The Role of Inflammation in the Pain, Fatigue, and Sleep Disturbance Symptom Cluster in Advanced Cancer

被引：107
作者：
Kwekkeboom, Kristine L. [1 ]
Tostrud, Lauren [1 ]
Costanzo, Erin [1 ]
Coe, Christopher L. [1 ]
Serlin, Ronald C. [1 ]
Ward, Sandra E. [1 ]
Zhang, Yingzi [1 ]
机构：
[1] Univ Wisconsin, Madison, WI 53705 USA
来源：
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT | 2018年 / 55卷 / 05期
关键词：
Cancer; symptom cluster; psychological stress; inflammation; quality of life; C-REACTIVE PROTEIN; QUALITY-OF-LIFE; PERCEIVED STRESS; SICKNESS BEHAVIOR; DEPRESSION; DISTRESS; ASSOCIATION; PREVALENCE; MECHANISMS; CYTOKINES;
D O I：
10.1016/j.jpainsymman.2018.01.008
中图分类号：
R19 [保健组织与事业（卫生事业管理）];
学科分类号：
摘要：
Context. Symptom researchers have proposed a model of inflammatory cytokine activity and dysregulation in cancer to explain co-occurring symptoms including pain, fatigue, and sleep disturbance. Objectives. We tested the hypothesis that psychological stress accentuates inflammation and that stress and inflammation contribute to one's experience of the pain, fatigue, and sleep disturbance symptom cluster (symptom cluster severity, symptom cluster distress) and its impact (symptom cluster interference with daily life, quality of life). Methods. We used baseline data from a symptom cluster management trial. Adult participants (N = 158) receiving chemotherapy for advanced cancer reported pain, fatigue, and sleep disturbance on enrollment. Before intervention, participants completed measures of demographics, perceived stress, symptom cluster severity, symptom cluster distress, symptom cluster interference with daily life, and quality of life and provided a blood sample for four inflammatory biomarkers (interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha, and C-reactive protein). Results. Stress was not directly related to any inflammatory biomarker. Stress and tumor necrosis factor-a were positively related to symptom cluster distress, although not symptom cluster severity. Tumor necrosis factor-a was indirectly related to symptom cluster interference with daily life, through its effect on symptom cluster distress. Stress was positively associated with symptom cluster interference with daily life and inversely with quality of life. Stress also had indirect effects on symptom cluster interference with daily life, through its effect on symptom cluster distress. Conclusion. The proposed inflammatory model of symptoms was partially supported. Investigators should test interventions that target stress as a contributing factor in co-occurring pain, fatigue, and sleep disturbance and explore other factors that may influence inflammatory biomarker levels within the context of an advanced cancer diagnosis and treatment. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码：1286 / 1295
页数：10
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