Han Tatiana J, Felger Jennifer C, Lee Anna, Mister Donna, Miller Andrew H, Torres Mylin A
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA.
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Psychooncology. 2016 Feb;25(2):187-93. doi: 10.1002/pon.3831. Epub 2015 May 14.
This pilot study examined whether breast cancer patients with childhood trauma exhibit increased fatigue, depression, and stress in association with inflammation as a result of whole breast radiotherapy (RT).
Twenty breast cancer patients were enrolled in a prospective, longitudinal study of fatigue, depression, and perceived stress prior to RT, week 6 of RT, and 6 weeks post-RT. Six weeks after RT, subjects completed the childhood trauma questionnaire (CTQ). Patients were also administered the multidimensional fatigue inventory, inventory of depressive symptomatology-self-reported, and perceived stress scale at all three time-points and underwent blood sampling prior to RT for gene expression and inflammatory markers previously associated with childhood trauma and behavioral symptoms in breast cancer patients.
Eight subjects (40%) had past childhood trauma (CTQ+). Compared to CTQ- patients, CTQ+ patients had significantly higher fatigue, depression, and stress scores before, during, and after RT (p < 0.05); however, RT did not increase these symptoms in either group. CTQ+ patients also exhibited increased baseline expression of gene transcripts related to inflammatory signaling, and baseline inflammatory markers including c-reactive protein, interleukin (IL)-6, and IL-1 receptor antagonist were positively correlated with depression, fatigue, and stress scores in CTQ+ but not CTQ- patients.
Childhood trauma was prevalent and was associated with increased symptoms of fatigue, depression, and stress irrespective of RT. Increased symptoms in CTQ+ patients were also associated with baseline inflammatory markers. Treatments targeting childhood trauma and related inflammation may improve symptoms in breast cancer patients.
本初步研究探讨了童年期受过创伤的乳腺癌患者在接受全乳放疗（RT）后，是否会因炎症而出现疲劳、抑郁和压力增加的情况。
20名乳腺癌患者参与了一项关于疲劳、抑郁和感知压力的前瞻性纵向研究，研究时间点为放疗前、放疗第6周以及放疗后6周。放疗6周后，受试者完成童年创伤问卷（CTQ）。在所有三个时间点，患者还接受了多维疲劳量表、抑郁症状自评量表和感知压力量表的评估，并在放疗前进行了血液采样，以检测先前与乳腺癌患者童年创伤和行为症状相关的基因表达和炎症标志物。
8名受试者（40%）有童年创伤史（CTQ+）。与CTQ-患者相比，CTQ+患者在放疗前、放疗期间和放疗后的疲劳、抑郁和压力评分显著更高（p<0.05）；然而，放疗并未使两组患者的这些症状加重。CTQ+患者还表现出与炎症信号相关的基因转录本基线表达增加，并且基线炎症标志物包括C反应蛋白、白细胞介素（IL）-6和IL-1受体拮抗剂与CTQ+患者的抑郁、疲劳和压力评分呈正相关，但与CTQ-患者无关。
童年创伤很常见，且与疲劳、抑郁和压力症状增加相关，与放疗无关。CTQ+患者症状增加也与基线炎症标志物有关。针对童年创伤和相关炎症的治疗可能会改善乳腺癌患者的症状。
