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Miaskowski C, Conley YP, Cooper BA, Paul SM, Smoot BJ, Hammer MJ, Fu M, Levine JD. Identification Of A Higher Risk Lymphedema Phenotype And Associations With Cytokine Gene Polymorphisms. J Pain Symptom Manage 2024; 67:375-383.e3. [PMID: 38307372 DOI: 10.1016/j.jpainsymman.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
CONTEXT Breast cancer-related lymphedema (BCRL) is chronic condition that occurs in 5% to 75% of women following treatment for breast cancer. However, little is known about the risk factors and mechanisms associated with a worse BCRL profile. OBJECTIVES Identify distinct BCRL profiles in women with the condition (i.e., lower vs. higher risk phenotype) and evaluate for associations with pro- and anti-inflammatory genes. METHODS Latent class profile analysis (LCPA) was used to identify the BCRL profiles using phenotypic characteristics evaluated prior to surgery. Candidate gene analyses were done to identify cytokine genes associated with the two BCRL profiles. RESULTS Of the 155 patients evaluated, 35.5% (n = 55) were in the Lower and 64.5% (n = 100) were in the Higher Risk classes. Risk factors for membership in the Higher class included: lower functional status, having sentinel lymph node biopsy, axillary lymph node dissection, mastectomy, higher number of positive lymph nodes, and receipt of chemotherapy. Polymorphisms for interleukin (IL)1-beta and IL6 were associated with membership in the Higher Risk class. CONCLUSION The readily available and clinically relevant phenotypic characteristics associated with a worse BCRL profile can be used by clinicians to identify higher risk patients. If confirmed, these characteristics can be tested in predictive risk models. In addition, the candidate gene findings may guide the development of mechanistically-based interventions to decrease the risk of BCRL.
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Affiliation(s)
- Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA.
| | | | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Betty J Smoot
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Mei Fu
- School of Nursing and Health Studies, University of Missouri, Kansas City, MO, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
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Oppegaard KR, Mayo SJ, Armstrong TS, Dokiparthi V, Melisko M, Levine JD, Olshen AB, Anguera JA, Roy R, Paul S, Cooper B, Conley YP, Hammer MJ, Miaskowski C, Kober KM. Neurodegenerative disease pathways are perturbed in patients with cancer who self-report cognitive changes and anxiety: A pathway impact analysis. Cancer 2024. [PMID: 38676932 DOI: 10.1002/cncr.35336] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/31/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI) and anxiety co-occur in patients with cancer. Little is known about mechanisms for the co-occurrence of these two symptoms. The purposes of this secondary analysis were to evaluate for perturbed pathways associated with the co-occurrence of self-reported CRCI and anxiety in patients with low versus high levels of these two symptoms and to identify potential mechanisms for the co-occurrence of CRCI and anxiety using biological processes common across any perturbed neurodegenerative disease pathways. METHODS Patients completed the Attentional Function Index and the Spielberger State-Trait Anxiety Inventory six times over two cycles of chemotherapy. Based on findings from a previous latent profile analysis, patients were grouped into none versus both high levels of these symptoms. Gene expression was quantified, and pathway impact analyses were performed. Signaling pathways for evaluation were defined with the Kyoto Encyclopedia of Genes and Genomes database. RESULTS A total of 451 patients had data available for analysis. Approximately 85.0% of patients were in the none class and 15.0% were in the both high class. Pathway impact analyses identified five perturbed pathways related to neurodegenerative diseases (i.e., amyotrophic lateral sclerosis, Huntington disease, Parkinson disease, prion disease, and pathways of neurodegeneration-multiple diseases). Apoptosis, mitochondrial dysfunction, oxidative stress, and endoplasmic reticulum stress were common biological processes across these pathways. CONCLUSIONS This study is the first to describe perturbations in neurodegenerative disease pathways associated with CRCI and anxiety in patients receiving chemotherapy. These findings provide new insights into potential targets for the development of mechanistically based interventions.
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Affiliation(s)
- Kate R Oppegaard
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, USA
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Samantha J Mayo
- Princess Margaret Cancer Centre, University Health Network, Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Terri S Armstrong
- Neuro-Oncology Branch, Office of Patient-Centered Outcomes Research, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Michelle Melisko
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jon D Levine
- School of Dentistry, University of California San Francisco, San Francisco, California, USA
| | - Adam B Olshen
- Department of Epidemiology and Biostatistics, Bakar Computational Health Sciences Institute, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Joaquin A Anguera
- Weill Institute for Neurosciences, Kavli Institute for Fundamental Neuroscience, Sandler Neurosciences Center, University of California San Francisco, San Francisco, California, USA
| | - Ritu Roy
- Helen Diller Family Comprehensive Cancer Center, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Steven Paul
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce Cooper
- Department of Physiological Nursing, University of California San Francisco, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburg, Pittsburgh, Pennsylvania, USA
| | - Marilyn J Hammer
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesia and Perioperative Care, Pain and Addiction Research Center, University of California San Francisco, San Francisco, California, USA
| | - Kord M Kober
- Department of Physiological Nursing, Bakar Computational Health Sciences Institute, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
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Oppegaard KR, Hammer MJ, Conley YP, Harris CS, Cooper BA, Paul SM, Shin J, Morse L, Abrams GM, Levine JD, Miaskowski C. Self-Reported Cancer-Related Cognitive Impairment in Patients With Breast Cancer Is Associated With Potassium Channel Gene Polymorphisms. Oncol Nurs Forum 2024; 51:263-274. [PMID: 38668911 DOI: 10.1188/24.onf.263-274] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVES To evaluate for associations of polymorphisms for potassium channel genes in patients with breast cancer who were classified as having high or low-moderate levels of cancer-related cognitive impairment (CRCI). SAMPLE & SETTING 397 women who were scheduled to undergo surgery for breast cancer on one breast were recruited from breast care centers located in a comprehensive cancer center, two public hospitals, and four community practices. METHODS & VARIABLES CRCI was assessed using the Attentional Function Index prior to and for six months after surgery. The attentional function classes were identified using growth mixture modeling. RESULTS Differences between patients in the high versus low-moderate attentional function classes were evaluated. Six single nucleotide polymorphisms for potassium channel genes were associated with low-moderate class membership. IMPLICATIONS FOR NURSING The results contribute to knowledge of the mechanisms for CRCI. These findings may lead to the identification of high-risk patients and the development of novel therapeutics.
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Shin J, Miaskowski C, Wong ML, Yates P, Olshen AB, Roy R, Dokiparthi V, Cooper B, Paul S, Conley YP, Levine JD, Hammer MJ, Kober K. Perturbations in inflammatory pathways are associated with shortness of breath profiles in oncology patients receiving chemotherapy. Support Care Cancer 2024; 32:250. [PMID: 38532105 DOI: 10.1007/s00520-024-08446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE One plausible mechanistic hypothesis is the potential contribution of inflammatory mechanisms to shortness of breath. This study was aimed to evaluate for associations between the occurrence of shortness of breath and perturbations in inflammatory pathways. METHODS Patients with cancer reported the occurrence of shortness of breath six times over two cycles of chemotherapy. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath occurrence profiles (i.e., none (70.5%), decreasing (8.2%), increasing (7.8%), high (13.5%)). Using an extreme phenotype approach, whole transcriptome differential gene expression and pathway impact analyses were performed to evaluate for perturbed signaling pathways associated with shortness of breath between the none and high classes. Two independent samples (RNA-sequencing (n = 293) and microarray (n = 295) methodologies) were evaluated. Fisher's combined probability method was used to combine these results to obtain a global test of the null hypothesis. In addition, an unweighted knowledge network was created using the specific pathway maps to evaluate for interconnections among these pathways. RESULTS Twenty-nine Kyoto Encyclopedia of Genes and Genomes inflammatory signaling pathways were perturbed. The mitogen-activated protein kinase signaling pathway node had the highest closeness, betweenness, and degree scores. In addition, five common respiratory disease-related pathways, that may share mechanisms with cancer-related shortness of breath, were perturbed. CONCLUSIONS Findings provide preliminary support for the hypothesis that inflammation contribute to the occurrence of shortness of breath in patients with cancer. In addition, the mechanisms that underlie shortness of breath in oncology patients may be similar to other respiratory diseases.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
- School of Medicine, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, CA, USA
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adam B Olshen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Ritu Roy
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Vasuda Dokiparthi
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Bruce Cooper
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Steven Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Yvette P Conley
- School of Nursing, Univeristy of Pittsburgh, 3500 Victoria St, Pittsburgh, 15213, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Kord Kober
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
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Coupe K, Block A, Mark S, Cooper BA, Paul SM, Dunn LB, Hammer MJ, Conley YP, Levine JD, Miaskowski C. Increases in stress and adverse childhood experiences are associated with the co-occurrence of anxiety and depression in oncology patients. J Psychosoc Oncol 2024:1-24. [PMID: 38528755 DOI: 10.1080/07347332.2024.2326146] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE Identify subgroups of patients with distinct joint anxiety AND depression profiles and evaluate for differences in demographic and clinical characteristics, as well as stress, resilience, and coping. DESIGN Longitudinal study. PARTICIPANTS Patients (n = 1328) receiving chemotherapy. METHODS Measures of state anxiety and depression were done six times over two cycles of chemotherapy. All of the other measures were completed prior to second or third cycle of chemotherapy. Latent profile analysis was used to identify the distinct joint anxiety and depression profiles. FINDINGS Three classes were identified (i.e. Low Anxiety and Low Depression (57.5%); Moderate Anxiety and Moderate Depression (33.7%), High Anxiety and High Depression (8.8%)). For all of the stress measures, a dose response effect was seen among the profiles. Two worst profiles reported higher occurrence rates for a number of adverse childhood experiences. IMPLICATIONS FOR PROVIDERS Patients need referrals for stress reduction techniques and mental health and social services.
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Affiliation(s)
- Katie Coupe
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Astrid Block
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Sueann Mark
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Laura B Dunn
- Department of Psychiatry, School of Medicine, University of Arkansas, Little Rock, AK, USA
| | - Marilyn J Hammer
- Phyllis F. Cantor Research Center, Dana Farber Cancer Institute, Boston, MA, USA
| | - Yvette P Conley
- Department of Health Promotion and Prevention, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
- Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
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Araldi D, Khomula EV, Bonet IJM, Bogen O, Green PG, Levine JD. Role of pattern recognition receptors in chemotherapy-induced neuropathic pain. Brain 2024; 147:1025-1042. [PMID: 37787114 PMCID: PMC10907096 DOI: 10.1093/brain/awad339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/23/2023] [Revised: 07/25/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023] Open
Abstract
Progress in the development of effective chemotherapy is producing a growing population of patients with acute and chronic painful chemotherapy-induced peripheral neuropathy (CIPN), a serious treatment-limiting side effect for which there is currently no US Food and Drug Administration-approved treatment. CIPNs induced by diverse classes of chemotherapy drugs have remarkably similar clinical presentations, leading to the suggestion they share underlying mechanisms. Sensory neurons share with immune cells the ability to detect damage associated molecular patterns (DAMPs), molecules produced by diverse cell types in response to cellular stress and injury, including by chemotherapy drugs. DAMPs, in turn, are ligands for pattern recognition receptors (PRRs), several of which are found on sensory neurons, as well as satellite cells, and cells of the immune system. In the present experiments, we evaluated the role of two PRRs, TLR4 and RAGE, present in dorsal root ganglion (DRG), in CIPN. Antisense (AS)-oligodeoxynucleotides (ODN) against TLR4 and RAGE mRNA were administered intrathecally before ('prevention protocol') or 3 days after ('reversal protocol') the last administration of each of three chemotherapy drugs that treat cancer by different mechanisms (oxaliplatin, paclitaxel and bortezomib). TLR4 and RAGE AS-ODN prevented the development of CIPN induced by all three chemotherapy drugs. In the reversal protocol, however, while TLR4 AS-ODN completely reversed oxaliplatin- and paclitaxel-induced CIPN, in rats with bortezomib-induced CIPN it only produced a temporary attenuation. RAGE AS-ODN, in contrast, reversed CIPN induced by all three chemotherapy drugs. When a TLR4 antagonist was administered intradermally to the peripheral nociceptor terminal, it did not affect CIPN induced by any of the chemotherapy drugs. However, when administered intrathecally, to the central terminal, it attenuated hyperalgesia induced by all three chemotherapy drugs, compatible with a role of TLR4 in neurotransmission at the central terminal but not sensory transduction at the peripheral terminal. Finally, since it has been established that cultured DRG neurons can be used to study direct effects of chemotherapy on nociceptors, we also evaluated the role of TLR4 in CIPN at the cellular level, using patch-clamp electrophysiology in DRG neurons cultured from control and chemotherapy-treated rats. We found that increased excitability of small-diameter DRG neurons induced by in vivo and in vitro exposure to oxaliplatin is TLR4-dependent. Our findings suggest that in addition to the established contribution of PRR-dependent neuroimmune mechanisms, PRRs in DRG cells also have an important role in CIPN.
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Affiliation(s)
- Dionéia Araldi
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Eugen V Khomula
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Ivan J M Bonet
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Oliver Bogen
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Paul G Green
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA 94143, USA
- Department of Preventative and Restorative Dental Sciences, Division of Neuroscience, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Jon D Levine
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA 94143, USA
- Department of Medicine, Division of Neuroscience, University of California at San Francisco, San Francisco, CA 94143, USA
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Romanovska V, Block A, Paul SM, Cooper BA, Hammer MJ, Conley YP, Levine JD, Kober KM, Miaskowski C. Exploration of the Relationships Between Stress and Distinct Pain and Sleep Disturbance Profiles in Patients Undergoing Chemotherapy. Cancer Nurs 2024; 47:E108-E122. [PMID: 36584234 PMCID: PMC10300234 DOI: 10.1097/ncc.0000000000001185] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Unrelieved pain and sleep disturbance are common symptoms in oncology patients. Increased stress may be an underlying cause for both symptoms. OBJECTIVES The purposes of this study were to identify subgroups of outpatients with distinct pain and sleep disturbance profiles and to evaluate differences among these subgroups in demographic and clinical characteristics. Differences in global stress, cancer-specific stress, and cumulative life stress, as well as resilience and coping, were evaluated. METHODS Patients (N = 1343) completed self-report questionnaires for demographic and clinical characteristics and stress, resilience, and coping. Latent profile analysis was used to identify subgroups of patients with distinct pain and sleep disturbance profiles. Differences among the subgroups were determined using parametric and nonparametric tests. RESULTS Three distinct profiles were identified (ie, No Pain + Moderate Sleep Disturbance (SD) (27.6%), Moderate Pain + Moderate SD (38.6%), Severe Pain + High SD (33.8%)). Compared with the other 2 classes, Severe Pain + High SD class was younger, had fewer years of education, was more likely to be female, more likely to live alone, less likely to be employed, and had a higher level of comorbidity. This class had the highest stress scores and was more likely to report higher rates of adverse childhood experiences. CONCLUSION Over 70% of our sample reported clinically meaningful levels of both symptoms, and 33.8% reported relatively high rates of adverse childhood experiences. IMPLICATION FOR PRACTICE Clinicians need to perform routine assessments, particularly of adverse childhood experiences, and initiate appropriate referrals.
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Affiliation(s)
- Vita Romanovska
- Author Affiliations: School of Nursing (Mss Romanovska and Block, Drs Paul, Cooper, Kober, and Miaskowski) and School of Medicine (Drs Levine and Miaskowski), University of California, San Francisco; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; and School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania
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Fitzsimons LA, Staurengo-Ferrari L, Bogen O, Araldi D, Bonet IJM, Jordan EE, Levine JD, Tucker KL. The Primary Cilium and its Hedgehog Signaling in Nociceptors Contribute to Inflammatory and Neuropathic Pain. Res Sq 2024:rs.3.rs-3812442. [PMID: 38464172 PMCID: PMC10925437 DOI: 10.21203/rs.3.rs-3812442/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The primary cilium, a 1-3 μm long hair-like structure protruding from the surface of almost all cells in the vertebrate body, is critical for neuronal development and also functions in the adult. As the migratory neural crest settles into dorsal root ganglia (DRG) sensory neurons elaborate a single primary cilium at their soma that is maintained into adult stages. While it is not known if primary cilia are expressed in nociceptors, or their potential function in the mature DRG neuron, recent studies have shown a role for Hedgehog, whose signaling demonstrates a dependence on primary cilia, in nociceptor sensitization. Here we report the expression of primary cilia in rat and mouse nociceptors, where they modulate mechanical nociceptive threshold, and contribute to inflammatory and neuropathic pain. When siRNA targeting Ift88, a primary cilium-specific intraflagellar transport (IFT) protein required for ciliary integrity, was administered by intrathecal injection, in the rat, it resulted in loss of Ift88 mRNA in DRG, and primary cilia in neuronal cell bodies, which was associated with an increase in mechanical nociceptive threshold, and abrogation of hyperalgesia induced by the pronociceptive inflammatory mediator, prostaglandin E2, and painful peripheral neuropathy induced by a neurotoxic chemotherapy drug, paclitaxel. To provide further support for the role of the primary cilium in nociceptor function we also administered siRNA for another IFT protein, Ift52. Ift52 siRNA results in loss of Ift52 in DRG and abrogates paclitaxel-induced painful peripheral neuropathy. Attenuation of Hedgehog-induced hyperalgesia by Ift88 knockdown supports a role for the primary cilium in the hyperalgesia induced by Hedgehog, and attenuation of paclitaxel chemotherapy-induced neuropathy (CIPN) by cyclopamine, which attenuates Hedgehog signaling, suggests a role of Hedgehog in CIPN. Our findings support a role of nociceptor primary cilia in the control of mechanical nociceptive threshold and in inflammatory and neuropathic pain, the latter, at least in part, Hedgehog dependent.
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Affiliation(s)
- Lindsey A. Fitzsimons
- Dept. of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States
- Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
| | - Larissa Staurengo-Ferrari
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California San Francisco, San Francisco, United States
| | - Oliver Bogen
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California San Francisco, San Francisco, United States
| | - Dioneia Araldi
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California San Francisco, San Francisco, United States
| | - Ivan J. M. Bonet
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California San Francisco, San Francisco, United States
| | - Ethan E. Jordan
- Dept. of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States
- Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
| | - Jon D. Levine
- Department of Oral and Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California San Francisco, San Francisco, United States
| | - Kerry L. Tucker
- Dept. of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States
- Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
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Wright F, Cooper BA, Hammer MJ, Paul SM, Conley YP, Levine JD, Miaskowski C, Kober KM. Stress Exposures Contribute to Worse Joint Morning and Evening Fatigue Profiles in Patients With Cancer During Chemotherapy. Oncol Nurs Forum 2024; 51:89-106. [PMID: 38442280 DOI: 10.1188/24.onf.89-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVES To evaluate differences among stress, resilience, and coping strategies related to morning and evening fatigue profiles (both low, low morning and moderate evening, both moderate, and both high). SAMPLE & SETTING Data were collected from 1,334 adult patients with cancer receiving chemotherapy. METHODS & VARIABLES Morning and evening fatigue severity were rated over two cycles of chemotherapy using the Lee Fatigue Scale. Latent profile analysis was used to identify patient subgroups with distinct joint morning and evening profiles. Data were collected on global, cancer-specific, and cumulative life stress; resilience; and coping strategies. Differences among the latent classes were evaluated using parametric and nonparametric tests. RESULTS Compared to the other three classes, the both high class reported the highest stress scores, highest occurrence of and effects from a variety of stressful life events, lowest resilience scores, and higher use of disengagement coping strategies. The both high class met the criteria for subsyndromal post-traumatic stress disorder. IMPLICATIONS FOR NURSING When patients report high levels of fatigue, detailed assessments of stress are warranted to provide tailored interventions.
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Morse L, Cooper BA, Ritchie CS, Wong ML, Kober KM, Harris C, Shin J, Oppegaard K, Hammer MJ, Schimmel AC, Paul SM, Conley YP, Levine JD, Miaskowski C. Stability and consistency of symptom clusters in younger versus older patients receiving chemotherapy. BMC Geriatr 2024; 24:164. [PMID: 38365584 PMCID: PMC10870638 DOI: 10.1186/s12877-024-04755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/28/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND By 2035, the number of newly diagnosed cancer cases will double and over 50% will be in older adults. Given this rapidly growing demographic, a need exists to understand how age influences oncology patients' symptom burden. The study purposes were to evaluate for differences in the occurrence, severity, and distress of 38 symptoms in younger (< 60 years) versus older (≥ 60 years) oncology patients undergoing chemotherapy and to evaluate for differences in the stability and consistency of symptom clusters across the two age groups. METHODS A total of 1329 patients were dichotomized into the younger and older groups. Patients completed demographic and clinical questionnaires prior to the initiation of their second or third cycle of chemotherapy. A modified version of Memorial Symptom Assessment Scale was used to evaluate the occurrence, severity, and distress of 38 common symptoms associated with cancer and its treatment. Differences between the two age groups in demographic and clinical characteristics and ratings of occurrence, severity, and distress for the 38 symptoms were evaluated using parametric and nonparametric tests. Exploratory factor analyses were done within each age group to identify symptom clusters using symptom occurrence rates. RESULTS Compared to the younger group (14.8 (± 7.0)), older adults reported a lower mean number of symptoms (12.9 (± 7.2)). Older patients experienced lower occurrence rates for almost 50% of the symptoms. Regarding symptom clusters, an eight-factor solution was selected for both age groups. Across the two age groups, the eight symptom clusters (i.e., physical and cognitive fatigue, respiratory, psychological, hormonal, chemotherapy-related toxicity, weight gain, gastrointestinal, epithelial) were stable. However, symptoms within the physical and cognitive, chemotherapy-related toxicity, and gastrointestinal clusters were not consistent across the age groups. CONCLUSIONS To be able to provide tailored and effective symptom management interventions to older oncology patients, routine assessments of the core symptoms unique to the symptom clusters identified for this group warrants consideration. The underlying mechanism(s) for these inconsistencies in symptom burden is an important focus for future studies.
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Affiliation(s)
- Lisa Morse
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital Morgan Institute, Boston, MA, USA
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Medical Group, Oakland, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Carolyn Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joosun Shin
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, CA, USA.
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way- N631Y, 94143-0610, San Francisco, CA, USA.
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11
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Shin J, Hammer M, Cooley ME, Cooper BA, Paul SM, Cartwright F, Kober KM, Conley YP, Levine JD, Miaskowski C. Common and distinct risk factors that influence more severe and distressing shortness of breath profiles in oncology outpatients. Cancer Med 2024; 13:e7013. [PMID: 38400684 PMCID: PMC10891479 DOI: 10.1002/cam4.7013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Shortness of breath occurs in 10%-70% of oncology patients. Very little is known about interindividual variability in its severity and distress and associated risk factors. Using latent profile analyses (LPAs), purpose was to identify subgroups of patients with distinct severity and distress profiles for shortness of breath as single symptom dimensions. In addition, a joint LPA was done using patients' severity AND distress ratings. For each of the three LPAs, differences among the shortness of breath classes in demographic, clinical, symptom, stress, and resilience characteristics were evaluated. METHODS Patients completed ratings of severity and distress from shortness of breath a total of six times over two cycles of chemotherapy. All of the other measures were completed at enrollment (i.e., prior to the second or third cycle of chemotherapy). Separate LPAs were done using ratings of severity and distress, as well as a joint analysis using severity AND distress ratings. Differences among the latent classes were evaluated using parametric and nonparametric tests. RESULTS For severity, two classes were identified (Slight to Moderate [91.6%] and Moderate to Severe [8.4%]). For distress, two classes were identified (A Little Bit to Somewhat [83.9%] and Somewhat to Quite a Bit [16.1%]). For the joint LPA, two classes were identified (Lower Severity and Distress [79.9%] and Higher Severity and Distress [20.1%]). While distinct risk factors were associated with each of the LPAs, across the three LPAs, the common risk factors associated with membership in the worse class included: a past or current history of smoking, poorer functional status, and higher comorbidity burden. In addition, these patients had a higher symptom burden and higher levels of cancer-specific stress. CONCLUSIONS Clinicians can use the information provided in this study to identify high-risk patients and develop individualized interventions.
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Affiliation(s)
- Joosun Shin
- Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | - Bruce A. Cooper
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Steven M. Paul
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Kord M. Kober
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yvette P. Conley
- School of NursingUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Jon D. Levine
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Christine Miaskowski
- School of NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- School of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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12
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Chen J, Mark S, Mackin L, Paul SM, Cooper BA, Hammer MJ, Conley YP, Levine JD, Miaskowski C. Increased Stress Is Associated With Severe Pain and Decrements in Cognitive Function in Patients Receiving Chemotherapy. Semin Oncol Nurs 2024; 40:151577. [PMID: 38245388 DOI: 10.1016/j.soncn.2023.151577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/18/2023] [Accepted: 12/20/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVES Purposes were to identify subgroups of adult oncology patients (n = 1342) with distinct joint profiles of worst pain and cognitive function (CF) and evaluate for differences in demographic and clinical characteristics, as well as the severity of three distinct types of stress, resilience, and coping. DATA SOURCES Measures of pain and CF were evaluated six times over two cycles of chemotherapy. The other measures of demographic and clinical characteristics, stress, resilience, and coping were completed at enrollment (ie, prior to the second or third cycle of chemotherapy). RESULTS Using latent profile analysis, four distinct profiles were identified (ie, no pain + moderate CF [27.6%], moderate pain + high CF [22.4%] moderate pain and moderate CF [32.4%, both moderate], severe pain and low CF [17.5%, both severe]). Both moderate and both severe classes reported higher global, cancer-specific, and cumulative life stress, lower levels of resilience, and greater use of disengagement coping strategies. The Both severe class had higher occurrence rates for a number of adverse childhood experiences (ie, family violence in childhood, physical abuse at <16 years, forced sex at <16 years). Risk factors associated with membership in the two worst profiles included: being female, having a lower annual income, having a higher comorbidity burden, and having a poorer functional status. CONCLUSION Findings suggest that 72.4% of the patients reported pain scores in the moderate to severe range and 77.6% reported low to moderate levels of CF. Clinicians need to assess for both symptoms and various types of stress on a routine basis.
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Affiliation(s)
- Jacqueline Chen
- School of Nursing, University of California, San Francisco, CA
| | - Sueann Mark
- School of Nursing, University of California, San Francisco, CA
| | - Lynda Mackin
- School of Nursing, University of California, San Francisco, CA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA; School of Medicine, University of California, San Francisco, CA.
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13
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Calvo-Schimmel A, Paul SM, Cooper BA, Harris C, Shin J, Oppegaard K, Hammer MJ, Cartwright F, Conley YP, Kober KM, Levine JD, Miaskowski C. Various types of stress and greater use of disengagement coping are associated with worse sleep disturbance in oncology patients undergoing chemotherapy. Stress Health 2024; 40:e3279. [PMID: 37265072 PMCID: PMC10692307 DOI: 10.1002/smi.3279] [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: 12/02/2022] [Revised: 03/31/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
Various types of stress and the choice of coping strategies may be risk factors for higher levels of sleep disturbance in oncology patients. Purposes were to evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and the use of coping strategies among three subgroups of patients with distinct sleep disturbance profiles (i.e., Low, High, Very High). Oncology outpatients (n = 1331) completed measures of global (Perceived Stress Scale), cancer-specific (Impact of Event Scale-Revised), and cumulative life (Life Stressor Checklist-Revised) stress, resilience (Connor-Davidson Resilience Scale) and coping (Brief Cope) prior to their second or third cycle of chemotherapy. Sleep disturbance was assessed six times over two chemotherapy cycles. Differences were evaluated using parametric and non-parametric tests. All stress measures showed a dose response effect (i.e., as the sleep disturbance profile worsened, levels of all types of stress increased). Compared to Low class, the other two classes reported higher levels of global perceived stress and higher occurrence rates and effect from previous stressful life events. Impact of Event Scale-Revised scores for the Very High class indicated post-traumatic symptomatology. Patients in High and Very High classes had resilience scores below the normative score for the United States population and used a higher number of disengagement coping strategies. Our findings suggest that very high levels of sleep disturbance are associated with higher levels of various types of stress, lower levels of resilience, and higher use of disengagement coping strategies. Clinicians need to perform routine assessments and implement symptom management interventions to reduce stress and encourage the use of engagement coping strategies.
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Affiliation(s)
| | - Steven M. Paul
- School of Nursing, University of California, San Francisco, CA
| | - Bruce A. Cooper
- School of Nursing, University of California, San Francisco, CA
| | - Carolyn Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Joosun Shin
- School of Nursing, University of California, San Francisco, CA
| | - Kate Oppegaard
- School of Nursing, University of California, San Francisco, CA
| | | | | | | | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA
| | - Jon D. Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA
- School of Medicine, University of California, San Francisco, CA
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14
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Garcia P, Block A, Mark S, Mackin L, Paul SM, Cooper BA, Conley YP, Hammer MJ, Levine JD, Miaskowski C. Higher Levels of Multiple Types of Stress Are Associated With Worse State Anxiety and Morning Fatigue Profiles in Patients Receiving Chemotherapy. Cancer Nurs 2024:00002820-990000000-00209. [PMID: 38259094 DOI: 10.1097/ncc.0000000000001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Anxiety and fatigue are common problems in patients receiving chemotherapy. Unrelieved stress is a potential cause for the co-occurrence of these symptoms. OBJECTIVES The aims of this study were to identify subgroups of patients with distinct state anxiety and morning fatigue profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, as well as measures of global, cancer-specific, and cumulative life stress and resilience and coping. METHODS Patients (n = 1335) completed measures of state anxiety and morning fatigue 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was used to identify the state anxiety and morning fatigue profiles. RESULTS Three distinct joint profiles were identified: Low Anxiety and Low Morning Fatigue (59%), Moderate Anxiety and Moderate Morning Fatigue (33.4%), and High Anxiety and High Morning Fatigue (7.6%). Patients in the 2 highest classes were younger, were less likely to be married/partnered, and had a higher comorbidity burden. All of the stress scores demonstrated a dose-response effect (ie, as anxiety and morning fatigue profiles worsened, stress increased). Patients in the 2 highest classes reported higher rates of emotional abuse, physical neglect, physical abuse, and sexual harassment. CONCLUSIONS More than 40% of these patients experienced moderate to high levels of both anxiety and morning fatigue. Higher levels of all 3 types of stress were associated with the 2 highest profiles. IMPLICATIONS FOR PRACTICE Clinicians need to perform comprehensive evaluations of patients' levels of stress and recommend referrals to psychosocial services.
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Affiliation(s)
- Philip Garcia
- Author Affiliations: School of Nursing, University of California, San Francisco (Mr Garcia, Ms Block, and Drs Mark, Mackin, Paul, Cooper, and Miaskowski); School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); School of Medicine, University of California, San Francisco (Drs Miaskowski and Levine)
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15
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Calvo-Schimmel A, Hammer MJ, Wright AA, Blank SV, Cohen B, Harris C, Shin J, Conley Y, Paul S, Cooper B, Levine JD, Miaskowski C. Worse Depression Profiles Are Associated With Higher Symptom Burden and Poorer Quality of Life in Patients With Gynecologic Cancer. Cancer Nurs 2024:00002820-990000000-00210. [PMID: 38259059 DOI: 10.1097/ncc.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Depression is a pervasive symptom in patients with gynecological cancer undergoing chemotherapy. OBJECTIVES Purposes were to identify subgroups of patients with distinct depression profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life (QOL) outcomes among these subgroups. METHODS Patients with gynecological cancer (n = 231) completed the Center for Epidemiologic Studies-Depression Scale 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct depression profiles. Differences were evaluated using parametric and nonparametric tests. RESULTS Three distinct profiles were identified: low (60.1%), high (35.1%), and very high (4.8%). Compared with low class, the other 2 classes had lower functional status and were more likely to self-report a diagnosis of depression. Patients in the 2 worse profiles reported a higher comorbidity burden, higher levels of trait and state anxiety, sleep disturbance, and fatigue, as well as lower levels of cognitive function and poorer QOL. State and trait anxiety, evening fatigue, and sleep disturbance scores exhibit a "dose-response effect" (ie, as the depression profile worsened, the severity of these symptoms increased). CONCLUSIONS Almost 40% of our sample experienced high or very high levels of depression across 2 cycles of chemotherapy. IMPLICATIONS FOR PRACTICE Clinicians can use the identified risk factors to identify high patients risk and provide tailored psychological interventions aimed to decrease symptom burden and prevent decrements in QOL.
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Affiliation(s)
- Alejandra Calvo-Schimmel
- Author Affiliations: School of Nursing, University of California, San Francisco (Drs Calvo-Schimmel, Shin, Paul, Cooper, and Miaskowski); Dana Farber Cancer Institute, Boston, Massachusetts (Drs Hammer and Wright); Mount Sinai Medical Center, New York (Drs Blank and Cohen); School of Nursing, University of Pittsburgh, Pennsylvania (Drs Harris and Conley); and School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
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16
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Bogen O, Araldi D, Sucher A, Kober K, Ohara PT, Levine JD. Isolectin B4 (IB4)-conjugated streptavidin for the selective knockdown of proteins in IB4-positive (+) nociceptors. bioRxiv 2024:2023.12.18.572242. [PMID: 38260446 PMCID: PMC10802253 DOI: 10.1101/2023.12.18.572242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
In vivo analysis of protein function in nociceptor subpopulations using antisense oligonucleotides and short interfering RNAs is limited by their non-selective cellular uptake. To address the need for selective transfection methods, we covalently linked isolectin B4 (IB4) to streptavidin and analyzed whether it could be used to study protein function in IB4(+)-nociceptors. Rats treated intrathecally with IB4-conjugated streptavidin complexed with biotinylated antisense oligonucleotides for protein kinase C epsilon (PKCε) mRNA were found to have: a) less PKCε in dorsal root ganglia (DRG), b) reduced PKCε expression in IB4(+) but not IB4(-) DRG neurons, and c) fewer transcripts of the PKCε gene in the DRG. This knockdown in PKCε expression in IB4(+) DRG neurons is sufficient to reverse hyperalgesic priming, a rodent model of chronic pain that is dependent on PKCε in IB4(+)-nociceptors. These results establish that IB4-streptavidin can be used to study protein function in a defined subpopulation of nociceptive C-fiber afferents.
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17
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Lin Y, Bailey DE, Xiao C, Hammer M, Paul SM, Cooper BA, Conley YP, Levine JD, Kober KM, Miaskowski C. Distinct Co-occurring Morning and Evening Fatigue Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy. Cancer Nurs 2024; 47:E28-E37. [PMID: 36076314 PMCID: PMC10232668 DOI: 10.1097/ncc.0000000000001148] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with gastrointestinal cancers experience diurnal variations in fatigue severity during chemotherapy that decrease their functional status and quality of life. OBJECTIVES Study purposes were to identify subgroups of patients with distinct co-occurring morning and evening fatigue profiles and evaluate for differences among these subgroups in demographic, clinical, stress, and symptom characteristics. METHODS Patients with gastrointestinal cancers (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. The Lee Fatigue Scale was used to evaluate diurnal variations in fatigue severity. Latent profile analysis was used to identify subgroups of patients with distinct co-occurring morning AND evening fatigue profiles. Differences among the subgroups in demographic, clinical, stress, and symptom characteristics at enrollment were evaluated using parametric and nonparametric analyses. RESULTS Two classes were identified, namely: low morning and moderate evening fatigue (ie, Low-Moderate, 60.0%) and high morning and high evening fatigue (ie, Both High, 40.0%). Compared with the Low-Moderate class, the Both High class was significantly younger, female, unmarried, and unemployed and lacked regular exercise. In addition, they had childcare responsibilities, lower annual income, lower functional status, higher comorbidity burden, and self-reported anemia and depression. Patients in the Both High class reported higher levels of anxiety, depressive symptoms, sleep disturbance, pain, and stress, and lower levels of energy and cognitive function. CONCLUSIONS Findings provide new insights into the risk factors for higher levels of co-occurring morning and evening fatigue in patients with gastrointestinal cancers. IMPLICATIONS FOR PRACTICE Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.
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Affiliation(s)
- Yufen Lin
- Author Affiliations: Nell Hodgson Woodruff School of Nursing, Emory University (Drs Lin and Xiao), Atlanta, Georgia; School of Nursing, Duke University (Dr Bailey), Durham, North Carolina; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; School of Nursing, University of California San Francisco (Drs Paul, Cooper, Kober, and Miaskowski); School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania; and School of Medicine, University of California San Francisco (Drs Levine and Miaskowski)
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18
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Khomula EV, Araldi D, Green PG, Levine JD. Sensitization of human and rat nociceptors by low dose morphine is toll-like receptor 4-dependent. Mol Pain 2024; 20:17448069241227922. [PMID: 38195088 PMCID: PMC10851754 DOI: 10.1177/17448069241227922] [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: 12/23/2023] [Accepted: 01/06/2024] [Indexed: 01/11/2024] Open
Abstract
While opioids remain amongst the most effective treatments for moderate-to-severe pain, their substantial side effect profile remains a major limitation to broader clinical use. One such side effect is opioid-induced hyperalgesia (OIH), which includes a transition from opioid-induced analgesia to pain enhancement. Evidence in rodents supports the suggestion that OIH may be produced by the action of opioids at Toll-like Receptor 4 (TLR4) either on immune cells that, in turn, produce pronociceptive mediators to act on nociceptors, or by a direct action at nociceptor TLR4. And, sub-analgesic doses of several opioids have been shown to induce hyperalgesia in rodents by their action as TLR4 agonists. In the present in vitro patch-clamp electrophysiology experiments, we demonstrate that low dose morphine directly sensitizes human as well as rodent dorsal root ganglion (DRG) neurons, an effect of this opioid analgesic that is antagonized by LPS-RS Ultrapure, a selective TLR4 antagonist. We found that low concentration (100 nM) of morphine reduced rheobase in human (by 36%) and rat (by 26%) putative C-type nociceptors, an effect of morphine that was markedly attenuated by preincubation with LPS-RS Ultrapure. Our findings support the suggestion that in humans, as in rodents, OIH is mediated by the direct action of opioids at TLR4 on nociceptors.
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Affiliation(s)
- Eugen V Khomula
- Department of Oral & Maxillofacial Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Dionéia Araldi
- Department of Oral & Maxillofacial Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Paul G Green
- Department of Oral & Maxillofacial Surgery, University of California at San Francisco, San Francisco, CA, USA
- Department of Preventative & Restorative Dental Sciences, and Division of Neuroscience, University of California at San Francisco, San Francisco, CA, USA
| | - Jon D Levine
- Department of Oral & Maxillofacial Surgery, University of California at San Francisco, San Francisco, CA, USA
- Department of Medicine, Division of Neuroscience, and UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA, USA
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19
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Xu Z, Lee MC, Sheehan K, Fujii K, Rabl K, Rader G, Varney S, Sharma M, Eilers H, Kober K, Miaskowski C, Levine JD, Schumacher MA. Chemotherapy for pain: reversing inflammatory and neuropathic pain with the anticancer agent mithramycin A. Pain 2024; 165:54-74. [PMID: 37366593 PMCID: PMC10723648 DOI: 10.1097/j.pain.0000000000002972] [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: 12/20/2021] [Revised: 02/08/2023] [Accepted: 04/25/2023] [Indexed: 06/28/2023]
Abstract
ABSTRACT The persistence of inflammatory and neuropathic pain is poorly understood. We investigated a novel therapeutic paradigm by targeting gene networks that sustain or reverse persistent pain states. Our prior observations found that Sp1-like transcription factors drive the expression of TRPV1, a pain receptor, that is blocked in vitro by mithramycin A (MTM), an inhibitor of Sp1-like factors. Here, we investigate the ability of MTM to reverse in vivo models of inflammatory and chemotherapy-induced peripheral neuropathy (CIPN) pain and explore MTM's underlying mechanisms. Mithramycin reversed inflammatory heat hyperalgesia induced by complete Freund adjuvant and cisplatin-induced heat and mechanical hypersensitivity. In addition, MTM reversed both short-term and long-term (1 month) oxaliplatin-induced mechanical and cold hypersensitivity, without the rescue of intraepidermal nerve fiber loss. Mithramycin reversed oxaliplatin-induced cold hypersensitivity and oxaliplatin-induced TRPM8 overexpression in dorsal root ganglion (DRG). Evidence across multiple transcriptomic profiling approaches suggest that MTM reverses inflammatory and neuropathic pain through broad transcriptional and alternative splicing regulatory actions. Mithramycin-dependent changes in gene expression following oxaliplatin treatment were largely opposite to and rarely overlapped with changes in gene expression induced by oxaliplatin alone. Notably, RNAseq analysis revealed MTM rescue of oxaliplatin-induced dysregulation of mitochondrial electron transport chain genes that correlated with in vivo reversal of excess reactive oxygen species in DRG neurons. This finding suggests that the mechanism(s) driving persistent pain states such as CIPN are not fixed but are sustained by ongoing modifiable transcription-dependent processes.
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Affiliation(s)
- Zheyun Xu
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Man-Cheung Lee
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Kayla Sheehan
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Keisuke Fujii
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
| | - Katalin Rabl
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Gabriella Rader
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Scarlett Varney
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Manohar Sharma
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Helge Eilers
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Kord Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, United States
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, United States
| | - Jon D. Levine
- Division of Neuroscience, Departments of Medicine and Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Mark A. Schumacher
- Department of Anesthesia and Perioperative Care and the UCSF Pain and Addiction Research Center, University of California, San Francisco, San Francisco, CA, United States
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20
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Green PG, Levine JD. A novel anti-pruritic: Topical co-administration of high molecular weight hyaluronan (HMWH) with protamine, a transdermal transport enhancer. Mol Pain 2024; 20:17448069241254455. [PMID: 38728068 PMCID: PMC11088296 DOI: 10.1177/17448069241254455] [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: 04/02/2024] [Revised: 05/09/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
Pruritis, the sensation of itch, is produced by multiple substances, exogenous and endogenous, that sensitizes specialized sensory neurons (pruriceptors and pruri-nociceptors). Unfortunately, many patients with acute and chronic pruritis obtain only partial relief when treated with currently available treatment modalities. We recently demonstrated that the topical application of high molecular weight hyaluronan (HMWH), when combined with vehicles containing transdermal transport enhancers, produce potent long-lasting reversal of nociceptor sensitization associated with inflammatory and neuropathic pain. In the present experiments we tested the hypothesis that the topical formulation of HMWH with protamine, a transdermal transport enhancer, can also attenuate pruritis. We report that this topical formulation of HMWH markedly attenuates scratching behavior at the nape of the neck induced by serotonin (5-hydroxytryptamine, 5-HT), in male and female rats. Our results support the hypothesis that topical HMWH in a transdermal transport enhancer vehicle is a strong anti-pruritic.
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Affiliation(s)
- Paul G Green
- Department of Oral & Maxillofacial Surgery, and UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA, USA
- Department of Preventative & Restorative Dental Sciences, and Division of Neuroscience, University of California at San Francisco, San Francisco, CA, USA
| | - Jon D Levine
- Department of Oral & Maxillofacial Surgery, and UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA, USA
- Department of Medicine, and Division of Neuroscience, University of California at San Francisco, San Francisco, CA, USA
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21
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Bogen O, Araldi D, Sucher A, Kober K, Ohara PT, Levine JD. Isolectin B4 (IB4)-conjugated streptavidin for the selective knockdown of proteins in IB4-positive (+) nociceptors. Mol Pain 2024; 20:17448069241230419. [PMID: 38246917 PMCID: PMC10851726 DOI: 10.1177/17448069241230419] [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: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
In vivo analysis of protein function in nociceptor subpopulations using antisense oligonucleotides and short interfering RNAs is limited by their non-selective cellular uptake. To address the need for selective transfection methods, we covalently linked isolectin B4 (IB4) to streptavidin and analyzed whether it could be used to study protein function in IB4(+)-nociceptors. Rats treated intrathecally with IB4-conjugated streptavidin complexed with biotinylated antisense oligonucleotides for protein kinase C epsilon (PKCε) mRNA were found to have: (a) less PKCε in dorsal root ganglia (DRG), (b) reduced PKCε expression in IB4(+) but not IB4(-) DRG neurons, and (c) fewer transcripts of the PKCε gene in the DRG. This knockdown in PKCε expression in IB4(+) DRG neurons is sufficient to reverse hyperalgesic priming, a rodent model of chronic pain that is dependent on PKCε in IB4(+)-nociceptors. These results establish that IB4-streptavidin can be used to study protein function in a defined subpopulation of nociceptive C-fiber afferents.
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Affiliation(s)
- Oliver Bogen
- Department of Oral & Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California, San Francisco, CA, USA
| | - Dionéia Araldi
- Department of Oral & Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California, San Francisco, CA, USA
| | - Anatol Sucher
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Peter T Ohara
- Department of Anatomy, University of California, San Francisco, CA, USA
| | - Jon D Levine
- Department of Oral & Maxillofacial Surgery, UCSF Pain and Addiction Research Center, University of California, San Francisco, CA, USA
- Division of Neuroscience, Department of Medicine, University of California, San Francisco, CA, USA
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Fitzsimons LA, Staurengo-Ferrari L, Bogen O, Araldi D, Bonet IJM, Jordan EE, Levine JD, Tucker KL. The Primary Cilium and its Hedgehog Signaling in Nociceptors Contribute to Inflammatory and Neuropathic Pain. bioRxiv 2023:2023.12.27.573420. [PMID: 38234719 PMCID: PMC10793418 DOI: 10.1101/2023.12.27.573420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
The primary cilium, a 1-3 μm long hair-like structure protruding from the surface of almost all cells in the vertebrate body, is critical for neuronal development and also functions in the adult. As the migratory neural crest settles into dorsal root ganglia (DRG) sensory neurons elaborate a single primary cilium at their soma that is maintained into adult stages. While it is not known if primary cilia are expressed in nociceptors, or their potential function in the mature DRG neuron, recent studies have shown a role for Hedgehog, whose signaling demonstrates a dependence on primary cilia, in nociceptor sensitization. Here we report the expression of primary cilia in rat and mouse nociceptors, where they modulate mechanical nociceptive threshold, and contribute to inflammatory and neuropathic pain. When siRNA targeting Ift88 , a primary cilium-specific intra-flagellar transport (IFT) protein required for ciliary integrity, was administered by intrathecal injection, in the rat, it resulted in loss of Ift88 mRNA in DRG, and primary cilia in neuronal cell bodies, which was associated with an increase in mechanical nociceptive threshold, and abrogation of hyperalgesia induced by the pronociceptive inflammatory mediator, prostaglandin E 2 , and painful peripheral neuropathy induced by a neurotoxic chemotherapy drug, paclitaxel. To provide further support for the role of the primary cilium in nociceptor function we also administered siRNA for another IFT protein, Ift 52. Ift 52 siRNA results in loss of Ift 52 in DRG and abrogates paclitaxel-induced painful peripheral neuropathy. Attenuation of Hedgehog-induced hyperalgesia by Ift88 knockdown supports a role for the primary cilium in the hyperalgesia induced by Hedgehog, and attenuation of paclitaxel chemotherapy-induced neuropathy (CIPN) by cyclopamine, which attenuates Hedgehog signaling, suggests a role of Hedgehog in CIPN. Our findings support a role of nociceptor primary cilia in the control of mechanical nociceptive threshold and in inflammatory and neuropathic pain, the latter, at least in part, Hedgehog dependent.
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23
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Khomula EV, Levine JD. Sensitization of Human and Rat Nociceptors by Low Dose Morphine is TLR4-dependent. bioRxiv 2023:2023.12.19.572472. [PMID: 38187676 PMCID: PMC10769211 DOI: 10.1101/2023.12.19.572472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
While opioids remain amongst the most effective treatments for moderate-to-severe pain, their substantial side effect profile remains a major limitation to broader clinical use. One such side effect is opioid-induced hyperalgesia (OIH), which includes a transition from opioid-induced analgesia to pain enhancement. Evidence in rodents supports the suggestion that OIH may be produced by the action of opioids at Toll-like Receptor 4 (TLR4) either on immune cells that, in turn, produce pronociceptive mediators to act on nociceptors, or by a direct action at nociceptor TLR4. And, sub-analgesic doses of several opioids have been shown to induce hyperalgesia in rodents by their action as TLR4 agonists. In the present in vitro patch-clamp electrophysiology experiments, we demonstrate that low dose morphine directly sensitizes human as well as rodent dorsal root ganglion (DRG) neurons, an effect of this opioid analgesic that is antagonized by LPS-RS Ultrapure, a selective TLR4 antagonist. We found that morphine (100 nM) reduced rheobase in human (by 36%) and rat (by 26%) putative C-type nociceptors, an effect of morphine that was markedly attenuated by preincubation with LPS-RS Ultrapure. Our findings support the suggestion that in humans, as well as in rodents, OIH is mediated by the direct action of opioids at TLR4 on nociceptors.
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24
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Bonet IJM, Araldi D, Green PG, Levine JD. Topical coapplication of hyaluronan with transdermal drug delivery enhancers attenuates inflammatory and neuropathic pain. Pain 2023; 164:2653-2664. [PMID: 37467181 PMCID: PMC10794581 DOI: 10.1097/j.pain.0000000000002993] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/27/2023] [Accepted: 05/16/2023] [Indexed: 07/21/2023]
Abstract
ABSTRACT We have previously shown that intradermal injection of high-molecular-weight hyaluronan (500-1200 kDa) produces localized antihyperalgesia in preclinical models of inflammatory and neuropathic pain. In the present experiments, we studied the therapeutic effect of topical hyaluronan, when combined with each of 3 transdermal drug delivery enhancers (dimethyl sulfoxide [DMSO], protamine or terpene), in preclinical models of inflammatory and neuropathic pain. Topical application of 500 to 1200 kDa hyaluronan (the molecular weight range used in our previous studies employing intradermal administration), dissolved in 75% DMSO in saline, markedly reduced prostaglandin E 2 (PGE 2 ) hyperalgesia, in male and female rats. Although topical 500- to 1200-kDa hyaluronan in DMSO vehicle dose dependently, also markedly, attenuated oxaliplatin chemotherapy-and paclitaxel chemotherapy-induced painful peripheral neuropathy (CIPN) in male rats, it lacked efficacy in female rats. However, following ovariectomy or intrathecal administration of an oligodeoxynucleotide antisense to G-protein-coupled estrogen receptor (GPR30) mRNA, CIPN in female rats was now attenuated by topical hyaluronan. Although topical coadministration of 150 to 300, 300 to 500, or 1500 to 1750 kDa hyaluronan with DMSO also attenuated CIPN, a slightly lower-molecular-weight hyaluronan (70-120 kDa) did not. The topical administration of a combination of hyaluronan with 2 other transdermal drug delivery enhancers, protamine and terpene, also attenuated CIPN hyperalgesia, an effect that was more prolonged than with DMSO vehicle. Repeated administration of topical hyaluronan prolonged the duration of antihyperalgesia. Our results support the use of topical hyaluronan, combined with chemically diverse nontoxic skin penetration enhancers, to induce marked antihyperalgesia in preclinical models of inflammatory and neuropathic pain.
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Affiliation(s)
- Ivan J. M. Bonet
- Department of Oral & Maxillofacial Surgery, and Division of Neuroscience, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Dionéia Araldi
- Department of Oral & Maxillofacial Surgery, and Division of Neuroscience, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Paul G. Green
- Department of Oral & Maxillofacial Surgery, and Division of Neuroscience, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
- Departments of Preventative & Restorative Dental Sciences and Oral & Maxillofacial Surgery, and Division of Neuroscience, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Jon D. Levine
- Department of Oral & Maxillofacial Surgery, and Division of Neuroscience, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
- Departments of Medicine and Oral & Maxillofacial Surgery, and Division of Neuroscience, UCSF Pain and Addiction Research Center, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, USA
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Oppegaard KR, Mayo SJ, Armstrong TS, Kober KM, Anguera J, Hammer MJ, Levine JD, Conley YP, Paul S, Cooper B, Miaskowski C. Adverse Childhood Experiences and Higher Levels of Stress Are Associated With the Co-occurrence of Cancer-Related Cognitive Impairment and Anxiety. Semin Oncol Nurs 2023; 39:151513. [PMID: 37914659 DOI: 10.1016/j.soncn.2023.151513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES We sought to identify subgroups of patients with distinct joint cancer-related cognitive impairment (CRCI) AND anxiety profiles and evaluate for differences in demographic and clinical characteristics, as well as levels of global stress, cancer-specific stress, cumulative life stress, and resilience. DATA SOURCES Patients (n = 1332) completed the Attentional Function Index and the Spielberger State Anxiety Inventory six times over two cycles of chemotherapy. Global, cancer-specific, and cumulative life stress and resilience were evaluated using Perceived Stress Scale, Impact of Event Scale-Revised, Life Stressor Checklist-Revised, and Connor-Davidson Resilience Scale, respectively. Latent profile analysis was used to identify subgroups of patients with distinct joint CRCI AND anxiety profiles. Differences were evaluated using parametric and nonparametric tests. RESULTS Three classes were identified (ie, No CRCI and Low Anxiety [57.3%], Moderate CRCI and Moderate Anxiety [34.5%], and High CRCI and High Anxiety [8.2%]). All of the stress measures showed a dose-response effect (ie, as the CRCI AND anxiety profile worsened, scores for all three types of stress increased). The two highest symptom classes reported higher occurrence rates for six specific stressors (eg, emotional abuse, physical abuse, sexual harassment). CONCLUSIONS Findings suggest that higher levels of co-occurring CRCI AND anxiety are associated with some common risk factors, as well as higher levels of stress and lower levels of resilience. Increased knowledge of modifiable risk factors and sources of stress associated with the co-occurrence of these two symptoms will assist clinicians to identify high-risk patients and implement individualized interventions.
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Affiliation(s)
- Kate R Oppegaard
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA
| | - Samantha J Mayo
- Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Canada
| | - Terri S Armstrong
- Neuro-Oncology Branch, Office of Patient-Centered Outcomes Research, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Kord M Kober
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA
| | - Joaquin Anguera
- Weill Institute for Neurosciences, Departments of Neurology and Psychiatry, University of California San Francisco, San Francisco, CA
| | - Marilyn J Hammer
- Director of Research and Evidence-based Practice, Dana-Farber Cancer Institute, Boston, MA
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburg, Pittsburgh, PA
| | - Steven Paul
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA
| | - Bruce Cooper
- Department of Physiological Nursing, University of California, San Francisco, CA
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.
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Sorrera D, Block A, Mackin L, Paul SM, Cooper BA, Hammer MJ, Conley YP, Levine JD, Miaskowski C. Decrements in Both Physical and Cognitive Function Are Associated With a Higher Symptom Burden in Oncology Patients. Semin Oncol Nurs 2023; 39:151516. [PMID: 37968207 DOI: 10.1016/j.soncn.2023.151516] [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: 04/11/2023] [Revised: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES Physical and cognitive function are two of the most important patient-reported outcomes. In oncology patients receiving chemotherapy (N = 1331), purposes were to identify subgroups of patients with distinct joint physical and cognitive function profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life outcomes. DATA SOURCES Measures of physical and cognitive functions were obtained six times over two cycles of chemotherapy. All of the other measures were done prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct joint physical and cognitive function profiles. Differences among the profiles were evaluated using parametric and nonparametric tests. CONCLUSION Five distinct profiles were identified (ie, Very Low Physical and Low Cognitive Function [18.4%; Both Low], Low Physical and High Cognitive Function [19.8%], Moderate Physical and Low Cognitive Function [26.7%], Changing Physical and Cognitive Function [5.4%], and Normal Physical and Cognitive Function [29.7%]). Patients in the Both Low class had the highest symptom burden and the poorest quality of life. Over 70% of the sample had moderate to severe decrements in one or both of these extremely important patient outcomes. IMPLICATIONS FOR NURSING PRACTICE Clinicians need to assess for both physical and cognitive function using simple subjective and objective measures.
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Affiliation(s)
- Dianne Sorrera
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Astrid Block
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Lynda Mackin
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Marilyn J Hammer
- Cantor Center for Research in Nursing and Patient Care Services, Dan Farber Cancer Institute, Boston, MA
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA.
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27
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Oppegaard K, Kober KM, Harris C, Shin J, Morse L, Calvo-Schimmel A, Paul SM, Cooper BA, Conley YP, Hammer M, Dokiparthi V, Levine JD, Miaskowski C. Anxiety in oncology outpatients is associated with perturbations in pathways identified in anxiety focused network pharmacology research. Support Care Cancer 2023; 31:727. [PMID: 38012456 PMCID: PMC10682221 DOI: 10.1007/s00520-023-08196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Evaluate for perturbed signaling pathways associated with subgroups of patients with low versus high levels of state anxiety. These pathways were compared to the pathways identified across eight network pharmacology studies of the anxiolytic effect(s) of a variety of compounds. METHODS Adult outpatients had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct anxiety profiles based on Spielberger State Anxiety Inventory scores that were obtained six times over two cycles of chemotherapy. Blood samples were processed using RNA sequencing (i.e., RNA-seq sample, n = 244) and microarray (i.e., microarray sample; n = 256) technologies. Pathway perturbations were assessed using pathway impact analysis. Fisher's combined probability method was used to combine test results using a false discovery rate of 0.01. RESULTS In the RNA-seq sample, 62.3% and 37.7% of the patients were in the low- and high-anxiety classes, respectively. In the microarray sample, 61.3% and 38.7% were in the low and high-anxiety classes, respectively. Forty-one perturbed signaling pathways were identified. Eight of these pathways were common to those identified in the network pharmacology studies. CONCLUSIONS Findings increase our knowledge of the molecular mechanisms that underlie anxiety in patients receiving chemotherapy. This study provides initial insights into how anxiety in patients with cancer may share common mechanisms with anxiety in patients with other clinical conditions.
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Affiliation(s)
- Kate Oppegaard
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Carolyn Harris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joosun Shin
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Lisa Morse
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Alejandra Calvo-Schimmel
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Vasuda Dokiparthi
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, CA, USA.
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Calvo-Schimmel A, Paul SM, Cooper BA, Shin J, Harris C, Oppegaard K, Hammer MJ, Cartwright F, Conley YP, Kober KM, Levine JD, Miaskowski C. Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life. Cancer Nurs 2023; 46:417-431. [PMID: 35688433 PMCID: PMC9729413 DOI: 10.1097/ncc.0000000000001139] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anxiety and sleep disturbance are frequent symptoms during chemotherapy. OBJECTIVES Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups. METHODS Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles. RESULTS Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life. CONCLUSIONS More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms. IMPLICATIONS FOR PRACTICE Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.
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Affiliation(s)
- Alejandra Calvo-Schimmel
- Author affiliations: School of Nursing, University of California, San Francisco (Drs Calvo-Schimmel, Paul, Cooper, Kober, and Miaskowski and Mss Shin, Harris, and Oppegaard); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); Department of Nursing, Mount Sinai Medical Center, New York (Dr Cartwright); School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Conley); and School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
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29
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Shin J, Kober K, Yates P, Wong ML, Cooper BA, Paul SM, Hammer M, Conley Y, Levine JD, Wright F, Miaskowski C. Higher Lifetime Stress and Symptom Burden Contribute to the Occurrence of Shortness of Breath. Semin Oncol Nurs 2023; 39:151471. [PMID: 37500312 DOI: 10.1016/j.soncn.2023.151471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Among four classes of patients with distinct shortness of breath profiles, evaluate for differences in levels of global, cancer-specific, and cumulative life stress, as well as resilience; evaluate for differences in the occurrence rates for various stressful life events, and evaluate for differences in the severity of common co-occurring symptoms. DATA SOURCES Outpatients (N = 1338) completed questionnaires six times over two cycles of chemotherapy. The occurrence of shortness of breath was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath profiles. Differences among the classes were evaluated using parametric and nonparametric tests. CONCLUSION Shortness of breath classes were labeled based on their distinct occurrence trajectories: None (70.5%), Decreasing (8.2%), Increasing (7.8%), and High (13.5%). Compared to None class, Decreasing and High classes had higher global and cancer-specific stress scores. The High class reported higher occurrence rates for several adverse childhood experiences. Compared to None class, Decreasing and High classes had higher depression, anxiety, and morning fatigue scores and lower morning energy and cognitive function scores. IMPLICATIONS FOR NURSING PRACTICE Given the additive or synergistic relationships between stress, co-occurring symptoms, and shortness of breath, multimodal interventions that include stress management, exercise training, and/or symptom management may decrease shortness of breath in oncology patients.
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Affiliation(s)
- Joosun Shin
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Kord Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melisa L Wong
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Marilyn Hammer
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Yvette Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesia, School of Nursing and School of Medicine, University of California, San Francisco, California.
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Hun Kwak J, Mackin LA, Block A, Paul SM, Cooper BA, Abbott M, Chang SM, Hammer MJ, Kober KM, Levine JD, Pozzar R, Rhoads KF, Snowberg KE, Tsai KK, Van Blarigan EL, Van Loon K, Miaskowski C. Risk Factors for a Higher Symptom Burden in Patients With Cancer During the COVID-19 Pandemic. Oncol Nurs Forum 2023; 50:647-664. [PMID: 37677766 DOI: 10.1188/23.onf.647-664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To evaluate for subgroups of patients with distinct symptom profiles and differences in demographic and clinical characteristics and stress and resilience among these subgroups. SAMPLE & SETTING 1,145 patients with cancer aged 18 years or older completed a survey online. Data were collected between May 2020 and February 2021. METHODS & VARIABLES Patients completed measures for depression, state anxiety, cognitive function, morning fatigue, evening fatigue, morning energy, evening energy, sleep disturbance, pain, stress, and resilience. Latent class profile analysis was used to identify subgroups of patients with distinct symptom profiles. Differences among the subgroups on study measures were evaluated using parametric and nonparametric tests. RESULTS Four distinct profiles were identified (none, low, high, and very high). Patients in the high and very high classes reported clinically meaningful levels of all nine symptoms. Differences among the four profiles for stress and resilience exhibited a dose-response effect. IMPLICATIONS FOR NURSING Findings can serve as benchmark data of the symptom burden of patients with cancer following the COVID-19 pandemic.
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Pozzar RA, Hammer MJ, Paul SM, Cooper BA, Conley YP, Chen LM, Levine JD, Miaskowski C. Associations Between Distinct State Anxiety Profiles, Exposure to Stressful Life Events, Resilience, and Coping in Patients with Gynecologic Cancers Receiving Chemotherapy. Semin Oncol Nurs 2023; 39:151431. [PMID: 37164885 DOI: 10.1016/j.soncn.2023.151431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES In a sample of patients with gynecologic cancers who are receiving chemotherapy, subgroups of patients with distinct state anxiety profiles were identified, and differences among the subgroups in demographic and clinical characteristics, stress, exposure to stressful life events, resilience, and coping behaviors were evaluated. DATA SOURCES Patients (n = 230) completed questionnaires six times over two chemotherapy cycles. State anxiety was measured using the Spielberger State Anxiety Inventory. Subgroups of patients with distinct state anxiety profiles were identified using latent profile analysis. Differences among the classes were assessed using parametric and nonparametric tests. CONCLUSION Three distinct state anxiety profiles were identified: low (55.2%), moderate (38.3%), and very high (6.5%). Compared with the low class, persons in the other two classes had lower functional status, more comorbidities, higher perceived stress, and lower resilience and were more likely to report a history of depression and to use disengagement coping strategies. Compared with the low class, the very high class was more likely to report childcare responsibilities; have a history of lung disease, stomach disease, or low back pain; have experienced physical neglect, serious money problems, a serious disaster, or foster care; or were a caregiver for someone with a severe disability. IMPLICATIONS FOR NURSING PRACTICE Nearly 45% of patients reported clinically meaningful levels of state anxiety that persisted over two cycles of chemotherapy. Experiences with a variety of stressors may be risk factors for higher levels of anxiety during chemotherapy. Clinicians need to perform comprehensive social histories and assess for anxiety in patients receiving chemotherapy.
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Affiliation(s)
- Rachel A Pozzar
- Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marilyn J Hammer
- Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - Yvette P Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lee-May Chen
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesiology, University of California, San Francisco, California, USA.
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Harris C, Kober KM, Paul SM, Cooper BA, Shin J, Oppegaard K, Morse L, Calvo-Schimmel A, Conley Y, Levine JD, Miaskowski C. Neurotransmitter Gene Polymorphisms Are Associated with Symptom Clusters in Patients Undergoing Radiation Therapy. Semin Oncol Nurs 2023; 39:151461. [PMID: 37419849 DOI: 10.1016/j.soncn.2023.151461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES Purpose was to evaluate for associations between the severity of three distinct symptom clusters (ie, sickness-behavior, mood-cognitive, treatment-related) and polymorphisms for 16 genes involved in catecholaminergic, GABAergic, and serotonergic neurotransmission. DATA SOURCES Patients with breast and prostate cancer (n = 157) completed study questionnaires at the completion of radiation therapy. Memorial Symptom Assessment Scale was used to assess the severity of 32 common symptoms. Three distinct symptom clusters were identified using exploratory factor analysis. Associations between the symptom cluster severity scores and neurotransmitter gene polymorphisms were evaluated using regression analyses. CONCLUSION Severity scores for the sickness-behavior symptom cluster were associated with polymorphisms for solute carrier family 6 (SLC6A) member 2 (SLC6A2), SLC6A3, SLC6A1, and 5-hydroxytryptamine receptor (HTR) 2A (HTR2A) genes. For the mood-cognitive symptom cluster, severity scores were associated with polymorphisms for adrenoreceptor alpha 1D, SLC6A2, SLC6A3, SLC6A1, HTR2A, and HTR3A. Severity scores for the treatment-related symptom cluster were associated with polymorphisms for SLC6A2, SLC6A3, catechol-o-methyltransferase, SLC6A1, HTR2A, SLC6A4, and tryptophan hydroxylase 2. IMPLICATIONS FOR NURSING PRACTICE Findings suggest that polymorphisms for several neurotransmitter genes are involved in the severity of sickness-behavior, mood-cognitive, and treatment-related symptom clusters in oncology patients at the completion of radiation therapy. Four genes with various associated polymorphisms were common across the three distinct symptom clusters (ie, SLC6A2, SLC6A3, SLC6A1, HTR2A) which suggest that these clusters have common underlying mechanisms.
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Affiliation(s)
- Carolyn Harris
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Joosun Shin
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Kate Oppegaard
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Lisa Morse
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Alejandra Calvo-Schimmel
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Yvette Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- Department of Medicine, School of Nursing and School of Medicine, University of California, San Francisco, California
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California.
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Hammer MJ, Cooper BA, Chen LM, Wright AA, Pozzar R, Blank SV, Cohen B, Dunn L, Paul S, Conley YP, Levine JD, Miaskowski C. Identification of distinct symptom profiles in patients with gynecologic cancers using a pre-specified symptom cluster. Support Care Cancer 2023; 31:485. [PMID: 37480403 DOI: 10.1007/s00520-023-07954-6] [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: 01/29/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Pain, fatigue, sleep disturbance, and depression are four of the most common symptoms in patients with gynecologic cancer. The purposes were to identify subgroups of patients with distinct co-occurring pain, fatigue, sleep disturbance, and depression profiles (i.e., pre-specified symptom cluster) in a sample of patients with gynecologic cancer receiving chemotherapy and assess for differences in demographic and clinical characteristics, as well as the severity of other common symptoms and QOL outcomes among these subgroups. METHODS Patients completed symptom questionnaires prior to their second or third cycle of chemotherapy. Latent profile analysis was used to identify subgroups of patients using the pre-specified symptom cluster. Parametric and nonparametric tests were used to evaluate for differences between the subgroups. RESULTS In the sample of 233 patients, two distinct latent classes were identified (i.e., low (64.8%) and high (35.2%)) indicating lower and higher levels of symptom burden. Patients in high class were younger, had child care responsibilities, were unemployed, and had a lower annual income. In addition, these women had a higher body mass index, a higher comorbidity burden, and a lower functional status. Patients in the high class reported higher levels of anxiety, as well as lower levels of energy and cognitive function and poorer quality of life scores. CONCLUSIONS This study identified a number of modifiable and non-modifiable risk factors associated with membership in the high class. Clinicians can use this information to refer patients to dieticians and physical therapists for tailored interventions.
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Affiliation(s)
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Lee-May Chen
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Laura Dunn
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Oppegaard KR, Mayo SJ, Armstrong TS, Kober KM, Anguera J, Wright F, Levine JD, Conley YP, Paul S, Cooper B, Miaskowski C. An Evaluation of the Multifactorial Model of Cancer-Related Cognitive Impairment. Nurs Res 2023; 72:272-280. [PMID: 37104681 PMCID: PMC10330009 DOI: 10.1097/nnr.0000000000000660] [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: 04/29/2023]
Abstract
BACKGROUND Up to 45% of patients report cancer-related cognitive impairment (CRCI). A variety of characteristics are associated with the occurrence and/or severity of CRCI. However, an important gap in knowledge of risk factors for CRCI is the relative contribution of each factor. The multifactorial model of cancer-related cognitive impairment (MMCRCI) is a conceptual model of CRCI that can be used to evaluate the strength of relationships between various factors and CRCI. OBJECTIVES The purpose of this study was to use structural regression methods to evaluate the MMCRCI using data from a large sample of outpatients receiving chemotherapy ( n = 1,343). Specifically, the relationships between self-reported CRCI and four MMCRCI concepts (i.e., social determinants of health, patient-specific factors, treatment factors, and co-occurring symptoms) were examined. The goals were to determine how well the four concepts predicted CRCI and determine the relative contribution of each concept to deficits in perceived cognitive function. METHODS This study is part of a larger, longitudinal study that evaluated the symptom experience of oncology outpatients receiving chemotherapy. Adult patients were diagnosed with breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding 4 weeks; were scheduled to receive at least two additional cycles of chemotherapy; were able to read, write, and understand English; and gave written informed consent. Self-reported CRCI was assessed using the attentional function index. Available study data were used to define the latent variables. RESULTS On average, patients were 57 years of age, college educated, and with a mean Karnofsky Performance Status score of 80. Of the four concepts evaluated, whereas co-occurring symptoms explained the largest amount of variance in CRCI, treatment factors explained the smallest amount of variance. A simultaneous structural regression model that estimated the joint effect of the four exogenous latent variables on the CRCI latent variable was not significant. DISCUSSION These findings suggest that testing individual components of the MMCRCI may provide useful information on the relationships among various risk factors, as well as refinements of the model. In terms of risk factors for CRCI, co-occurring symptoms may be more significant than treatment factors, patient-specific factors, and/or social determinants of health in patients receiving chemotherapy.
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Affiliation(s)
| | - Samantha J. Mayo
- Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Canada
| | | | - Kord M. Kober
- School of Nursing, University of California San Francisco
| | | | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Jon D. Levine
- School of Medicine, University of California San Francisco
| | | | - Steven Paul
- School of Nursing, University of California San Francisco
| | - Bruce Cooper
- School of Nursing, University of California San Francisco
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco
- School of Medicine, University of California San Francisco
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Wright F, Cooper BA, Paul SM, Hammer MJ, Conley YP, Levine JD, Miaskowski C, Kober KM. Distinct Profiles of Morning and Evening Fatigue Co-Occurrence in Patients During Chemotherapy. Nurs Res 2023; 72:259-271. [PMID: 37084242 PMCID: PMC10330127 DOI: 10.1097/nnr.0000000000000661] [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: 04/22/2023]
Abstract
BACKGROUND Morning and evening fatigue are distinct and distressing symptoms experienced during chemotherapy that demonstrate a large amount of interindividual variability. OBJECTIVES The objectives of this study were to identify subgroups of patients with distinct morning and evening fatigue co-occurrence profiles and evaluate for differences among these subgroups in demographic, clinical, and symptom characteristics and quality of life. METHODS Oncology patients ( n = 1,334) completed the Lee Fatigue Scale to self-report morning and evening fatigue, six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct morning and evening physical fatigue profiles. RESULTS Four distinct morning and evening fatigue profiles were identified (i.e., Both Low, Low Morning + Moderate Evening, Both Moderate, and Both High). Compared to the Both Low profile, the Both High profile was significantly younger, less likely to be married or partnered, more likely to live alone, had a higher comorbidity burden, and lower functional status. The Both High profile had higher levels of anxiety, depressive symptoms, sleep disturbance, and pain and lower levels of quality of life. DISCUSSION The variability in the morning and evening severity scores among the four profiles supports the hypothesis that morning and evening fatigue are distinct but related symptoms. Clinically meaningful levels of both morning and evening fatigue were reported by 50.4% of our sample, which suggests that the co-occurrence of these two symptoms is relatively common. Patients in Both Moderate and Both High profiles experienced an extremely high symptom burden that warrants ongoing assessments and aggressive symptom management interventions.
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Affiliation(s)
- Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Bruce A. Cooper
- School of Nursing, University of California, San Francisco, CA
| | - Steven M. Paul
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Jon D. Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA
- School of Medicine, University of California, San Francisco, CA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA
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Singh KP, Cooper BA, Tofthagen CS, Fryer JD, Singh P, Pituch K, Zhu Q, Gu H, Hammer MJ, Conley YP, Levine JD, Miaskowski C. Higher Levels of Stress and Neuropsychological Symptoms Are Associated With a High Nausea Profile in Patients With Cancer Receiving Chemotherapy. Oncol Nurs Forum 2023; 50:461-473. [PMID: 37677748 DOI: 10.1188/23.onf.461-473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To evaluate differences in the severity of global, cancer-specific, and cumulative life stress, resilience, and common neuropsychological symptoms among four subgroups of patients with distinct chemotherapy-induced nausea (CIN) profiles. SAMPLE & SETTING Adult patients with cancer (N = 1,343) receiving chemotherapy. METHODS & VARIABLES Patients completed stress, resilience, and neuropsychological symptom severity measures. The Memorial Symptom Assessment Scale was used to assess CIN occurrence six times over two cycles of chemotherapy. Parametric and nonparametric statistics were used to evaluate differences among subgroups of patients with distinct CIN profiles. RESULTS The high class had significantly higher levels of global, cancer-specific, and cumulative life stress; significantly higher levels of depression, anxiety, sleep disturbance, morning and evening fatigue, and pain; and lower levels of morning and evening energy and cognitive dysfunction. IMPLICATIONS FOR NURSING Clinicians need to evaluate CIN occurrence across each cycle of chemotherapy and assess patients for various types of stress and common neuropsychological symptoms.
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Davis JK, Mark S, Mackin L, Paul SM, Cooper BA, Conley YP, Hammer MJ, Levine JD, Miaskowski C. Sleep disturbance and decrements in morning energy contribute to a higher symptom burden in oncology patients. Sleep Med 2023; 108:124-136. [PMID: 37354746 DOI: 10.1016/j.sleep.2023.06.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE/BACKGROUND An emerging area of research is the relationship between sleep disturbance and decrements in energy. Given the paucity of research on the co-occurrence of these two symptoms, study purposes were to identify subgroups of oncology patients with distinct joint sleep disturbance AND morning energy profiles and evaluate for differences among the subgroups in demographic, clinical, and sleep disturbance characteristics, as well as the severity of other common symptoms and QOL outcomes. PATIENTS/METHODS Patients (n = 1336) completed measures of sleep disturbance and energy 6 times over two cycles of chemotherapy. All of the other measures were completed at enrollment. Latent profile analysis was used to identify the distinct joint sleep disturbance and morning energy profiles. RESULTS Three distinct profiles were identified (i.e., Low Sleep Disturbance and High Morning Energy (Normal, 20.6%), Moderate Sleep Disturbance and Low Morning Energy (Moderately Severe, 52.1%), Very High Sleep Disturbance and Very Low Morning Energy (Very Severe, 27.3%). Compared to Normal class, other two classes were more likely to be female, less likely to be employed, and had higher comorbidity burden and poorer functional status. Symptom scores and QOL outcomes exhibited a dose response effect (i.e., as the profile worsened, symptom scores increased and QOL scores decreased). CONCLUSIONS Given the associations between sleep disturbance and decrements in energy and a higher symptom burden, poorer QOL outcomes, and increased mortality, assessment of these two symptoms needs to be a high priority for clinicians and appropriate interventions initiated.
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Affiliation(s)
| | - Sueann Mark
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Lynda Mackin
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA.
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Staurengo-Ferrari L, Araldi D, Green PG, Levine JD. Neuroendocrine mechanisms in oxaliplatin-induced hyperalgesic priming. Pain 2023; 164:1375-1387. [PMID: 36729863 PMCID: PMC10182219 DOI: 10.1097/j.pain.0000000000002828] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/18/2022] [Revised: 09/16/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT Stress plays a major role in the symptom burden of oncology patients and can exacerbate cancer chemotherapy-induced peripheral neuropathy (CIPN), a major adverse effect of many classes of chemotherapy. We explored the role of stress in the persistent phase of the pain induced by oxaliplatin. Oxaliplatin induced hyperalgesic priming, a model of the transition to chronic pain, as indicated by prolongation of hyperalgesia produced by prostaglandin E 2 , in male rats, which was markedly attenuated in adrenalectomized rats. A neonatal handling protocol that induces stress resilience in adult rats prevented oxaliplatin-induced hyperalgesic priming. To elucidate the role of the hypothalamic-pituitary-adrenal and sympathoadrenal neuroendocrine stress axes in oxaliplatin CIPN, we used intrathecally administered antisense oligodeoxynucleotides (ODNs) directed against mRNA for receptors mediating the effects of catecholamines and glucocorticoids, and their second messengers, to reduce their expression in nociceptors. Although oxaliplatin-induced hyperalgesic priming was attenuated by intrathecal administration of β 2 -adrenergic and glucocorticoid receptor antisense ODNs, oxaliplatin-induced hyperalgesia was only attenuated by β 2 -adrenergic receptor antisense. Administration of pertussis toxin, a nonselective inhibitor of Gα i/o proteins, attenuated hyperalgesic priming. Antisense ODNs for Gα i 1 and Gα o also attenuated hyperalgesic priming. Furthermore, antisense for protein kinase C epsilon, a second messenger involved in type I hyperalgesic priming, also attenuated oxaliplatin-induced hyperalgesic priming. Inhibitors of second messengers involved in the maintenance of type I (cordycepin) and type II (SSU6656 and U0126) hyperalgesic priming both attenuated hyperalgesic priming. These experiments support a role for neuroendocrine stress axes in hyperalgesic priming, in male rats with oxaliplatin CIPN.
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Affiliation(s)
| | | | - Paul G. Green
- Departments of Oral and Maxillofacial Surgery and
- Preventative and Restorative Dental Sciences, UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA, United States
| | - Jon D. Levine
- Departments of Oral and Maxillofacial Surgery and
- Preventative and Restorative Dental Sciences, UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA, United States
- Division of Neuroscience, Department of Medicine, UCSF Pain and Addiction Research Center, University of California at San Francisco, San Francisco, CA, United States
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Sheng Y, Carpenter JS, Paul SM, Conley YP, Levine JD, Miaskowski C. Patients with palpitations experience a higher symptom burden prior to breast cancer surgery. Eur J Oncol Nurs 2023; 65:102341. [PMID: 37327556 DOI: 10.1016/j.ejon.2023.102341] [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: 10/05/2022] [Revised: 04/11/2023] [Accepted: 04/29/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Anxiety, depression, sleep disturbance, fatigue, cognitive dysfunction, and pain are common symptoms reported by patients with breast cancer. Recent evidence suggests that palpitations, a feeling of the heart racing or pounding, may be equally common. Study purpose was to compare the severity and clinically meaningful occurrence rates of common symptoms and quality of life (QOL) outcomes between patients with breast cancer who did and did not report palpitations prior to surgery. METHODS Patients (n = 398) were classified as having or not having palpitations using a single item from the Menopausal Symptoms Scale. Valid and reliable measures were used to assess state and trait anxiety, depression, sleep disturbance, fatigue, energy, cognitive function, breast symptoms, and QOL. Between group differences were evaluated using parametric and non-parametric tests. RESULTS Patients with palpitations (15.1%) reported significantly higher severity scores for state and trait anxiety, depression, sleep disturbance, and fatigue as well as significant decrements in energy and cognitive function (all p < .05). A higher percentage of these patients had clinically meaningful levels of state anxiety, depression, sleep disturbance and decrements in cognitive function (all p < .05). Except for spiritual well-being, QOL scores were lower in the palpitations group (all p < .001). CONCLUSION Findings support the need for routine assessment of palpitations and management of multiple symptoms in women prior to breast cancer surgery.
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Affiliation(s)
- Ying Sheng
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | | | - Steven M Paul
- School of Nursing, University of California at San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California at San Francisco, San Francisco, CA, USA; School of Medicine, University of California at San Francisco, San Francisco, CA, USA.
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Harris CS, Miaskowski CA, Conley YP, Hammer MJ, Dunn LB, Dhruva AA, Levine JD, Olshen AB, Kober KM. Epigenetic Regulation of Inflammatory Mechanisms and a Psychological Symptom Cluster in Patients Receiving Chemotherapy. Nurs Res 2023; 72:200-210. [PMID: 36929768 PMCID: PMC10121746 DOI: 10.1097/nnr.0000000000000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND A psychological symptom cluster is the most common cluster identified in oncology patients. Although inflammatory mechanisms are hypothesized to underlie this cluster, epigenetic contributions are unknown. OBJECTIVES This study's purpose was to evaluate associations between the occurrence of a psychological symptom cluster and levels of DNA methylation for inflammatory genes in a heterogeneous sample of patients with cancer receiving chemotherapy. METHODS Prior to their second or third cycle of chemotherapy, 1,071 patients reported the occurrence of 38 symptoms using the Memorial Symptom Assessment Scale. A psychological cluster was identified using exploratory factor analysis. Differential methylation analyses were performed in two independent samples using Illumina Infinium 450K and EPIC microarrays. Expression-associated CpG (eCpG) loci in the promoter region of 114 inflammatory genes on the 450K and 112 genes on the EPIC microarray were evaluated for associations with the psychological cluster. Robust rank aggregation was used to identify differentially methylated genes across both samples. Significance was assessed using a false discovery rate of 0.05 under the Benjamini-Hochberg procedure. RESULTS Cluster of differentiation 40 ( CD40 ) was differentially methylated across both samples. All six promoter eCpGs for CD40 that were identified across both samples were hypomethylated in the psychological cluster group. CONCLUSIONS This study is the first to suggest associations between a psychological symptom cluster and differential DNA methylation of a gene involved in tissue inflammation and cell-mediated immunity. Our findings suggest that increased CD40 expression through hypomethylation of promoter eCpG loci is involved in the occurrence of a psychological symptom cluster in patients receiving chemotherapy. These findings suggest a direction for mechanistic studies.
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Shin J, Oppegaard K, Calvo-Schimmel A, Harris C, Cooper BA, Paul SM, Conley YP, Hammer MJ, Cartwright F, Kober KM, Levine JD, Miaskowski C. Distinct Worst Pain Profiles in Oncology Outpatients Undergoing Chemotherapy. Cancer Nurs 2023; 46:176-188. [PMID: 35439202 PMCID: PMC9554042 DOI: 10.1097/ncc.0000000000001095] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND While pain is a significant problem for oncology patients, little is known about interindividual variability in pain characteristics. OBJECTIVE The aims of this study were to identify subgroups of patients with distinct worst pain severity profiles and evaluate for differences among these subgroups in demographic, clinical, and pain characteristics and stress and symptom scores. METHODS Patients (n = 934) completed questionnaires 6 times over 2 chemotherapy cycles. Worst pain intensity was assessed using a 0- to 10-point numeric rating scale. Brief Pain Inventory was used to assess various pain characteristics. Latent profile analysis was used to identify subgroups of patients with distinct pain profiles. RESULTS Three worst pain profiles were identified (low [17.5%], moderate [39.9%], severe [42.6%]). Compared with the other 2 classes, severe class was more likely to be single and unemployed and had a lower annual household income, a higher body mass index, a higher level of comorbidity, and a poorer functional status. Severe class was more likely to have both cancer and noncancer pain, a higher number of pain locations, higher frequency and duration of pain, worse pain quality scores, and higher pain interference scores. Compared with the other 2 classes, severe class reported lower satisfaction with pain management and higher global, disease-specific, and cumulative life stress, as well as higher anxiety, depression, fatigue, sleep disturbance, and cognitive dysfunction scores. CONCLUSIONS Unrelieved pain is a significant problem for more than 80% of outpatients. IMPLICATIONS FOR PRACTICE Clinicians need to perform comprehensive pain assessments; prescribe pharmacologic and nonpharmacologic interventions; and initiate referrals for pain management and psychological services.
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Affiliation(s)
- Joosun Shin
- Author Affiliations: School of Nursing, University of California, San Francisco (Mss Shin, Oppegaard, and Harris and Drs Calvo-Schimmel, Cooper, Paul, Kober, and Miaskowski); School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); Mount Sinai Medical Center, New York (Dr Cartwright); and School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
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Sheng Y, Carpenter JS, Smith BJ, Paul SM, Melisko M, Moslehi J, Levine JD, Conley YP, Kober KM, Miaskowski C. A Pilot Study of Associations Between the Occurrence of Palpitations and Cytokine Gene Variations in Women Prior to Breast Cancer Surgery. Biol Res Nurs 2023; 25:289-299. [PMID: 36255356 PMCID: PMC10236444 DOI: 10.1177/10998004221134684] [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: 11/17/2022]
Abstract
OBJECTIVES Palpitations are common and have a negative impact on women's quality of life. While evidence suggests that inflammatory mechanisms may play a role in the development of palpitations, no studies have evaluated for this association in patients with breast cancer who report palpitations prior to surgery. The purpose of this pilot study was to evaluate for associations between the occurrence of palpitations and single nucleotide polymorphisms (SNPs) in genes for pro- and anti-inflammatory cytokines, their receptors, and transcriptional regulators. METHODS Patients were recruited prior to surgery and completed a self-report questionnaire on the occurrence of palpitations. Genotyping of SNPs in cytokine genes was performed using a custom array. Multiple logistic regression analyses were done to identify associations between the occurrence of palpitations and SNPs in fifteen candidate genes. RESULTS Of the 82 SNPs evaluated in the bivariate analyses, eleven SNPs in 6 genes were associated with the occurrence of palpitations. After controlling for functional status, the occurrence of back pain, and self-reported and genomic estimates of race/ethnicity, 3 SNPs in 3 different genes (i.e., interleukin (IL) 1-beta (IL1B) rs1143643, IL10 rs3024505, IL13 rs1295686) were associated with the occurrence of palpitations prior to surgery (all p ≤ .038). CONCLUSIONS While these preliminary findings warrant replication, they suggest that inflammatory mechanisms may contribute to the subjective sensation of palpitations in women prior to breast cancer surgery.
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Affiliation(s)
- Ying Sheng
- School of Nursing, Vanderbilt University,
Nashville, TN, USA
| | | | - Brenda J. Smith
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Steven M. Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Michelle Melisko
- School of Nursing, University of California, San Francisco, CA, USA
| | - Javid Moslehi
- School of Nursing, University of California, San Francisco, CA, USA
| | - Jon D. Levine
- School of Nursing, University of California, San Francisco, CA, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kord M. Kober
- School of Nursing, University of California, San Francisco, CA, USA
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Morse L, Paul SM, Cooper BA, Oppegaard K, Shin J, Calvo-Schimmel A, Harris C, Hammer M, Conley Y, Wright F, Levine JD, Kober KM, Miaskowski C. Higher Stress in Oncology Patients is Associated With Cognitive and Evening Physical Fatigue Severity. J Pain Symptom Manage 2023; 65:203-215. [PMID: 36423801 DOI: 10.1016/j.jpainsymman.2022.11.017] [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: 09/01/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Cognitive and physical fatigue are common symptoms experienced by oncology patients. Exposure to stressful life events (SLE), cancer-related stressors, coping styles, and levels of resilience may influence the severity of both dimensions of fatigue. OBJECTIVES Evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and coping in oncology patients (n=1332) with distinct cognitive fatigue AND evening physical fatigue profiles. METHODS Latent profile analysis, which combined the two symptom scores, identified three subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles (i.e., Low, Moderate, High). Patients completed measures of global, cancer-specific, and cumulative life stress as well measures of resilience and coping. Differences among the latent classes in the various measures were evaluated using parametric and nonparametric tests. RESULTS Compared to Low class, the other two classes reported higher global and cancer-specific stress. In addition, they reported higher occurrence rates for sexual harassment and being forced to touch prior to 16 years of age. Compared to the other two classes, High class reported lower resilience scores and higher use of denial, substance use, and behavioral disengagement. CONCLUSION To decrease both cognitive and evening physical fatigue, clinicians need to assess for relevant stressors and initiate interventions to increase resilience and the use of engagement coping strategies. Additional research is warranted on the relative contribution of various social determinants of health to both cognitive and physical fatigue in oncology patients receiving chemotherapy.
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Affiliation(s)
- Lisa Morse
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Steven M Paul
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Bruce A Cooper
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Kate Oppegaard
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Joosun Shin
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Alejandra Calvo-Schimmel
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Carolyn Harris
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts
| | - Yvette Conley
- School of Nursing (C.H.,Y.C.,), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Fay Wright
- Rory Meyers College of Nursing (F.W.), New York University, New York, New York
| | - Jon D Levine
- School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California
| | - Christine Miaskowski
- School of Nursing (L.M.,S.M. P.,B.A.C.,K.O.,J.S.,A.C.S.,K.M.K.,C.M.), University of California, San Francisco, California;; School of Medicine (J.D.L, C.M.), University of California, San Francisco, California, USA.
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Singh K, Pituch K, Zhu Q, Gu H, Ernst B, Tofthagen C, Brewer M, Kober KM, Cooper BA, Paul SM, Conley YP, Hammer M, Levine JD, Miaskowski C. Distinct Nausea Profiles Are Associated With Gastrointestinal Symptoms in Oncology Patients Receiving Chemotherapy. Cancer Nurs 2023; 46:92-102. [PMID: 35671438 PMCID: PMC9437145 DOI: 10.1097/ncc.0000000000001076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unrelieved chemotherapy-induced nausea (CIN) occurs 48% of patients undergoing chemotherapy and is one of the most debilitating symptoms that patients report. OBJECTIVE The aims of this study were to identify subgroups of patients with distinct CIN profiles and determine how these subgroups differed on demographic and clinical characteristics; severity, frequency, and distress of CIN; and the co-occurrence of common gastrointestinal symptoms. METHODS Patients (n = 1343) completed demographic questionnaire and Memorial Symptom Assessment Scale 6 times over 2 cycles of chemotherapy. Latent class analysis was used to identify subgroups of patients with distinct CIN profiles. Differences among these subgroups were evaluated using parametric and nonparametric statistics. RESULTS Four distinct CIN profiles were identified: none (40.8%), increasing-decreasing (21.5%), decreasing (8.9%), and high (28.8%). Compared with the none class, patients in the high class were younger, had a lower annual household income, had child care responsibilities, had a lower Karnofsky Performance Status score and a higher Self-administered Comorbidity Questionnaire score, and were more likely to have received chemotherapy on a 14-day cycle and a highly emetogenic chemotherapy regimen. In addition, patients in the high class reported high occurrence rates for dry mouth, feeling bloated, diarrhea, lack of appetite, abdominal cramps, difficulty swallowing, mouth sores, weight loss, and change in the way food tastes. CONCLUSIONS That 60% of the patients reported moderate to high CIN occurrence rates confirms that this unrelieved symptom is a significant clinical problem. IMPLICATIONS FOR PRACTICE Nurses need to evaluate patients' level of adherence to their antiemetic regimen and make appropriate referrals for physical therapy, psychological services, and dietary counseling.
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Affiliation(s)
- Komal Singh
- Author Affiliations: Edson College of Nursing and Health Innovation, Arizona State University, Phoenix (Drs Singh, Pituch, and Brewer); Biodesign Center for Fundamental and Applied Microbiomics, Arizona State University, Tempe (Dr Zhu); Department of Environmental Health Sciences, Florida International University, Port Saint Lucie (Dr Gu); Cancer Center, Mayo Clinic, Phoenix, Arizona (Drs Singh and Ernst); Department of Nursing, Mayo Clinic, Jacksonville, Florida (Dr Tofthagen), HonorHealth Research Institute, Scottsdale, Arizona (Dr Brewer); School of Nursing, University of California, San Francisco (Drs Kober, Cooper, Paul, and Miaskowski); School of Nursing, University of Pittsburgh, Pennsylvania (Dr Conley); The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
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45
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Shin J, Kober KM, Wong ML, Yates P, Cooper BA, Paul SM, Hammer M, Conley Y, Levine JD, Miaskowski C. Distinct Shortness of Breath Profiles in Oncology Outpatients Undergoing Chemotherapy. J Pain Symptom Manage 2023; 65:242-255. [PMID: 36423799 DOI: 10.1016/j.jpainsymman.2022.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/29/2022] [Revised: 10/03/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Shortness of breath is a distressing symptom that occurs in 10% to 70% of oncology patients. Despite this broad range in its occurrence, little is known about inter-individual variability in shortness of breath and associated risk factors among patients receiving chemotherapy. OBJECTIVES Identify subgroups of patients with distinct shortness of breath profiles; evaluate for differences among these subgroups in demographic and clinical characteristics; evaluate for differences among symptom dimensions of shortness of breath, and evaluate for differences in quality of life outcomes. METHODS Outpatients (n=1338) completed questionnaires six times over two chemotherapy cycles. Occurrence of shortness of breath was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath profiles. RESULTS Four distinct shortness of breath profiles were identified (None [70.5%], Decreasing [8.2%], Increasing [7.8%], High [13.5%]). Risk factors for membership in High class included: history of smoking, self-reported diagnosis of lung disease, having lung cancer, and receipt of a higher number of cancer treatments. Compared to the None class, High class reported poorer physical, psychological, and social functioning. CONCLUSIONS Almost 14% of patients with heterogeneous types of cancer receiving chemotherapy had persistently high occurrence rates of shortness of breath for almost two months. In addition, compared to the Decreasing and Increasing classes, the High class' episodes of shortness of breath were more frequent and more severe. Clinicians need to assess all oncology patients for shortness of breath and provide targeted interventions.
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Affiliation(s)
- Joosun Shin
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Melisa L Wong
- School of Medicine (M.L.W., J.D.L., C.M.), University of California, San Francisco, California, USA
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health (P.Y.), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bruce A Cooper
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA
| | - Marilyn Hammer
- Dana Farber Cancer Institute (M.H.), Boston, Massachusetts, USA
| | - Yvette Conley
- School of Nursing (Y.C.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jon D Levine
- School of Medicine (M.L.W., J.D.L., C.M.), University of California, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing (J.S., K.M.K., B.A.C., S.M.P., C.M.), University of California, San Francisco, California, USA; School of Medicine (M.L.W., J.D.L., C.M.), University of California, San Francisco, California, USA.
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46
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Sheng Y, Carpenter JS, Paul SM, Cooper BA, Conley YP, Kober KM, Levine JD, Miaskowski C. Palpitations and Co-Occurring Menopausal Symptoms in Women Prior to Breast Cancer Surgery. Oncol Nurs Forum 2023; 50:215-228. [PMID: 37677805 DOI: 10.1188/23.onf.215-228] [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: 09/09/2023]
Abstract
OBJECTIVES To determine the occurrence rate of palpitations in women prior to breast cancer surgery and evaluate for differences in demographic and clinical characteristics and menopausal symptoms in patients with and without palpitations. SAMPLE & SETTING Presurgery data on palpitations and menopausal symptoms from 398 patients who underwent breast cancer surgery were analyzed. METHODS & VARIABLES The Menopausal Symptoms Scale was used to evaluate the occurrence, severity, and distress of 46 symptoms, including palpitations. Parametric and nonparametric tests were used to evaluate for differences between patients with and without palpitations. RESULTS Women with palpitations had lower annual income, lower functional status, higher comorbidity burden, and higher rates of back pain than women without palpitations. Women with palpitations had twice the number of menopausal symptoms and had higher occurrence rates for 39 of the 45 menopausal symptoms. They reported significantly higher severity scores for difficulty concentrating, dizziness, swollen hands/feet, and wake during the night, and higher distress scores for anxiety, hot flashes, swollen hands/feet, and wake during the night. IMPLICATIONS FOR NURSING Clinicians should perform routine assessments of palpitations and make appropriate referrals to a cardiologist.
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Stacker T, Kober KM, Dunn L, Viele C, Paul SM, Hammer M, Conley YP, Levine JD, Miaskowski C. Associations Between Demographic, Clinical, and Symptom Characteristics and Stress in Oncology Patients Receiving Chemotherapy. Cancer Nurs 2023; 46:E62-E69. [PMID: 35671412 PMCID: PMC9437148 DOI: 10.1097/ncc.0000000000001069] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients undergoing cancer treatment experience global stress and cancer-specific stress. Both types of stress are associated with a higher symptom burden. OBJECTIVE In this cross-sectional study, we used a comprehensive set of demographic, clinical, and symptom characteristics to evaluate their relative contribution to the severity of global and cancer-specific stress. METHODS Patients (N = 941) completed study questionnaires before their second or third cycle of chemotherapy. RESULTS Consistent with our a priori hypothesis, we found both common and distinct characteristics associated with higher levels of global stress and cancer-specific stress. A significant proportion of our patients had scores on the Impact of Event Scale-Revised suggestive of subsyndromal (29.4%) or probable (13.9%) posttraumatic stress disorder. Four of the 5 stepwise linear regression analyses for the various stress scales explained between 41.6% and 54.5% of the total variance. Compared with various demographic and clinical characteristics, many of the common symptoms associated with cancer and its treatments uniquely explained a higher percentage of the variance in the various stress scales. Symptoms of depression made the largest unique contribution to the percentage of total explained variance across all 5 scales. CONCLUSION Clinicians need to assess for global stress, cancer-specific stress, and depression in patients receiving chemotherapy. IMPLICATIONS FOR PRACTICE Patients may benefit from integrative interventions (eg, mindfulness-based stress reduction, cognitive behavioral therapy, acupuncture) that simultaneously address stress and symptoms commonly associated with cancer and its treatments.
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Affiliation(s)
- Tara Stacker
- Author Affiliations: School of Nursing, University of California (Ms Stacker and Viele, and Drs Kober, Paul, and Miaskowski), San Francisco; School of Medicine, Stanford University (Dr Dunn), California; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania; and School of Medicine, University of California (Drs Levine and Miaskowski), San Francisco
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48
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Shin J, Kober KM, Harris C, Oppegaard K, Calvo-Schimmel A, Paul SM, Cooper BA, Olshen A, Dokiparthi V, Conley YP, Hammer M, Levine JD, Miaskowski C. Perturbations in Neuroinflammatory Pathways Are Associated With a Worst Pain Profile in Oncology Patients Receiving Chemotherapy. J Pain 2023; 24:84-97. [PMID: 36115520 DOI: 10.1016/j.jpain.2022.08.007] [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] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/26/2022] [Accepted: 08/06/2022] [Indexed: 02/08/2023]
Abstract
Unrelieved pain occurs in 55% of cancer patients. Identification of molecular mechanisms for pain may provide insights into therapeutic targets. Purpose was to evaluate for perturbations in neuroinflammatory pathways between oncology patients with and without severe pain. Worst pain severity was rated using a 0 to 10 numeric rating scale six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct pain profiles. Pathway impact analyses were performed in two independent samples using gene expression data obtained from RNA sequencing (n = 192) and microarray (n = 197) technologies. Fisher's combined probability test was used to identify significantly perturbed pathways between None versus the Severe pain classes. In the RNA sequencing and microarray samples, 62.5% and 56.3% of patients were in the Severe pain class, respectively. Nine perturbed pathways were related to neuroinflammatory mechanisms (i.e., retrograde endocannabinoid signaling, gamma-aminobutyric acid synapse, glutamatergic synapse, Janus kinase-signal transducer and activator of transcription signaling, phagosome, complement and coagulation cascades, cytokine-cytokine receptor interaction, chemokine signaling, calcium signaling). First study to identify perturbations in neuroinflammatory pathways associated with severe pain in oncology outpatients. Findings suggest that complex neuroimmune interactions are involved in the maintenance of chronic pain conditions. Perspective: In this study that compared oncology patients with none versus severe pain, nine perturbed neuroinflammatory pathways were identified. Findings suggest that complex neuroimmune interactions are involved in the maintenance of persistent pain conditions.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Carolyn Harris
- School of Nursing, University of California, San Francisco, CA, USA
| | - Kate Oppegaard
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Adam Olshen
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA.
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Calvo-Schimmel A, Kober KM, Paul SM, Cooper BA, Harris C, Shin J, Hammer MJ, Conley YP, Dokiparthi V, Olshen A, Levine JD, Miaskowski C. Sleep disturbance is associated with perturbations in immune-inflammatory pathways in oncology outpatients undergoing chemotherapy. Sleep Med 2023; 101:305-315. [PMID: 36470166 DOI: 10.1016/j.sleep.2022.11.014] [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: 09/19/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep disturbance is a common problem in patients receiving chemotherapy. Purpose was to evaluate for perturbations in immune-inflammatory pathways between oncology patients with low versus very high levels of sleep disturbance. PATIENTS/METHODS Sleep disturbance was evaluated using the General Sleep Disturbance Scale six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct sleep disturbance profiles. Pathway impact analyses were performed in two independent samples using gene expression data obtained from RNA sequencing (n = 198) and microarray (n = 162) technologies. Fisher's combined probability test was used to identify significantly perturbed pathways between Low versus Very High sleep disturbance classes. RESULTS In the RNA sequencing and microarray samples, 59.1% and 51.9% of patients were in the Very High sleep disturbance class, respectively. Thirteen perturbed pathways were related to immune-inflammatory mechanisms (i.e., endocytosis, phagosome, antigen processing and presentation, natural killer cell mediated cytotoxicity, cytokine-cytokine receptor interaction, apoptosis, neutrophil extracellular trap formation, nucleotide-binding and oligomerization domain-like receptor signaling, Th17 cell differentiation, intestinal immune network for immunoglobulin A production, T-cell receptor signaling, complement and coagulation cascades, and tumor necrosis factor signaling). CONCLUSIONS First study to identify perturbations in immune-inflammatory pathways associated with very high levels of sleep disturbance in oncology outpatients. Findings suggest that complex immune-inflammatory interactions underlie sleep disturbance.
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Affiliation(s)
- Alejandra Calvo-Schimmel
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Kord M Kober
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Steven M Paul
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Bruce A Cooper
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Carolyn Harris
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Joosun Shin
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Vasuda Dokiparthi
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
| | - Adam Olshen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Jon D Levine
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA.
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50
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Haas ND, Viele C, Paul SM, Abrams G, Smoot B, Melisko M, Levine JD, Miaskowski C, Kober KM. Polymorphisms in Cytokine Receptor and Regulator Genes are Associated with Levels of Exercise in Women Prior to Breast Cancer Surgery. Biol Res Nurs 2023; 25:76-87. [PMID: 36036249 DOI: 10.1177/10998004221120091] [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] [Indexed: 12/14/2022]
Abstract
Background: Little is known about the genetic characteristics associated with exercise in women undergoing breast cancer surgery. Purpose: In a sample of women who were evaluated prior to breast cancer surgery (n = 310), we evaluated for differences in demographic and clinical characteristics between patients who did and did not exercise on a regular basis and evaluated for associations between polymorphisms in genes for pro- and anti-inflammatory cytokines, their receptors, and their transcriptional regulators. Methods: Patients completed an investigator-developed exercise questionnaire. Based on the recommended level of exercise (≥150 minutes/week), survivors were classified into no exercise (NoEx), less exercise (LessEx), or recommended exercise (RecEx) groups. Candidate gene analyses were done to identify relationships between polymorphisms and exercise group membership (i.e., NoEx vs. RecEx). Only 23.5% of the total sample met the recommendations for regular exercise. Results: Compared to the RecEx group (n = 78), patients in the NoEx group (n = 120) had less education; were less likely to report being White or Asia/Pacific Islander; more likely to report a lower household income; had a higher body mass index (BMI), had a poorer functional status; had a higher comorbidity burden; were more likely to self-report high blood pressure; and were more likely to have received neoadjuvant chemotherapy. Polymorphisms in IFNGR1 and NFKB1 were associated with membership in the NoEx group. Conclusions: While they warrant replication, our findings suggest that variations in cytokine-related genes may play a role in exercise behavior, and that clinicians need to assess for barriers to regular exercise and educate patients on its benefits.
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Affiliation(s)
- Nadia D Haas
- School of Nursing, 8785University of California, San Francisco, CA, USA
| | - Carol Viele
- School of Nursing, 8785University of California, San Francisco, CA, USA
| | - Steve M Paul
- School of Nursing, 8785University of California, San Francisco, CA, USA
| | - Gary Abrams
- School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Betty Smoot
- School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Michelle Melisko
- School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, 8785University of California, San Francisco, CA, USA.,School of Medicine, 8785University of California, San Francisco, CA, USA
| | - Kord M Kober
- School of Nursing, 8785University of California, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, CA, USA
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