Associations among salivary cortisol, melatonin, catecholamines, sleep quality and stress in women with breast cancer and healthy controls

Dysregulations in several biological systems in breast cancer patients have been reported, including abnormalities in endocrine and sympathetic nervous system indices, as well as psychological disturbances and sleep disorders. The purpose of this exploratory study was to compare women with breast cancer to healthy control women on measures of salivary cortisol, urinary catecholamines, overnight urinary melatonin, and self-reported sleep quality, symptoms of stress, depression, anxiety and mood disturbance, to determine if discernable patterns of dysregulations across systems were apparent. Thirty-three women were tested in each group, with an average age of approximately 52 years, primarily Caucasian and welleducated. Forty percent of the women with breast cancer had stage 2 disease and they were an average of 1.36 years post-diagnosis. Women with breast cancer had significantly higher levels of disturbance on all the psychological indices, but there were no differences between groups on any of the biological measures, with the exception that the control women had higher dopamine values than the participants with breast cancer. None of the psychological scores were correlated with the biological measures. These results are consistent with other studies of early-stage breast cancer and highlight the importance of considering disease characteristics when investigating endocrine and sympathetic nervous system functioning. KEY WORDS: breast cancer; cortisol; melatonin; catecholamines; stress; depression; anxiety. Women with breast cancer have been documented to have dysregulation in several important circadian systems, including hormonal, sleep and autonomic rhythm

What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review and individual participant data meta-analysis

This study was supported by the Dutch Cancer Society (KWF) grant number 10936.Objective Care for fear of cancer recurrence (FCR) is considered the most common unmet need among cancer survivors. Yet the prevalence of FCR and predisposing factors remain inconclusive. To support targeted care, we provide a comprehensive overview of the prevalence and severity of FCR among cancer survivors and patients, as measured using the short form of the validated Fear of Cancer Recurrence Inventory (FCRI-SF). We also report on associations between FCR and clinical and demographic characteristics. Methods This is a systematic review and individual participant data (IPD) meta-analysis on the prevalence of FCR. In the review, we included all studies that used the FCRI-SF with adult (≥18 years) cancer survivors and patients. Date of search: 7 February 2020. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. Results IPD were requested from 87 unique studies and provided for 46 studies comprising 11,226 participants from 13 countries. 9311 respondents were included for the main analyses. On the FCRI-SF (range 0–36), 58.8% of respondents scored ≥13, 45.1% scored ≥16 and 19.2% scored ≥22. FCR decreased with age and women reported more FCR than men. FCR was found across cancer types and continents and for all time periods since cancer diagnosis. Conclusions FCR affects a considerable number of cancer survivors and patients. It is therefore important that healthcare providers discuss this issue with their patients and provide treatment when needed. Further research is needed to investigate how best to prevent and treat FCR and to identify other factors associated with FCR. The protocol was prospectively registered (PROSPERO CRD42020142185).Publisher PDFPeer reviewe

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Non-pharmacological treatment of insomnia in cancer patients: a randomized, controlled, non-inferiority trial investigating mindfulness-based and cognitive-behavioral approaches.

Patients who are diagnosed and treated for cancer are three times more likely than the general population to experience disturbed sleep and insomnia. The presence of persistent insomnia places patients at a higher risk for psychological and physical morbidity and reduced quality of life. This dissertation examined the use of non-pharmacological interventions to address insomnia in a heterogeneous sample of cancer patients. Cognitive-Behavioral Therapy for insomnia (CBT-I) is considered a well-established intervention, however a substantial proportion of people do not experience a treatment response or complete insomnia remittance. Mindfulness-Based Stress Reduction (MBSR) is generating a considerable amount of research interest in the area of insomnia due to its demonstrated effectiveness in reducing cognitive and physiological arousal, factors associated with disturbed sleep. We employed a non-inferiority design to determine whether MBSR performs to the same standard as CBT-I for insomnia, while providing additional benefits such as improved mood and lower appraisals of stress. MBSR was non-inferior to CBT-I for improving sleep when assessed three months after treatment completion, but not immediately post-program. This result is attributed to MBSR producing slower but continual improvements over time while CBT-I generated rapid effects that were largely maintained. While both groups demonstrated the ability to reduce stress symptoms and mood disturbance, those receiving CBT-I uniquely improved sleep quality and dysfunctional sleep beliefs. Secondary analyses were performed on the full sample (N=111) to examine associations between dispositional mindfulness, sleep and psychological outcomes. Mindfulness facets of acting with awareness, non-judging and non-reacting were associated with better sleep and psychological outcomes, but mindfulness was not predictive of fewer sleep disturbances above and beyond the influence of symptoms of stress and mood disturbance. We then focused specifically on the MBSR group (n=32) to examine whether improvements in mindfulness were associated with sleep and psychological outcomes. This sub-study suggests that one of the mechanisms by which MBSR may improve sleep outcomes is through a reduction in dysfunctional sleep-related beliefs. This body of work emphasizes the need to conduct patient-centered research and expands potential treatment options for patients with insomnia