Biobehavioral Factors in Clinical Care and Survivorship
A better understanding of biobehavioral factors in the clinical care of cancer patients and during survivorship continues to be a priority of the BOP, with the long term goal of developing interventions that can be used in clinical practice to enhance patients' treatment experiences and outcomes.
- Inflammation plays a central role in peritoneal carcinomatosis (PC) etiology and progression, and circulating levels of inflammatory biomarkers prior to surgery predict progression-free and overall survival in PC patients. Depression and fatigue are prevalent among PC patients, and experimental research shows that these symptoms may be mediated by proinflammatory cytokines. BOP members found that, consistent with hypotheses, higher IL-6 levels were associated with more severe fatigue and neurovegetative symptoms of depression in PC patients. IL-6 was also related to poorer physical quality of life. CRP showed similar significant relationships with fatigue and physical quality of life. (Low et. al., Brain Behav Immun. 2014 Jul 6.)
- A study was undertaken to examine the association of the serotonin transport gene and post-discharge nausea and vomiting (PDNV) in women following breast cancer surgery. It was discovered that women who inherited the LA/LA genotypes were at greater risk for nausea and vomiting when compared to women who carried any other combination of genotypes. Those women who experienced PDNV reported significantly higher anxiety and pain scores. These findings suggest that variability in the genotypes of the serotonin transport gene may help to explain the variability in PDNV in women following breast cancer surgery and why 20%-30% of patients do not respond to antiemetic medications. (Wesmiller et. al., Oncol Nurs Forum. 2014 Mar 1;41(2):195-202.)
- Susceptibility to motion sickness is a predictor of postoperative nausea and vomiting, and studies in humans suggest that genetic factors determine sensitivity to motion sickness. In a recent animal study, BOP members genetically bred musk shrews for either high or low motion sickness responsiveness. They found that while there were no significant differences in total emetic responses or emetic latency between strains after nicotine injection or CuSO4 gavage, isoflurane exposure stimulated more emesis in high versus low strain animals. These results suggests a relationship between vestibular- and inhalational anesthesia-induced emesis, and indicate genetic determinants of motion sickness in a preclinical model and a potential common mechanism for motion sickness and inhalational anesthesia-induced emesis. Future work may include genetic mapping of potential "emetic sensitivity genes" to develop novel therapies or diagnostics for patients with high risk of nausea and vomiting. (Horn et. al., Physiol Behav. 2014 Jan 30;124:129-37.)