Journal
JOURNAL OF PSYCHOSOMATIC RESEARCH
Volume 173, Issue -, Pages -Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.jpsychores.2023.111455
Keywords
Pain; Fatigue; Depression; Cognitive impairment; Symptom cluster; cancer; Oncology; Cytokines; Kynurenine; Tryptophan
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This study found that a substantial number of cancer patients experienced a cluster of psycho-neurological symptoms, and that older age and elevated pro-inflammatory cytokines were associated with experiencing the symptom cluster. The activity of indolamine-2.3 dioxygenase (IDO) was associated with pro-inflammatory cytokine activity and the symptom cluster experience. Symptom severity, pro-inflammatory cytokines, and IDO activity were higher in cancer patients compared to healthy controls.
Objective: This study examined (a) whether there are a subgroup of cancer patients experiencing the selected psycho-neurological symptoms as a cluster (depression, cognitive impairment, fatigue, sleep disturbance, and pain); (b) whether demographic and clinical characteristics and pro-inflammatory cytokines (IL-1 & alpha;, IL-1 & beta;, IL-4, IL-6, TNF-alpha) are associated with subgroup membership; and (c) whether the activity of indolamine-2.3 dioxygenase(IDO) is associated with pro-inflammatory cytokine activity and psycho-neurological symptom cluster experience.Methods: This was a prospective cohort study where 149 hematologic patients were recruited from a university hospital and 65 healthy volunteers provided control data. Latent profile analyses were conducted to identify subgroups at two time points: the last day of chemotherapy and 1 week after chemotherapy completion. Influencing factors of subgroup membership were examined by logistic regression.Results: A substantial number of patients (33%, 34% at each time point) experienced the selected psycho neurological symptoms as a cluster. Older age and elevated IL-1 & alpha; and IL-6 were associated with experiencing the psycho-neurological symptom cluster. IDO activity was higher in the patients experiencing psycho neurological symptom cluster; and was positively associated with IL-6. Symptom severity, IL-1 & alpha;, IL-6, and IDO activity were all significantly higher in cancer patients than in the healthy controls. The findings were preserved across time points.Conclusions: The activation of pro-inflammatory cytokines and their cross-talk with IDO may be a common biological mechanism, underlying a psycho-neurological symptom cluster experience. The novel approaches for symptom assessment and management can be developed by assessing multiple psycho-neurological symptoms as a cluster and by targeting their common biological pathway.
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