炎症在晚期癌症疼痛、疲劳和睡眠障碍症状群中的作用。
The Role of Inflammation in the Pain, Fatigue, and Sleep Disturbance Symptom Cluster in Advanced Cancer.
机构信息
University of Wisconsin, Madison, Wisconsin, USA.
University of Wisconsin, Madison, Wisconsin, USA.
出版信息
J Pain Symptom Manage. 2018 May;55(5):1286-1295. doi: 10.1016/j.jpainsymman.2018.01.008. Epub 2018 Jan 31.
CONTEXT
Symptom researchers have proposed a model of inflammatory cytokine activity and dysregulation in cancer to explain co-occurring symptoms including pain, fatigue, and sleep disturbance.
OBJECTIVES
We tested the hypothesis that psychological stress accentuates inflammation and that stress and inflammation contribute to one's experience of the pain, fatigue, and sleep disturbance symptom cluster (symptom cluster severity, symptom cluster distress) and its impact (symptom cluster interference with daily life, quality of life).
METHODS
We used baseline data from a symptom cluster management trial. Adult participants (N = 158) receiving chemotherapy for advanced cancer reported pain, fatigue, and sleep disturbance on enrollment. Before intervention, participants completed measures of demographics, perceived stress, symptom cluster severity, symptom cluster distress, symptom cluster interference with daily life, and quality of life and provided a blood sample for four inflammatory biomarkers (interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein).
RESULTS
Stress was not directly related to any inflammatory biomarker. Stress and tumor necrosis factor-α were positively related to symptom cluster distress, although not symptom cluster severity. Tumor necrosis factor-α was indirectly related to symptom cluster interference with daily life, through its effect on symptom cluster distress. Stress was positively associated with symptom cluster interference with daily life and inversely with quality of life. Stress also had indirect effects on symptom cluster interference with daily life, through its effect on symptom cluster distress.
CONCLUSION
The proposed inflammatory model of symptoms was partially supported. Investigators should test interventions that target stress as a contributing factor in co-occurring pain, fatigue, and sleep disturbance and explore other factors that may influence inflammatory biomarker levels within the context of an advanced cancer diagnosis and treatment.
背景
症状研究人员提出了一种炎症细胞因子活动和失调的癌症模型，以解释包括疼痛、疲劳和睡眠障碍在内的同时发生的症状。
目的
我们检验了以下假设，即心理压力会加重炎症，而压力和炎症会导致人们体验到疼痛、疲劳和睡眠障碍症状群（症状群严重程度、症状群困扰）及其影响（症状群对日常生活的干扰、生活质量）。
方法
我们使用了一项症状群管理试验的基线数据。接受晚期癌症化疗的成年参与者（N=158）在入组时报告了疼痛、疲劳和睡眠障碍。在干预之前，参与者完成了人口统计学、感知压力、症状群严重程度、症状群困扰、症状群对日常生活的干扰以及生活质量的测量，并提供了一份血液样本，用于检测四种炎症生物标志物（白细胞介素-1β、白细胞介素-6、肿瘤坏死因子-α和 C 反应蛋白）。
结果
压力与任何炎症生物标志物都没有直接关系。压力和肿瘤坏死因子-α与症状群困扰呈正相关，尽管与症状群严重程度无关。肿瘤坏死因子-α通过对症状群困扰的影响，与症状群对日常生活的干扰呈间接相关。压力与症状群对日常生活的干扰呈正相关，与生活质量呈负相关。压力也通过对症状群困扰的影响，对症状群对日常生活的干扰有间接影响。
结论
提出的症状炎症模型得到了部分支持。研究人员应该测试针对压力的干预措施，压力是同时发生的疼痛、疲劳和睡眠障碍的一个促成因素，并探索在晚期癌症诊断和治疗背景下可能影响炎症生物标志物水平的其他因素。
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