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Rio CJ, Blumhorst C, Kwiat CA, Nguyen CM, Livinski AA, Saligan LN. Self-reporting of psychoneurophysical (PNP) symptoms in adults with four chronic diseases: a protocol for a scoping review. Syst Rev 2024; 13:102. [PMID: 38575995 PMCID: PMC10996099 DOI: 10.1186/s13643-024-02498-0] [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: 01/18/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Patient self-reporting of health-specific information, including symptoms, allows healthcare providers to provide more timely, personalized, and patient-centered care to meet their needs. It is critical to acknowledge that symptom reporting draws from the individual's unique sociocultural background influencing how one perceives health and illness. This scoping review will explore whether racial groups with 4 chronic diseases (cardiovascular diseases, respiratory diseases, cancers, and diabetes) differ in self-reporting of psychoneurophysical (PNP) symptoms. The PNP symptoms of interest include depressive symptoms, fatigue, anxiety, pain, cognitive impairment, sleep impairment, mood impairment, irritability, and shortness of breath. METHODS Four databases will be searched by a biomedical librarian: CINAHL Plus (EBSCOhost), Embase (Elsevier), PubMed (NLM), Web of Science: Core Collection (Clarivate Analytics), and limited to publications written in the English language. Two independent reviewers will screen the records' title, abstract, and then full text and extract the data from included articles using Covidence. A third reviewer will be used for resolving disagreements. Included articles must comprise adult patients with at least one of the specified chronic diseases who self-report at least one of the specified PNP symptoms. Studies that used clinician-administered questionnaires or obtained symptom responses from primary caregiver or patient designee will be excluded. Articles on patient-reported functionality or perceived quality of life will also be excluded from the review. Two reviewers will independently extract data (e.g., demographics, study design, racial group, chronic disease, measure/scale used for self-report) from each included article using Covidence and Microsoft Excel for data cleaning and analyses. DISCUSSION This scoping review may potentially identify the relevant and practical implications related to clinical decision-making and health outcomes for patients experiencing the psychoneurophysical symptoms included in this study. The authors will present how the results can be utilized in clinical practice, health policy, and research planning. SYSTEMATIC REVIEW REGISTRATION The protocol was registered on Open Science Framework (OSF) at: https://osf.io/ps7aw.
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Affiliation(s)
- Carielle Joy Rio
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA
| | - Catherine Blumhorst
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA
| | - Catherine A Kwiat
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA
| | - Christopher M Nguyen
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Leorey N Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing, Research, National Institutes of Health, Bethesda, MD, USA.
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Rio CJ, Saligan LN, Li X, Crouch A, Von Ah D. Correlates of frailty in older female cancer survivors. J Geriatr Oncol 2024; 15:101682. [PMID: 38104481 PMCID: PMC10922550 DOI: 10.1016/j.jgo.2023.101682] [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: 08/18/2023] [Revised: 10/31/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Cancer survivors are at risk of frailty because of cancer and its treatment. Understanding the factors that increase the risk of frailty is an important aspect of cancer care for the development of interventions to prevent or manage frailty, thus improving cancer survival and overall quality of life of cancer survivors. This study aimed to identify demographic, clinical, and psychosocial correlates of frailty in older, female cancer survivors. MATERIALS AND METHODS This is a sub-study focusing on the exploratory aim of a larger cross-sectional study (NURS-IIR-IUSCC-0748). A total of 213 female cancer survivors aged 59-87 years old were included from the parent study in the current analysis. Frailty, the primary outcome, was measured using the Tilburg Frailty Indicator scale. The independent variables were age, relationship status, clinical stage of cancer, treatment type, comorbidity, depression, affect, optimism, stress, and social support. Stepwise linear regression modeling identified the independent variables that were significantly associated with frailty. RESULTS The final regression model revealed that high patient-reported stress and depression, comorbidity, not being married or living with a partner, and low positive affect were significantly associated with worsening frailty in this population. DISCUSSION Understanding the context of frailty is important for the design of interventions that target factors known to be associated with frailty in older cancer survivors. Further validation with a larger and a more diverse sample from a broad spectrum of sociodemographic and clinical population would fully account for the multiple independent variables influencing frailty in cancer survivors.
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Affiliation(s)
- Carielle Joy Rio
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States of America
| | - Leorey N Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States of America.
| | - Xiaobai Li
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, MD, United States of America
| | - Adele Crouch
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Diane Von Ah
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
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Walitt B, Singh K, LaMunion SR, Hallett M, Jacobson S, Chen K, Enose-Akahata Y, Apps R, Barb JJ, Bedard P, Brychta RJ, Buckley AW, Burbelo PD, Calco B, Cathay B, Chen L, Chigurupati S, Chen J, Cheung F, Chin LMK, Coleman BW, Courville AB, Deming MS, Drinkard B, Feng LR, Ferrucci L, Gabel SA, Gavin A, Goldstein DS, Hassanzadeh S, Horan SC, Horovitz SG, Johnson KR, Govan AJ, Knutson KM, Kreskow JD, Levin M, Lyons JJ, Madian N, Malik N, Mammen AL, McCulloch JA, McGurrin PM, Milner JD, Moaddel R, Mueller GA, Mukherjee A, Muñoz-Braceras S, Norato G, Pak K, Pinal-Fernandez I, Popa T, Reoma LB, Sack MN, Safavi F, Saligan LN, Sellers BA, Sinclair S, Smith B, Snow J, Solin S, Stussman BJ, Trinchieri G, Turner SA, Vetter CS, Vial F, Vizioli C, Williams A, Yang SB, Nath A. Deep phenotyping of post-infectious myalgic encephalomyelitis/chronic fatigue syndrome. Nat Commun 2024; 15:907. [PMID: 38383456 PMCID: PMC10881493 DOI: 10.1038/s41467-024-45107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
Post-infectious myalgic encephalomyelitis/chronic fatigue syndrome (PI-ME/CFS) is a disabling disorder, yet the clinical phenotype is poorly defined, the pathophysiology is unknown, and no disease-modifying treatments are available. We used rigorous criteria to recruit PI-ME/CFS participants with matched controls to conduct deep phenotyping. Among the many physical and cognitive complaints, one defining feature of PI-ME/CFS was an alteration of effort preference, rather than physical or central fatigue, due to dysfunction of integrative brain regions potentially associated with central catechol pathway dysregulation, with consequences on autonomic functioning and physical conditioning. Immune profiling suggested chronic antigenic stimulation with increase in naïve and decrease in switched memory B-cells. Alterations in gene expression profiles of peripheral blood mononuclear cells and metabolic pathways were consistent with cellular phenotypic studies and demonstrated differences according to sex. Together these clinical abnormalities and biomarker differences provide unique insight into the underlying pathophysiology of PI-ME/CFS, which may guide future intervention.
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Affiliation(s)
- Brian Walitt
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Komudi Singh
- National Heart, Lung and Blood Institute (NHLBI), Bethesda, MD, USA
| | - Samuel R LaMunion
- National Institute of Diabetes, Digestion, and Kidney Disease (NIDDK), Bethesda, MD, USA
| | - Mark Hallett
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Steve Jacobson
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Kong Chen
- National Institute of Diabetes, Digestion, and Kidney Disease (NIDDK), Bethesda, MD, USA
| | | | - Richard Apps
- NIH Center for Human Immunology, Autoimmunity, and Inflammation (CHI), Bethesda, MD, USA
| | | | - Patrick Bedard
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Robert J Brychta
- National Institute of Diabetes, Digestion, and Kidney Disease (NIDDK), Bethesda, MD, USA
| | | | - Peter D Burbelo
- National Institute of Dental and Craniofacial Research (NIDCR), Bethesda, MD, USA
| | - Brice Calco
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Brianna Cathay
- Texas A&M School of Engineering Medicine, College Station, TX, USA
| | - Li Chen
- Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Snigdha Chigurupati
- George Washington University Hospital, District of Columbia, Washington, DC, USA
| | - Jinguo Chen
- NIH Center for Human Immunology, Autoimmunity, and Inflammation (CHI), Bethesda, MD, USA
| | - Foo Cheung
- NIH Center for Human Immunology, Autoimmunity, and Inflammation (CHI), Bethesda, MD, USA
| | | | | | - Amber B Courville
- National Institute of Diabetes, Digestion, and Kidney Disease (NIDDK), Bethesda, MD, USA
| | | | | | | | | | - Scott A Gabel
- National Institute of Environmental Health Sciences (NIEHS), Chapel Hill, NC, USA
| | - Angelique Gavin
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - David S Goldstein
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | | | - Sean C Horan
- Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Silvina G Horovitz
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Kory R Johnson
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Anita Jones Govan
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Kristine M Knutson
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Joy D Kreskow
- National Institute of Nursing Research (NINR), Bethesda, MD, USA
| | - Mark Levin
- National Heart, Lung and Blood Institute (NHLBI), Bethesda, MD, USA
| | - Jonathan J Lyons
- National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA
| | - Nicholas Madian
- National Center for Complementary and Integrative Health (NCCIH), Bethesda, MD, USA
| | - Nasir Malik
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Andrew L Mammen
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, MD, USA
| | | | - Patrick M McGurrin
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | | | - Ruin Moaddel
- National Institute of Aging (NIA), Baltimore, MD, USA
| | - Geoffrey A Mueller
- National Institute of Environmental Health Sciences (NIEHS), Chapel Hill, NC, USA
| | - Amrita Mukherjee
- NIH Center for Human Immunology, Autoimmunity, and Inflammation (CHI), Bethesda, MD, USA
| | - Sandra Muñoz-Braceras
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, MD, USA
| | - Gina Norato
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Katherine Pak
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, MD, USA
| | - Iago Pinal-Fernandez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, MD, USA
| | - Traian Popa
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Lauren B Reoma
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Michael N Sack
- National Heart, Lung and Blood Institute (NHLBI), Bethesda, MD, USA
| | - Farinaz Safavi
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
- National Institute of Allergy and Infectious Disease (NIAID), Bethesda, MD, USA
| | - Leorey N Saligan
- National Institute of Nursing Research (NINR), Bethesda, MD, USA
| | - Brian A Sellers
- NIH Center for Human Immunology, Autoimmunity, and Inflammation (CHI), Bethesda, MD, USA
| | | | - Bryan Smith
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Joseph Snow
- National Institute of Mental Health (NIMH), Bethesda, MD, USA
| | | | - Barbara J Stussman
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
- National Center for Complementary and Integrative Health (NCCIH), Bethesda, MD, USA
| | | | | | | | - Felipe Vial
- Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Carlotta Vizioli
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA
| | - Ashley Williams
- Oakland University William Beaumont School of Medicine, Rochester, NY, USA
| | | | - Avindra Nath
- National Institute of Neurological Diseases and Stroke (NINDS), Bethesda, MD, USA.
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Hsiao CP, Von Ah D, Chen MK, Saligan LN. Relationship of cancer-related fatigue with psychoneurophysiological (PNP) symptoms in breast cancer survivors. Eur J Oncol Nurs 2024; 68:102469. [PMID: 38039708 PMCID: PMC10922833 DOI: 10.1016/j.ejon.2023.102469] [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: 04/30/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a highly prevalent and debilitating symptom reported by breast cancer survivors (BCS). CRF has been associated with the co-occurrence of anxiety, depression, poor sleep quality, cognitive impairment, which are collectively termed as psychoneurophysiological (PNP) symptoms. CRF and these PNP symptoms are often reported during and after treatment with long-lasting distress. It is unclear how CRF and these PNP symptoms influence each other. This study aimed to explore predictive factors (i.e., PNP symptoms and social-demographic factors) of CRF, and test exploratory path models of the relationships of CRF with PNP symptoms (depression, anxiety, sleep disturbance, pain, and cognitive function) in BCS. METHODS This paper is part of a larger descriptive, correlational, and cross-sectional study. Validated and reliable instruments assessed CRF, depression, anxiety, sleep disturbance, pain, and cognitive function. Descriptive statistics, Pearson correlation, multiple linear regression models, and path analysis were employed. RESULTS Patients (N = 373) who reported less bodily pain had worst CRF (r = -0.45, p < .01). Significant predictors of CRF included depression, sleep disorder, bodily pain, perceived cognitive ability, and dispositional (state) optimism. Depression alone accounted for 31% of the variance in CRF. An integrative path model with bodily pain, neuropathic pain, CRF, and depression showed a good fit across different indices (CFI = 0.993, RMSEA = 0.047, 90% CI 0-0.12, SRMR = 0.027). CONCLUSIONS This study identified significant predictors of CRF and revealed a good fit mediation model with significant pathways for CRF, suggesting that a common etiology may underpin the co-occurrence of CRF with PNP symptoms (pain and depression). However, further investigation with longitudinal design is necessary to explore the causal relationships of these symptoms. Evidence-based strategies/interventions are needed to reduce or eliminate the burden of these symptoms on the lives of BCS.
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Affiliation(s)
- Chao-Pin Hsiao
- Case Western Reserve University School of Nursing, Cleveland, OH, USA
| | - Diane Von Ah
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Mei-Kuang Chen
- The University of Arizona Department of Psychology, Tucson, AZ, USA
| | - Leorey N Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
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Gonsalves SG, Saligan LN, Bergeron CM, Lee PR, Fishbein KW, Spencer RG, Zampino M, Sun X, Sheng JYS, Stearns V, Carducci M, Ferrucci L, Lukkahatai N. Exploring the links of skeletal muscle mitochondrial oxidative capacity, physical functionality, and mental well-being of cancer survivors. Sci Rep 2024; 14:2669. [PMID: 38302539 PMCID: PMC10834492 DOI: 10.1038/s41598-024-52570-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024] Open
Abstract
Physical impairments following cancer treatment have been linked with the toxic effects of these treatments on muscle mass and strength, through their deleterious effects on skeletal muscle mitochondrial oxidative capacity. Accordingly, we designed the present study to explore relationships of skeletal muscle mitochondrial oxidative capacity with physical performance and perceived cancer-related psychosocial experiences of cancer survivors. We assessed skeletal muscle mitochondrial oxidative capacity using in vivo phosphorus-31 magnetic resonance spectroscopy (31P MRS), measuring the postexercise phosphocreatine resynthesis time constant, τPCr, in 11 post-chemotherapy participants aged 34-70 years. During the MRS procedure, participants performed rapid ballistic knee extension exercise to deplete phosphocreatine (PCr); hence, measuring the primary study outcome, which was the recovery rate of PCr (τPCr). Patient-reported outcomes of psychosocial symptoms and well-being were assessed using the Patient-Reported Outcomes Measurement Information System and the 36-Item Short Form health survey (SF-36). Rapid bioenergetic recovery, reflected through a smaller value of τPCr was associated with worse depression (rho ρ = - 0.69, p = 0.018, and Cohen's d = - 1.104), anxiety (ρ = - 0.61, p = .046, d = - 0.677), and overall mental health (ρ = 0.74, p = 0.010, d = 2.198) scores, but better resilience (ρ = 0.65, p = 0.029), and coping-self efficacy (ρ = 0.63, p = 0.04) scores. This is the first study to link skeletal muscle mitochondrial oxidative capacity with subjective reports of cancer-related behavioral toxicities. Further investigations are warranted to confirm these findings probing into the role of disease status and personal attributes in these preliminary results.
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Affiliation(s)
- Stephen G Gonsalves
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Christopher M Bergeron
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Philip R Lee
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Kenneth W Fishbein
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Richard G Spencer
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Marta Zampino
- Department of Internal Medicine, University of Maryland, Baltimore, MD, USA
| | - Xinyi Sun
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Vered Stearns
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Carducci
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Luigi Ferrucci
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute On Aging, National Institutes of Health, Baltimore, MD, USA
| | - Nada Lukkahatai
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Goto T, Saligan LN, Li X, Xiang L, Kwiat C, Nguyen C, Crouch A, Von Ah D. Associations of brain-derived neurotrophic factor rs6265 polymorphism and cognitive function in breast cancer survivors from a cross-sectional study. Cancer Med 2024; 13:e6975. [PMID: 38379321 PMCID: PMC10839126 DOI: 10.1002/cam4.6975] [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: 07/12/2023] [Revised: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Breast cancer survivors (BCS) often complain of cancer-related cognitive impairment (CRCI) during and even months after completing primary cancer treatments, particularly chemotherapy. The etiology of CRCI is unknown, but associations of CRCI with germline genetic polymorphisms have been reported, including Brain-Derived Neurotrophic Factor (BDNF) rs6265 polymorphism. The current study investigated the associations of specific BDNF rs6265 with CRCI. METHODS Cancer-related cognitive impairment was assessed using subjective reports of cognitive symptoms (the version 1.0, 8-item short-forms of the Patient-Reported Outcomes Measurement Information System®) and computerized objective cognitive function scores (CANTAB®). BDNF rs6265 genotypes were determined from buccal swabs. The associations of specific BDNF rs6265 with CRCI were examined by either one-way analysis of variance or the Kruskal-Wallis test followed by post hoc tests and rank-based regression analysis. RESULTS We examined 356 female BCS. The mean (SD) age was 55.6 (9.8) years old, the median (IQR) years since cancer diagnosis were 4.0 (6.0), and 331 (92.7%) were self-described as White. BCS carrying the Met/Met genotype showed poorer results on 'visual episodic memory and new learning' and 'spatial working memory and executive function.' This relationship was observed regardless of prior chemotherapy. CONCLUSION Our findings suggest that carrying the BDNF rs6265 Met/Met genotype increases the risk for CRCI in BCS. These results are foundational in nature and provide important information to identify mechanisms underpinning CRCI.
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Affiliation(s)
- Taichi Goto
- Symptoms Biology Unit, Division of Intramural ResearchNational Institute of Nursing Research, National Institutes of HealthBethesdaMarylandUSA
| | - Leorey N. Saligan
- Symptoms Biology Unit, Division of Intramural ResearchNational Institute of Nursing Research, National Institutes of HealthBethesdaMarylandUSA
| | - Xiaobai Li
- Department of BiostatisticsNational Institutes of Health Clinical CenterBethesdaMarylandUSA
| | - Lichen Xiang
- Symptoms Biology Unit, Division of Intramural ResearchNational Institute of Nursing Research, National Institutes of HealthBethesdaMarylandUSA
| | - Catherine Kwiat
- Symptoms Biology Unit, Division of Intramural ResearchNational Institute of Nursing Research, National Institutes of HealthBethesdaMarylandUSA
| | - Christopher Nguyen
- Symptoms Biology Unit, Division of Intramural ResearchNational Institute of Nursing Research, National Institutes of HealthBethesdaMarylandUSA
| | - Adele Crouch
- Indiana University School of NursingIndianapolisIndianaUSA
| | - Diane Von Ah
- The Ohio State University College of NursingColumbusOhioUSA
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Goto T, Wang C, Kwiat C, Nguyen C, Saligan LN. Community-Based Wound Care Programs for Unhoused Individuals. J Epidemiol Glob Health 2023; 13:604-614. [PMID: 37847465 PMCID: PMC10686911 DOI: 10.1007/s44197-023-00157-6] [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: 07/31/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023] Open
Abstract
Wound care management for unhoused individuals is challenging due to the lack of healthcare infrastructure to handle the unique needs of this population. Therefore, we aimed to obtain insights for best practices and to establish a care clinic that is low threshold, community-based and meets the needs of unhoused people. We employed two approaches: (1) conduct a targeted narrative review of the literature of existing or proposed community-based program models that can address the wound care needs of unhoused individuals, and (2) assess cost-effectiveness and describe the results of a survey administered to unhoused clients and their health care providers at a community-based wound care program in Honolulu, Hawai'i. The literature search and screening yielded 11 articles relevant to the topic. Per the literature, existing community-based healthcare programs were successful when: (1) wound care services were incorporated into a broader social/health program, (2) cost-effective, and (3) comprehensive services were provided. Survey results in Honolulu found that the wound care program matched the needs of the targeted population and was cost-effective. Difficulty in following clients until wound closure and the sustainability of the program, particularly the lack of insurance reimbursement for street-based services, were perceived challenges. Additionally, the lack of insurance reimbursement for street-based wound care services continues to impact sustainability. Community-based programs can be successful in addressing the wound care needs of unhoused individuals if they address complex fundamental issues. This paper highlights existing gaps in logistics and policies that must be addressed to meet the specific medical needs of these vulnerable individuals.
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Affiliation(s)
- Taichi Goto
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Christina Wang
- Hawaii Health & Harm Reduction Center, Honolulu, HI, USA
| | - Catherine Kwiat
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Christopher Nguyen
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, 3 Center Drive, Building 3, Room 5E14, Bethesda, MD, 20892, USA.
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Lukkahatai N, Park J, Jia HM, Martin D, Li J, Sheng JYS, Gill J, Saligan LN, Stearns V, Carducci M. Feasibility of DNA Methylation Age as a Biomarker of Symptoms and Resilience among Cancer Survivors with Multiple Chronic Conditions. Biomedicines 2023; 11:3076. [PMID: 38002076 PMCID: PMC10669866 DOI: 10.3390/biomedicines11113076] [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: 10/12/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
This study aims to examine the feasibility of DNA methylation age as a biomarker for symptoms and resilience in cancer survivors with multiple chronic conditions (MCCs). We included ten participants from our parent study, an ongoing randomized control trial study. Participants' symptoms and resilience were assessed, and peripheral blood was collected. DNA methylation age calculation was performed using DNAge® analysis. Data were analyzed using Spearman's correlation analysis and the Mann-Whitney U test. Participants in the intervention group tended to have a decrease in DNA methylation age and age acceleration after completing an exercise program (mean difference = -0.83 ± 1.26). The change in DNA methylation age was significantly correlated with the change in resilience score (r = -0.897, p = 0.015). The preliminary results suggest that DNA methylation age can be a potential biomarker for improving resilience in cancer survivors with multiple chronic conditions. This finding is limited by the small sample size, and a larger study is needed.
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Affiliation(s)
- Nada Lukkahatai
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jongmin Park
- College of Nursing, Research Institute of Nursing Science, Pusan National University, Yangsan-si 50612, Republic of Korea
| | - Hejingzi Monica Jia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Daniel Martin
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Junxin Li
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jennifer Yeong-Shin Sheng
- Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21205, USA
| | - Jessica Gill
- School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Vered Stearns
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Michael Carducci
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
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9
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Rio CJ, Goto T, Hsiao CP, Ross ALR, Saligan LN. Family Wellbeing and Sexual Health of Patients Receiving Treatment for Prostate Cancer. Cancer Manag Res 2023; 15:1197-1206. [PMID: 37929256 PMCID: PMC10625326 DOI: 10.2147/cmar.s421951] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose Prostate cancer and its treatment may affect patients' sexual function and social wellbeing. This study investigated the relationship between social/family wellbeing and sexual health in patients with prostate cancer. Additionally, the moderating effect of clinical characteristics on this relationship was also explored. Patients and Methods This is a descriptive correlational study using baseline data of a longitudinal study enrolling 137 patients with prostate cancer. Sexual Function (SF) and Sexual Function Distress (SFD) data were collected using the Symptom Index questionnaire. Demographic data were obtained during study intake and clinical data were obtained from chart review. Bivariate correlation determined the correlations among continuous demographic/clinical data, social/family wellbeing, and sexual health. Moderated regression analysis determined the moderating effects of clinical characteristics on the relationship of social/family wellbeing and sexual health. Results Moderate positive correlation was found between social/family wellbeing and SF, whereas a weak negative correlation was noted between social/family wellbeing and SFD. Depression was significantly correlated with social/family wellbeing and SFD. Both sexual health domains were significantly correlated with Gleason score. A significant difference was noted in the social/family wellbeing and both SF and SFD in participants receiving androgen deprivation therapy (ADT) compared to those not receiving ADT. Concomitant ADT use was the only clinical characteristic found to be a significant moderator of the relationship between social/family wellbeing and SFD, but none of the clinical characteristics was found to have a moderating effect on the relationship of social/family wellbeing and SF. Among patients who were not receiving ADT, high social/family wellbeing was associated with low SFD. Patients who were receiving ADT reported slightly higher SFD despite having higher social/family wellbeing. Conclusion Ensuring sexual health in patients with prostate cancer requires a comprehensive approach to address factors contributing to sexual health such as side effects of treatment and family wellbeing.
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Affiliation(s)
- Carielle Joy Rio
- National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, Bethesda, MD, USA
| | - Taichi Goto
- National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, Bethesda, MD, USA
| | - Chao-Pin Hsiao
- Case Western Reserve University School of Nursing, Cleveland, OH, USA
| | - Alexander L R Ross
- National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, Bethesda, MD, USA
| | - Leorey N Saligan
- Case Western Reserve University School of Nursing, Cleveland, OH, USA
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10
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Rio CJ, Saligan LN. Understanding physical activity from a cultural-contextual lens. Front Public Health 2023; 11:1223919. [PMID: 37601221 PMCID: PMC10436229 DOI: 10.3389/fpubh.2023.1223919] [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: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
This paper aims to emphasize the need to acknowledge unique cultural and contextual meanings of physical activity to improve health outcomes in different communities. Leininger's Sunrise Model was used as the theoretical base to understand the complex cultural and contextual factors that influence physical activity. Beliefs and practices surrounding physical activity are influenced by a variety of cultural and contextual factors. Providing culturally relevant contexts to the meaning of physical activity allows opportunities for improving policies or programs that would engage individuals and communities in physical activity in culturally meaningful ways. Incorporating cultural and contextual factors is critical to promote physical activity, especially in minority and vulnerable communities.
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Affiliation(s)
| | - Leorey N. Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
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11
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Oppegaard KR, Armstrong TS, Anguera JA, Kober KM, Debr LK, Laister RC, Saligan LN, Ayala AP, Kuruvilla J, Alm MW, Byker WH, Miaskowski C, Mayo SJ. Blood-Based Biomarkers of Cancer-Related Cognitive Impairment in Non-Central Nervous System Cancer: A Scoping Review. Crit Rev Oncol Hematol 2022; 180:103822. [PMID: 36152911 DOI: 10.1016/j.critrevonc.2022.103822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
This scoping review was designed to synthesize the extant literature on associations between subjective and/or objective measures of cancer-related cognitive impairment (CRCI) and blood-based biomarkers in adults with non-central nervous system cancers. The literature search was done for studies published from the start of each database searched (i.e., MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, grey literature) through to October 20, 2021. A total of 95 studies are included in this review. Of note, a wide variety of biomarkers were evaluated. Most studies evaluated patients with breast cancer. A variety of cognitive assessment measures were used. The most consistent significant findings were with various subjective and objective measures of CRCI and levels of interleukin-6 and tumor necrosis factor. Overall, biomarker research is in an exploratory phase. However, this review synthesizes findings and proposes directions for future research.
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Affiliation(s)
- Kate R Oppegaard
- University of California San Francisco, School of Nursing, Department of Physiological Nursing, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, USA
| | - Joaquin A Anguera
- University of California San Francisco, Department of Neurology and Psychiatry, USA
| | - Kord M Kober
- University of California San Francisco, School of Nursing, Department of Physiological Nursing, USA
| | - Lynch Kelly Debr
- University of Florida, College of Nursing, USA; University of Florida Health Cancer Center, USA
| | - Rob C Laister
- Princess Margaret Health Center, University Health Network, Canada
| | - Leorey N Saligan
- Symptoms Biology Unit, Division of Intramural Research, National Institutes of Health, USA
| | | | - John Kuruvilla
- Princess Margaret Health Center, University Health Network, Canada
| | - Mark W Alm
- Toronto General Hospital, University Health Network, Canada
| | | | - Christine Miaskowski
- University of California San Francisco, School of Medicine, Department of Anesthesia and Perioperative Care, USA
| | - Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.
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12
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Wolff BS, Allen HR, Feng LR, Saligan LN. BDNF Val66Met Polymorphism Reduces the Fatigue-Like Effects of 5-Fluorouracil on Voluntary Wheel-Running Activity in Mice. Front Behav Neurosci 2022; 16:880969. [PMID: 35558437 PMCID: PMC9087735 DOI: 10.3389/fnbeh.2022.880969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Fatigue is a persistent and debilitating symptom following cancer treatments such as chemotherapy. Recent clinical studies have suggested a common single-nucleotide polymorphism of brain-derived neurotrophic factor (BDNF), Val66Met (rs6265), may be related to the severity of fatigue following cancer treatment. In this study, we tested transgenic mice homozygous for the human Val66Met BDNF gene and wild-type controls. We injected three doses of 5-fluorouracil (5FU) as a model of chemotherapy treatment, and we used changes in voluntary wheel running activity (VWRA) as a measure of fatigue-like behavior. Prior to 5FU injection, we found that during the baseline wheel-running period, the Val66Met mice lost more weight than WT controls. We next administered 5FU and saw a robust fatigue-like phenotype that lasted about 2 weeks. During the first week, the fatigue-like phenotype was less severe in the Val66Met mice and unrelated to the age of the mice. In contrast, during the second week after 5FU treatment, the fatigue-like phenotype was unrelated to the BDNF genotype but was more severe in middle aged mice compared to young mice. We conclude that the BDNF polymorphism may play a direct, protective role against chemotherapy-induced fatigue.
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13
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Goklemez S, Saligan LN, Pirsl F, Holtzman NG, Ostojic A, Steinberg SM, Hakim FT, Rose JJ, Kang Z, Yu Y, Cao L, Mitchell SA, Im A, Pavletic SZ. Clinical characterization and cytokine profile of fatigue in hematologic malignancy patients with chronic graft-versus-host disease. Bone Marrow Transplant 2021; 56:2934-2939. [PMID: 34433916 PMCID: PMC8639672 DOI: 10.1038/s41409-021-01419-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
Limited information is available regarding clinical and biological properties of fatigue in patients with chronic graft-versus-host disease (cGvHD). Patients with moderate-to-severe cGvHD per NIH criteria were enrolled on a cross-sectional study and categorized as "fatigued" if SF-36 vitality score was <40. Clinical and laboratory parameters of fatigued (n = 109) and nonfatigued patients (n = 72) were compared. In univariate analysis, walk velocity, NIH joint-fascia score, human activity profile, and SF-36 physical and mental health self-report scales were correlates of fatigue. No cGvHD biomarkers were associated with fatigue. NIH joint score, Lee sleep and depression questions, and PG-SGA activities and function score jointly predicted fatigue. Though higher rates of depression and insomnia were reported in the fatigued group, antidepressant or sleep aid use did not differ between groups. Survival ratio was not significantly different by fatigue status. Pathophysiology of fatigue in patients with cGvHD is complex and may involve mechanisms unrelated to disease activity. Patients with cGvHD experiencing fatigue had higher rates of untreated depression and insomnia, highlighting the need to focus clinical management of these conditions to improve health-related quality of life.
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Affiliation(s)
- Sencer Goklemez
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | | | - Filip Pirsl
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Noa G. Holtzman
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Alen Ostojic
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD,Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | | | - Frances T. Hakim
- Experimental Transplantation and Immunotherapy Branch, NCI, NIH, Bethesda, MD
| | - Jeremy J. Rose
- Experimental Transplantation and Immunotherapy Branch, NCI, NIH, Bethesda, MD
| | - Zhigang Kang
- Center for Cancer Research, NCI, NIH, Bethesda, MD
| | - Yunkai Yu
- Center for Cancer Research, NCI, NIH, Bethesda, MD
| | - Liang Cao
- Center for Cancer Research, NCI, NIH, Bethesda, MD
| | - Sandra A. Mitchell
- Division of Cancer Control and Population Sciences, NCI, NIH, Bethesda, MD
| | - Annie Im
- University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA
| | - Steven Z. Pavletic
- Immune Deficiency and Cellular Therapy Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
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14
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Billones R, Liwang JK, Butler K, Graves L, Saligan LN. Dissecting the fatigue experience: A scoping review of fatigue definitions, dimensions, and measures in non-oncologic medical conditions. Brain Behav Immun Health 2021; 15:100266. [PMID: 34589772 PMCID: PMC8474156 DOI: 10.1016/j.bbih.2021.100266] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Fatigue is a prevalent and potentially debilitating symptom that impacts the health-related quality-of-life of individuals diagnosed with acute and chronic medical conditions. Yet, its etiologic mechanism is not fully understood. Additionally, the assessment and determination of the clinical meaning of fatigue and its multidimensionality may vary by medical condition. Methods A scoping literature review was conducted to investigate how fatigue is defined and measured, including its dimensions, in non-oncologic medical conditions. The PubMed database was searched using keywords. Results Overall, 8376 articles were screened at the title/abstract levels, where 293 articles were chosen for full-text review that mentioned fatigue or included fatigue measures. The review of the full text excluded 246 articles that did not assess at least one fatigue dimension using validated questionnaires and clinical tests. The final set included 47 articles. Physical fatigue was the most assessed fatigue dimension and the Multidimensional Fatigue Inventory was the most widely used questionnaire to assess fatigue in this review. Limitations This review was limited by including only English-language publications and using PubMed as the sole database for the search. Conclusions This review affirms that fatigue is a multidimensional construct, agnostic of medical condition, and that individual fatigue dimensions can be measured by validated clinical measures. Future research should focus on expanding the repertoire of clinical measures to assess specific fatigue dimensions. The 27 different validated clinical measures used to assess fatigue and its dimensions; 20 instruments assessed the physical, 8 for mental, 7 cognitive, 5 for motivational, 2 for emotional, 1 peripheral, 1 for central, 1 psychosocial. Physical was the most measured dimension, as assessed in 42 of 47 included articles. This review affirms that fatigue is a multidimensional construct, agnostic of medical condition, and that individual fatigue dimensions can be measured by validate clinical measures.
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Affiliation(s)
| | | | | | | | - Leorey N. Saligan
- Corresponding author. National Institute of Nursing Research, National Institutes of Health 9000, Rockville Pike, Building 3, Room 5E14, Bethesda, MD, 20892, USA.
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15
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Wolff BS, Alshawi SA, Feng LR, Juneau PL, Saligan LN. Inflammation plays a causal role in fatigue-like behavior induced by pelvic irradiation in mice. Brain Behav Immun Health 2021; 15:100264. [PMID: 34589770 PMCID: PMC8474574 DOI: 10.1016/j.bbih.2021.100264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
Fatigue is a persistent and debilitating symptom following radiation therapy for prostate cancer. However, it is not well-understood how radiation targeted to a small region of the body can lead to broad changes in behavior. In this study, we used targeted pelvic irradiation of healthy male mice to test whether inflammatory signaling mediates changes in voluntary physical activity levels. First, we tested the relationship between radiation dose, blood cell counts, and fatigue-like behavior measured as voluntary wheel-running activity. Next, we used oral minocycline treatments to reduce inflammation and found that minocycline reduces, but does not eliminate, the fatigue-like behavioral changes induced by radiation. We also used a strain of mice lacking the MyD88 adaptor protein and found that these mice also showed less fatigue-like behavior than the wild-type controls. Finally, using serum and brain tissue samples, we determined changes in inflammatory signaling induced by irradiation in wild-type, minocycline treated, and MyD88 knockout mice. We found that irradiation increased serum levels of IL-6, a change that was partially reversed in mice treated with minocycline or lacking MyD88. Overall, our results suggest that inflammation plays a causal role in radiation-induced fatigue and that IL-6 may be an important mediator.
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Key Words
- CCL, chemokine (CC) ligand
- CD30 L, CD30 ligand
- CFS, chronic fatigue syndrome
- CRF, cancer-related fatigue
- CXCL, chemokine (CXC) ligand
- Cancer-related fatigue
- Cytokines
- FGF, fibroblast growth factor
- Fas-L, Fas Ligand
- Fatigue
- G-CSF, granulocyte colony-stimulating factor
- GM-CSF, granulocyte-macrophage colony-stimulating factor
- ICAM, intercellular adhesion molecule
- IFN, interferon
- IL, interleukin
- Inflammation
- LIF, leukemia inhibitory factor
- M-CSF, macrophage colony-stimulating factor
- MCV, mean corpuscular volume
- Minocycline
- MyD88, myeloid differentiation primary response 88 protein
- PDGF-bb, platelet-derived growth factor subunit B
- RANTES, regulated on activation normal T cell expressed and secreted
- RBC, red blood cell
- Radiotherapy
- TIMP, tissue inhibitor of metalloproteinases
- TLR, toll-like receptor
- TNF, tumor necrosis factor
- VEGF, vascular endothelial growth factor
- VWRA, voluntary wheel running activity
- Voluntary wheel-running activity
- WBC, white blood cell
- myd88
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Affiliation(s)
- Brian S Wolff
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Sarah A Alshawi
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Paul L Juneau
- NIH Library, Office of Research Services, OD, National Institutes of Health, Bethesda, MD, USA/Contractor- Zimmerman Associates, Inc., Fairfax, VA, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
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16
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Goto T, Sapio MR, Maric D, Robinson JM, Domenichiello AF, Saligan LN, Mannes AJ, Iadarola MJ. Longitudinal peripheral tissue RNA-Seq transcriptomic profiling, hyperalgesia, and wound healing in the rat plantar surgical incision model. FASEB J 2021; 35:e21852. [PMID: 34499774 PMCID: PMC9293146 DOI: 10.1096/fj.202100347r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023]
Abstract
Postoperative pain and delayed healing in surgical wounds, which require complex management strategies have understudied complicated mechanisms. Here we investigated temporal changes in behavior, tissue structure, and transcriptomic profiles in a rat model of a surgical incision, using hyperalgesic behavioral tests, histological analyses, and next‐generation RNA sequencing, respectively. The most rapidly (1 hour) expressed genes were the chemokines, Cxcl1 and Cxcl2. Consequently, infiltrating leukocytes were abundantly observed starting at 6 and peaking at 24 hours after incising which was supported by histological analysis and appearance of the neutrophil markers, S100a8 and S100a9. At this time, hyperalgesia was at a peak and overall transcriptional activity was most highly activated. At the 1‐day timepoint, Nppb, coding for natriuretic peptide precursor B, was the most strongly upregulated gene and was localized by in situ hybridization to the epidermal keratinocytes at the margins of the incision. Nppb was basically unaffected in a peripheral inflammation model transcriptomic dataset. At the late phase of wound healing, five secreted, incision‐specific peptidases, Mmp2, Aebp1, Mmp23, Adamts7, and Adamtsl1, showed increased expression, supporting the idea of a sustained tissue remodeling process. Transcripts that are specifically upregulated at each timepoint in the incision model may be potential candidates for either biomarkers or therapeutic targets for wound pain and wound healing. This study incorporates the examination of longitudinal temporal molecular responses, corresponding anatomical localization, and hyperalgesic behavioral alterations in the surgical incision model that together provide important and novel foundational knowledge to understand mechanisms of wound pain and wound healing.
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Affiliation(s)
- Taichi Goto
- Symptoms Biology Unit, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Matthew R Sapio
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Dragan Maric
- Flow and Imaging Cytometry Core Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey M Robinson
- Translational Life Science Technology Program, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Anthony F Domenichiello
- Lipid Peroxidation Unit, Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Leorey N Saligan
- Symptoms Biology Unit, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Andrew J Mannes
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Michael J Iadarola
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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17
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Zhang Z, Fu W, Tian C, Zhang F, Zhao B, Mao J, Saligan LN. Professional identity of Chinese nursing students during the COVID-19 pandemic outbreak: A nation-wide cross-sectional study. Nurse Educ Pract 2021; 52:103040. [PMID: 33813343 DOI: 10.1016/j.nepr.2021.103040] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 01/16/2023]
Abstract
Practicing in unprecedented working environment and fighting against the COVID-19 crisis influenced the image of nursing in the general population, as well as among nurses themselves. This study aimed to describe the sense of professional identity among Chinese nursing students during the COVID-19 outbreak and to explore the relationship between psychological resilience and the sense of professional identity in this cohort. A nationwide online cross-sectional survey was conducted. Nursing students were recruited from 18 Chinese universities. The 10-item Connor-Davidson resilience scale (CD-RISC-10) evaluated psychological resilience and professional identity was assessed by the Professional Identity Questionnaire for Nursing Students (PIQNS). A total of 6348 respondents had a moderate level of professional identity to nursing (average PIQNS score at 62.02 ± 12.02). About 86% of respondents attributed the response to the COVID-19 pandemic in elevating the nursing image. Psychological resilience was the strongest contributor to professional identity (β = 0.371, P < 0.001). There was a high level of professional identity among Chinese nursing students during the COVID-19 crisis. Policy support and courses to enhance psychological resilience are critical to sustain professional identity among nursing students.
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Affiliation(s)
- Zeyu Zhang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wenning Fu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Chong Tian
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Fengzhi Zhang
- Department of Gynecology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Bing Zhao
- The Central Hospital Affiliated to Shenyang Medical College, Shengyang, Liaoning Province, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
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18
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Graves LY, Tamez P, Wallen GR, Saligan LN. Defining the role of individuals prepared as a doctor of nurse practice in symptoms science research. Nurs Outlook 2021; 69:542-549. [PMID: 33750612 DOI: 10.1016/j.outlook.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 11/13/2022]
Abstract
PURPOSE The Doctor of Nursing Practice (DNP) programs have grown exponentially for the last 10 years across the United States. However, the intra-professional collaboration among DNP and PhD scholars is not clearly demonstrated in the literature as it relates to frequency, training models, and the outcomes of these collaborations on translation. The purposes of this paper are to: (1) examine the role for DNP nurses in symptom science research and (2) describe training models to cultivate the PhD-DNP collaboration to strengthen the translation of discoveries from nursing research, to facilitate implementation of discoveries, and to improve clinical practice of nurses. METHODS A targeted review of the literature was conducted to identify, (1) the role of the DNP, (2) examples of PhD-DNP collaborations, (3) training models that support collaborations, and (4) the outcomes of these intra-professional collaborations. RESULTS Two articles reported on PhD-DNP collaboration within a university setting; however, they did not address how the partnership was modeled. One additional article described an academic-hospital partnership model aimed at MSN-prepared advanced practice nurses (APRN) by which outcomes were measured. No examples were found outside of academic settings. The National Institute of Nursing Research (NINR) has established the Symptom Science Center (SSC) with an interest in training the next generation of symptom scientists. By developing a training curriculum through the NINR SSC, DNP-prepared students and practitioners can be exposed to the research enterprise and potentially develop early partnerships with PhD-prepared students and scholars that lead to research translation. CONCLUSION The NINR Department of Intramural Research (DIR) and National Institutes of Health Clinical Center are dedicated to building stronger ties between PhD- and DNP-prepared scientists. The SSC can serve as an optimal platform to promote the collaboration of PhD and DNP nurses to advance symptom science translation. CLINICAL RELEVANCE Nurses have a remarkable role in early detection of disease progression. Training opportunities to cultivate the PhD-DNP collaboration have significant relevance for expediting the translation of nursing science to nursing practice.
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Affiliation(s)
- Letitia Y Graves
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Pamela Tamez
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Gwenyth R Wallen
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; National Institutes of Health, Clinical Center, Nursing Department, Bethesda, MD
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
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19
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Feng LR, Barb JJ, Regan J, Saligan LN. Plasma metabolomic profile associated with fatigue in cancer patients. Cancer Med 2021; 10:1623-1633. [PMID: 33534943 PMCID: PMC7940245 DOI: 10.1002/cam4.3749] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Metabolomics is the newest -omics methodology and allows for a functional snapshot of the biochemical activity and cellular state. The goal of this study is to characterize metabolomic profiles associated with cancer-related fatigue, a debilitating symptom commonly reported by oncology patients. METHODS Untargeted ultrahigh performance liquid chromatography/mass spectrometry metabolomics approach was used to identify metabolites in plasma samples collected from a total of 197 participants with or without cancer. Partial least squares-discriminant analysis (PLS-DA) was used to identify discriminant metabolite features, and diagnostic performance of selected classifiers was quantified using area under the receiver operating characteristics (AUROC) curve analysis. Pathway enrichment analysis was performed using Fisher's exact test and the Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic pathway database. FINDINGS The global metabolomics approach yielded a total of 1120 compounds of known identity. Significant metabolic pathways unique to fatigued cancer versus control groups included sphingolipid metabolism, histidine metabolism, and cysteine and methionine metabolism. Significant pathways unique to non-fatigued cancer versus control groups included inositol phosphate metabolism, primary bile acid biosynthesis, ascorbate and aldarate metabolism, starch and sucrose metabolism, and pentose and glucuronate interconversions. Pathways shared between the two comparisons included caffeine metabolism, tyrosine metabolism, steroid hormone biosynthesis, sulfur metabolism, and phenylalanine metabolism. CONCLUSIONS We found significant metabolomic profile differences associated with cancer-related fatigue. By comparing metabolic signatures unique to fatigued cancer patients with metabolites associated with, but not unique to, fatigued cancer individuals (overlap pathways) and metabolites associated with cancer but not fatigue, we provided a broad view of the metabolic phenotype of cancer-related fatigue.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing ResearchNational Institutes of HealthBethesdaMDUSA
| | | | - Jeniece Regan
- The Pennsylvania State University College of MedicineHersheyPAUSA
| | - Leorey N. Saligan
- National Institute of Nursing ResearchNational Institutes of HealthBethesdaMDUSA
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20
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Gonzalez-Mercado VJ, Marrero S, Pérez-Santiago J, Tirado-Gómez M, Marrero-Falcón MA, Pedro E, Saligan LN. Association of Radiotherapy-Related Intestinal Injury and Cancer-related Fatigue: A Brief Review and Commentary. P R Health Sci J 2021; 40:6-11. [PMID: 33876912 PMCID: PMC9109698] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Radiotherapy treatment-induced intestinal injury and gut microbial perturbation/dysbiosis have been implicated in the pathobiology of cancer-related fatigue. The objective of this brief review was to explore the available evidence of the relationship between intestinal injury and self-reported fatigue, especially among cancer patients. The scientific evidence-including our own-linking gut mucosal barrier dysfunction and gut microbial perturbation/dysbiosis induced by cancer treatment with worsening of cancer related fatigue (perhaps through the gut-brain axis) is limited but promising. Emerging data suggest that lifestyle interventions and the administration of specific probiotics may favorably modulate the gut microbiota and potentially mediate beneficial effects leading to improvements in fatigue.
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Affiliation(s)
| | - Sara Marrero
- College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Josué Pérez-Santiago
- Assistant Professor of Computational Biology and Bioinformatics Director, Puerto Rico Omics Center Comprehensive Cancer Center, University of Puerto Rico San Juan, PR
| | - Maribel Tirado-Gómez
- Assistant Professor of Medicine, Department of Hematology and Oncology, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| | | | - Elsa Pedro
- Assistant Professor, School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, PR
| | - Leorey N Saligan
- Tenure-Track Investigator and Chief of Symptom Biology Unit NINR/NIH, Bethesda, MD, United States
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21
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González-Mercado VJ, Lim J, Marrero S, Pedro E, Saligan LN. Gut microbiota and fatigue in rectal cancer patients: a cross-sectional pilot study. Support Care Cancer 2021; 29:4615-4621. [PMID: 33495850 DOI: 10.1007/s00520-021-06013-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/19/2021] [Indexed: 12/17/2022]
Abstract
CONTEXT Although microbial-mediated disturbance of intestinal mucosal homeostasis (dysbiosis) is believed to contribute to the pathogenesis of chemotherapy and radiotherapy (CRT)-related fatigue, potential differences in the gut microbial diversity and in the abundance of gut microbial taxa between fatigued and non-fatigued patients have not been adequately examined, particularly in the rectal cancer population. PURPOSE In this cross-sectional study, we aim to examine the differences in (a) gut microbial diversity and gut microbial abundances and (b) predicted functional pathways of the gut microbiome between rectal cancer participants with and without fatigue at the end of CRT. METHODS Rectal cancer patients (n = 50) provided stool samples for 16S rRNA gene sequencing and symptom ratings for fatigue at the end of CRT. Gut microbiome data were analyzed using QIIME2, LEfSe, and the R statistical package. RESULTS Fatigued (n = 35) participants showed enriched bacterial abundances of Eubacterium, Streptococcus, Adlercreutzia, and Actinomyces, as well as enriched abundances of the microbial sucrose degradation pathway, compared to non-fatigued patients at the end of CRT (n = 15). CONCLUSIONS Differentially abundant microbial taxa were identified in fatigued and non-fatigued rectal cancer participants at the end of CRT. However, the exact role of these taxa (and identification of species) in the biology of CRT-related fatigue remains to be examined.
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Affiliation(s)
| | - Jean Lim
- University of Miami, Miami, FL, USA
| | - Sara Marrero
- College of Arts and Sciences, University of South Florida, Tampa, FL, USA
| | - Elsa Pedro
- School of Pharmacy, Medical Science Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Leorey N Saligan
- Symptom Science Center, Principal Investigator, Symptom Biology Unit, Division of Intramural Research, NINR, NIH, DHHS, Bethesda, MD, USA
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22
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Park J, Won CW, Saligan LN, Kim YJ, Kim Y, Lukkahatai N. Accelerated Epigenetic Age in Normal Cognitive Aging of Korean Community-Dwelling Older Adults. Biol Res Nurs 2021; 23:464-470. [PMID: 33406883 DOI: 10.1177/1099800420983896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Epigenetic age acceleration has been studied as a promising biomarker of age-related conditions, including cognitive aging. This pilot study aims to explore potential cognitive aging-related biomarkers by investigating the relationship of epigenetic age acceleration and cognitive function and by examining the epigenetic age acceleration differences between successful cognitive aging (SCA) and normal cognitive aging (NCA) among Korean community-dwelling older adults (CDOAs). METHODS We used data and blood samples of Korean CDOAs from the Korean Frailty and Aging Cohort Study. The participants were classified into two groups, SCA (above the 50th percentile in all domains of cognitive function) and NCA. The genome-wide DNA methylation profiling array using Illumina Infinium MethylationEPIC BeadChip was used to calculate the following: the DNA methylation age, universal epigenetic age acceleration, intrinsic epigenetic age acceleration (IEAA), and extrinsic epigenetic age acceleration (EEAA). We also used Pearson correlation analysis and independent t-tests to analyze the data. RESULTS Universal age acceleration correlated with the Frontal Assessment Battery test results (r = -0.42, p = 0.025); the EEAA correlated with the Word List Recognition test results (r = -0.41, p = 0.027). There was a significant difference between SCA and NCA groups in IEAA (p = 0.041, Cohen's d = 0.82) and EEAA (p = 0.042, Cohen's d = 0.78). CONCLUSIONS Epigenetic age acceleration can be used as a biomarker for early detection of cognitive decline in Korean community-dwelling older adults. Large longitudinal studies are warranted.
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Affiliation(s)
- Jongmin Park
- College of Nursing, 34996Pusan National University, Gyeongsangnam-do, Republic of Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Youn-Jung Kim
- College of Nursing Science, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Yoonju Kim
- College of Nursing Science, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Nada Lukkahatai
- School of Nursing, 1466Johns Hopkins University, Baltimore, MD, USA
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23
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Goto T, Sapio MR, Maric D, Robinson JM, Saligan LN, Mannes AJ, Iadarola MJ. Longitudinal Transcriptomic Profiling in Carrageenan-Induced Rat Hind Paw Peripheral Inflammation and Hyperalgesia Reveals Progressive Recruitment of Innate Immune System Components. J Pain 2020; 22:322-343. [PMID: 33227508 DOI: 10.1016/j.jpain.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 12/28/2022]
Abstract
Pain is a common but potentially debilitating symptom, often requiring complex management strategies. To understand the molecular dynamics of peripheral inflammation and nociceptive pain, we investigated longitudinal changes in behavior, tissue structure, and transcriptomic profiles in the rat carrageenan-induced peripheral inflammation model. Sequential changes in the number of differentially expressed genes are consistent with temporal recruitment of key leukocyte populations, mainly neutrophils and macrophages with each wave being preceded by upregulation of the cell-specific chemoattractants, Cxcl1 and Cxcl2, and Ccl2 and Ccl7, respectively. We defined 12 temporal gene clusters based on expression pattern. Within the patterns we extracted genes comprising the inflammatory secretome and others related to nociceptive tissue remodeling and to sensory perception of pain. Structural tissue changes, involving upregulation of multiple collagens occurred as soon as 1-hour postinjection, consistent with inflammatory tissue remodeling. Inflammatory expression profiling revealed a broad-spectrum, temporally orchestrated molecular and cellular recruitment process. The results provide numerous potential targets for modulation of pain and inflammation. PERSPECTIVE: This study investigates the highly orchestrated biological response during tissue inflammation with precise assessment of molecular dynamics at the transcriptional level. The results identify transcriptional changes that define an evolving inflammatory state in rats. This study provides foundational data for identifying markers of, and potential treatments for, inflammation and pain in patients.
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Affiliation(s)
- Taichi Goto
- National Institutes of Health, National Institute of Nursing Research, Symptom Biology Unit, Bethesda, Maryland
| | - Matthew R Sapio
- National Institutes of Health, Clinical Center, Department of Perioperative Medicine, Bethesda, Maryland
| | - Dragan Maric
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Flow and Imaging Cytometry Core Facility, Bethesda, Maryland
| | - Jeffrey M Robinson
- University of Maryland, Baltimore County, Translational Life Science Technology Program, Baltimore, Maryland
| | - Leorey N Saligan
- National Institutes of Health, National Institute of Nursing Research, Symptom Biology Unit, Bethesda, Maryland
| | - Andrew J Mannes
- National Institutes of Health, Clinical Center, Department of Perioperative Medicine, Bethesda, Maryland
| | - Michael J Iadarola
- National Institutes of Health, Clinical Center, Department of Perioperative Medicine, Bethesda, Maryland.
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Abstract
Fatigue and anhedonia are commonly reported, co-occurring clinical symptoms associated with chronic illnesses. Fatigue is a multidimensional construct that is defined as a distressing, persistent, subjective sense of physical, cognitive, or emotional tiredness that interferes with usual functioning. Anhedonia is a component of depressive disorders and other psychiatric conditions, such as schizophrenia, and is defined by the reduced ability to experience pleasure. Both symptoms greatly affect the health-related quality of life of patients with chronic illnesses. Although fatigue and anhedonia are commonly associated with each other, understanding the differences between the two constructs is necessary for diagnosis and clinical treatment. A scoping review was conducted based on published guidance, starting with a comprehensive search of existing literature to understand the similarities and differences between fatigue and anhedonia. An initial search of PubMed using fatigue and anhedonia as medical subject headings yielded a total of 5254 articles. A complete full-text review of the final 21 articles was conducted to find articles that treated both constructs similarly and articles that presented fatigue and anhedonia as distinct constructs. About 60% of the reviewed articles consider both constructs as distinct, but a considerable number of the reviewed articles found these constructs indistinguishable. Nomenclature and biology were two themes from the reviewed articles supporting the idea that anhedonia and fatigue are indistinguishable constructs. The information generated from this review is clinically relevant to optimize the management of fatigue related to anhedonia from other fatigue subtypes.
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Affiliation(s)
- Ruel R. Billones
- grid.280738.60000 0001 0035 9863National Institute of Nursing Research, National Institutes of Health, Bethesda, MD USA
| | - Saloni Kumar
- grid.280738.60000 0001 0035 9863National Institute of Nursing Research, National Institutes of Health, Bethesda, MD USA
| | - Leorey N. Saligan
- grid.280738.60000 0001 0035 9863National Institute of Nursing Research, National Institutes of Health, Bethesda, MD USA
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25
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González-Mercado VJ, Henderson WA, Sarkar A, Lim J, Saligan LN, Berk L, Dishaw L, McMillan S, Groer M, Sepehri F, Melkus GD. Changes in Gut Microbiome Associated With Co-Occurring Symptoms Development During Chemo-Radiation for Rectal Cancer: A Proof of Concept Study. Biol Res Nurs 2020; 23:31-41. [PMID: 32700552 DOI: 10.1177/1099800420942830] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine a) whether there are significant differences in the severity of symptoms of fatigue, sleep disturbance, or depression between patients with rectal cancer who develop co-occurring symptoms and those with no symptoms before and at the end of chemotherapy and radiation therapy (CRT); b) differences in gut microbial diversity between those with co-occurring symptoms and those with no symptoms; and c) whether before-treatment diversity measurements and taxa abundances can predict co-occurrence of symptoms. METHODS Stool samples and symptom ratings were collected from 31 patients with rectal cancer prior to and at the end of (24-28 treatments) CRT. Descriptive statistics were computed and the Mann-Whitney U test was performed for symptoms. Gut microbiome data were analyzed using R's vegan package software. RESULTS Participants with co-occurring symptoms reported greater severity of fatigue at the end of CRT than those with no symptoms. Bacteroides and Blautia2 abundances differed between participants with co-occurring symptoms and those with no symptoms. Our random forest classification (unsupervised learning algorithm) predicted participants who developed co-occurring symptoms with 74% accuracy, using specific phylum, family, and genera abundances as predictors. CONCLUSION Our preliminary results point to an association between the gut microbiota and co-occurring symptoms in rectal cancer patients and serves as a first step in potential identification of a microbiota-based classifier.
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Affiliation(s)
- Velda J González-Mercado
- NYU Rory Meyers College of Nursing, New York, NY, USA.,College of Nursing, 7831University of South Florida, Tampa, FL, USA
| | | | - Anujit Sarkar
- College of Nursing and College of Public Health, 7831University of South Florida, Tampa, FL, USA
| | - Jean Lim
- 96722Rosenstiel School of Marine and Atmosphereic Science, University of Miami, FL, USA
| | - Leorey N Saligan
- Symptom Science Center, Symptom Biology Unit, Division of Intramural Research, NINR, NIH, DHHS, Bethesda, MD, USA
| | - Lawrence Berk
- College of Medicine Radiology, 7831University of South Florida, Tampa, FL, USA
| | - Larry Dishaw
- Department of Pediatrics, Molecular Genetics Children's Research Institute, 7831University of South Florida, St. Petersburg, FL, USA
| | - Susan McMillan
- College of Nursing, 7831University of South Florida, Tampa, FL, USA
| | - Maureen Groer
- College of Nursing, 7831University of South Florida, Tampa, FL, USA
| | - Farrah Sepehri
- College of Nursing, 7831University of South Florida, Tampa, FL, USA
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26
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Wolff BS, Raheem SA, Alshawi SA, Regan JM, Feng LR, Saligan LN. Induction of fatigue-like behavior by pelvic irradiation of male mice alters cognitive behaviors and BDNF expression. PLoS One 2020; 15:e0235566. [PMID: 32614931 PMCID: PMC7332074 DOI: 10.1371/journal.pone.0235566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
Fatigue and cognitive deficits are often co-occurring symptoms reported by patients after radiation therapy for prostate cancer. In this study, we induced fatigue-like behavior in mice using targeted pelvic irradiation to mimic the clinical treatment regimen and assess cognitive behavioral changes. We observed that pelvic irradiation produced a robust fatigue phenotype, a reduced rate of spontaneous alternation in a Y-maze test, and no behavioral change in an open field test. We found that reversal learning for fatigued mice was slower with respect to time, but not with respect to effort put into the test, suggesting that fatigue may impact the ability or motivation to work at a cognitive task without impairing cognitive capabilities. In addition, we found that mice undergoing pelvic irradiation show lower whole-brain levels of mature BDNF, and that whole-brain proBDNF levels also correlate with spontaneous alternation in a Y-maze test. These results suggest that changes in BDNF levels could be both a cause and an effect of fatigue-related changes in behavior.
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Affiliation(s)
- Brian S. Wolff
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sumiyya A. Raheem
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sarah A. Alshawi
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jeniece M. Regan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Leorey N. Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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27
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Gonzalez-Mercado VJ, Marrero S, Marrero-Falcon MA, Saligan LN. Factors Affecting the Severity of Fatigue during Radiotherapy for Prostate Cancer; an Exploratory Study. Urol Nurs 2020; 40:129-138. [PMID: 34220179 PMCID: PMC8248518] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Limited studies have examined potential risk factors associated with the fatigue experience of a sample of Puerto Rican men treated with radiotherapy for non-metastatic prostate cancer. Identifying these factors may provide initial information about targets for individualized interventions, leading to more effective management of fatigue in this population. PURPOSE To examine the relationship of age, body max index, depressive symptoms, physical activity, and sleep disturbance with fatigue during radiotherapy for prostate cancer. METHODS Twenty six participants completed five inventories: demographic intake, health form, the Functional Assessment of Cancer-Therapy-fatigue, Patient-Reported Outcome Measures Information System-Sleep disturbance, and the International Physical Activity Questionnaire-Short Form before, middle/days 19-21 and completion/days 38-42 of radiotherapy. The principal investigator rated the Hamilton depression scale. Descriptive statistics were performed. Interactions and influence of variables on fatigue were assessed using bivariate correlation and multiple linear regression, respectively. RESULTS At each study time point, sleep disturbance and depressive symptoms were strongly correlated with each other and fatigue. The linear combination of sleep disturbance and depressive symptoms was significantly related to fatigue. CONCLUSION Given the high association of sleep disturbance and depressive symptoms with fatigue, clinicians should assess and develop interventions to manage these symptoms altogether.
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Affiliation(s)
| | - Sara Marrero
- University of South Florida College of Arts and Sciences, Tampa, FL, United States
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28
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Feng LR, Wolff BS, Liwang J, Regan JM, Alshawi S, Raheem S, Saligan LN. [Corrigendum] Cancer‑related fatigue during combined treatment of androgen deprivation therapy and radiotherapy is associated with mitochondrial dysfunction. Int J Mol Med 2020; 45:1960. [PMID: 32186755 PMCID: PMC7169963 DOI: 10.3892/ijmm.2020.4546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/06/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Li Rebekah Feng
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Brian S Wolff
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Josephine Liwang
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeniece M Regan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sarah Alshawi
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sumiyya Raheem
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Leorey N Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
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29
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Cernea A, Fernández-Martínez JL, deAndrés-Galiana EJ, Fernández-Ovies FJ, Alvarez-Machancoses O, Fernández-Muñiz Z, Saligan LN, Sonis ST. Robust pathway sampling in phenotype prediction. Application to triple negative breast cancer. BMC Bioinformatics 2020; 21:89. [PMID: 32164540 PMCID: PMC7068866 DOI: 10.1186/s12859-020-3356-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Phenotype prediction problems are usually considered ill-posed, as the amount of samples is very limited with respect to the scrutinized genetic probes. This fact complicates the sampling of the defective genetic pathways due to the high number of possible discriminatory genetic networks involved. In this research, we outline three novel sampling algorithms utilized to identify, classify and characterize the defective pathways in phenotype prediction problems, such as the Fisher’s ratio sampler, the Holdout sampler and the Random sampler, and apply each one to the analysis of genetic pathways involved in tumor behavior and outcomes of triple negative breast cancers (TNBC). Altered biological pathways are identified using the most frequently sampled genes and are compared to those obtained via Bayesian Networks (BNs). Results Random, Fisher’s ratio and Holdout samplers were more accurate and robust than BNs, while providing comparable insights about disease genomics. Conclusions The three samplers tested are good alternatives to Bayesian Networks since they are less computationally demanding algorithms. Importantly, this analysis confirms the concept of “biological invariance” since the altered pathways should be independent of the sampling methodology and the classifier used for their inference. Nevertheless, still some modifications are needed in the Bayesian networks to be able to sample correctly the uncertainty space in phenotype prediction problems, since the probabilistic parameterization of the uncertainty space is not unique and the use of the optimum network might falsify the pathways analysis.
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Affiliation(s)
- Ana Cernea
- Group of Inverse Problems, Optimization and Machine Learning, Department of Mathematics, University of Oviedo, C/ Federico García-Lorca, 18, 33007, Oviedo, Spain
| | - Juan Luis Fernández-Martínez
- Group of Inverse Problems, Optimization and Machine Learning, Department of Mathematics, University of Oviedo, C/ Federico García-Lorca, 18, 33007, Oviedo, Spain.
| | - Enrique J deAndrés-Galiana
- Group of Inverse Problems, Optimization and Machine Learning, Department of Mathematics, University of Oviedo, C/ Federico García-Lorca, 18, 33007, Oviedo, Spain.,Department of Informatics and Computer Science, University of Oviedo, C/ Federico García-Lorca, 18, 33007, Oviedo, Spain
| | - Francisco Javier Fernández-Ovies
- Group of Inverse Problems, Optimization and Machine Learning, Department of Mathematics, University of Oviedo, C/ Federico García-Lorca, 18, 33007, Oviedo, Spain
| | - Oscar Alvarez-Machancoses
- Group of Inverse Problems, Optimization and Machine Learning, Department of Mathematics, University of Oviedo, C/ Federico García-Lorca, 18, 33007, Oviedo, Spain
| | - Zulima Fernández-Muñiz
- Group of Inverse Problems, Optimization and Machine Learning, Department of Mathematics, University of Oviedo, C/ Federico García-Lorca, 18, 33007, Oviedo, Spain
| | - Leorey N Saligan
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, USA
| | - Stephen T Sonis
- Primary Endpoint Solutions, Watertown, MA, USA.,Brigham and Women's Hospital and the Dana-Farber Cancer Institute, Boston, MA, USA
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30
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Yeh CH, Caswell K, Pandiri S, Sair H, Lukkahatai N, Campbell CM, Stearns V, Van de Castle B, Perrin N, Smith TJ, Saligan LN. Dynamic Brain Activity Following Auricular Point Acupressure in Chemotherapy-Induced Neuropathy: A Pilot Longitudinal Functional Magnetic Resonance Imaging Study. Glob Adv Health Med 2020; 9:2164956120906092. [PMID: 32110475 PMCID: PMC7019394 DOI: 10.1177/2164956120906092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/20/2020] [Indexed: 01/25/2023] Open
Abstract
Background The objective of this study was to investigate the dynamic brain activity
following auricular point acupressure (APA) in chemotherapy-induced
neuropathy (CIN). Methods Participants received 4 weeks of APA in an open-pilot trial with repeated
observation. Along with the clinical self-reported CIN outcomes, objective
outcomes were measured over the course of the treatment by physiological
changes in pain sensory thresholds from quantitative sensory testing (QST)
and repeated functional magnetic resonance imaging scans. Results After 4 weeks of APA, participants had reported clinically significant
improvements (ie, ≥30%) in a reduction of CIN symptoms (including pain,
numbness, tingling, and stiffness) in lower extremity stiffness (32%),
reduced foot sensitivity (13%), and higher pain threshold (13%). Across the
11 intrinsic brain networks examined, there was a trend toward significance
of the connectivity of the basal ganglia network (BGN) to the salience
network (SAL), which was decreased pre-APA versus immediate-APA (effect size
[ES] = 1.04, P = .07). The BGN also demonstrated decreased
connectivity with the language network pre-APA versus delayed imaging
post-APA (ES = −0.92, P = .07). Furthermore, there was
increased executive control network (ECN) and SAL within-network
connectivity comparing pre-APA to delayed imaging post-APA, trending toward
significance (ES = 0.41, P = .09 and ES = 0.17,
P = .09, respectively). Conclusion The changes in connectivity and activity within or between the ECN, SAL, and
BGN from pre- to post-APA suggest ongoing alterations in brain functional
connectivity following APA, particularly in the insula, anterior cingulate,
and dorsolateral prefrontal cortices, which play significant roles in pain,
memory, and cognitive function.
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Affiliation(s)
- Chao Hsing Yeh
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Keenan Caswell
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Sonaali Pandiri
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Haris Sair
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nada Lukkahatai
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vered Stearns
- Breast and Ovarian Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara Van de Castle
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
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Feng LR, Wolff BS, Liwang J, Regan JM, Alshawi S, Raheem S, Saligan LN. Cancer‑related fatigue during combined treatment of androgen deprivation therapy and radiotherapy is associated with mitochondrial dysfunction. Int J Mol Med 2019; 45:485-496. [PMID: 31894256 PMCID: PMC6984780 DOI: 10.3892/ijmm.2019.4435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/06/2019] [Indexed: 01/02/2023] Open
Abstract
Combined androgen deprivation therapy (ADT) and radiation therapy (RT) is the standard of care treatment for non-metastatic prostate cancer (NMPC). Despite the efficacy, treatment-related symptoms including fatigue greatly reduce the quality of life of cancer patients. The goal of the study is to examine the influence of combined ADT/RT on fatigue and understand its underlying mechanisms. A total of 64 participants with NMPC were enrolled. Fatigue was assessed using the Functional Assessment of Cancer Therapy-Fatigue. Mitochondrial function parameters were measured as oxygen consumption from peripheral blood mononuclear cells (PBMCs) extracted from participants' whole blood. An ADT/RT-induced fatigue mouse model was developed, with fatigue measured as a reduction in voluntary wheel-running activity (VWRA) in 54 mice. Mitochondrial function was assessed in the ADT/RT mouse brains using western blot analysis of glucose transporter 4 (GLUT4) and transcription factor A, mitochondrial (TFAM). The results demonstrated that fatigue in the ADT group was exacerbated during RT compared with the non-ADT group. This effect was specific to fatigue, as depressive symptoms were unaffected. PBMCs of fatigued subjects exhibited decreased ATP coupling efficiency compared to non-fatigued subjects, indicative of mitochondrial dysfunction. The ADT/RT mice demonstrated the synergistic effect of ADT and RT in decreasing VWRA. Brain tissues of ADT/RT mice exhibited decreased levels of GLUT4 and TFAM suggesting that impaired neuronal metabolic homeostasis may contribute to fatigue pathogenesis. In conclusion, these findings suggest that fatigue induced by ADT/RT may be attributable to mitochondrial dysfunction both peripherally and in the central nervous system (CNS). The synergistic effect of ADT/RT is behaviorally reproducible in a mouse model and its mechanism may be related to bioenergetics in the CNS.
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Affiliation(s)
- Li Rebekah Feng
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Brian S Wolff
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Josephine Liwang
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeniece M Regan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sarah Alshawi
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sumiyya Raheem
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Leorey N Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA
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Hsiao CP, Dickinson K, Gonzalez-Mercado V, Kelly DL, Lukkahatai N, McCabe M, Mayo S, Musanti R, Saligan LN. Consortium Building for Nurse Scientists Interested in Symptoms Research in the Era of Precision Health. J Nurs Scholarsh 2019; 52:183-191. [PMID: 31804774 DOI: 10.1111/jnu.12534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE This article aims to provide perspectives on the establishment of a consortium for nurse scientists with similar career trajectories interested in cancer-related symptoms (CRS) research. Hereby, we describe the development of and recent outcomes from the CRS consortium, the lessons learned in establishing the consortium, and future directions to advance the science of CRS. MODEL AND METHODS New and innovative strategies are needed to address the complexity of CRS research. A CRS consortium was created to allow a mechanism for oncology nurse scientists with varying expertise to collaborate to advance CRS research. The National Institutes of Health (NIH) Symptom Science Model (SSM) guides the research of the CRS Consortium. DISCUSSION AND CONCLUSIONS A need for improved CRS assessment and management has been identified. The CRS consortium was created as a collaborative think tank to begin to address this need. Guided by the NIH SSM, CRS consortium members have worked to define symptom phenotypes, enhance understanding of the biologic mechanisms that can contribute to symptom phenotypes, and develop tailored interventions to improve symptom management. Dissemination of the CRS consortium efforts involve publications and presentations. CLINICAL IMPLICATIONS Nurse scientists interested in symptom science and biobehavorial research face many challenges on how to initiate and sustain independent programs of research. Through the formation of a CRS consortium, oncology nurse scientists can work together to address identified issues in symptom measurement and management.
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Affiliation(s)
- Chao-Pin Hsiao
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Kristin Dickinson
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Nada Lukkahatai
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Margaret McCabe
- Center for Pediatric Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samantha Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Rita Musanti
- School of Nursing, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Leorey N Saligan
- Psi Beta, National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, Bethesda, NJ, USA
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Feng LR, Regan J, Shrader JA, Liwang J, Ross A, Kumar S, Saligan LN. Cognitive and motor aspects of cancer-related fatigue. Cancer Med 2019; 8:5840-5849. [PMID: 31407525 PMCID: PMC6792503 DOI: 10.1002/cam4.2490] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a debilitating symptom frequently reported by patients during and after treatment for cancer. CRF is a multidimensional experience and is often solely assessed by self-report measures. The goal of the study is to examine the physical and cognitive aspects of self-reported CRF using a cognitive function test and a physical fatigue index in order to provide objective measures that can characterize the CRF phenotype. METHODS A total of 59 subjects with nonmetastatic prostate cancer receiving external beam radiation therapy were included in the study. Fatigue was measured using the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire. Cognitive characteristics of CRF was measured using the Stroop Color-Word Interference computerized test and the motor aspect of fatigue was measured using the static fatigue test using a handgrip dynamometer. FINDINGS Functional Assessment of Cancer Therapy-Fatigue scores significantly correlated with the Stroop Interference score, but not performance accuracy in all test conditions. Fatigued subjects exhibited a more rapid decline to 50% of maximal strength and increased static fatigue index in the handgrip test, whereas maximal grip strength was not affected. CONCLUSIONS The results suggest that CRF exhibits both cognitive and physical characteristics. Subjective fatigue was associated with increased time required to overcome cognitive interference, but not cognitive performance accuracy. Fatigued patients exhibited decreased physical endurance and the ability to sustain maximal strength over time. These objective measures may serve as valuable tools for clinicians to detect cognitive and physical impairment associated with CRF.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Jeniece Regan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Joseph A Shrader
- Clinical Center Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland
| | - Josephine Liwang
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Alexander Ross
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Saloni Kumar
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland
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Gonzalez VJ, Beckstead J, Groer M, McMillan S, Ortiz D, Marrero S, Saligan LN. Exploring the Relationship between Diarrhea and Fatigue that can occur during Cancer Treatment: Using Structural Equation Modeling. P R Health Sci J 2019; 38:81-86. [PMID: 31260550 PMCID: PMC6719553] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine the relationship of the symptoms of diarrhea and fatigue by testing a model that included multiple dimensions of the cancer related-symptom experience. METHODS A secondary data analysis was conducted on data from the self-reports of 102 cancer patients co experiencing diarrhea and fatigue during treatment at a comprehensive cancer center in the Southeastern United States. Structural equational modeling was employed to examine the relationship between the 2variables. Fatigue and diarrhea were assessed using items from the Cancer Symptom Scale. RESULTS The structural model results showed that (a) the model fit was adequate (b) diarrhea explained 7% of the variance in fatigue, and (c) the structural or path coefficient between diarrhea and fatigue was significant (0.267; p<0.05). Diarrhea had the strongest effect on fatigue interference (0.251). CONCLUSION Diarrhea is a potential contributing factor to the symptom of fatigue and a potential target for interventions to prevent and ameliorate fatigue.
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Affiliation(s)
- Velda J Gonzalez
- Postdoctoral Fellow, College of Nursing, University of South Florida, Tampa, FL, United States; UPR/MDACC Partnership for Excellence in Cancer Research U54 CA096297
| | - Jason Beckstead
- Associate Professor, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Maureen Groer
- Gordon Keller Professor, College of Nursing, University of South Florida, Tampa, FL United States
| | - Susan McMillan
- Distinguished Professor and Thompson Professor of Oncology Nursing and Quality of Life, College of Nursing,University of South Florida, Tampa, FL, United States
| | - Desiree Ortiz
- Medical student, St. George's University, Grenada, West Indies
| | - Sara Marrero
- Student, College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Leorey N Saligan
- Tenure-Track Investigator and Chief of Symptom Biology Unit, NINR/NIH, Bethesda, MD, United States
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Saligan LN, Farmer C, Ballard ED, Kadriu B, Zarate CA. Disentangling the association of depression on the anti-fatigue effects of ketamine. J Affect Disord 2019; 244:42-45. [PMID: 30312839 PMCID: PMC6226316 DOI: 10.1016/j.jad.2018.10.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/10/2018] [Accepted: 10/05/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Fatigue and depression are closely associated. The purpose of this secondary analysis was to understand the relationships between depression and improvements in specific depression domains on the anti-fatigue effects of ketamine, which we previously reported. METHODS This secondary analysis re-evaluated data collected longitudinally from 39 patients with treatment-resistant Major Depressive Disorder (MDD) enrolled in a double-blind, randomized, placebo-controlled, crossover trial using a single intravenous infusion of ketamine hydrochloride (0.5 mg/kg over 40 minutes) or placebo. A mediation model assessed the effect of depression on the anti-fatigue effects of a single dose of intravenous ketamine versus placebo at Day 1 post-infusion. Fatigue was measured using the National Institutes of Health-Brief Fatigue Inventory (NIH-BFI), and depression was assessed by the Montgomery-Ǻsberg Depression Rating Scale (MADRS). RESULTS Compared to placebo, ketamine significantly improved fatigue (p = .0003) as measured by the NIH-BFI, but the anti-fatigue effects of ketamine disappeared (p = .47) when controlling for depression as measured by MADRS total score. In this study sample, the anti-fatigue effects of ketamine were mostly accounted for by the changes in amotivation and depressed mood scores. CONCLUSIONS In this study, ketamine did not have a unique effect on fatigue outside of its general antidepressant effects in patients with treatment-resistant depression. Specifically, the anti-fatigue effects of ketamine observed in this study seem to be explained by the effects of ketamine on two symptom domains of depression: amotivation and depressed mood. The study findings suggest that the anti-fatigue effects of ketamine should be assessed by fatigue-specific measures other than the NIH-BFI or future studies should enroll fatigued patients without depression.
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Affiliation(s)
- Leorey N. Saligan
- Division of Intramural Research, National Institute of Nursing Research, National Institutes of Health (NIH), Bethesda, Maryland USA
| | - Cristan Farmer
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland, USA
| | - Elizabeth D. Ballard
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland, USA
| | - Bashkim Kadriu
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland, USA
| | - Carlos A. Zarate
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, NIH, Bethesda, Maryland, USA
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Dickinson KA, Kelly DL, Lai JS, Saligan LN. Development of the PROMIS-based Research Assessment and Clinical Tool-Fatigue (ReACT-F). Support Care Cancer 2019; 27:3375-3383. [PMID: 30635711 PMCID: PMC6660506 DOI: 10.1007/s00520-018-4614-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/11/2018] [Indexed: 11/25/2022]
Abstract
Purpose Evidence has shown that cancer-related fatigue (CRF) may be a treatment-limiting symptom and often impairs health-related quality of life. Accurate assessment of the multidimensional nature of CRF could help drive interventions to mitigate this debilitating symptom. Currently, there are no clinical tools to effectively and efficiently assess the multidimensionality of CRF. The purpose of this paper is to introduce a CRF-specific short form that can assess the multidimensional nature of CRF for use in the clinical setting. Methods The CRF-specific short form was developed using the 95-item PROMIS® fatigue bank. Bi-factor analysis was used to evaluate dimensionality of the alternative model using fatigue for the general factor and physical, cognitive, affective, global, and motivational for the local factors. After unidimensionality was confirmed (loading factor > 0.3), one item from each local factor was selected using discrimination power for inclusion in the CRF-specific short form. Results The Research Assessment and Clinical Tool-Fatigue (ReACT-F) was created from the 95-item PROMIS fatigue bank using established item parameters. The ReACT-F assesses five common dimensions of CRF as well as perceived burden of the fatigue dimensions. Conclusions The ReACT-F is a CRF-specific self-report short form that addresses the need for a brief, clinically useful tool to quickly assess the multidimensional nature of CRF. We anticipate that the ReACT-F can be completed in the clinical setting in approximately 3 minutes, providing clinicians with meaningful data to drive personalized interventions. Further validation of the ReACT-F is highly encouraged.
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Affiliation(s)
- Kristin A Dickinson
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, USA. .,National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
| | | | - Jin-Shei Lai
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
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Feng LR, Fuss T, Dickinson K, Ross A, Saligan LN. Co-Occurring Symptoms Contribute to Persistent Fatigue in Prostate Cancer. Oncology 2019; 96:183-191. [PMID: 30625479 DOI: 10.1159/000494620] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/17/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Cancer-related fatigue is one of the most debilitating side effects of cancer and cancer therapy. We aimed to investigate co-occurring symptoms associated with persistent fatigue in men receiving external beam radiation therapy (EBRT) for nonmetastatic prostate cancer. METHODS A sample of 47 men with prostate cancer scheduled to receive radiotherapy (RT) were followed at baseline and 1 year after RT. Clinical and demographic data were obtained from chart review. Symptom measurements included urinary dysfunction (American Urological Association symptoms score), fatigue (Functional Assessment of Cancer Therapy - Fatigue questionnaire), sleep disturbance (Patient-Reported Outcomes Measurement Information System - Sleep Disturbance form), pain (physical well-being domain pain item of the Functional Assessment of Cancer Therapy - General), and depressive symptoms (Hamilton Depression Rating Scale). Paired t tests, correlations, general linear models, and logistic regressions were used to determine associations between fatigue and other symptom scores. RESULTS At 1 year after RT, 34% of subjects continued to experience fatigue. Urinary dysfunction was the best clinical predictor of persistent fatigue. Pain and depressive symptoms further improved the predictive power of the model. A multivariate linear regression model containing all these three clinical variables (urinary dysfunction, pain, and depressive symptoms) explained 74% of total variance associated with persistent fatigue after RT. CONCLUSIONS Persistent fatigue at 1 year after EBRT in prostate cancer survivors is likely related to a cluster of symptoms elicited by chronic inflammation. Therapies that target each of these symptoms will likely reduce fatigue in this patient population.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Timothy Fuss
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Kristin Dickinson
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexander Ross
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA,
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Lukkahatai N, Walitt B, Deandrés-Galiana EJ, Fernández-Martínez JL, Saligan LN. A predictive algorithm to identify genes that discriminate individuals with fibromyalgia syndrome diagnosis from healthy controls. J Pain Res 2018; 11:2981-2990. [PMID: 30538537 PMCID: PMC6255277 DOI: 10.2147/jpr.s169499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives Fibromyalgia syndrome (FMS) is a chronic and often debilitating condition that is characterized by persistent fatigue, pain, bowel abnormalities, and sleep disturbances. Currently, there are no definitive prognostic or diagnostic biomarkers for FMS. This study attempted to utilize a novel predictive algorithm to identify a group of genes whose differential expression discriminated individuals with FMS diagnosis from healthy controls. Methods Secondary analysis of gene expression data from 28 women with FMS and 19 age-and race-matched healthy women. Expression of discriminatory genes were identified using fold-change differential and Fisher’s ratio (FR). Discriminatory accuracy of the differential expression of these genes was determined using leave-one-out-cross-validation. Functional networks of the discriminating genes were described from the Ingenuity’s Knowledge Base. Results The small-scale signature contained 57 genes whose expressions were highly discriminatory of the FMS diagnosis. The combination of these high discriminatory genes with FR higher than 1.45 provided a leave-one-out-cross-validation accuracy for the FMS diagnosis of 85.11%. The discriminatory genes were associated with 3 canonical pathways: hepatic stellate cell activation, oxidative phosphorylation, and airway pathology related to COPD. Conclusion The discriminating genes, especially the 2 with the highest accuracy, are associated with mitochondrial function or oxidative phosphorylation and glutamate signaling. Further validation of the clinical utility of this finding is warranted.
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Affiliation(s)
- Nada Lukkahatai
- Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA,
| | - Brian Walitt
- Symptoms Biology Unit, National Institute of Nursing Research (NINR), Bethesda, MD, USA
| | - Enrique J Deandrés-Galiana
- Group of Inverse Problems, Optimization and Machine Learning, Applied Mathematics, University of Oviedo, Oviedo, Spain
| | - Juan Luis Fernández-Martínez
- Group of Inverse Problems, Optimization and Machine Learning, Applied Mathematics, University of Oviedo, Oviedo, Spain
| | - Leorey N Saligan
- Symptoms Biology Unit, National Institute of Nursing Research (NINR), Bethesda, MD, USA
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Abstract
PURPOSE To describe the collaborative framework used by National Institute of Nursing Research (NINR) investigators to advance symptom science and to provide a research exemplar. MODEL The National Institutes of Health (NIH) Symptom Science Model (SSM) was developed to guide symptom science researchers to understand the molecular underpinnings of symptoms using innovative "omics" approaches. The process begins with a review of the literature to understand the state of the science of the symptoms of interest and is followed by cross-sectional, case-controlled, or longitudinal studies to identify potential biological correlates of these symptoms. The final steps include validation of these potential symptom biomarkers using multidisciplinary, collaborative, preclinical experiments, and proof-of-concept clinical trials. RESEARCH EXEMPLAR Using the NIH SSM as a guide, the identification of biologic correlates of symptoms using omics and bioinformatic strategies depends on determining the distinct phenotype of the symptoms of interest. The identified biologic correlates of these symptoms are then validated for their functional relevance using in vitro and ex vivo experiments, or through proof-of-concept clinical trials. NINR investigators observed that activation of specific receptors in neural networks can trigger inflammation-related fatigue development and predispose patients to develop chronicity of symptoms. Specifically targeting these neural receptors can reduce symptom intensity. CONCLUSIONS Through using the NIH SSM as a guide, NINR investigators quickly generate data and discoveries that significantly advance symptom science by simultaneously collaborating with multiple experts and core laboratories to identify more correlates and validate their functional relevance in order to further understand the biological underpinnings of the symptoms of interest. CLINICAL RELEVANCE The collaborative framework used by NINR investigators as guided by the NIH SSM identifies functionally relevant clinical markers that can explain the biological underpinnings of symptoms and can be targeted to optimize symptom management.
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Affiliation(s)
- Leorey N Saligan
- Psi Beta, Nurse Scientist, National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, Bethesda, MD, USA
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Gonzalez-Mercado VJ, Saligan LN, Rodriguez CS, Ortiz D, Pedro E, McMillan SC. Validation of the Spanish version of the Cancer Symptom Scale in Hispanic cancer patients. Int J Nurs Pract 2018; 24:e12700. [PMID: 30284336 DOI: 10.1111/ijn.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/27/2022]
Abstract
AIM To assess the validity of the translated Spanish Cancer Symptom Scale. BACKGROUND Instruments to facilitate comprehensive and objective assessments of the cancer symptom experience in underrepresented populations are essential. METHODS The Cancer Symptom Scale was translated into Spanish, and a back translation was conducted. During June 2016, a sample of 121 Hispanic Puerto Rican patients with any cancer diagnosis, all undergoing cancer treatments, completed four paper surveys. A subgroup of 15 patients agreed to complete the Spanish Cancer Symptom Scale a second time after a short delay of 1 to 2 hours. Construct validity and reliability (internal consistency via Cronbach alpha and test-retest reliability) was evaluated. RESULTS All the Intensity Items of the Spanish Cancer Symptom Scale correlated significantly with the matched items on the MD Anderson Symptom Inventory. In a subgroup of 77 participants, each Cancer Symptom Scale subscale total of scores correlated significantly with the total scores from the Functional Assessment of Cancer Therapy-General. Discriminant validity was demonstrated between those receiving chemotherapy and those from post treatment. The Spanish Cancer Symptom Scale internal consistency reliability was 0.98. CONCLUSION The Spanish Cancer Symptom Scale has excellent evidence of validity and reliability for assessing cancer-therapy-related symptoms.
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Affiliation(s)
| | - Leorey N Saligan
- National Institute of Nursing Research Intramural Research Program, Bethesda, Maryland, USA
| | | | | | - Elsa Pedro
- School of Pharmacy, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - Susan C McMillan
- University of South Florida College of Nursing, Tampa, Florida, USA
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González-Mercado VJ, Saligan LN, Ji M, Groer M, Pedro E, McMillan S. Differences in the Severity, Distress, Interference, and Frequency on Cancer-Related Symptoms Between Island Hispanic Puerto Ricans and Mainland Non-Hispanic Whites. J Immigr Minor Health 2018; 20:1029-1039. [PMID: 28921411 PMCID: PMC5860921 DOI: 10.1007/s10903-017-0651-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The knowledge base of cancer-related symptoms is increasing; yet, limited attention has been given to provide evidence on differences in the perception of cancer symptoms between ethnic groups, especially in the Hispanic Puerto Rican (PR) population. To examine whether there are significant differences in the severity, distress, interference, and frequency of cancer symptoms between island Hispanic PR and mainland non-Hispanic whites. In this secondary data analysis, data from 109 Hispanic PR was matched by age, gender and cancer diagnosis with data from non-Hispanic whites. Cancer symptoms were assessed using the Cancer Symptom Scale (CSS). Mann-Whitney statistical test was used to evaluate pairwise differences between Hispanic PR and non-Hispanic whites on symptoms from the CSS. There were significant differences on some symptoms including PR reporting: (a) more intense itching, swelling, taste change, difficulty sleeping, bloating, depression, sadness, worry, and nervousness; (b) significantly greater distress about taste change, appetite, anxiety, depression, worry, and feeling nervous; (c) rash, anxiety, depression, sadness, and nervousness interfered the most with their daily lives; and, (d) that the frequency of occurrence of the symptoms of pain, itching, dizziness, taste change, anxiety, sadness, and nervousness was higher compared to non-Hispanic whites. PR cancer patients are at increased risk for experiencing greater severity of cancer symptoms compared to non-Hispanic whites. But because the Hispanic oncology population does not always report symptoms, risking under-assessment and under-management, this suggests there may be a greater need for symptoms surveillance for this population.
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Affiliation(s)
- Velda J González-Mercado
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612-4766, USA.
| | - Leorey N Saligan
- National Institute of Nursing Research Intramural Research Program, Bethesda, MD, USA
| | - Ming Ji
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612-4766, USA
| | - Maureen Groer
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612-4766, USA
| | - Elsa Pedro
- School of Pharmacy, University of Puerto Rico, Medical Science Campus, San Juan, PR, USA
| | - Susan McMillan
- University of South Florida College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612-4766, USA
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Gonzalez-Mercado VJ, Fridley BL, Saligan LN. Sestrin family of genes and their role in cancer-related fatigue. Support Care Cancer 2018; 26:2071-2074. [PMID: 29532246 PMCID: PMC5984137 DOI: 10.1007/s00520-018-4139-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Velda J Gonzalez-Mercado
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612-4766, USA.
| | - Brooke L Fridley
- Department of Biostatistics & Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Leorey N Saligan
- Symptoms Biology Unit, National Institute of Nursing Research at the National Institute of Health, Bethesda, MD, USA
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Feng LR, Fernández-Martínez JL, Zaal KJ, deAndrés-Galiana EJ, Wolff BS, Saligan LN. mGluR5 mediates post-radiotherapy fatigue development in cancer patients. Transl Psychiatry 2018; 8:110. [PMID: 29849049 PMCID: PMC5976668 DOI: 10.1038/s41398-018-0161-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/26/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023] Open
Abstract
Cancer-related fatigue (CRF) is a common burden in cancer patients and little is known about its underlying mechanism. The primary aim of this study was to identify gene signatures predictive of post-radiotherapy fatigue in prostate cancer patients. We employed Fisher Linear Discriminant Analysis (LDA) to identify predictive genes using whole genome microarray data from 36 men with prostate cancer. Ingenuity Pathway Analysis was used to determine functional networks of the predictive genes. Functional validation was performed using a T lymphocyte cell line, Jurkat E6.1. Cells were pretreated with metabotropic glutamate receptor 5 (mGluR5) agonist (DHPG), antagonist (MPEP), or control (PBS) for 20 min before irradiation at 8 Gy in a Mark-1 γ-irradiator. NF-κB activation was assessed using a NF-κB/Jurkat/GFP Transcriptional Reporter Cell Line. LDA achieved 83.3% accuracy in predicting post-radiotherapy fatigue. "Glutamate receptor signaling" was the most significant (p = 0.0002) pathway among the predictive genes. Functional validation using Jurkat cells revealed clustering of mGluR5 receptors as well as increased regulated on activation, normal T cell expressed and secreted (RANTES) production post irradiation in cells pretreated with DHPG, whereas inhibition of mGluR5 activity with MPEP decreased RANTES concentration after irradiation. DHPG pretreatment amplified irradiation-induced NF-κB activation suggesting a role of mGluR5 in modulating T cell activation after irradiation. These results suggest that mGluR5 signaling in T cells may play a key role in the development of chronic inflammation resulting in fatigue and contribute to individual differences in immune responses to radiation. Moreover, modulating mGluR5 provides a novel therapeutic option to treat CRF.
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Affiliation(s)
- Li Rebekah Feng
- 0000 0001 2297 5165grid.94365.3dNational Institute of Nursing Research, National Institutes of Health, Bethesda, MD USA
| | | | - Kristien J.M. Zaal
- 0000 0001 2297 5165grid.94365.3dLight Imaging Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | | | - Brian S. Wolff
- 0000 0001 2297 5165grid.94365.3dNational Institute of Nursing Research/National Cancer Institute, National Institutes of Health, Bethesda, MD USA
| | - Leorey N. Saligan
- 0000 0001 2297 5165grid.94365.3dNational Institute of Nursing Research, National Institutes of Health, Bethesda, MD USA
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Abstract
Fatigue is a common and debilitating condition that affects most cancer patients. To date, fatigue remains poorly characterized with no diagnostic test to objectively measure the severity of this condition. Here we describe an optimized method for assessing mitochondrial function of PBMCs collected from fatigued cancer patients. Using a compact extracellular flux system and sequential injection of respiratory inhibitors, we examined PBMC mitochondrial functional status by measuring basal mitochondrial respiration, spare respiratory capacity, and energy phenotype, which describes the preferred energy pathway to respond to stress. Fresh PBMCs are readily available in the clinical setting using standard phlebotomy. The entire assay described in this protocol can be completed in less than 4 hours without the involvement of complex biochemical techniques. Additionally, we describe a normalization method that is necessary for obtaining reproducible data. The simple procedure and normalization methods presented allow for repeated sample collection from the same patient and generation of reproducible data that can be compared between time points to evaluate potential treatment effects.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health
| | - Quang Nguyen
- National Institute of Nursing Research, National Institutes of Health
| | - Alexander Ross
- National Institute of Nursing Research, National Institutes of Health
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health;
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Feng LR, Suy S, Collins SP, Lischalk JW, Yuan B, Saligan LN. Comparison of Late Urinary Symptoms Following SBRT and SBRT with IMRT Supplementation for Prostate Cancer. Curr Urol 2018; 11:218-224. [PMID: 29997466 DOI: 10.1159/000447222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 07/26/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background Prostate cancer survivors commonly experience late-onset lower urinary tract symptoms following radiotherapy. We aimed to compare lower urinary tract symptoms in patients treated with stereotactic body radiotherapy (SBRT) to those treated with a combination of lower dose SBRT and supplemental intensity-modulated radiotherapy (SBRT + IMRT). Methods Subjects with localized prostate carcinoma scheduled to receive SBRT or a combination of SBRT and IMRT were enrolled and followed for up to 2 years after treatment completion. Participants treated with SBRT received 35-36.25 Gy in 5 fractions, while those treated with SBRT + IMRT received 19.5 Gy of SBRT in 3 fractions followed by 45-50.4 Gy of IMRT in 25-28 fractions. Urinary symptoms were measured using the American Urological Association (AUA) Symptom Score. Results Two hundred patients received SBRT (52% intermediate risk, 37.5% low risk according to D'Amico classification) and 145 patients received SBRT + IMRT (61.4% high risk, 35.2% intermediate risk). Both groups experienced a transient spike in urinary symptoms 1 month after treatment. More severe late urinary flare (increase in AUA scores ≥ 5 points from baseline to 1 year after treatment completion and an AUA score ≥ 15 at 1 year after treatment) was experienced by patients who received SBRT compared to those treated with SBRT + IMRT. Conclusion Participants who received SBRT and supplemental IMRT experienced less severe late urinary flare 1 year after treatment compared to those who received higher dose SBRT alone. This information can be used by clinicians to provide patients with anticipatory counseling to mitigate any psychological burden that comes with unanticipated late urinary toxicities.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Jonathan W Lischalk
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Berwin Yuan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
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Abstract
PURPOSE Cancer-related fatigue is a common complaint during cancer treatment and is often associated with cognitive impairment. This study examined cognitive deficits that were associated with fatigue symptoms during external-beam radiation therapy (EBRT) in men with localized prostate cancer. METHODS A total of 36 participants were enrolled and followed up at baseline, 24 h, 7 days, 14 days after EBRT initiation, at midpoint, and at completion of EBRT. Fatigue was measured by self-report using the Functional Assessment of Cancer Therapy - Fatigue (FACT-F), and cognitive impairment by the Computer Assessment of Mild Cognitive Impairment (CAMCI®). RESULTS Subjects with increased fatigue during EBRT reported a significant decline in cognitive function and had difficulties with CAMCI®'s route finding and item recall tasks during EBRT. Increased fatigue during EBRT was associated with perceived cognitive difficulties in executive function and recognition memory, but not with attention or verbal memory. CONCLUSIONS Our results suggest that there might be specific cognitive domains that are associated with increased fatigue during EBRT. These findings will provide important information for targeting specific cognitive domains using pharmacotherapy or behavioral interventions. CAMCI® is a valuable tool for psycho social providers to detect subtle cognitive impairment in fatigued cancer patients in a clinical setting.
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Gonzalez VJ, McMillan S, Pedro E, Tirado-Gomez M, Saligan LN. The Health related Quality of Life of Puerto Ricans during Cancer Treatments; A Pilot Study. P R Health Sci J 2018; 37:46-51. [PMID: 29547684 PMCID: PMC5863575] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine the health related quality of life (HRQOL) experienced by 79 Puerto Rican adults during cancer treatments. METHODS This study used a descriptive, cross-sectional design. Participants completed a demographics form and the Functional Assessment of Cancer Therapy-General QOL questionnaire (FACT-G). Descriptive statistics were generated. RESULTS Participants were ages 28-78; most of the participants had breast (38.0%), prostate (14.0%) and cervical and ovarian cancers (10.1%) treated with chemotherapy (45.6%). The participants had a mean total score on the FACT-G of 75.2 (SD = 18.9). As a group, the functional well-being was the most affected (mean 17.2, SD 6.8), and the Social/Familial was the least affected (mean 20.7, SD 6.0). CONCLUSION Cancer is the leading cause of death in the island of Puerto Rico. Female Puerto Rican cancer patients in this study sample had increased risk for experiencing worse: overall HRQOL, physical well-being and emotional well-being compared to males. Given that the Hispanic oncology population does not always report symptoms, risking under-assessment and under management, this suggests there may be a greater need for HRQOL surveillance for this population.
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Affiliation(s)
- Velda J Gonzalez
- Postdoctoral Fellow, College of Nursing, University of South Florida, Tampa, FL
| | - Susan McMillan
- Distinguished Professor and Thompson Professor of Oncology Nursing and Quality of Life at the University of South Florida College of Nursing, FL
| | - Elsa Pedro
- Assistant Professor, School of Pharmacy, University of Puerto Rico Medical Science Campus, San Juan, PR
| | - Maribel Tirado-Gomez
- Assistant Professor, Department of Hematology Oncology, University of Puerto Rico Medical Science Campus, San Juan, PR
| | - Leorey N Saligan
- Tenure-Track Investigator, Chief, Symptoms Biology Unit, NINR/NIH
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Gonzalez VJ, Abbas-Aghababazadeh F, Fridley BL, Ghansah T, Saligan LN. Expression of Sestrin Genes in Radiotherapy for Prostate Cancer and Its Association With Fatigue: A Proof-of-Concept Study. Biol Res Nurs 2018; 20:218-226. [PMID: 29325451 DOI: 10.1177/1099800417749319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Genetic factors that influence inflammation and energy production/expenditure in cells may affect patient outcomes following treatment with external beam radiation therapy (EBRT). Sestrins, stress-inducible genes with antioxidant properties, have recently been implicated in several behaviors including fatigue. This proof-of-concept study explored whether the sestrin family of genes ( SESN1, SESN2, and SESN3) were differentially expressed from baseline to the midpoint of EBRT in a sample of 26 Puerto Rican men with nonmetastatic prostate cancer. We also examined whether changes in expression of these genes were associated with changes in fatigue scores during EBRT. METHOD Participants completed the 13-item Functional Assessment of Cancer Therapy-Fatigue subscale, Spanish version. Whole blood samples were collected at baseline and at the midpoint of EBRT. Gene expression data were analyzed using the limma package in the R (version R 2.14.0.) statistical software. Linear models and empirical Bayes moderation, adjusted for radiation fraction (total number of days of prescribed radiation treatment), were used to examine potential associations between changes in gene expression and change in fatigue scores. RESULTS Expression of SESN3 (adjusted p < .01, log fold change -0.649) was significantly downregulated during EBRT, whereas the expressions of SESN1 and SESN2 remained unchanged. After adjustment for radiation fraction, change in SESN3 expression was associated with change in fatigue during EBRT (false discovery rate <.01). CONCLUSIONS Downregulation of SESN3, a novel pharmacoactive stress response gene, was associated with fatigue intensification during EBRT. SESN3 may serve as an interventional target and a biomarker for the cellular and molecular events associated with EBRT-related fatigue.
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Affiliation(s)
- Velda J Gonzalez
- 1 College of Nursing, University of South Florida, Tampa, FL, USA.,2 UPR/MDACC Partnership for Excellence in Cancer Research, San Juan, Puerto Rico
| | | | - Brooke L Fridley
- 3 Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Tomar Ghansah
- 4 Department of Molecular Medicine, University of South Florida, Tampa, FL, USA
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Saligan LN, Lukkahatai N, Zhang ZJ, Cheung CW, Wang XM. Altered Cd8+ T lymphocyte Response Triggered by Arginase 1: Implication for Fatigue Intensification during Localized Radiation Therapy in Prostate Cancer Patients. ACTA ACUST UNITED AC 2018; 8:1249-1262. [PMID: 30364895 DOI: 10.4172/neuropsychiatry.1000454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Fatigue, the most common side effect of cancer treatments, is observed to intensify during external-beam radiation therapy (EBRT). The underlying molecular mechanisms remain unclear. This study investigated the differentially expressed genes/proteins and their association with fatigue intensification during EBRT. Fatigue scores measured by FACT-F and peripheral blood were collected prior to treatment (baseline D0), at midpoint (days 19-21, D21) and endpoint (days 38-42, D42) from men (n=30) with non-metastatic prostate cancer undergoing EBRT. RNA extracted from peripheral blood was used for gene expression analysis. Plasma arginase I and arginine were examined using ELISA and liquid chromatography-tandem mass spectrometry. Differences in fatigue scores, gene and protein expression between times points following EBRT were analyzed by one way ANOVA followed by Post Hoc t-test. Fatigue scores decreased significantly from baseline (44.6 ± 8.1) to midpoint (37.3 ± 10.6, p=0.000, low scores indicating high fatigue) and to endpoint (37.4 ± 10.1, p=0.001) during EBRT. ARG1 (encoding arginase type 1) was significantly up regulated from baseline to midpoint of EBRT (fold change =2.41, p<0.05) whereas genes associated with the adaptive immune functional pathway (CD28, CD27, CCR7, CD3D, CD8A and HLA-DOB) were significantly downregulated >2-fold between the study time points. The changes in gene expression were associated with patient reported fatigue intensity. Moreover, the upregulation of ARG1 was negatively correlated with the absolute lymphocyte count (R2=0.561, p=0.01) only in the high level of fatigue group (n=17) during EBRT. Increased ARG1 expression is known to result in arginine deficiency, which leads to immunosuppression by impairing lymphocyte proliferation and activation. EBRT-induced ARG1 upregulation may play an essential role in fatigue intensification via the arginine deficiency and suppression of T-cell proliferation pathways. These findings may provide novel insights into the molecular-genetic mechanisms underlying the development and intensification of cancer treatment-related fatigue.
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Affiliation(s)
- Leorey N Saligan
- Nursing Research, Division of Intramural Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Nada Lukkahatai
- School of Nursing, Johns Hopkins University, 525 North Wolfe Street, Baltimore, MD 21205 USA
| | - Zhang-Jin Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Chi Wai Cheung
- Laboratory and Clinical research Institute for Pain, the University of Hong Kong, Hong Kong.,Department of Anesthesiology, the University of Hong Kong, Hong Kong
| | - Xiao-Min Wang
- Laboratory and Clinical research Institute for Pain, the University of Hong Kong, Hong Kong.,Department of Anesthesiology, the University of Hong Kong, Hong Kong
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Gonzalez VJ, Saligan LN, Fridley BL, Ortiz-Zuazaga H, Aaronson LS. Gene Expression, and Fatigue in Puerto Rican Men during Radiotherapy for Prostate Cancer: an Exploratory Study. P R Health Sci J 2017; 36:223-231. [PMID: 29220067 PMCID: PMC5804490] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine the trajectory of fatigue experienced by 26 Puerto Rican (PR) men over the course of External Beam Radiation Therapy (EBRT) and to assess gene expression changes from baseline to midpoint of EBRT using microarray technology. Design/Research Approach- Prospective exploratory and comparative design study. Setting- RT facility located in San Juan, PR. Sample/Participants-26 PR men with non-metastatic prostate cancer. METHODS Participants completed 2 paper forms: demographics and the Spanish version of the 13-item FACT-fatigue at baseline, midpoint, and end of EBRT. Wholeblood samples were collected at baseline and at midpoint of EBRT. Descriptive data was analyzed using t-test, Wilcoxon, and Friedman test for repeated measures. Gene expression data was analyzed using the LIMMA package in R; the functional network analysis was conducted using Ingenuity Pathway analysis. Main Research Variable-Fatigue scores, gene expression. RESULTS Subjects were of ages 52-81 with fatigue scores that remained unchanged during EBRT (baseline=42.38, SD=9.34; midpoint=42.11, SD=8.93, endpoint=43.04, SD=8.62). Three hundred seventy-three genes (130-up regulated and 243-down regulated) were differentially expressed from baseline to mid-point of EBRT (FDR<0.01). The top distinct canonical pathways of the differentially expressed probesets (p<0.0001) were: "Phospholipase C Signaling," "Role of NFAT in Regulation of the Immune Response," and "Gαq Signaling." CONCLUSION While fatigue did not worsen over the course of EBRT for this sample as a group, there was variability in fatigue across the sample. It is possible that the over expression of the SESN3 gene, known to suppress oxidative damage, may have contributed to the attenuation of fatigue in this clinical population.
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Affiliation(s)
- Velda J Gonzalez
- College of Nursing, University of South Florida, Tampa, FL, United States, UPR/ MDACC Partnership for Excellence in Cancer Research U54 CA096297
| | - Leorey N Saligan
- Tenure-Track Investigator, Chief, Symptoms Biology Unit, NINR/NIH
| | - Brooke L Fridley
- Chair, Dept. Biostatistics & Bioinformatics, Moffitt Cancer Center
| | - Humberto Ortiz-Zuazaga
- Associate Professor at University of Puerto Rico, UPR/MDACC Partnership for Excellence in Cancer Research U54 CA096297
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