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. 2017 Jan 1;23(1):52-61.
doi: 10.1158/1078-0432.CCR-16-0574. Epub 2016 Jul 12.

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

Barbara L Andersen  1 , Neha Godiwala Goyal  2 , Travis D Westbrook  3 , Brenden Bishop  3 , William E Carson 3rd  3
Affiliations

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

Barbara L Andersen et al. Clin Cancer Res. .

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.

Experimental design: 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 (N = 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 psychologic and innate immunity markers from diagnosis to18 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. Clin Cancer Res; 23(1); 52-61. ©2016 AACR.

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Conflict of interest statement

The authors have no conflicts of interest to disclose. This manuscript contains original work that is not currently being considered for publication elsewhere.

Figures

Figure 1
Figure 1
Example of a linear-linear multiphase function is provided. The intercept is where Phase I intersects the Y axis; its value is β0. Phase I is the line between the intercept and knot; its slope is β1. The two phases meet at a point called the knot. Phase II is the line to right of the knot; its slope is β2.
Figure 2
Figure 2
Top: The estimated Impact of Events Scale (IES) trajectory (natural log) for the average individual (N=113) from initial to 60 month assessment. Data points have been jittered to reduce over plotting. Bottom: A plot (natural log) using the most extreme individual trajectories predicted by the model. A/B trajectories are examples of patients with the highest/lowest intercepts. C/D trajectories are examples of patients with the highest/lowest second phase slopes.
Figure 3
Figure 3
Top: The estimated Center for Epidemiologic Studies-Depression (CESD) scale trajectory (natural log) for the average individual (N=113) from initial to 60 month assessment. Data points have been jittered to reduce over plotting. Bottom: A plot (natural log) using the most extreme individual trajectories predicted by the CESD model. The A/B trajectories are examples of patients with the highest/lowest intercepts. The C/D trajectories are examples of patients with the highest/lowest second phase slopes.
Figure 4
Figure 4
Top: The estimated natural killer cell cytotoxicity (NKCC) at E:T 25:1 trajectory (raw) for the average individual (N=113) from initial to 60-month assessment. Data points have been jittered to reduce over plotting. Bottom: A plot (raw) using the most extreme individual trajectories predicted by the model. A/B trajectories are examples of patients with the highest/lowest intercepts.
Figure 5
Figure 5
Top: The estimated concanavalin A (ConA) at 2.5 serial dilution trajectory (natural log) for the average individual (N=113) from initial to 60 month assessment. Data points have been jittered to reduce over plotting. Bottom: A plot (natural log) using the most extreme individual trajectories predicted by the model. The E/F trajectories are examples of patients having the highest/lowest first phase slopes.
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References

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MeSH terms