Cognitive Behavioral Effects on Sleep, Pain, and Cytokines in Gynecologic Cancer

认知行为对妇科癌症睡眠、疼痛和细胞因子的影响

• 批准号: 8711020
• 负责人: DEIDRE B PEREIRA
• 金额: $ 17.98万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-20 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8711020
• 关键词: Adjuvant Chemotherapy; Adrenal Glands; Arousal; Behavioral; Cancer Etiology; Cessation of life; Clinical; Cognitive; Cognitive Therapy; Disease-Free Survival; Empirical Research; Growth Factor; Gynecologic Oncology; Health; Hydrocortisone; Hypothalamic structure; IL8 gene; Individual; Inflammatory; Interleukin-1; Interleukin-6; Intervention; Length; Literature; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Mediating; Medicine; Modeling; Moods; Morbidity - disease rate; Outcome; Pain; Pain interference; Pain quality; Patient-Focused Outcomes; Pattern; Peripheral; Physiological; Pituitary Gland; Population; Psychological Factors; Psychoneuroimmunology; Public Health; Quality of life; Reproductive Immunology; Research; Salivary; Secondary to; Sensory; Serum; Severities; Sleep; Sleeplessness; Stress; System; Techniques; Testing; Time; Treatment/Psychosocial Effects; Tumor Biology; Tumor Necrosis Factor-alpha; Up-Regulation; Vascular Endothelial Growth Factors; Waiting Lists; Woman; anxious; biobehavior; cancer therapy; central sensitization; clinical care; cytokine; depressive symptoms; experience; hypothalamic-pituitary-adrenal axis; illness length; improved; innovation; intervention effect; mortality; multi-component intervention; multidisciplinary; negative mood; oncology; patient oriented; post intervention; psychologic; psychological stressor; public health priorities; response; sleep onset; standard of care; stressor; theories; tumor microenvironment; tumorigenesis

DESCRIPTION (provided by applicant): Gynecologic cancers cause substantial morbidity and mortality among women. Developing, implementing, and disseminating interventions that reduce morbidity and mortality secondary to gynecologic cancers are a public health priority. To the extent that psychological factors may influence quality of life and tumor biology among women with gynecologic cancers, psychological interventions may represent an important adjunct to standard clinical care in this population. Among individuals with cancer, there is emerging evidence that stressors and psychological responses to stressors activate central and peripheral stress systems, resulting in downstream effects on the tumor microenvironment, e.g. hypothalamic-pituitary-adrenal (HPA) axis dysregulation, inflammatory/growth factor upregulation, that may favor tumorigenesis. Little is known about whether psychological interventions may modulate biobehavioral factors that may promote tumorigenesis among women with gynecologic cancer. This is a significant gap in the literature. Sleep quality, pain, and mood are three patient-centered outcomes that may represent important intervention targets for women with gynecologic cancers, as insomnia, pain, and negative mood states are (1) prevalent and (2) have been associated with HPA dysregulation and inflammatory/growth factor up regulation in this population in empirical research. The objective of this application is to examine cognitive behavioral therapy (CBT) intervention effects on patient- centered and physiological outcomes among women with gynecologic cancers undergoing adjuvant chemotherapy. Grounded within the Central Arousal Theory of Stress (CATS) and a biobehavioral model of tumor biology, the central hypothesis of this application is that a CBT intervention targeting insomnia and pain will (a) improve nighttime sleep patterns, pain, and negative mood states, and (b) reduce cortisol levels, normalize daytime cortisol rhythm, and reduce proinflammatory/proangiogenic cytokine levels in women with gynecologic cancers. If hypothesized relationships emerge, they will guide future research examining the extent to which CBT may impact long-term quality of life, response to cancer treatment, and length of disease- free interval/survival in women with gynecologic cancer. The proposed study will be implemented by a multidisciplinary team with research/clinical experience in psycho-oncology, psychoneuroimmunology (PNI), behavioral sleep medicine, pain, reproductive immunology, and gynecologic oncology. The proposed study is innovative in that it will (1) combine empirically-supported CBT techniques for insomnia and pain into a multicomponent intervention tailored for women with gynecologic cancers, and (2) examine CBT effects on central sensitization of pain among individuals with cancer using quantitative sensory testing (QST). The results of this research will be significant to public health initiatives, because although gynecologic cancers are among the leading causes of cancer-related death among women, there is a paucity of research examining the effects of psychosocial interventions on patient-centered and physiological outcomes in this population.

描述（由申请人提供）：妇科癌症引起妇女的大量发病率和死亡率。开发，实施和传播干预措施，以降低妇科癌症之后的发病率和死亡率是公共卫生的优先事项。在某种程度上，心理因素可能影响妇科癌症女性的生活质量和肿瘤生物学的质量，心理干预可能代表了该人群中标准临床护理的重要辅助。在患有癌症的个体中，有新的证据表明，压力源和对压力源的心理反应激活了中央和周围压力系统，从而对肿瘤微环境产生了下游影响，例如下丘脑 - 垂体 - 肾上腺（HPA）轴失调，炎症/生长因子上调，可能有利于肿瘤发生。关于心理干预措施是否可能调节可能促进妇科癌女性肿瘤发生的生物行为因素，知之甚少。这是文献中的重要差距。睡眠质量，疼痛和情绪是三个以患者为中心的结局，可能代表了患有妇科癌症女性的重要干预靶标，因为失眠，疼痛和负面情绪状态（1）普遍存在，并且（2）与HPA失调失调和炎症/生长因子相关。该应用的目的是检查认知行为疗法（CBT）干预对接受辅助化疗的妇科癌女性的患者和生理结果的影响。 Grounded within the Central Arousal Theory of Stress (CATS) and a biobehavioral model of tumor biology, the central hypothesis of this application is that a CBT intervention targeting insomnia and pain will (a) improve nighttime sleep patterns, pain, and negative mood states, and (b) reduce cortisol levels, normalize daytime cortisol rhythm, and reduce proinflammatory/proangiogenic cytokine levels in women with妇科癌。如果假设的关系出现，他们将指导未来的研究，以研究CBT可能影响长期生活质量，对癌症治疗的反应以及妇科妇女女性的疾病无间隔/生存时间的程度。拟议的研究将由一个多学科团队实施，具有心理肿瘤，心理肌免疫学（PNI），行为睡眠医学，疼痛，生殖免疫学和妇科肿瘤学方面的研究/临床经验。拟议的研究具有创新性，因为它将（1）结合经济上支持的CBT技术，用于失眠和疼痛，为针对患有妇科癌症的女性量身定制的多组分干预措施，（2）检查CBT使用定量敏感性测试（QST）检查患有癌症患者疼痛中心疼痛的CBT对中心敏化的影响（QST）。这项研究的结果对公共卫生计划将是重要的，因为尽管妇科癌症是妇女与癌症相关死亡的主要原因之一，但仍有很少的研究研究了社会心理干预对以患者为中心的和生理结果的影响。

项目成果

Impacts of Cognitive Behavioral Therapy for Insomnia and Pain on Sleep in Women with Gynecologic Malignancies: A Randomized Controlled Trial.

• DOI: 10.1080/15402002.2021.1932500
• 发表时间: 2022-07
• 期刊: Behavioral sleep medicine
• 影响因子: 3.1
• 作者: Padron A;McCrae CS;Robinson ME;Waxenberg LB;Antoni MH;Berry RB;Castagno J;Schultz G;Kacel EL;Ulfig C;Garey S;Patidar S;Sannes T;Trinastic L;Wong S;Pereira DB
• 通讯作者: Pereira DB

Psychosocial factors and mortality in women with early stage endometrial cancer.

• DOI: 10.1111/bjhp.12070
• 发表时间: 2014-11
• 期刊: British journal of health psychology
• 影响因子: 7.9
• 作者: Telepak LC;Jensen SE;Dodd SM;Morgan LS;Pereira DB
• 通讯作者: Pereira DB

Depressive symptoms and cortisol variability prior to surgery for suspected endometrial cancer.

• DOI: 10.1016/j.psyneuen.2012.06.001
• 发表时间: 2013-02
• 期刊: PSYCHONEUROENDOCRINOLOGY
• 影响因子: 3.7
• 作者: Sannes, Timothy S.;Jensen, Sally E.;Dodd, Stacy M.;Kneipp, Shawn M.;Smith, Stephanie Garey;Patidar, Seenna M.;Marsiske, Michael M.;Lutgendorf, Susan M.;Morgan, Linda S.;Pereira, Deidre B.
• 通讯作者: Pereira, Deidre B.