in patients receiving palbociclib and endocrine therapy for advanced HR+ HER2- breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-09-01.
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Affiliation(s)
- Shadab A Rahman
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Erica L Mayer
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | | | - Deborah Schrag
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | | | - Eric S Zhou
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | | | | | | | | | - Hadine Joffe
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA
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Gold EB, Crawford SL, Leung K, Greendale G, Reeves KW, Joffe H, Avis NE. Vasomotor symptoms in midlife women with incident breast cancer: pink SWAN. Breast Cancer Res Treat 2022; 191:125-135. [PMID: 34694536 PMCID: PMC8758653 DOI: 10.1007/s10549-021-06425-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/14/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE We compared trajectories of vasomotor symptoms (VMS) and their risk factors in women with breast cancer (BrCa) to those of cancer-free controls. METHODS Data were from 15 nearly annual follow-up visits (1996-2017) of the multi-racial/ethnic cohort of midlife women enrolled in the Study of Women's Health Across the Nation (SWAN). We compared women with incident BrCa to controls for patterns of VMS, controlling for risk factors identified in bivariate analyses using multivariable longitudinal analyses. RESULTS Characteristics at study entry largely did not differ between cases (n = 151) and controls (n = 2161). Adjusted prevalence of any VMS increased significantly among cases from diagnosis to 2.75 years post diagnosis [per-year adjusted odds ratio (aOR) = 1.76, 95% confidence interval (CI) 1.39-2.24], peaking at 2.75 years post diagnosis, whereas prevalence was stable among controls in this interval [aOR = 1.04, 95% CI 0.99-1.11]. Beyond 2.75 years post diagnosis, prevalence declined significantly in cases [aOR = 0.72, 95% CI 0.61-0.84] and less in controls [aOR = 0.96, 95% CI 0.92-1.00]. Patterns were similar for frequent VMS. Adjustment for tamoxifen use slightly reduced the per-year OR for any prevalent VMS post diagnosis, partially explaining excess VMS in cases. Other treatments were unassociated with VMS. CONCLUSIONS Patterns of prevalent VMS reporting differed significantly between cases and controls, particularly post diagnosis, the latter only partially explained by tamoxifen use among cases. Risk factors for VMS largely did not differ between cases and controls.
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Affiliation(s)
- Ellen B Gold
- University of California Davis School of Medicine, Davis, USA.
- Department of Public Health Sciences, University of California Davis, One Shields Ave., Med Sci 1C, Davis, CA, 95616, USA.
| | | | | | - Gail Greendale
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Katherine W Reeves
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, USA
| | - Hadine Joffe
- Harvard Medical School, Brigham and Women's Hospital, Boston, USA
| | - Nancy E Avis
- Wake Forest University School of Medicine, Winston-Salem, USA
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Bower JE, Partridge AH, Wolff AC, Thorner ED, Irwin MR, Joffe H, Petersen L, Crespi CM, Ganz PA. Targeting Depressive Symptoms in Younger Breast Cancer Survivors: The Pathways to Wellness Randomized Controlled Trial of Mindfulness Meditation and Survivorship Education. J Clin Oncol 2021; 39:3473-3484. [PMID: 34406839 PMCID: PMC8547916 DOI: 10.1200/jco.21.00279] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Younger women are at risk for depression and related symptoms following breast cancer. The Pathways to Wellness study, a randomized, multi-institution, three-arm trial, tested the efficacy of two behavioral interventions for younger breast cancer survivors with elevated depressive symptoms: mindful awareness practices (MAPs) and survivorship education (SE) (Clincaltrials.gov identifier: NCT03025139). METHODS Women diagnosed with breast cancer at or before 50 years of age who had completed treatment and had elevated depressive symptoms were randomly assigned to 6 weeks of MAPs, SE, or wait-list control (WLC). Assessments were conducted preintervention and postintervention and at 3-month and 6-month postintervention follow-ups. Analyses compared each intervention to WLC using linear mixed models. The primary outcome was change in depressive symptoms from preintervention to postintervention on the Center for Epidemiologic Studies-Depression Scale; secondary outcomes included change in fatigue, insomnia, and vasomotor symptoms. RESULTS Two hundred forty-seven women (median age = 46 years) were randomly assigned to MAPs (n = 85), SE (n = 81), or WLC (n = 81). MAPs and SE led to significant decreases in depressive symptoms from preintervention to postintervention relative to WLC (mean change relative to WLC [95% CI]: MAPs, -4.7 [-7.5 to -1.9]; SE, -4.0 [-6.9 to -1.1]), which persisted at 6-month follow-up for MAPs (mean change relative to WLC [95% CI]: MAPs, -3.7 [-6.6 to -0.8]; SE, -2.8 [-5.9 to 0.2]). MAPs, but not SE, also had beneficial effects on fatigue, insomnia, and vasomotor symptoms that persisted at 6-month follow-up (P < .05). CONCLUSION Mindfulness meditation and SE reduced depressive symptoms in younger breast cancer survivors. These interventions can be widely disseminated over virtual platforms and have significant potential benefit for quality of life and overall survivorship in this vulnerable group.
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Affiliation(s)
- Julienne E. Bower
- Department of Psychology, UCLA, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Ann H. Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Antonio C. Wolff
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Elissa D. Thorner
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Michael R. Irwin
- Department of Psychology, UCLA, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Laura Petersen
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Catherine M. Crespi
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Patricia A. Ganz
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
- Department of Medicine (Hematology-Oncology), David Geffen School of Medicine at UCLA, Los Angeles, CA
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Panay N, Anderson RA, Joffe H, Caetano C, Pawsey S, Seitz C, Zuurman L, Simon J. Elinzanetant (NT-814): a novel, non-hormonal dual NK-1,3 receptor antagonist for the treatment of vasomotor symptoms - key findings from the Phase 2 SWITCH-1 study. Maturitas 2021. [DOI: 10.1016/j.maturitas.2021.08.018] [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] [Indexed: 10/20/2022]
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Bowman MA, Kline CE, Buysse DJ, Kravitz HM, Joffe H, Matthews KA, Bromberger JT, Roecklein KA, Krafty RT, Hall MH. Longitudinal Association Between Depressive Symptoms and Multidimensional Sleep Health: The SWAN Sleep Study. Ann Behav Med 2021; 55:641-652. [PMID: 33410460 DOI: 10.1093/abm/kaaa107] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depressive symptoms and sleep disturbances disproportionately affect midlife women. While there may be a bidirectional association, few studies have examined whether depressive symptoms are longitudinally associated with subsequent sleep. Sleep is typically considered unidimensional, despite emerging evidence that multidimensional sleep health provides novel information on the sleep-health link. PURPOSE The current study examined whether higher depressive symptoms were longitudinally associated with poorer multidimensional sleep health. METHOD Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale across six to nine annual assessments in 302 midlife women from the Study of Women's Health Across the Nation. Six months after their last assessment, actigraphy (mean ± standard deviation = 29.3 ± 6.9 days) and self-report were used to assess sleep health components: efficiency, duration, mid-sleep timing, regularity, alertness, and satisfaction, which were dichotomized and summed to create a composite multidimensional sleep health score. Mixed-effects models were used to evaluate the longitudinal associations between depressive symptoms and multidimensional sleep health, as well as individual sleep health components, adjusting for covariates. Exploratory analyses stratified models by race/ethnicity. RESULTS Higher depressive symptoms were associated with subsequent poorer multidimensional sleep health (p < .0.001) and lower alertness (p < .0001) and satisfaction with sleep (p < .0001). CONCLUSIONS Our finding that higher average depressive symptoms were associated longitudinally with actigraphy-measured poorer sleep health in midlife women is novel and converges with the larger body of evidence that these two common symptoms are strongly associated. The bidirectional relationship between these two prevalent symptoms needs to be studied in prospective longitudinal studies.
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Affiliation(s)
- Marissa A Bowman
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher E Kline
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard M Kravitz
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA.,Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joyce T Bromberger
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Robert T Krafty
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Matthews KA, Lee L, Kravitz HM, Joffe H, Neal-Perry G, Swanson LM, Evans MA, Hall MH. Influence of the menopausal transition on polysomnographic sleep characteristics: a longitudinal analysis. Sleep 2021; 44:6291662. [PMID: 34081126 PMCID: PMC8598193 DOI: 10.1093/sleep/zsab139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/25/2020] [Revised: 04/08/2021] [Indexed: 01/28/2023] Open
Abstract
STUDY OBJECTIVES To evaluate how change in menopausal status related to spectral analysis and polysomnographic measures of sleep characteristics. METHODS The Study of Women's Health Across the Nation (SWAN) Ancillary Sleep Study evaluated sleep characteristics of 159 women who were initially pre- or early perimenopausal and repeated the assessment about 3½ years later when 38 were pre- or early perimenopausal, 31 late perimenopausal, and 90 postmenopausal. Participants underwent in-home ambulatory polysomnography for two to three nights. Average EEG power in the delta and beta frequency bands was calculated during NREM and REM sleep, and sleep duration, wake after sleep onset (WASO), and apnea hypopnea index (AHI) were based on visually-scored sleep. RESULTS The women who transitioned to postmenopause had increased beta NREM EEG power at the second assessment, compared to women who remained pre-or early premenopausal; no other sleep measures varied by change in menopausal status. In multivariate models the associations remained; statistical controls for self-reported hot flashes did not explain findings. In secondary analysis, NREM beta power at the second assessment was greater among women who transitioned into the postmenopause after adjustments for initial NREM beta power. CONCLUSIONS Sleep duration and WASO did not vary by menopause transition group across assessments. Consistent with prior cross-sectional analysis, elevated beta EEG power in NREM sleep was apparent among women who transitioned to postmenopause, suggesting that independent of self-reported hot flashes, the menopausal transition is associated with physiological hyperarousal during sleep.
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Affiliation(s)
- Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA,Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA,Corresponding author. Karen A. Matthews, 3811 O’Hara St, Pittsburgh, PA 15213.
| | - Laisze Lee
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard M Kravitz
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA,Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Hadine Joffe
- Connors Center for Women’s Health and Gender Biology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Genevieve Neal-Perry
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marissa A Evans
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA,Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
Women remain underrepresented within academic medicine despite past and present efforts to promote gender equity. The authors discuss how the COVID-19 pandemic could stymie progress toward gender parity within the biomedical workforce and limit the retention and advancement of women in science and medicine. Women faculty face distinct challenges as they navigate the impact of shelter-in-place and social distancing on work and home life. An unequal division of household labor and family care between men and women means women faculty are vulnerable to inequities that may develop in the workplace as they strive to maintain academic productivity and professional development without adequate assistance with domestic tasks and family care. Emerging data suggest that gender differences in academic productivity may be forthcoming as a direct result of the pandemic. Existing gender inequities in professional visibility, networking, and collaboration may be exacerbated as activities transition from in-person to virtual environments and create new barriers to advancement. Meanwhile, initiatives designed to promote gender equity within academic medicine may lose key funding due to the economic impact of COVID-19 on higher education. To ensure that the gender gap within academic medicine does not widen, the authors call upon academic leaders and the broader biomedical community to support women faculty through deliberate actions that promote gender equity, diversity, and inclusion. The authors provide several recommendations, including faculty needs assessments; review of gender bias within tenure-clock-extension offers; more opportunities for mentorship, sponsorship, and professional recognition; and financial commitments to support equity initiatives. Leadership for these efforts should be at the institutional and departmental levels, and leaders should ensure a gender balance on task forces and committees to avoid overburdening women faculty with additional service work. Together, these strategies will contribute to the development of a more equitable workforce capable of transformative medical discovery and care.
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Affiliation(s)
- Nicole C. Woitowich
- N.C. Woitowich is research assistant professor, Women’s Health Research Institute and Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-3449-2547
| | - Shikha Jain
- S. Jain is assistant professor, Division of Hematology/Oncology, Rush University Medical Center, Chicago, Illinois
| | - Vineet M. Arora
- V.M. Arora is Herbert T. Abelson professor of medicine and assistant dean for scholarship and discovery, University of Chicago Pritzker School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-4745-7599
| | - Hadine Joffe
- H. Joffe is Paula A. Johnson associate professor of psychiatry, Mary Horrigan Connors Center for Women’s Health and Gender Biology and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Conforti F, Pala L, Pagan E, Bagnardi V, De Pas T, Queirolo P, Pennacchioli E, Catania C, Cocorocchio E, Ferrucci PF, Saponara M, Orsolini G, Zagami P, Nicoló E, De Marinis F, Tortora G, Bria E, Minucci S, Joffe H, Veronesi P, Wargo J, Rosenthal R, Swanton C, Mantovani A, Gelber RD, Viale G, Goldhirsch A, Giaccone G. Sex-Based Dimorphism of Anticancer Immune Response and Molecular Mechanisms of Immune Evasion. Clin Cancer Res 2021; 27:4311-4324. [PMID: 34016641 PMCID: PMC7611463 DOI: 10.1158/1078-0432.ccr-21-0136] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/01/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
Purpose We previously demonstrated that sex influences response to immune-checkpoint inhibitors. Here we investigate sex-based differences in the molecular mechanisms of anticancer immune-response and immune evasion in patients with NSCLC. Experimental Design We analyzed a) transcriptome-data of 2575 early-stage NSCLCs from 7 different datasets; b) 327 tumor-samples extensively characterized at the molecular level from the TRACERx lung study; c) two independent cohorts of respectively 329 and 391 patients with advanced NSCLC treated with anti-PD1/anti-PDL1 drugs. Results As compared with men, the tumor microenvironment (TME) of women was significantly enriched for a number of innate and adaptive immune cell-types, including specific T-cell subpopulations. NSCLCs of men and women exploited different mechanisms of immune evasion. The TME of females was characterized by significantly greater T-cell dysfunction status, higher expression of inhibitory immune-checkpoint molecules and higher abundance of immune-suppressive cells, including Cancer Associated Fibroblasts, MDSCs and Regulatory T-cells. By contrast, the TME of males was significantly enriched for a T-cells excluded phenotype. We reported data supporting impaired neoantigens presentation to immune system in tumors of men, as molecular mechanism explaining the findings observed. Finally, in line with our results, we showed significant sex-based differences in the association between TMB and outcome of patients with advanced NSCLC treated with anti-PD1/PDL1 drugs. Conclusions We demonstrated meaningful sex-based differences of anticancer immune response and immune evasion mechanisms, that may be exploited to improve immunotherapy efficacy for both women and men.
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Affiliation(s)
- Fabio Conforti
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Laura Pala
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Tommaso De Pas
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Queirolo
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisabetta Pennacchioli
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Catania
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Emilia Cocorocchio
- Division of Medical Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Pier Francesco Ferrucci
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Maristella Saponara
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianmarco Orsolini
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Zagami
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Eleonora Nicoló
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giampaolo Tortora
- Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Medical Oncology, Department of Translational Medicine and Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Medical Oncology, Department of Translational Medicine and Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Saverio Minucci
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Hadine Joffe
- Harvard Medical School, Boston, Massachusetts. Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paolo Veronesi
- Division of Breast Cancer Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy; Faculty of Medicine, University of Milan, Milan, Italy
| | - Jennifer Wargo
- Department of Surgical Oncology and Department of Genomic Medicine MD Anderson Cancer Center, Houston, Texas
| | - Rachel Rosenthal
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, United Kingdom
| | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, United Kingdom
| | - Alberto Mantovani
- Humanitas Clinical and Research Center IRCCS and Humanitas University, Milan, Italy
| | - Richard D Gelber
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Frontier Science & Technology Research Foundation, Boston, Massachusetts
| | - Giuseppe Viale
- Department of Pathology, IEO, European Institute of Oncology IRCCS Milan, Italy.,University of Milan, Milan, Italy
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Solomon DH, Ruppert K, Habel LA, Finkelstein JS, Lian P, Joffe H, Kravitz HM. Prescription medications for sleep disturbances among midlife women during 2 years of follow-up: a SWAN retrospective cohort study. BMJ Open 2021; 11:e045074. [PMID: 33975865 PMCID: PMC8127972 DOI: 10.1136/bmjopen-2020-045074] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the effects of prescription sleep medications on patient-reported sleep disturbances. DESIGN Retrospective cohort. SETTING Longitudinal cohort of community-dwelling women in the USA. PARTICIPANTS Racially and ethnically diverse middle-aged women who reported a sleep disturbance. INTERVENTIONS New users of prescription sleep medications propensity score matched to women not starting sleep medications. MAIN OUTCOMES AND MEASURES Self-reported sleep disturbance during the previous 2 weeks-difficulty initiating sleep, waking frequently and early morning awakening-using a 5-point Likert scale, ranging from no difficulty on any night (rating 1) to difficulty on 5 or more nights a week (rating 5). Sleep disturbances were compared at 1 year (primary outcome) and 2 years of follow-up. RESULTS 238 women who started sleep medications were matched with 447 non-users. Participants had a mean age of 49.5 years and approximately half were white. At baseline, sleep disturbance ratings were similar: medication users had a mean score for difficulty initiating sleep of 2.7 (95% CI 2.5 to 2.9), waking frequently 3.8 (95% CI 3.6 to 3.9) and early morning awakening 2.8 (95% CI 2.6 to 3.0); non-users ratings were 2.6 (95% CI 2.5 to 2.7), 3.7 (95% CI 3.6 to 3.9) and 2.7 (95% CI 2.6 to 2.8), respectively. After 1 year, ratings for medication users were 2.6 (95% CI 2.4 to 2.8) for initiating sleep, 3.6 (95% CI 3.4 to 3.8) for waking frequently and 2.8 (95% CI 2.6 to 3.0) for early morning awakening; for non-users, the mean ratings were 2.3 (95% CI 2.2 to 2.5), 3.5 (95% CI 3.3 to 3.6) and 2.5 (95% CI 2.3 to 2.6), respectively. None of the 1 year changes were statistically significant nor were they different between medication users and non-users. Two-year follow-up results were consistent, without statistically significant reductions in sleep disturbance in medication users compared with non-users. CONCLUSIONS These analyses suggest that women who initiated sleep medications rated their sleep disturbances similar after 1 and 2 years. The effectiveness of long-term sleep medication use should be re-examined.
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Affiliation(s)
- Daniel H Solomon
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristine Ruppert
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Joel S Finkelstein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pam Lian
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hadine Joffe
- Psychiatry, Harvard Univerisity, Boston, Massachusetts, USA
| | - Howard M Kravitz
- Department of Psychiatry, Rush Medical College of Rush University, Chicago, Illinois, USA
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Grant LK, Coborn JE, Cohn A, Abramson M, Elguenaoui E, Russell JA, Wiley A, Nathan MD, Scheer FAJL, Klerman EB, Kaiser UB, Rahman SA, Joffe H. Effect of Experimentally Induced Sleep Fragmentation and Hypoestrogenism on Fasting Nutrient Utilization in Pre-Menopausal Women. J Endocr Soc 2021. [PMCID: PMC8090018 DOI: 10.1210/jendso/bvab048.1575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Both sleep disturbance and menopause have independently been associated with weight gain in women. Possible mechanisms contributing to this weight gain may be changes in resting energy expenditure (REE) and/or nutrient utilization. Therefore, in the current study we aimed to examine the effects of experimentally induced sleep fragmentation and pharmacologic estradiol (E2) withdrawal on REE and nutrient utilization in the fasted state. Design: We studied pre-menopausal women during 5-night inpatient studies repeated in the mid-to-late follicular phase (high-E2; n=21) and following leuprolide-induced hypoestrogenism (low-E2; n=9 completed second visit). During each admission there were two nights of unfragmented sleep [8-h time in bed (TIB)] and three nights of fragmented sleep [9-h TIB]. Sleep was fragmented using an auditory stimulus delivered every 15 minutes that sustained wake for 2 minutes, producing 1 hour of wake after sleep onset. Study diets consisted of 3 meals and a snack each day and were iso-caloric across the two visits. REE and nutrient utilization were assessed in the fasted state via indirect calorimetry and compared between E2 states following unfragmented and fragmented sleep using linear mixed models. Results: Sleep fragmentation in the high-E2 state increased the respiratory quotient (RQ; +3%; p=0.03) with an accompanying increase in carbohydrate oxidation (+20%; p=0.02) and decrease in fat oxidation (-16%; p=0.03). The same effect was observed in response to E2-withdrawl during unfragmented sleep [increased RQ (+5%; p=0.01) and carbohydrate oxidation (+33%; p=0.01), and decreased fat oxidation (-26%; p=0.01)]. There was no additive effect of sleep fragmentation on nutrient utilization in the low-E2 state suggesting a possible ceiling (RQ and carbohydrate oxidation) and floor (fat oxidation) effect. There was no effect of sleep fragmentation or E2 state on REE. Conclusion: Both sleep fragmentation and hypoestrogenism were shown to alter fasting nutrient utilization, but not REE, in a manner that may contribute to weight gain in menopausal women. These findings are important for understanding weight gain during menopause, which is characterized by estrogen withdrawal and often accompanied by sleep disturbances.
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Affiliation(s)
- Leilah K Grant
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jamie E Coborn
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Aviva Cohn
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mathena Abramson
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Julia A Russell
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Aleta Wiley
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Margo D Nathan
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Elizabeth B Klerman
- Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ursula B Kaiser
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Shadab A Rahman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hadine Joffe
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Swanson LM, Hood MM, Hall MH, Kravitz HM, Matthews KA, Joffe H, Thurston RC, Butters MA, Ruppert K, Harlow SD. Associations between sleep and cognitive performance in a racially/ethnically diverse cohort: the Study of Women's Health Across the Nation. Sleep 2021; 44:5904755. [PMID: 32918472 DOI: 10.1093/sleep/zsaa182] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/08/2020] [Revised: 08/25/2020] [Indexed: 01/04/2023] Open
Abstract
STUDY OBJECTIVES To determine whether actigraphy-assessed indices of sleep are associated with cognitive performance in women, and explore whether these associations vary by race/ethnicity. METHODS Participants were 1,126 postmenopausal community-dwelling females (mean age 65 years) from the observational Study of Women's Health Across the Nation (SWAN); 25% were black, 46% white, 13% Chinese, 11% Japanese, and 5% Hispanic. Actigraphy-assessed sleep measures included total sleep time, wake after sleep onset (WASO), and fragmentation. Cognitive measures included immediate and delayed verbal memory, working memory, and information processing speed. All measures were assessed in conjunction with SWAN annual visit 15. RESULTS Across the sample, after covariate adjustment, greater WASO and fragmentation were concurrently associated with slower information processing speed. Black participants had significantly worse sleep relative to other race/ethnic groups. Significant race/sleep interactions were observed; in black, but not white, participants, greater fragmentation was concurrently associated with worse verbal memory and slower information processing speed, and greater WASO was concurrently associated with slower information processing speed. Sleep-cognitive performance associations were not different in Chinese and Japanese participants relative to white participants. CONCLUSIONS Greater wakefulness and fragmentation during sleep are concurrently associated with slower information processing. Sleep continuity impacted concurrent cognitive performance in black, but not white, women. This effect may not have been detected in white women because their sleep was largely within the normal range. Future longitudinal studies in diverse samples are critical to further understand whether race/ethnicity moderates the influence of sleep on cognitive performance.
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Affiliation(s)
| | - Michelle M Hood
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | | | - Howard M Kravitz
- Department of Psychiatry and Behavioral Sciences and Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | | | - Hadine Joffe
- Connors Center for Women's Health and Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Siobán D Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
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Lensen S, Archer D, Bell RJ, Carpenter JS, Christmas M, Davis SR, Giblin K, Goldstein SR, Hillard T, Hunter MS, Iliodromiti S, Jaisamrarn U, Joffe H, Khandelwal S, Kiesel L, Kim BV, Lambalk CB, Lumsden MA, Maki PM, Nappi RE, Panay N, Roberts H, Shifren J, Simon JA, Vincent A, Wolfman W, Hickey M. A core outcome set for vasomotor symptoms associated with menopause: the COMMA (Core Outcomes in Menopause) global initiative. Menopause 2021; 28:852-858. [PMID: 33906204 DOI: 10.1097/gme.0000000000001787] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Vasomotor symptoms (VMS) (hot flashes and night sweats) affect most women over the menopause transition. Comparing the safety and effectiveness of treatments for vasomotor symptoms is limited by the use of inconsistent outcome measures, and uncertainty as to which outcomes are most important to symptomatic women. To address this, we have developed a Core Outcome Set (COS) for use in clinical trials of treatments for VMS. METHODS We systematically reviewed the primary outcomes measured in randomized controlled trials of treatments for VMS. These were refined and entered into a two-round modified Delphi survey completed by clinicians, researchers, and postmenopausal women between November 2019 and March 2020. Outcomes were scored on a nine-point scale from "not important" to "critically important." Two international consensus meetings were held to finalize the COS. RESULTS Based on the systematic review, 13 separate outcomes were included in the Delphi process. This was completed by 227 participants of whom 58% were postmenopausal women, 34% clinicians, and 8% researchers. Predefined thresholds were applied to categorize importance scores obtained during Round 2 of the Delphi survey. These informed discussions at the consensus meetings which were attended by 56 participants from 28 countries. The final COS includes six outcomes: 1) frequency of VMS, 2) severity of VMS, 3) distress, bother or interference caused by VMS, 4) impact on sleep, 5) satisfaction with treatment, and 6) side-effects of treatment. CONCLUSION Implementation of this COS will: better enable research studies to accurately reflect the joint priorities of postmenopausal women, clinicians and researchers, standardize outcome reporting, and facilitate combining and comparing results from different studies, and ultimately improve outcomes for women with bothersome VMS.
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Affiliation(s)
- Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - David Archer
- Obstetrics and Gynaecology, Eastern Virginia Medical School, Norfolk, VA
| | - Robin J Bell
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Monica Christmas
- Department of Obstetrics and Gynaecology, University of Chicago, Chicago, IL
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karen Giblin
- Red Hot Mamas North America, Inc, Town of Ridgefield, CT
| | - Steven R Goldstein
- Obstetrics and Gynecology, New York University School of Medicine, New York, NY
| | - Tim Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset NHS Trust, Poole, Dorset, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stamatina Iliodromiti
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University London, London, UK
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sunila Khandelwal
- Department of Obstetrics and Gynaecology, Fortis Escort Hospital, Jaipur, India
| | - Ludwig Kiesel
- Department of Gynaecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Bobae V Kim
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Cornelis B Lambalk
- Amsterdam Reproduction and Development, Center for Reproductive Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mary Ann Lumsden
- Department of Reproductive and Maternal medicine, School of Medicine, University of Glasgow, Glasgow, UK
| | - Pauline M Maki
- University of Illinois at Chicago, Departments of Psychiatry, Psychology and Obstetrics and Gynecology, Chicago, IL
| | - Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Nick Panay
- Queen Charlotte's and Chelsea and Chelsea and Westminster Hospitals, Imperial College London, London, UK
| | - Helen Roberts
- Auckland District Health Board, Auckland, New Zealand
| | - Jan Shifren
- Midlife Women's Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - James A Simon
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC
| | - Amanda Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy Wolfman
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Matthews KA, Kravitz HM, Lee L, Harlow SD, Bromberger JT, Joffe H, Hall MH. Does midlife aging impact women's sleep duration, continuity, and timing?: A longitudinal analysis from the Study of Women's Health Across the Nation. Sleep 2021; 43:5601413. [PMID: 31633180 DOI: 10.1093/sleep/zsz259] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/05/2019] [Revised: 09/25/2019] [Indexed: 02/06/2023] Open
Abstract
Our study objectives were to evaluate the age-related changes in actigraphy measures of sleep duration, continuity, and timing across 12 years in midlife women as they traversed the menopause, and to take into account factors affecting women's sleep that also change with age. Black, white, and Chinese women were recruited from the Study of Women's Health Across the Nation (SWAN) to participate in an ancillary sleep study on two occasions over 3 years apart and a third assessment 12 years after the first (N = 300, mean ages, 52, 55, and 64 at the three assessments). Women had at least four consecutive nights of actigraphy (95% with 7 nights) and sleep diaries, and self-reported sleep complaints measured at each time point. Partial correlations adjusted for time between assessments across the 12 years were significant and moderate in size (r's = .33-.58). PROC MIXED/GLIMMIX multivariate models showed that sleep duration increased over time; wake after sleep onset (WASO) declined, midpoint of sleep interval increased, and sleep latency and number of sleep complaints did not change between the first and third assessments. Blacks and whites had a greater increase in sleep duration than Chinese. Taken together, the results of this longitudinal study suggest that sleep may not worsen, in general, in midlife women. Perhaps, the expected negative effect of aging in midlife into early old age on sleep is overstated.
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Affiliation(s)
- Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Howard M Kravitz
- Department of Psychiatry, Rush University Medical Center, Chicago, IL.,Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Laisze Lee
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Siobán D Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, MI.,Departments of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Joyce T Bromberger
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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Abstract
Sleep disturbances and insomnia are common among breast cancer survivors, and can have a significant effect on quality of life and numerous other significant outcomes. Among risks for sleep disturbance is the introduction of anti-estrogen endocrine therapies. The possible contributing factors to sleep disturbance in endocrine therapy are complex, and include pre-existing sleep disorders, the effects of chemotherapy and other treatments, and concurrent symptoms such as hot flashes. In addition, sleep disturbance in menopause, the natural downregulation of reproductive hormones in older age, is a common occurrence, and can offer a model for understanding the high prevalence of sleep problems in breast cancer survivors on endocrine therapy, as well as suggesting possible treatments such as behavioral interventions and pharmaceuticals. Altogether, significantly more research is needed to better understand and address sleep disturbance in breast cancer survivors on endocrine therapy in order to support quality of life and treatment adherence.
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Affiliation(s)
- Kathleen Van Dyk
- UCLA David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, UCLA Jonsson Comprehensive Cancer Center
| | - Hadine Joffe
- Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital; Department of Psychiatry, Brigham and Women's Hospital, Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School
| | - Judith E Carroll
- UCLA David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, Cousins Center for Psychoneuroimmunology
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de Wit AE, Giltay EJ, de Boer MK, Nathan M, Wiley A, Crawford S, Joffe H. Predictors of irritability symptoms in mildly depressed perimenopausal women. Psychoneuroendocrinology 2021; 126:105128. [PMID: 33493755 DOI: 10.1016/j.psyneuen.2021.105128] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/15/2020] [Accepted: 01/05/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Irritability is a highly burdensome complaint, commonly, but not universally, linked with depressive symptoms. While increased variability in estradiol has been associated with depressive symptoms during perimenopause, more insight is needed into reproductive hormone dynamics and other factors that predispose perimenopausal women to irritable mood. METHODS Among 50 mildly depressed perimenopausal women (mean (SD) age 48.4 (3.9) years), severity of irritability symptoms (on Symptom Questionnaire Hostility subscale, range 0-23) was assessed weekly for eight weeks, concurrent with potential predictors. Associations between these were examined using generalized estimating equating models. RESULTS Most women (82.0%) reported having moderate to severe irritability at least once. However, the severity of irritability was highly variable from week-to-week (between-subject mean coefficient of variation [CV] 72.9% and within-subject mean CV 63.7%). In multivariate analyses, less variable serum estradiol levels (standardized β within-person CV -0.23 95%CI [-0.32, -0.14], p < 0.001), greater depression severity (0.45 [0.35, 0.56], p < 0.001), younger age (-0.23, [-0.28, -0.09], p < 0.001), and more frequent vasomotor symptoms (0.14 [0.05, 0.23], p = 0.002) were associated with more irritability. Depression severity explained the largest portion of the variance in irritability, but still not more than 20.3%. Neither crude values, weekly change in, or variability of progesterone or FSH levels were associated with irritability. CONCLUSIONS Irritability was highly prevalent among mildly depressed perimenopausal women. In contrast to depressive symptoms, decreased rather than increased variability in estradiol levels was associated with more irritability. This highlights that irritable mood can be disentangled from depressive symptoms in perimenopausal women and might be linked with different estradiol dynamics.
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Affiliation(s)
- Anouk E de Wit
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Thorn 1117, MA 02115, United States.
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, 2300 RC B1-P, The Netherlands.
| | - Marrit K de Boer
- Department of Psychiatry, University of Groningen / University Medical Center Groningen, 9700 RB, PO Box 30.001 (CC 43), Groningen, The Netherlands.
| | - Margo Nathan
- Connors Center for Women's Health and Gender Biology / Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Thorn 1117, MA 02115, United States.
| | - Aleta Wiley
- Connors Center for Women's Health and Gender Biology / Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Thorn 1117, MA 02115, United States.
| | - Sybil Crawford
- Dept of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Graduate School of Nursing, 55 Lake Avenue North, S1-853, MA 01655, United States.
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology / Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Thorn 1117, MA 02115, United States.
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McConnell DS, Crawford SL, Gee NA, Bromberger JT, Kazlauskaite R, Avis NE, Crandall CJ, Joffe H, Kravitz HM, Derby CA, Gold EB, El Khoudary SR, Harlow S, Greendale GA, Lasley BL. Lowered progesterone metabolite excretion and a variable LH excretion pattern are associated with vasomotor symptoms but not negative mood in the early perimenopausal transition: Study of Women's Health Across the Nation. Maturitas 2021; 147:26-33. [PMID: 33832644 DOI: 10.1016/j.maturitas.2021.03.003] [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: 08/05/2020] [Revised: 12/02/2020] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The menopausal transition is characterized by progressive changes in ovarian function and increasing circulating levels of gonadotropins, with some women having irregular menstrual cycles well before their final menstrual period. These observations indicate a progressive breakdown of the hypothalamic-pituitary-ovarian axis often associated with an increase in menopausal symptoms. Relationships between vasomotor symptoms (VMS) and depressed mood and sleep as well as a bidirectional association between VMS and depressed mood in mid-life women have been reported, but the endocrine foundations and hormone profiles associated with these symptoms have not been well described. Our objective was to determine the relationship between daily urinary hormone profiles and daily logs of affect and VMS during the early perimenopausal transition. STUDY DESIGN SWAN, the Study of Women's Health Across the Nation, is a large, mutli-ethnic, multisite cohort study of 3302 women aged 42-52 at baseline, designed to examine predictors of health and disease in women as they traversed the menopause. Inclusion criteria were: an intact uterus and at least one ovary present, at least one menstrual period in the previous three months, no use of sex steroid hormones in the previous three months, and not pregnant or lactating. A subset (n = 849) of women aged 43-53 years from all study sites in the first Daily Hormone Study collection were evaluated for this substudy. OUTCOME MEASURES We measured daily VMS, and urinary hormones: follicle stimulating hormone (FSH), luteinizing hormone (LH), pregnanediol glucuronide (PdG) and estradiol (estrone conjugate, E1C). RESULTS A variable pattern of LH and negative LH feedback were the hormone patterns most strongly associated with increased VMS. In contrast, no hormone pattern was significantly related to negative mood. CONCLUSION Fluctuations of LH associated with low progesterone production were associated with VMS but not negative mood, suggesting different endocrine patterns may be related to increased negative mood than to the occurrence of VMS.
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Affiliation(s)
- Daniel S McConnell
- Department of Epidemiology, School of Public Health, The University of Michigan, Ann Arbor, MI, United States.
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, United States
| | - Nancy A Gee
- Center for Health and the Environment, John Muir Institute of the Environment, University of California, Davis, CA, United States
| | - Joyce T Bromberger
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States
| | | | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Carolyn J Crandall
- David Geffen School of Medicine at University of California, Department of Medicine, Los Angeles, CA, United States
| | - Hadine Joffe
- Mary Horrigan Connors Center for Women's Health and Gender Biology, Paula A. Johnson Associate Professor of Psychiatry in the Field of Women's Health, Harvard Medical School, Vice Chair for Research, Department of Psychiatry, Brigham and Women's Hospital, Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Dana Farber/Harvard Cancer Center Breast Cancer Program, Harvard Medical School, Boston, MA, United States
| | - Howard M Kravitz
- Department of Psychiatry, Rush University Medical Center, Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Carol A Derby
- Albert Einstein College of Medicine, Saul R. Korey Department of Neurology, Department of Epidemiology and Population Health, Bronx, NY, United States
| | - Ellen B Gold
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, United States
| | - Samar R El Khoudary
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sioban Harlow
- Department of Epidemiology, School of Public Health, The University of Michigan, Ann Arbor, MI, United States
| | - Gail A Greendale
- Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Bill L Lasley
- Center for Health and the Environment, University of California Davis, Davis, CA, United States
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Ganz P, Bower JE, Partridge AH, Wolff AC, Thorner ED, Joffe H, Irwin MR, Petersen L, Petersen L, Crespi CM. Abstract GS2-10: Targeting depressive symptoms in younger breast cancer survivors: A randomized controlled trial of mindfulness meditation and survivorship education. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-gs2-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose Breast cancer before age 50 comprises 25% of incident breast cancer cases in women. Younger breast cancer survivors (YBCS) are at increased risk for the negative effects of cancer diagnosis and treatment, including elevated levels of depression and related symptoms (i.e., anxiety, stress, fatigue, sleep disturbance, vasomotor symptoms), leading to significantly diminished quality of life. Patients and Methods This Phase III, randomized, multi-institution trial was designed to examine the efficacy of two brief interventions- mindfulness meditation and survivorship education - for YBCS (ClinicalTrials.gov NCT03025139). We recruited women diagnosed at age 50 or younger with early-stage breast cancer who had completed cancer treatment between 6 months and 5 years earlier and endorsed at least mild depressive symptoms. Participants were randomly assigned to Mindful Awareness Practices (MAPs), Survivorship Education (SE), or wait-list control (WL). Both intervention programs were tailored for YBCS and included 6 weeks of structured content delivered in a group format. Assessments were conducted at baseline, post-intervention, and at 3- and 6- month post-intervention follow-ups. The primary outcome was depressive symptoms (Center for Epidemiologic Studies Depression scale; CESD) at post-intervention; secondary outcomes included anxiety (Generalized Anxiety Disorder-7), fatigue severity (Fatigue Symptom Inventory), sleep disturbance (Insomnia Severity Index), and hot flashes (BCPT symptom checklist). Results We enrolled and randomized 247 women (85 MAPS, 81 SE, 81 WL). On average, participants were 45.4 years old at study entry and had been diagnosed 2.6 years earlier. Linear mixed models were conducted to compare each intervention group to WL on primary and secondary outcomes, controlling for baseline differences across groups in study site, race, and marital status. MAPs led to significant reductions in depressive symptoms at post-intervention and at 3- and 6-month follow-up relative to WL (Ps < .01); see Table 1. SE also led to significant reductions in the CESD at post-intervention and 3-month follow-up (Ps < .01). Both MAPs and SE produced reductions in anxiety at post-intervention relative to WL (Ps < .05), though effects did not persist over follow-up. MAPs also had beneficial effects on other secondary outcomes, yielding significant decreases in fatigue severity, sleep disturbance, and hot flashes that persisted over the 6-month follow-up (Ps < .05). In contrast, there was minimal evidence that SE impacted these outcomes. Conclusion Two brief behavioral intervention programs specially designed for YBCS were effective in reducing depressive symptoms and, in the case of mindfulness, improving related symptoms (fatigue, sleep disturbance) that pose serious threats to younger women’s health and well-being after cancer. These interventions are standardized, manualized, and have the potential for wide dissemination over virtual platforms. Table 1 Adjusted means and standard error (SE) for CESD depressive symptoms by group and time, controlling for study site, race, marital status. A CESD score of 16 or greater indicates moderately severe depressive symptoms. P-values are for differences between intervention and waitlist control groups in change over time between Baseline and Post-Intervention (1-2), Baseline to 3-month Follow-up (1-3), and Baseline to 6-month Follow-up (P 1-4).
BaselinePost-intvP (1-2)3 mo FUP (1-3)6 mo FUP (1-4)GroupCESDCESDCESDPCESDMindful Awareness Practices (MAPs)18.4 (1.0)13.6 (1.1).00113.4 (1.1)<.00112.9 (1.1).013Survivorship Education (SE)17.4 (1.1)13.3 (1.1).00713.6 (1.2).00312.7 (1.2).063Waitlist (WL)16.5 (1.1)16.3 (1.1)17.3 (1.2)14.6 (1.1)
Citation Format: Patty Ganz, Julienne E Bower, Ann H Partridge, Antonio C Wolff, Elissa D Thorner, Hadine Joffe, Michael R Irwin, Laura Petersen, Laura Petersen, Catherine M Crespi. Targeting depressive symptoms in younger breast cancer survivors: A randomized controlled trial of mindfulness meditation and survivorship education [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS2-10.
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Affiliation(s)
- Patty Ganz
- 1Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | | | | | - Antonio C Wolff
- 4The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Elissa D Thorner
- 4The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Hadine Joffe
- 5Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | | | - Laura Petersen
- 2UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Laura Petersen
- 2UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA
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de Wit AE, Giltay EJ, de Boer MK, Bosker FJ, Cohn AY, Nolen WA, Kaiser UB, Joffe H, Penninx BW, Schoevers RA. Plasma androgens and the presence and course of depression in a large cohort of women. Transl Psychiatry 2021; 11:124. [PMID: 33579903 PMCID: PMC7881099 DOI: 10.1038/s41398-021-01249-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 01/05/2023] Open
Abstract
Major depressive disorder (MDD) has a higher prevalence in women with supraphysiologic androgen levels. Whether there is also an association between depression and androgen levels in the physiological range, is unknown. This study examined if women with current MDD have higher androgen levels compared to women who have never had MDD, and if androgen levels are associated with onset and remission of MDD. In 1659 women (513 current MDD, 754 remitted MDD, and 392 never MDD), baseline plasma levels of total testosterone, 5α-dihydrotestosterone, and androstenedione were determined with liquid chromatography-tandem mass spectrometry, and dehydroepiandrosterone-sulfate and sex hormone binding globulin (SHBG) with radioimmunoassays. Free testosterone was calculated. MDD status was assessed at baseline, and at 2 and 4 years follow-up. Women were aged between 18 and 65 years (mean age 41) with total testosterone levels in the physiological range (geometric mean 0.72 nmol/L [95% CI 0.27-1.93]). After adjusting for covariates and multiple testing, women with current MDD had a higher mean free testosterone than women who never had MDD (adjusted geometric mean 8.50 vs. 7.55 pmol/L, p = 0.0005), but this difference was not large enough to be considered clinically meaningful as it was consistent with statistical equivalence. Levels of other androgens and SHBG did not differ and were also statistically equivalent between the groups. None of the androgens or SHBG levels predicted onset or remission of MDD. Our findings support the idea that plasma androgens within the physiological range have no or only limited effects on depressive disorders in women.
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Affiliation(s)
- Anouk E. de Wit
- grid.4494.d0000 0000 9558 4598University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Erik J. Giltay
- grid.10419.3d0000000089452978Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
| | - Marrit K. de Boer
- grid.4494.d0000 0000 9558 4598University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Fokko J. Bosker
- grid.4494.d0000 0000 9558 4598University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Aviva Y. Cohn
- Brigham and Women’s Hospital, Harvard Medical School, Department of Medicine, Boston, MA USA
| | - Willem A. Nolen
- grid.4494.d0000 0000 9558 4598University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Ursula B. Kaiser
- Brigham and Women’s Hospital, Harvard Medical School, Department of Medicine, Boston, MA USA
| | - Hadine Joffe
- Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Boston, MA USA ,Brigham and Women’s Hospital, Harvard Medical School, Connors Center for Women’s Health and Gender Biology, Boston, MA USA
| | - Brenda W.J.H. Penninx
- grid.12380.380000 0004 1754 9227Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Robert A. Schoevers
- grid.4494.d0000 0000 9558 4598University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
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Hickey M, Moss KM, Brand A, Wrede CD, Domchek SM, Meiser B, Mishra GD, Joffe H. What happens after menopause? (WHAM): A prospective controlled study of depression and anxiety up to 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy. Gynecol Oncol 2021; 161:527-534. [PMID: 33583580 DOI: 10.1016/j.ygyno.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/27/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Risk-reducing bilateral salpingo-oophorectomy (RRBSO) substantially reduces ovarian cancer risk in women with pathogenic gene variants and is generally recommended by age 34-45 years. Natural menopause is a vulnerable period for mood disturbance, but the risk of depression and anxiety in the first 12 months after RRBSO and potential modifying effect of hormone therapy are uncertain. METHODS Prospective controlled observational study of 95 premenopausal women planning RRBSO and a Comparison group of 99 premenopausal women who retained their ovaries,- 95% of whom were at population level risk of ovarian cancer. Clinically significant symptoms of depression and anxiety were measured using standardised instruments at baseline, 3, 6 and 12 months. Chi-square tests and adjusted logistic regression models compared differences between groups. RESULTS Baseline symptoms and previous depression or anxiety did not differ between groups. At 3 months after RRBSO clinically significant depressive symptoms were doubled (14.5% vs 27.1%, p = 0.010), which persisted at 12 months. Depressive symptoms were stable in comparisons. At 3 months after RRBSO, clinically significant anxiety symptoms almost trebled (6.1% vs 17.7%, p = 0.014) before plateauing at 6 months and returning to baseline at 12 months. Compared to comparisons, RRBSO participants were at 3.0-fold increased risk of chronic depressive symptoms (Wald 95% CI 1.27-7.26), 2.3-fold increased risk of incident depression (95% Wald CI 1.08-5.13) and 2.0-fold increase of incident anxiety (Wald 95% CI 0.78-5.00). Depression and anxiety were slightly more common in Hormone Therapy users after RRBSO vs non-users. CONCLUSIONS RRBSO leads to a rapid increase in clinically significant depressive and anxiety symptoms despite Hormone Therapy use.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Victoria, Australia.
| | - Katrina M Moss
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Alison Brand
- Department of Gynaecological Oncology, Westmead Hospital, Sydney, New South Wales, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - C David Wrede
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Victoria, Australia; Gynae-oncology and Dysplasia Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Susan M Domchek
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Hadine Joffe
- Psychiatry Department and Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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43
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Ganz PA, Bower JE, Partridge AH, Wolff AC, Thorner ED, Joffe H, Irwin MR, Petersen L, Crespi CM. Screening for Depression in Younger Breast Cancer Survivors: Outcomes From Use of the 9-item Patient Health Questionnaire. JNCI Cancer Spectr 2021; 5:pkab017. [PMID: 34164605 PMCID: PMC8216636 DOI: 10.1093/jncics/pkab017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Major cancer organizations recommend depression screening in patients and survivors. The 9-item Patient Health Questionnaire (PHQ-9) is often suggested, with limited information about its use. Methods Enrollment data collected from younger breast cancer survivors participating in a behavioral intervention trial were used to examine the relationship between PHQ-9 scores (range = 0-27), patient characteristics, and responses to standardized psychosocial assessment tools. Major depressive disorder criterion was met if responses to the first 2 PHQ-9 items (range = 0-6) were 3 or greater. The sample was categorized by total PHQ-9 scores: less than 5 (minimal depressive symptoms), 5-9 (mild to moderate depressive symptoms), and 10 or greater (moderate to severe depression). PHQ-9 category associations with medical, demographic, psychosocial, and behavioral characteristics were examined using analysis of variance for continuous variables and χ2 tests for categorical variables. Results A total of 231 women met the study prescreening eligibility criterion of mild depressive symptoms and enrolled in the study. On average, they were 45.2 years old and 2.6 years since diagnosis. At enrollment, 22.1% met the screening criterion for possible major depressive disorder; among those with PHQ-9 scores of 10 or greater, 58.3% met this criterion. Anxiety, fatigue, insomnia, and intrusive thoughts about cancer were frequent and were associated with depressive symptom severity (all P < .001). In contrast, neither demographic nor cancer treatment characteristics were associated with depressive symptoms. Conclusions Depressive symptoms in this selected sample of younger breast cancer survivors were independent of demographic characteristics or cancer treatment history, suggesting that depression screening is necessary to detect uncontrolled depressive symptoms.
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Affiliation(s)
- Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Medicine (Hematology-Oncology), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Julienne E Bower
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles, CA, USA.,Department of Psychology, UCLA, Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elissa D Thorner
- The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael R Irwin
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles, CA, USA.,Cousins Center for Psychoneuroimmunology, UCLA, Los Angeles, CA, USA
| | - Laura Petersen
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Catherine M Crespi
- UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.,Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Thurston RC, Aslanidou Vlachos HE, Derby CA, Jackson EA, Brooks MM, Matthews KA, Harlow S, Joffe H, El Khoudary SR. Menopausal Vasomotor Symptoms and Risk of Incident Cardiovascular Disease Events in SWAN. J Am Heart Assoc 2021; 10:e017416. [PMID: 33470142 PMCID: PMC7955448 DOI: 10.1161/jaha.120.017416] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Cardiovascular disease (CVD) in women has unique features, including associations with reproductive factors that are incompletely understood. Vasomotor symptoms (VMS), the classic menopausal symptom, are linked to CVD risk factors and subclinical CVD. Evidence linking VMS to CVD events is limited. We tested whether frequent and/or persistent VMS were associated with increased risk for fatal and nonfatal CVD events in SWAN (Study of Women’s Health Across the Nation). Methods and Results A total of 3083 women, aged 42 to 52 years at baseline, underwent up to 16 in‐person visits over 22 years. Assessments included questionnaires on VMS frequency (0, 1–5, or ≥6 days/2 weeks), physical measures, phlebotomy, and reported CVD events (myocardial infarction, stroke, heart failure, and revascularization). A subset of events was adjudicated via medical record. Death certificates were obtained. Relationships between baseline VMS or persistent VMS over the follow‐up (proportion of visits with frequent VMS) with combined incident nonfatal and fatal CVD were tested in Cox proportional hazards models adjusted for demographics, medication use, and CVD risk factors. Participants experienced 231 CVD events over the follow‐up. Women with frequent baseline VMS had an elevated risk of subsequent CVD events (relative to no VMS; ≥6 days: hazard ratio [HR] [95% CI], 1.51 [1.05–2.17], P=0.03; 1–5 days: HR [95% CI], 1.02 [0.75–1.39], P=0.89, multivariable). Women with frequent VMS that persisted over time also had an increased CVD event risk (>33% versus ≤33% of visits: HR [95% CI], 1.77 [1.33–2.35], P<0.0001, multivariable). Conclusions Frequent and persistent VMS were associated with increased risk of later CVD events. VMS may represent a novel female‐specific CVD risk factor.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry University of Pittsburgh School of Medicine Pittsburgh PA.,Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | | | - Carol A Derby
- Saul R. Korey Department of Neurology Department of Epidemiology and Population Health Albert Einstein College of Medicine New York NY
| | - Elizabeth A Jackson
- Division of Cardiology Department of Medicine University of Alabama at Birmingham School of Medicine Birmingham AL
| | - Maria Mori Brooks
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | - Karen A Matthews
- Department of Psychiatry University of Pittsburgh School of Medicine Pittsburgh PA.,Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
| | - Sioban Harlow
- Department of Epidemiology Henry F. Vaughn School of Public Health University of Michigan Ann Arbor MI
| | - Hadine Joffe
- Department of Epidemiology Henry F. Vaughn School of Public Health University of Michigan Ann Arbor MI.,Department of Psychiatry Harvard Medical SchoolBrigham and Women's Hospital Boston MA
| | - Samar R El Khoudary
- Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
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Spagnolo PA, Manson JE, Joffe H. Sex and Gender Differences in Health. Ann Intern Med 2021; 174:143-144. [PMID: 33460539 DOI: 10.7326/l20-1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Primavera A Spagnolo
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - JoAnn E Manson
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
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Matthews KA, Chang Y, Brooks MM, Crawford SL, Janssen I, Joffe H, Kravitz HM, Thurston RC, El Khoudary SR. Identifying women who share patterns of reproductive hormones, vasomotor symptoms, and sleep maintenance problems across the menopause transition: group-based multi-trajectory modeling in the Study of Women's Health Across the Nation. Menopause 2020; 28:126-134. [PMID: 33038144 PMCID: PMC9238015 DOI: 10.1097/gme.0000000000001663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/25/2022]
Abstract
OBJECTIVE To identify groups of women who share levels and patterns of change in follicle-stimulating hormone (FSH), self-reported sleep maintenance problems, and frequent vasomotor symptoms (VMS) up to 10 years before and after their final menstrual period and to evaluate their premenopausal characteristics. METHOD Group-based multi-trajectory modeling grouped 1,407 women from the Study of Women's Health Across the Nation who had an observed natural menopause and did not use hormone therapy, based on repeated measures of FSH, sleep maintenance problems, and frequent VMS relative to final menstrual period. Multivariable analyses assessed race/ethnicity, body mass index, smoking, and depressive symptoms as predictors of group membership. RESULTS Women formed five distinct groups: (1) low symptoms (low VMS/sleep problems)/high FSH rise (N = 552; 39.2%); (2) moderate VMS and sleep problems/low FSH rise (N = 169; 12.0%); (3) dominant sleep problems (lower VMS/high sleep problems)/high FSH rise (N = 203; 14.4%); (4) dominant VMS (high VMS/lower sleep problems)/high FSH rise (N = 297; 21.1%)); and (5) high symptoms (high VMS/high sleep problems)/intermediate FSH rise (N = 186; 13.2%)). Multivariate analyses showed that race/ethnicity, premenopausal body mass index and depressive symptoms, and increasing depressive symptoms during the early phase of the transition predicted group membership. CONCLUSIONS Women can be classified based on shared levels and patterns of FSH, sleep maintenance problems, and frequent VMS across the menopause transition. Either VMS or sleep maintenance problems can be dominant in the face of high FSH. Experiencing one menopause-related symptom or hormone profile does not automatically imply that another is also being experienced.
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Affiliation(s)
- Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Yuefang Chang
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Maria M Brooks
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Sybil L Crawford
- Department of Medicine, University of Massachusetts, Worcester, MA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Howard M Kravitz
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
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Yusufov M, Nathan M, Wiley A, Russell J, Partridge A, Joffe H. Predictors of increased risk for early treatment non-adherence to oral anti-estrogen therapies in early-stage breast cancer patients. Breast Cancer Res Treat 2020; 185:53-62. [PMID: 32918659 DOI: 10.1007/s10549-020-05920-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/12/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Non-adherence to the oral anti-estrogen therapies (AET) tamoxifen and aromatase inhibitors in early-stage hormone receptor-positive breast cancer is associated with numerous negative clinical outcomes. Prior studies have identified that non-adherence is associated with psychological and menopause-related factors which are present during AET, but the presence of these characteristics prior to AET initiation has not been investigated. METHODS Psychological and menopause symptoms (depression, generalized anxiety, insomnia, somatosensory amplification, hot flash frequency, and hot flash-related interference) were assessed pre-AET initiation as predictors of subsequent non-adherence in 73 participants (Mage = 55.0, SD = 10.1 years). Participants self-reported treatment adherence after three and 6 weeks on AET. Participants who did not initiate treatment were excluded from the analysis. RESULTS Discriminant function analyses revealed that the hypothesized set of psychological and menopause symptoms at baseline (pre-AET) together statistically distinguished between those who were non-adherent (n = 19; 26.0%) from adherent (n = 54; 74.0%) at 6 weeks. Model classification accuracy was statistically significant (Wilks' ƛ = 0.782, χ2(6) = 15.50, p = 0.017) at the 6-week timepoint. Results were consistent at 3 weeks. Pre-AET psychological and menopause symptoms correctly classified 6-week treatment adherence 77.9% of the time. Depression contributed most to distinguishing between adherers and non-adherers. CONCLUSIONS The presence of a composite profile of psychological and menopause symptoms prior to AET initiation may help to identify early treatment non-adherence. Results can be used to identify patients at risk for non-adherence and to guide psychological and symptom management interventions.
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Affiliation(s)
- Miryam Yusufov
- Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Psychiatry, Harvard Medical School Brigham and Women's Hospital, 75 Francis Street, Thorn 1111, Boston, MA, 02215, USA
| | - Margo Nathan
- Women's Hormones and Aging Research Program, Department of Psychiatry, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Department of Psychiatry, Harvard Medical School Brigham and Women's Hospital, 75 Francis Street, Thorn 1111, Boston, MA, 02215, USA
| | - Aleta Wiley
- Women's Hormones and Aging Research Program, Department of Psychiatry, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Julia Russell
- Women's Hormones and Aging Research Program, Department of Psychiatry, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Ann Partridge
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Hadine Joffe
- Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Women's Hormones and Aging Research Program, Department of Psychiatry, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Psychiatry, Harvard Medical School Brigham and Women's Hospital, 75 Francis Street, Thorn 1111, Boston, MA, 02215, USA.
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Abstract
The authors of this commentary call for sex- and gender-specific and differentiating factors to be urgently included in the research, prevention, and therapeutics implementation response to the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Primavera A Spagnolo
- National Institute on Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland (P.A.S.)
| | - JoAnn E Manson
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (J.E.M., H.J.)
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (J.E.M., H.J.)
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Affiliation(s)
- Deborah Bartz
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Hadine Joffe
- Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - JoAnn E Manson
- Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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50
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Bowman MA, Brindle RC, Joffe H, Kline CE, Buysse DJ, Appelhans BM, Kravitz HM, Matthews KA, Neal-Perry GS, Krafty RT, Hall MH. Multidimensional sleep health is not cross-sectionally or longitudinally associated with adiposity in the Study of Women's Health Across the Nation (SWAN). Sleep Health 2020; 6:790-796. [PMID: 32680819 DOI: 10.1016/j.sleh.2020.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/05/2019] [Revised: 03/09/2020] [Accepted: 04/05/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The association between sleep and adiposity (indexed by body mass index or waist-to-hip ratio) has typically been evaluated using a single dimension of self-reported sleep. However, other dimensions and behavioral measures of sleep may also be associated with adiposity. This study evaluated whether multidimensional sleep health calculated from actigraphy and self-report was longitudinally associated with adiposity in a sample of midlife women who have a high prevalence of sleep disturbances and adiposity. DESIGN Longitudinal study with 11-14 years of follow-up time between the sleep health assessment and body mass index / waist-to-hip ratio measurements. PARTICIPANTS Two hundred and twenty-one midlife women enrolled in the Study of Women's Health Across the Nation Sleep Study. MEASUREMENTS Multidimensional sleep health was quantified using actigraphy (M[SD] = 29.1[7.2] nights) measures of sleep efficiency, midpoint, duration, regularity, and self-report measures of alertness and satisfaction. Each component was dichotomized and summed; higher values indicated better sleep health. Height, body weight, and waist and hip circumference were measured at the sleep study and at follow-up. Linear regression models were used to assess associations between sleep health and adiposity, adjusting for demographic and menopausal covariates. RESULTS There was no substantial within-person change in adiposity over time. Better sleep health was cross-sectionally and longitudinally associated with lower adiposity in unadjusted, but not in adjusted, models. Individual sleep health components were not associated with adiposity after adjustment. CONCLUSION We did not observe cross-sectional or longitudinal associations between multidimensional sleep health and adiposity. The sleep-adiposity link may be weaker in midlife adults than in other age groups.
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Affiliation(s)
- Marissa A Bowman
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ryan C Brindle
- Department of Cognitive and Behavioral Science & Neuroscience Program, Washington and Lee University, Lexington, VA, USA
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and the Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher E Kline
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Howard M Kravitz
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA; Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
| | - Karen A Matthews
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA
| | - Genevieve S Neal-Perry
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert T Krafty
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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