Purpose Five-year disease endpoint trajectories are available for every cancer site. In contrast, there are few longitudinal, biobehavioral studies of survivors extending beyond the first or second year following diagnosis. This gap is addressed with stress, depressive symptom, and immunity data from breast cancer patients followed continuously for 5 years. Methods Women (N=113) diagnosed and surgically treated for breast cancer and awaiting adjuvant therapy completed self-report measures of stress and depressive symptoms and provided blood for immune assays [natural killer cell cytotoxicity (NKCC) and T cell blastogenesis]. Assessments (12) were repeated every 4 to 6 months for 5 years. Results Multiphase linear mixed models show phases of change and identified specific time points of change. Cancer stress shows two distinct phases of decline, with the change point being 12 months. In contrast, a steep decline in depressive symptoms occurs by 7 months, with stable, low levels thereafter. NKCC shows a steady upward trajectory through 18 months and upper limit stability thereafter, whereas there was no reliable trajectory for T cell blastogenesis. Conclusions For the first time, trajectories and specific time points of change in biobehavioral data for breast cancer survivors are provided, traced through 5 years. Following diagnosis, the breast survivor experience is one of a co-occurrence of change (recovery) in psychological and innate immunity markers from diagnosis to 18 months, and a pattern of stability (depression, NKCC) or continued improvement (stress) through year 5. These data provide new directions for survivorship care and detail of the biobehavioral trajectory.

Objective Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia and is incurable. The course and treatment of CLL is unique and characterized by repeated cycles of treatment, stable disease, and relapse. Utilizing a Self-Regulatory Model framework (Leventhal et al., 1980), we examined the relationship between patients’ illness perceptions and cancer-specific stress, depression, and fatigue. Our aim was to test illness perceptions as predictors of these outcomes when variance due to disease and treatment variables was controlled. Design Data were collected on 147 patients with relapsed/refractory CLL as they entered a phase-II clinical trial of an investigational medication at a university affiliated, National Cancer Institute designated comprehensive cancer center. Main outcome measures Cancer-specific stress, depressive symptoms, and fatigue interference. Results Hierarchical multiple regression was used. Consequences and emotional representation were related to all outcomes (ps <.01). Illness concern was related to cancer-specific stress (p <.01), and identity was related to fatigue interference (p <.01). All relationships were observed while controlling for number of previous CLL therapies received. Conclusion Illness perceptions are related to cancer-specific stress, depressive symptoms, and fatigue interference in relapsed/refractory CLL. Interventions targeted at restructuring maladaptive illness perceptions may have clinical benefit in this population.

Background Individuals with functional gastrointestinal disorders (FGIDs) report experiencing trauma more often than healthy controls, but little is known regarding psychophysical correlates. Purpose Test the hypothesis that adolescents and young adults with FGIDs since childhood and a trauma history (n = 38) would exhibit heightened temporal summation to thermal pain stimuli, an index of central sensitization, and greater clinical symptoms compared to patients with FGIDs and no trauma history (n = 95) and healthy controls (n =135). Methods Participants completed self-report measures, an experimental pain protocol, and psychiatric diagnostic interview as part of a larger longitudinal study. Results FGID+Trauma patients exhibited greater temporal summation than FGID+No Trauma patients and healthy controls. Additionally, FGID+Trauma patients exhibited greater gastrointestinal and non-gastrointestinal symptom severity, number of chronic pain sites, and disability. Conclusions Assessing for trauma history in patients with FGIDs could identify a subset at risk for greater central sensitization and pain-related symptoms.

Novel biobehavioral data from patients with relapsed/refractory CLL demonstrate that stress is related to heightened levels of cellular, cytokine, and chemokine markers associated previously with progressive disease in CLL. The current results indicate that stress is related to immune and inflammatory processes that contribute to cancer cell proliferation and survival. These data provide a first look into these processes. Cancer 2018. © 2018 American Cancer Society.

Findings suggest cancer-specific stress at treatment initiation may be a risk factor for poorer psychological functioning during treatment for patients with relapsed/refractory chronic lymphocytic leukemia.