Acute health-related quality of life outcomes and systemic inflammatory markers following contemporary breast cancer surgery.

Contemporary breast cancer surgical procedures vary greatly by the amount of tissue removed, anesthesia time, and reconstruction. Despite historical literature comparing the health-related quality of life (HRQOL) after lumpectomy and mastectomy, HRQOL data are limited regarding contemporary surgical procedures. Further, biological processes (e.g., inflammation) associated with HRQOL outcomes have not been described. We conducted two studies to examine differences in post-operative physical and mental functioning, pain, fatigue, and systemic inflammatory markers including interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) in women with early-stage breast cancer. Study 1 assessed women before and after surgery (n = 27) and Study 2 used a large cross-sectional sample (n = 240) to confirm findings from Study 1 and included a no-surgery comparison group. In Study 1, women who received mastectomy had lower physical functioning than lumpectomy (ps < 0.05), and those who received bilateral mastectomy had worse pain (p < 0.01) and fatigue (p = 0.029) than lumpectomy. Results were replicated in Study 2: mastectomy groups exhibited poorer physical functioning (ps < 0.01) and greater pain (ps < 0.001) than lumpectomy, and bilateral mastectomy was associated with worse fatigue (p < 0.05). Women who received bilateral mastectomy had higher levels of CRP than lumpectomy (p < 0.01) and higher TNF-α than the no-surgery group (p < 0.05). All surgery groups exhibited higher IL-6 than no-surgery (ps < 0.05). More extensive surgery is associated with poorer postoperative HRQOL. As compared to lumpectomy and no-surgery, mastectomy is associated with higher concentrations of systemic inflammatory markers.

Using the influenza vaccine as a mild, exogenous inflammatory challenge: When does inflammation peak?

BACKGROUND: The influenza vaccine has shown promise as a mild, exogenous inflammatory challenge, but use of this model is limited by lack of knowledge about the timing of the inflammatory response. This study was designed to characterize the time-course of the acute inflammatory response and explore psychological and behavioral predictors of that response. METHODS: Twenty-one young, healthy individuals were recruited to receive the annual influenza vaccine. Serial blood samples were collected immediately before, and 24, 48, and 72 â€‹h following influenza vaccination. Interleukin (IL)-6 concentrations were assayed at each time-point and psychological and behavioral factors (anxiety and depressive symptoms, sleep disturbance, and childhood adversity) were assessed at baseline. RESULTS: Significant elevations in IL-6 were observed at 24 â€‹h post-vaccination (mean increase â€‹= â€‹0.70 â€‹pg/mL, Cohen's d â€‹= â€‹0.54, p â€‹= â€‹.018)), with 61.9% of participants exhibiting peak concentrations at that time point, χ 2  â€‹= â€‹22.54, p â€‹< â€‹.001, η â€‹= â€‹0.52. In exploratory analyses, sleep disturbance was associated with greater increases in IL-6 at 24 â€‹h. CONCLUSIONS: By identifying the peak IL-6 response to influenza vaccination among a sample of young, healthy individuals, these findings support the use of the influenza vaccine in future PNI research. This vaccine model can be used to examine the impact of mild inflammatory challenges on the brain and behavior, and to identify psychological and behavioral factors (e.g., anxiety, sleep) that modulate inflammatory reactivity.