Expression of Inflammatory Molecules Among Breast Cancer Patients Receiving Different Chemotherapies:Implications for Chemobrain

Increased levels of MCP-1, IL-8 and IL-6 are associated with mild cognitive impairment, defined as frequent and irregular bouts of forgetfulness, difficulties with attention and/or difficulties with language-a condition with comparable symptomology reported by cancer patients experiencing chemobrain. High levels of these molecules may compromise neuronal and synaptic integrity, leading to cognitive impairment. Patients receiving doxorubicin-based (with cyclophosphamide, or cyclophosphamide and fluorouracil; AC/CAF) chemotherapy or a combination of cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy report experiencing chemobrain, but MCP-1, IL-8 and IL-6 may be differentially influenced by these regimens. The purpose of this study was to examine changes in expression of these molecules among breast cancer patients (N = 54) receiving combinations of AC/CAF or CMF. Changes in MCP-1, IL-8 and IL-6 were assessed at baseline (T1) and after 2 chemotherapy cycles (T2). T-tests were used to compare between group and within group differences on raw means and mean change (T2-T1). IL-6 significantly increased in the AC/CAF group (4.95 pg/mL,SEM = 2.31;P < 0.05), but MCP-1 (42.8 pg/mL;SEM = 40.36) and IL-8 (0.25 pg/mL;SEM = 1.19) did not. IL-6 (−1.46 pg/mL,SEM = 0.94), MCP-1 (−15.8 pg/mL,SEM = 49.95) and IL-8 (−0.79 pg/mL,SEM = 1.04) all decreased in the CMF group; however, none of these changes were significant. No significant differences in IL-6 (1.06 pg/mL, SEM = 1.05), MCP-1(73.48 pg/mL, SEM = 67.30), or IL-8 (−1.95 pg/mL, SEM = 3.28) at T1 were observed between AC/CAF and CMF groups. At T2, there was a significant difference in IL-6 (7.72 pg/mL,SEM = 3.82; P ≤ 0.05) between AC/CAF and CMF groups, but not in MCP-1 (131.91 pg/mL,SEM = 87.09) or IL-8 (5.72 pg/mL,SEM = 4.0). A significant change (T2-T1) in IL-6 (6.41 pg/mL,SEM = 2.57;P < 0.05) between AC/CAF and CMF groups was observed. Changes in MCP-1 (58.65 pg/mL,SEM = 63.94) and IL-8 (1.08 pg/mL,SEM = 1.58) between groups were not significant. These results suggest AC/CAF and CMF chemotherapy regimens elicit distinct inflammatory response patterns in MCP-1, IL-8 and IL-6 suggesting different mechanisms may be responsible for the development of chemobrain. Future research is needed to confirm these findings. Funding:NCI R25CA10618.

Cancer-related self-efficacy in African American prostate cancer patients compared to whites

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Background: African American (AA) men are nearly twice as likely as white (W) men to be diagnosed with prostate cancer. Cancer-related self-efficacy (i.e., confidence in one's ability to manage cancer) has been associated with better physical and psychosocial functioning, but little is known about self-efficacy in African American prostate cancer patients. This study compared AA and W ratings of cancer-related self-efficacy for 308 prostate cancer patients (M age = 66.13, SD = 8.48; 9% AA) who participated in a group therapy intervention. Method: Independent groups t-tests were used to determine whether there were significant differences at baseline in mean scores for each group on the Stanford Self-Efficacy Scale (SSE), which asks respondents to rate their confidence in the ability to cope with cancer on a 0–100 scale, with 0 indicating no confidence. SSE subscales measure self-efficacy in the ability to: a) communicate with family, friends, and healtcare providers; b) focus and relax; and c) cope with the possibility of dying. Results: A significant difference was observed on SSE total scores (AA mean = 60.39 vs. W mean = 72.70; t = 3.30; p = 0.003). There were also significant differences on the Focus/Relax (AA mean = 68.90 vs. W mean = 77.64; t = 2.04; p = 0.011) and Cope with Dying (AA mean = 49.72 vs. W mean = 70.12; t = 4.85; p = 0.001) subscales, with a trend towards significance on the Ability to Communicate (AA mean = 62.55 vs. W mean = 70.76; t = 3.36; p = 0.095). Conclusions: Results suggest that, compared to W men, AA men have less confidence in their ability to cope with prostate cancer following diagnosis. AA men report the least confidence in their ability to cope with the possibility of death as a result of cancer, and they also report less confidence in their ability to focus and relax. They may also have greater difficulty discussing their cancer with family, friends, and healthcare personnel. As cancer-related self-efficacy has been linked to symptom-related and psychological adjustment, interventions targeting self-efficacy in AA prostate cancer patients are needed that are tailored to their unique needs.

No significant financial relationships to disclose.

A phase III randomized prospective trial of the effect of psychotherapy on distress in 287 prostate cancer patients: A URCC CCOP Study

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Background: Cancer patients suffer from significant psychological distress, including mood and anxiety disorders. Psychiatric disorders are common in cancer and affect 22 to 43% of cancer patients. We previously showed that Supportive Expressive Group Therapy (SET) was effective in reducing distress in women with metastatic breast cancer. The current study expands our earlier research and examines the effect of SET on mood disturbance in prostate cancer patients. Methods: A sample of 318 cancer patients diagnosed with prostate cancer was assessed for mood disturbances by 9 geographically distinct URCC CCOP affiliates. The patients were randomly assigned to receive either 12 weeks of SET or education materials as a control. Patient-reported mood disturbance was assessed using the Profile of Mood States (POMS), a psychometrically valid and reliable measure of mood states, at baseline, 3, 6, 12, 18 and 24 months. Differences between treatment and control groups at follow-up were tested using a mixed-ANOVA model. The dependent variable was individual slopes on the POMS. Results: 287 patients (142 SET and 145 controls) provided complete data. No significant overall effect of intervention on mood was found (p=0.49) and the interaction between baseline mood scores and treatment arm was non-significant (p=0.075). There was a significant main effect for baseline mood (p<0.0001) suggesting that those who have the greatest mood disruption at baseline improve with time independently of treatment arm. Conclusions: This is the first large randomized clinical trial using group psychotherapy among men with prostate cancer. Results suggest that a brief SET intervention does not improve distress among men with prostate cancer. Future studies might consider recruiting patients with particular psychosymptomatology and tailoring interventions. Supported by U10 CA37420 and NCI 1R25CA102618.

No significant financial relationships to disclose.

Cytokine-mediated changes associated with improvements in cancer-related fatigue induced by exercise: Results from a randomized pilot study of cancer patients receiving radiotherapy

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Background: Radiation therapy (RTH) results in dysregulated inflammatory profiles which increase cancer-related fatigue (CRF). Research suggests physical exercise can have a positive influence on CRF during RTH. Exercise may mediate improvements in CRF through a self-regulating inflammatory exercise response involving cytokines and myokines (muscle contraction-induced cytokines known as exercise factors that mediate exercise benefits in other tissues) which help the body adapt to inflammation. We explored the influence of a home-based exercise intervention (HBEX), including resistance and aerobic training, on mediators of inflammation, as well as the association between changes in these mediators and CRF. Methods: Breast and prostate cancer patients (N=38; mean age=57; 71% breast/female), beginning at least 28 sessions of RTH, were randomized to a 4wk HBEX (7 days/wk) or standard care (SC; RTH with no exercise). Cytokines (IL-8, TNFα, TNFαr1, IL-8, IL-1β and IFNγ) and the myokine IL-6 were measured by enzyme-linked immunoassays and CRF was assessed via valid self-report questionnaires pre- and post-intervention. Results: ANCOVAs, controlling for baseline, revealed significant differences between groups in mean levels of IFNγ and IL-6 (p=<0.05) and a trend toward differences in IL-8 and TNFαr1 (p<0.10) with significant baseline interactions for IFNγ, IL-6 and IL-8 (p<0.05) post-intervention. ANCOVAs revealed no significant differences between groups in mean levels of TNFα and IL-1β. Pearson correlations revealed a significant inverse association between changes in IL-8 (p<0.05;r=-0.64) and CRF and a trend toward an inverse association between changes in IL-6 (p=0.10;r=-0.44) and CRF in the HBEX condition but not in the SC condition. Conclusions: These data suggest that exercise-induced changes in IL-8 and IL-6 may mediate improvements in CRF. Future phase III randomized controlled trials are needed with larger samples to fully investigate these relationships. Funded by NCI grant 1R25CA102618.

No significant financial relationships to disclose.

Higher cigarette prices influence cigarette purchase patterns

OBJECTIVE

To examine cigarette purchasing patterns of current smokers and to determine the effects of cigarette price on use of cheaper sources, discount/generic cigarettes, and coupons.

BACKGROUND

Higher cigarette prices result in decreased cigarette consumption, but price sensitive smokers may seek lower priced or tax-free cigarette sources, especially if they are readily available. This price avoidance behaviour costs states excise tax money and dampens the health impact of higher cigarette prices.

METHODS

Telephone survey data from 3602 US smokers who were originally in the COMMIT (community intervention trial for smoking cessation) study were analysed to assess cigarette purchase patterns, use of discount/generic cigarettes, and use of coupons.

RESULTS

59% reported engaging in a high price avoidance strategy, including 34% who regularly purchase from a low or untaxed venue, 28% who smoke a discount/generic cigarette brand, and 18% who report using cigarette coupons more frequently that they did five years ago. The report of engaging in a price avoidance strategy was associated with living within 40 miles of a state or Indian reservation with lower cigarette excise taxes, higher average cigarette consumption, white, non-Hispanic race/ethnicity, and female sex.

CONCLUSION

Data from this study indicate that most smokers are price sensitive and seek out measures to purchase less expensive cigarettes, which may decrease future cessation efforts.