e23100 Background: Sleep disturbances are highly prevalent in cancer patients and may be attributable to factors including pain, treatment side effects and psychological factors. However, the relationship between sleep and cancer is bidirectional. There is substantial evidence that sleep disturbance is associated with many aspects of cancer treatment, morbidity, mortality and quality of life. This study evaluated sleep quality in adult Filipinos with cancer and determined the association of demographic characteristics and clinical features to sleep quality. Methods: This was a cross-sectional surveillance study conducted among adult Filipinos with cancer seen at the Ambulatory Care Unit of a tertiary hospital. Questionnaires were answered to assess subjective sleep quality, pain score and quality of life. Frequency and percentages were determined. Determination of factors affecting sleep quality was analyzed using univariate and multivariate statistics. Results: Of the 406 cancer patients studied, 80% were women and the mean age was 53 years old. Majority (62%) had breast cancer. Seventy-nine percent (79%) of the patients had a PSQI score of 5 or greater, indicating poor sleep quality. Sleep among participants was characterized by prolonged time to fall asleep and shortened sleep duration. Majority reported some degree of daytime dysfunction due to poor sleep. Age, gender and marital status did not appear to affect the quality of sleep. Among disease-related factors, presence of more advanced disease, increasing pain severity and treatment with chemotherapy and/or radiotherapy were demonstrated to lead to poorer sleep quality. Surprisingly, even patients who were not receiving any active therapies (on-going surveillance) complained of sleep disturbance. Upon further investigation, poor sleep quality was shown to predict a worse quality of life among the study participants. Conclusions: Overall, the quality of sleep among adult Filipinos with cancer is significantly impaired. In particular, presence of more advanced disease, treatment with chemotherapy and radiotherapy and moderate to severe pain significantly increase the risk of having poor sleep. In turn, disturbed sleep predicted a poorer quality of life. These findings support the need to include assessment of sleep quality for a more holistic approach to cancer care.
cells from PBMC of healthy volunteers were activated with CD3/CD28, recombinant IL2 and treated with TDEs for different timespans. Exosome uptake by T cells was studied by confocal microscopy. Cell proliferation and differentiation was studied by flow cytometry analysis. qPCR analysis was performed to study the genes related to CD8þ naïve T cell differentiation and proliferation. Cytokine profile and T-bet expression were analysed by qPCR and flow cytometry analysis. Results: Activated CTLs uptake TDEs in a time-dependent manner. TDEs reduced cellular proliferation of activated CTLs and blocked effector differentiation. Cytotoxic properties of CTLs were attenuated post uptake of TDE. The later was found to alter Tbet expression in the CD8þ T cells. Conclusions: TDEs modulate CD8þT cell proliferation and differentiation in the tumor micro-environment. They also reduce the cytotoxic properties of CD8þT lymphocytes. TDE-mediated dysfunction of CTLs in the tumor microenvironment leads to proliferation of breast cancer cells.
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