Childhood adversity increases vulnerability for behavioral symptoms and immune dysregulation in women with breast cancer

Abstract

Women respond differentially to the stress-associated with breast cancer diagnosis and treatment, with some women experiencing more intense and/or sustained behavioral symptoms and immune dysregulation than others. Childhood adversity has been identified to produce long-term dysregulation of stress response systems, increasing reactivity to stressors encountered during adulthood. This study determined whether childhood adversity increased vulnerability for more intense and sustained behavioral symptoms (fatigue, perceived stress, and depressive symptoms), poorer quality of life, and greater immune dysregulation in women (N=40) with breast cancer. Evaluation was after breast surgery and through early survivorship. Hierarchical linear modeling was used to examine intra-individual and inter-individual differences with respect to initial status and to the pattern of change (i.e. trajectory) of outcomes. At initial assessment, women exposed to childhood emotional neglect/abuse had greater perceived stress, fatigue, depressive symptoms and poorer quality of life, as well as lower natural killer cell activity (NKCA). Although these outcomes improved over time, women with greater childhood emotional neglect/abuse exhibited worse outcomes through early survivorship. No effect was observed on the trajectory for these outcomes. In contrast, childhood physical neglect predicted sustained trajectories of greater perceived stress, worse quality of life, and elevated plasma IL-6; with no effect observed at initial assessment. Thus, childhood adversity leaves an enduring imprint, increasing vulnerability for behavioral symptoms, poor quality of life, and elevations in IL-6 in women with breast cancer. Further, childhood adversity predisposes to lower NKCA at a critical time when this immune-effector mechanism is most effective at halting nascent tumor seeding.

Association of Baseline Sleep Quality With Trajectories of Depressive Symptoms in Patients Undergoing Interferon Treatment

“…As examples, an unremitting an chronic course is associated with cortisol differences (96), poor sleep (97), avoidant coping style (98), socioeconomic position (99), and childhood abuse and neglect (100). For example, childhood physical neglect predicted chronic courses of depression (101) after depression had developed in those with a breast cancer diagnosis.…”

Childhood Adversity and Inflammation in Breast Cancer Survivors

“…These findings contradict extensive animal and human literature suggesting a powerfully detrimental effect of maternal separation on biological profiles (e.g., Refs. (60,61)) and preliminary evidence that physical neglect is associated with elevated IL-6 in breast cancer survivors (25). This may be because the Risky Families questionnaire assesses a lack of affection, rather than physical neglect or separation from a parent.…”

“…The Risky Families questionnaire was based on questions from a foundational study that demonstrated a dose-response relationship between early adverse experiences and disease incidence in a sample of 10,000 adults (14), and bolstered with questions developed through qualitative interviews (42). Previous work has shown associations between the Risky Families scale and biological outcomes (42,64–66); however, it does not assess all forms of childhood adversity including sexual abuse, physical neglect, and low socioeconomic status, which have been linked to increased adulthood inflammation (19,25,37,51). Chronicity and timing of adverse experiences also likely influence their impact, although these dimensions are not captured.…”

“…To our knowledge, only one previous study has examined the association between childhood adversity and inflammation in women with breast cancer. In a longitudinal study of 40 women diagnosed as having early-stage breast cancer and followed up for 9 months after tumor resection, Witek-Janusek and colleagues (25) found that childhood physical neglect (but not physical abuse or emotional/abuse neglect) was associated with a small increase in circulating IL-6 levels.…”

Day-to-Day Dynamics of Associations Between Sleep, Napping, Fatigue, and the Cortisol Diurnal Rhythm in Women Diagnosed as Having Breast Cancer

“…We previously demonstrated women with early stage breast cancer to report high levels of fatigue after surgery and during cancer treatment (14). Such fatigue may be attributed to sleep disturbance, which is more prevalent and intense prior to treatment onset and during the early weeks of treatment (15).…”