Microbiome-gut-brain axis in cancer treatment-related psychoneurological toxicities and symptoms: a systematic review

Purpose The microbiome-gut-brain (MGB) axis provides a dynamic model to understand associations between the gut microbiota and psychoneurological comorbidities. The role of the MGB axis in cancer treatment-related psychoneurological symptoms (PNS) remains unknown. The purpose of this study was to conduct a systematic review of the existing literature to identify the influence of the gut microbiota on cancer and cancer treatment-related PNS and toxicities mediated by the MGB axis. Methods We searched the databases of PubMed, Embase, and Web of Science from their earliest records to October 2019. All studies identified in the database searches were screened by title and abstract, followed by a review of the full texts. The Johns Hopkins Nursing Evidence-Based Practice Model was adopted to assess the evidence levels and qualities; the Joanna Briggs Institute critical appraisal tools were used to assess the methodological quality and the possibility of bias for each included study. All the study findings were combined, synthesized, and presented through narrative format. Results Six studies were included in this systematic review. These studies primarily focused on cancer survivorship while receiving chemotherapy, and they were conducted between 2016 and 2019. The gut microbiome was assessed via fecal samples, which were analyzed using 16S rRNA sequencing approaches. With small-scale studies, the gut microbiota was associated with cancer treatment-related PNS, including fatigue, anxiety, depression, sleep disturbance, cognitive impairment, and chemotherapy-induced peripheral neuropathy. A higher relative abundance ofBacteroideswas associated with a higher level of fear of cancer recurrence but a higher relative abundance ofLachnospiraceae.gandRuminococcuswas associated with a lower level in fear of cancer recurrence. Changes in fatigue interference were associated with the frequency of generaFaecalibacteriumandPrevotella, and changes in anxiety were associated with the frequency of generaCoprococcusandBacteroides. Conclusions The gut microbiota showed significant associations with cancer treatment-related PNS. Recent work regarding the MGB axis in cancer psychoneurological toxicities focused primarily on individual toxicity and symptoms in cancer survivors with chemotherapy exposure. Associations between the gut microbiota and PNS should be further studied in cancer populations across different ages, cancer types, and treatment modalities.

Automated summary

The microbiome-gut-brain (MGB) axis plays a role in understanding the connection between gut microbiota and psychoneurological comorbidities. This systematic review on six studies found significant associations between gut microbiota and cancer treatment-related psychoneurological symptoms (PNS), particularly in cancer survivors undergoing chemotherapy. The relative abundance of specific microbiota was linked to fear of cancer recurrence, fatigue, anxiety, depression, sleep disturbance, cognitive impairment, and chemotherapy-induced peripheral neuropathy.