Negative affect and stress-related brain metabolism in patients with metastatic breast cancer.

BACKGROUND: Cancer and its treatment represent major stressors requiring that patients make multiple adaptations. Despite evidence that poor adaptation to stressors is associated with more distress and negative affect (NA), neuroimmune dysregulation and poorer health outcomes, current understanding is very limited of how NA covaries with central nervous system changes to account for these associations. METHODS: NA was correlated with brain metabolic activity using 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) in several regions of interest in 61 women with metastatic breast cancer. Patients underwent 18 F-FDG PET/CT and completed an assessment of NA using the Brief Symptom Inventory. RESULTS: Regression analyses revealed that NA was significantly negatively correlated with the standardized uptake value ratio of the insula, thalamus, hypothalamus, ventromedial prefrontal cortex, and lateral prefrontal cortex. Voxel-wise correlation analyses within these 5 regions of interest demonstrated high left-right symmetry and the highest NA correlations with the anterior insula, thalamus (medial and ventral portion), lateral prefrontal cortex (right Brodmann area 9 [BA9], left BA45, and right and left BA10 and BA8), and ventromedial prefrontal cortex (bilateral BA11). CONCLUSIONS: The regions of interest most strongly negatively associated with NA represent key areas for successful adaptation to stressors and may be particularly relevant in patients with metastatic breast cancer who are dealing with multiple challenges of cancer and its treatment.

Emotional distress, brain functioning, and biobehavioral processes in cancer patients: a neuroimaging review and future directions.

Despite emerging evidence that distress and adversity can contribute to negative health outcomes in cancer, little is known about the brain networks, regions, or circuits that can contribute to individual differences in affect/distress states and health outcomes in treated cancer patients. To understand the state-of-the-science in this regard, we reviewed neuroimaging studies with cancer patients that examined the associations between negative affect (distress) and changes in the metabolism or structure of brain regions. Cancer patients showed changes in function and/or structure of key brain regions such as the prefrontal cortex, thalamus, amygdala, hippocampus, cingulate cortex (mainly subgenual area), hypothalamus, basal ganglia (striatum and caudate), and insula, which are associated with greater anxiety, depression, posttraumatic stress disorder (PTSD) symptoms, and distress. These results provide insights for understanding the effects of these psychological and emotional factors on peripheral stress-related biobehavioral pathways known to contribute to cancer progression and long-term health outcomes. This line of work provides leads for understanding the brain-mediated mechanisms that may explain the health effects of psychosocial interventions in cancer patients and survivors. A multilevel and integrated model for distress management intervention effects on psychological adaptation, biobehavioral processes, cancer pathogenesis, and clinical outcomes is proposed for future research.

Psychosocial oncology care resources in Europe: a study under the European Partnership for Action Against Cancer (EPAAC).

BACKGROUND: Cancer is a complex health problem requiring multidisciplinary care. There are clinical guidelines available in order to improve the process and outcomes of cancer care within Europe. However, strategic action is still needed in many European Union (EU) Member States to develop or improve national cancer control plans (NCCPs), which play a key role in cancer control and care. The current study clarifies the extent of implementation of psychosocial oncology care (PSOC) in the EU. METHOD: A survey methodology was used to cover four dimensions: (1) inclusion of PSOC in NCCPs; (2) structure and resources of PSOC delivery; (3) use of NCCP clinical guidelines; and (4) education and training resources available along with determination of training needs in PSOC. RESULTS: Twenty-seven (90%) countries returned questionnaires of which 21 (78%) include PSOC in their NCCP. However, only 10 (37%) reported having specific budgets for PSOC, 8 (30%) having nationally recommended PSOC clinical guidelines, and 6 countries (22%) reported having an official certification for PSOC education. CONCLUSION: Although many countries seem to have integrated PSOC into their NCCP, there is still much to do in terms of allocating resources and delivering psychosocial care equitably. Also, there is a need for improving training and certification in PSOC. The findings indicate the need to develop national policies concerning PSOC with clear targets for deliverables in an appropriate timetable in order that psychosocial services and existing clinical guidelines are implemented and fully integrated into EU NCCPs. Copyright © 2015 John Wiley & Sons, Ltd.

Greater perceived stress management skills and heightened brain metabolic activity in cortical and subcortical stress processing regions in metastatic breast cancer patients.

PURPOSE: Emotional distress and adversity can contribute to negative health outcomes in women with breast cancer. Individual differences in perceived stress management skills such as cognitive reframing and relaxation for coping with adversity have been shown to predict less distress and better psychological and physiological adaptation. Prior work shows that more distressed breast cancer patients reveal less metabolic activity in brain regions such as the insula, thalamus, ventromedial and lateral prefrontal cortices. This led us to pose the hypothesis that breast cancer patients with greater stress management skills (e.g., ability to reframe stressors and use relaxation) may conversely show greater activation in these brain regions and thereby identify brain activity that may be modifiable through stress management interventions. The main objective of this study was to examine the association of perceived stress management skill efficacy with the metabolism of 9 key stress-implicated brain regions in women diagnosed with metastatic breast cancer. METHODS: Sixty women (mean age 59.86 ± 10.04) with a diagnosis of mBC underwent 18F-fluorodeoxyglucose positron emission tomography. Perceived stress management skill efficacy was assessed with the Measure of Current Status Scale. RESULTS: Greater perceived stress management skill efficacy related significantly to higher metabolic activity in the insula, thalamus, ventromedial and lateral prefrontal cortices, and basal ganglia; this network of regions overlaps with those previously shown to be under-activated with greater level of distress in this same sample of metastatic breast cancer patients. CONCLUSION: This is the first study to demonstrate in metastatic cancer patients that greater perceptions of stress management skill efficacy are associated with metabolic activity in key brain regions and paves the way for future studies tracking neural mechanisms sensitive to change following stress management interventions for this population.

Breast cancer meanings: a cognitive-developmental study.

OBJECTIVE: This study addresses the meanings women with breast cancer attach to their illness within a cognitive-developmental framework. The aim of the present study was twofold: (i) to identify the content of women's meanings in five domains of breast cancer representation (identity, causes, consequences, timeline and controllability), and (ii) to verify if those meanings can be classified developmentally and propose a developmental sequence of meanings for breast cancer. METHODS: Fifty women treated for breast cancer, as outpatients by the Breast Surgery Multidisciplinary Team at Hospital S. José, Lisbon, Portugal, were randomly selected and interviewed using a semi-structured method, in order to obtain data on the significance they attached to their illness. RESULTS: A typical breast cancer representation profile was identified: 74% of women know their diagnosis, 70% conceive its causes as external factors, 50% refer to emotional and functional changes as main consequences, 62% are expectant towards the future and 36% considered themselves cured. It was possible to classify women's illness meanings into different developmental levels: the majority of women acceded only to lower (level 2=36%) and intermediate levels (level 3=50%). A developmental sequence of meanings for breast cancer is presented. CONCLUSIONS: The identification of women's illness meanings enhances understanding of the emotional reactions and coping processes they use in this stressful situation. Also, it enables the clinician to match clinical methodologies with the patient's developmental level. Cognitive and developmental approaches offer a useful framework for making decisions about prevention and clinical procedures with breast cancer women, which may benefit clinical outcomes.

Low social and family well-being is associated with greater RAGE ligand s100A8/A9 and interleukin-1 beta levels in metastatic breast cancer patients.

Greater inflammatory signaling has been shown to promote breast cancer disease progression and poorer clinical outcomes. Lower social support and social well-being have been related to greater inflammatory signaling and poorer clinical outcomes in women with non-metastatic breast cancer, and this appears to be independent of depression. However, little is known about these associations in women with metastatic disease. s100A8/A9 and interleukin 1 beta (IL-1ß) proteins are widely studied in breast cancer and are considered as biomarkers of cancer progression or as having a causal role in carcinogenesis and cancer progression and metastasis via inflammatory signaling. The aim of this study was to examine the associations between less social/family well-being (SWB) and S100A8/A9 and IL-1ß levels in women diagnosed with metastatic breast cancer. Sixty women (Mean age 58.95 â€‹± â€‹1.49) with a diagnosis of metastatic breast cancer participated in the study. The Functional Assessment of Cancer Therapy (FACT) social and family well-being (SWB) subscale and the Hospital Anxiety Depression Scale (HADS) were administered to patients undergoing a first- or second-line endocrine or oral chemotherapy treatment and who were not experiencing brain metastasis or visceral crisis. Salivary s100A8/A9 and IL-1ß levels were assessed at 5PM on two consecutive days and averaged. Multiple regression tested the independent contribution of SWB on s100 A8/A9 and IL-1b while controlling for depression. Lower levels of SWB were associated with greater S100A8/A9 (ߠ​= â€‹-0.345, p â€‹= â€‹0.007) and IL-1ß (ߠ​= â€‹-0.286, p â€‹= â€‹0.027) levels and these associations remained significant after controlling for depression. This work provides new evidence for the role of decreased SWB and greater s100A8/A9 and IL-1b levels in patients diagnosed with metastatic breast cancer. Psychosocial interventions that promote social support and positive social interactions through interpersonal skills may help metastatic breast cancer patients to improve their SWB. This may have salutary effects on cancer-promoting processes, which could provide psychological and physical health benefits.

Developmental levels in adult's conceptions of health and disease / Níveis de desenvolvimento nas concepções dos adultos sobre saúde e doença

A socio-cognitive developmental perspective suggests that conceptions regarding health and disease processes may present different levels of openness, flexibility, inclusiveness and differentiation, and thus can be ordered into different levels. We present a qualitative study on lay significations regarding health and disease processes, endorsed by 67 adults. The results show that these adults have different socio-cognitive developmental competences related to health and disease processes. For each dimension of significations of health and disease, it is possible to sequence lay person's conceptions developmentally. Each level is distinct qualitatively, including responses characterized by a higher degree of differentiation, integration and complexity than the previous level. Finally, the implications of this approach to clinical and educational methods are discussed.

Na perspectiva do desenvolvimento sociocognitivo, as concepções de saúde e doença podem apresentar diferentes níveis de abertura, flexibilidade, inclusividade e diferenciação e podem ser ordenadas em diferentes níveis de desenvolvimento. O presente estudo incidiu sobre as significações leigas de saúde e doença de um grupo de 67 adultos. Os resultados indicam que esses adultos se situam em diferentes níveis nas suas competências de desenvolvimento sociocognitivo relacionadas com os processos de saúde e doença, tendo sido possível sequenciar as suas significações em níveis distintos. Cada nível é distinto qualitativamente, incluindo respostas caracterizadas por uma maior diferenciação, integração e complexidade em relação ao nível precedente. As implicações dessa abordagem para os métodos clínicos e educativos são discutidas.

Developmental levels in adult's conceptions of health and disease / Níveis de desenvolvimento nas concepções dos adultos sobre saúde e doença

A socio-cognitive developmental perspective suggests that conceptions regarding health and disease processes may present different levels of openness, flexibility, inclusiveness and differentiation, and thus can be ordered into different levels. We present a qualitative study on lay significations regarding health and disease processes, endorsed by 67 adults. The results show that these adults have different socio-cognitive developmental competences related to health and disease processes. For each dimension of significations of health and disease, it is possible to sequence lay person's conceptions developmentally. Each level is distinct qualitatively, including responses characterized by a higher degree of differentiation, integration and complexity than the previous level. Finally, the implications of this approach to clinical and educational methods are discussed.(AU)

Na perspectiva do desenvolvimento sociocognitivo, as concepções de saúde e doença podem apresentar diferentes níveis de abertura, flexibilidade, inclusividade e diferenciação e podem ser ordenadas em diferentes níveis de desenvolvimento. O presente estudo incidiu sobre as significações leigas de saúde e doença de um grupo de 67 adultos. Os resultados indicam que esses adultos se situam em diferentes níveis nas suas competências de desenvolvimento sociocognitivo relacionadas com os processos de saúde e doença, tendo sido possível sequenciar as suas significações em níveis distintos. Cada nível é distinto qualitativamente, incluindo respostas caracterizadas por uma maior diferenciação, integração e complexidade em relação ao nível precedente. As implicações dessa abordagem para os métodos clínicos e educativos são discutidas.(AU)

Significações sobre causas e prevenção das doenças em jovens adultos, adultos de meia-idade e idosos / Significations about causes and prevention of diseases through adult life cycle

Tem havido pouco reconhecimento em psicologia da saúde sobre a contribuiçäo do estudo do ciclo de vida para se compreender melhor a forma como os adultos conceitualizam os processos de saúde e doença. Este artigo descreve uma pesquisa empírica sobre as significaçöes causais e de prevençäo das doenças, ao longo do ciclo de vida do adulto. Foram entrevistadas 67 pessoas, representando as diferentes fases do adulto (jovem adulto, meia-idade e idosos). Os resultados indicaram diferenças no conteúdo das significaçöes nos diferentes subgrupos etários. No final säo apontadas consequências destes dados para a Psicologia da Saúde, especificamente para os programas de Educaçäo para a Saúde

Significações sobre causas e prevenção das doenças em jovens adultos, adultos de meia-idade e idosos / Significations about causes and prevention of diseases through adult life cycle

Tem havido pouco reconhecimento em psicologia da saúde sobre a contribuição do estudo do ciclo de vida para se compreender melhor a forma como os adultos conceitualizam os processos de saúde e doença. Este artigo descreve uma pesquisa empírica sobre as significações causais e de prevenção das doenças, ao longo do ciclo de vida do adulto. Foram entrevistadas 67 pessoas, representando as diferentes fases do adulto (jovem adulto, meia-idade e idosos). Os resultados indicaram diferenças no conteúdo das significações nos diferentes subgrupos etários. No final são apontadas consequências destes dados para a Psicologia da Saúde, especificamente para os programas de Educação para a Saúde (AU)