Depressive symptoms and cortisol variability prior to surgery for suspected endometrial cancer

Endometrial cancer (EC) is the most common type of gynecologic cancer affecting women; however, very little research has examined relationships between psychological factors and hypothalamic-pituitary-adrenal (HPA) axis dysregulation in this population. The current study examined relations between depressive/anxious symptoms and salivary cortisol diurnal rhythm and variability in women undergoing surgery for suspected endometrial cancer. Depressive and anxious symptoms were measured prior to surgery using the Structured Interview Guide for the Hamilton Depression Inventory (SIGH-AD). Saliva was collected four times a day for the three days prior to surgery and then assayed by ELISA to obtain cortisol concentrations. Cortisol slopes and intraindividual variability were then calculated across subjects. Relations between depressive/anxious symptoms and cortisol indices were examined using multilevel modeling and linear regression analyses. Participants were 82 women with nonmetastatic endometrial cancer. Anxious symptoms were not associated with either cortisol slope or intraindividual variability, and depressive symptoms were unrelated to cortisol slope. However, after controlling for presence of poorer prognosis cancer subtypes, greater depressive symptoms (excluding symptoms possibly/definitely due to health/treatment factors) in the week preceding surgery were significantly related to greater cortisol intraindividual variability (β=.214; p<.05). These results suggest that depressive symptoms prior to surgery for suspected endometrial cancer are related to greater cortisol intraindividual variability, which is suggestive of more erratic HPA axis arousal. Future research should examine whether mood symptoms may be associated with compromised health outcomes via erratic HPA axis arousal in this population

Virally mediated cervical cancer in the iatrogenically immunocompromised: Applications for psychoneuroimmunology

Oncogenic or high-risk (HR) human papillomavirus (HPV) infection is implicated in the pathogenesis of a number of cancers, including cervical cancer. HPV infected individuals who are immunocompromised secondary to acquired (e.g., human immunodeficiency virus [HIV]) or iatrogenic (e.g., systemic lupus erythematosus [SLE] patients and organ and hematopoeitic stem cell transplant recipients undergoing immunosuppressive therapy) immune deficiency are particularly at risk for HPV-initiated cervical neoplasia and cancer. Psychoneuroimmunologic (PNI) research has demonstrated that psychosocial factors such as stress, pessimism, and sleep quality may play a role in the promotion of HPV-mediated cervical neoplasia in HIV-positive women. However, no research to our knowledge has examined PNI mechanisms of HPV-mediated cervical neoplasia and cancer in women who are undergoing iatrogenic immunosuppressive therapy for the treatment of autoimmune disease or the prevention of graft-rejection. This article reviews the PNI mechanisms that may underlie the promotion of HPV-mediated cervical neoplasia and applies this model to HPV-infected women who are iatrogenically immunosuppressed, an understudied population at-risk for cervical cancer. Female transplant recipients, one such group, may provide a unique paradigm in which to explore further PNI mechanisms of HPV-mediated cervical neoplasia

Depressive symptoms, intrusive thoughts, sleep quality and sexual quality of life in women co-infected with human immunodeficiency virus and human papillomavirus

Background: Women infected with human immunodeficiency virus (HIV) experience major challenges and often report marked decreases in sexual functioning and quality of life (QOL). HIV-infected women also face challenges concerned with other commonly observed concomitant sexually transmitted organisms, such as human papillomavirus (HPV), which may further affect sexual QOL. Despite advances made in understanding factors that predict sexual functioning and QOL in men with HIV, relatively little is understood about the role of behavioural and emotional factors in women. Methods: As a preliminary inquiry into this question, this study related depressive symptoms, AIDS-related intrusive thoughts and sleep quality with sexual QOL reports in 21 HIV +HPV+ women. Results: We found that depressive symptoms, intrusive thoughts and sleep quality individually predicted poorer sexual QOL. Further analyses suggested that depression mediated the relationship between intrusive thoughts and sexual QOL. Discussion: Implications for further work and clinical interventions to address depressive symptoms in this population are discussed

Depressive Symptoms, Intrusive Thoughts, Sleep Quality and Sexual Quality of Life in Women Co-Infected with Human Immunodeficiency Virus and Human Papillomavirus

Background: Women infected with human immunodeficiency virus (HIV) experience major challenges & often report marked decreases in sexual functioning & quality of life (QOL). HIV-infected women also face challenges concerned with other commonly observed concomitant sexually transmitted organisms, such as human papillomavirus (HPV), which may further affect sexual QOL. Despite advances made in understanding factors that predict sexual functioning & QOL in men with HIV, relatively little is understood about the role of behavioral & emotional factors in women. Methods: As a preliminary inquiry into this question, this study related depressive symptoms, AIDS-related intrusive thoughts & sleep quality with sexual QOL reports in 21 HIV+HPV+ women. Results: We found that depressive symptoms, intrusive thoughts & sleep quality individually predicted poorer sexual QOL. Further analyses suggested that depression mediated the relationship between intrusive thoughts & sexual QOL. Discussion: Implications for further work & clinical interventions to address depressive symptoms in this population are discussed. 18 References. Adapted from the source document

A Prospective Biopsychosocial Investigation Into Head And Neck Cancer Caregiving

Purpose: Head and neck cancer (HNC) patients suffer from significant morbidity, which may introduce challenging care demands and subsequent stress-induced mind–body interactions for informal caregivers. This prospective study evaluated patient and caregiver predictors of diurnal cortisol rhythm among HNC caregivers during radiation treatment. Method: Patient–caregiver dyads completed measures at radiation treatment start (T1; n = 32) and 5 weeks into treatment (T2; n = 29). Measures included the Functional Assessment of Cancer Therapy–Head and Neck, the Caregiver Quality of Life (QOL) Index–Cancer, the Caregiver Reaction Assessment, the Medical Outcomes Social Support Survey, and the Eating Assessment tool. Patients also received a clinical swallowing evaluation using the Functional Assessment of Oral Intake Scale. Caregiver cortisol concentrations were assessed from salivary samples at T1 and T2. Results: Caregiver cortisol slope became significantly flatter during radiation treatment. Greater caregiver schedule burden was associated with a flatter cortisol slope (β =.35, p =.05) in caregivers at T1. Lower patient functional QOL (β = −.41, p =.05) and lower overall caregiver QOL at T1 (β = −.39, p =.04) were each separately associated with a flatter cortisol slope in caregivers over treatment. Conclusions: Results suggest the presence of a mind–body interaction in HNC caregivers. Dysregulation in diurnal cortisol rhythm in caregivers was significantly associated with increased caregiver schedule burden and lower patient and caregiver QOL. Targeted interventions developed for HNC caregivers may help to prevent negative health outcomes associated with dysregulated cortisol

Burden, Quality Of Life, And Social Support In Caregivers Of Patients Undergoing Radiotherapy For Head And Neck Cancer: A Pilot Study

Objective: The purpose of this pilot study was to (1) obtain preliminary data on changes in burden and quality of life in head and neck cancer caregivers during and shortly following patient radiotherapy, (2) assess the relationship between perceived social support and burden as well as perceived social support and quality of life in caregivers during radiotherapy, and (3) identify preferences for sources of support among caregivers during radiotherapy. Methods: Caregivers completed burden and quality of life instruments at the start of patient radiotherapy (T1), 5 weeks into radiotherapy (T2), and 1 month post-radiotherapy (T3) and instruments for perceived social support and support preferences at T2 only. Results: Caregivers showed a trend toward increased burden and worsened quality of life for the majority of subscales at T2 or T3 than at T1. Caregivers reported significantly lower esteem and significantly greater disruption at T2 than at T1 and significantly worse health at T3 than at T2. Higher perceived social support was typically associated with lower burden and higher quality of life at T2. Spouses/partners were the most commonly preferred source of support. Discussion: These pilot findings suggest that caregivers experience psychosocial impairments during and shortly after patient radiotherapy, but more research using larger samples is warranted

A Prospective Biopsychosocial Investigation Into Head and Neck Cancer Caregiving

Purpose: Head and neck cancer (HNC) patients suffer from significant morbidity, which may introduce challenging care demands and subsequent stress-induced mind–body interactions for informal caregivers. This prospective study evaluated patient and caregiver predictors of diurnal cortisol rhythm among HNC caregivers during radiation treatment. Method: Patient–caregiver dyads completed measures at radiation treatment start (T1; n = 32) and 5 weeks into treatment (T2; n = 29). Measures included the Functional Assessment of Cancer Therapy–Head and Neck, the Caregiver Quality of Life (QOL) Index–Cancer, the Caregiver Reaction Assessment, the Medical Outcomes Social Support Survey, and the Eating Assessment tool. Patients also received a clinical swallowing evaluation using the Functional Assessment of Oral Intake Scale. Caregiver cortisol concentrations were assessed from salivary samples at T1 and T2. Results: Caregiver cortisol slope became significantly flatter during radiation treatment. Greater caregiver schedule burden was associated with a flatter cortisol slope (β =.35, p =.05) in caregivers at T1. Lower patient functional QOL (β = −.41, p =.05) and lower overall caregiver QOL at T1 (β = −.39, p =.04) were each separately associated with a flatter cortisol slope in caregivers over treatment. Conclusions: Results suggest the presence of a mind–body interaction in HNC caregivers. Dysregulation in diurnal cortisol rhythm in caregivers was significantly associated with increased caregiver schedule burden and lower patient and caregiver QOL. Targeted interventions developed for HNC caregivers may help to prevent negative health outcomes associated with dysregulated cortisol

Cognitive–behavioral stress management and psychological well-being in HIV+ racial/ethnic minority women with human papillomavirus.

OBJECTIVE: This study is a secondary analysis examining the effects of a cognitive behavioral stress management (CBSM) intervention on indicators of positive psychological well-being and negative psychological well-being in HIV-positive racial/ethnic minority women at risk for cervical cancer due to Human Papillomavirus (HPV) infection and/or cervical intraepithelial lesions (CIN). METHODS: Racial/ethnic minority women with HIV and HPV and/or CIN I were randomized to a 10-week CBSM group or a 1-day psychoeducational seminar. Participants completed a battery of measures of positive and negative psychological well-being at three time points: pre-intervention (Time 1 [T(1)]), three months post-enrollment (Time 2 [T(2)]), and nine months post-enrollment (Time 3 [T(3)]). RESULTS: Women in the CBSM group reported significant increases in domains of positive well-being, with no changes among women in the psychoeducational seminar (F[6, 63] = 2.42, p<.05, η(2) = 0.19). There were no significant changes in domains of negative well-being across time for either group (F[2, 65] = 2.60, p= .08, η(2) = 0.07). CONCLUSIONS: These findings suggest that racial/ethnic minority women with HIV at risk for cervical cancer who were randomized to a 10-week CBSM group experienced enhanced positive well-being. The lack of effects on negative well-being may be due to the relatively low levels of negative well-being present in this sample at study entry. Future research should examine whether these effects are replicated in a randomized controlled trial of women with biopsy-confirmed CIN who present with greater distress levels that also employs a time-equivalent comparison condition