Trajectories of Stress, Depressive Symptoms, and Immunity in Cancer Survivors: Diagnosis to 5 Years

Abstract

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.

Hope and benefit finding: Results from the PRISM randomized controlled trial

“…This is important because each has been associated with longer-term patient physical, emotional, and social health. 13,14,17,39,40 That PRISM may be delivered by trained, non-clinical staff using a standardized script also has implications for its dissemination and implementation. It may be integrated into early clinical care as an inexpensive, preventative, stepped-care model which provides a scaffold for later patient-level coping support and/or where scarce professional level psychosocial services are reserved for patients and families in crisis.…”

Plasma sphingolipids and depressive symptoms in coronary artery disease

“…Plasma sphingolipid concentrations were log-transformed to adjust for non-normal positively skewed distributions as done previously (Gracia-Garcia et al, 2011;Mielke et al, 2010Mielke et al, , 2014Saleem et al, 2013). HADS-D scores were natural log-transformed, after adding 1 to each score to account for the inability to transform scores of 0, to adjust for a non-normal positively skewed distribution as has been previously done with depression rating scales (Andersen, Goyal, Westbrook, Bishop, & Carson, 2016;Kiecolt-Glaser, Belury, Andridge, Malarkey, & Glaser, 2011;Mamalakis et al, 2006;Shah, Zonderman, & Waldstein, 2013). Associations between participant sociodemographic and clinical characteristics with HADS-D score were assessed using Pearson's correlations and analysis of variance (ANOVA).…”

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“…For example, among older adults with cancer, stress management reduces depression, goal seeking and problem solving improve psychosocial health, and mindfulness improves quality of life . Reductions in stress and distress improve immune function and reduce morbidity and mortality …”

“…17 Reductions in stress and distress improve immune function and reduce morbidity and mortality. [18][19][20] Cancer October 1, 2018 Unfortunately, delivering traditional psychosocial interventions is challenging among AYAs with serious illness. More than one-third decline traditional cognitive behavioral therapy (CBT), and an additional one-third discontinue participation because of CBT's typical time commitment.…”