Lopes-Júnior Luis C, Pereira-da-Silva Gabriela, Silveira Denise S C, Veronez Luciana C, Santos Jéssica C, Alonso Jonas B, Lima Regina A G
1 University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
2 University of São Paulo at Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil.
Integr Cancer Ther. 2018 Sep;17(3):928-940. doi: 10.1177/1534735418781725. Epub 2018 Jun 14.
Pediatric cancer patients experience different psychological processes during hospitalization that may regulate the immune response and affect recovery and response to cancer treatment. In this study, we aimed to examine the feasibility of longitudinal testing of psychophysiological parameters of stress and fatigue in pediatric osteosarcoma patients hospitalized for chemotherapy submitted to clown intervention; and to investigate whether changes in the levels of biomarkers are associated with psychological stress and fatigue levels in these patients after the clown intervention.
A pretest-posttest quasi-experimental pilot study was conducted at the pediatric oncology inpatient unit in a comprehensive cancer care center in Brazil including children and adolescents with osteosarcoma hospitalized for chemotherapy. Eight saliva samples were collected, comprising 4 at baseline (pre-intervention) and 4 after the clown intervention (+1, +4, +9, and +13 hours post-awakening). Salivary cortisol, α-amylase (sAA), cytokines, and matrix metalloproteinase-9 (MMP-9) levels were determined using high-sensitivity enzyme-linked immunosorbent assay (ELISA) kits. Stress and fatigue were measured by Child Stress Scale-ESI and PedsQL Multidimensional Fatigue Scale respectively. Bivariate association analysis between stress and fatigue scores and biomarker levels were investigated using nonparametric statistics. Effect sizes were calculated for each outcome variable.
Six pediatric osteosarcoma patients were enrolled with no missing data. No significant effects sizes were observed for psychophysiological outcomes. Effect sizes ranged from 0.54 (cortisol) to 0 (interleukin-1β [IL-1β]). Decreasing overall trends were observed for cortisol levels for all 6 pediatric osteosarcoma patients over time. In addition, a similar pattern of tumor necrosis factor-α (TNF-α) levels over time was found for all 6 patients. Patients with metastatic osteosarcoma showed a linear trend for a decrease in MMP-9 levels between 1 and 9 hours after the clown intervention and restoration to basal levels after 13 hours.
The results of this pilot study suggest that it is feasible longitudinally measure psychophysiological outcomes in the pediatric osteosarcoma inpatients for chemotherapy. Clown intervention merits further study as a way to reduce stress as well as fatigue, since that the stress and cytokines measurements are feasible based on our work.
儿科癌症患者在住院期间经历不同的心理过程，这些过程可能调节免疫反应并影响癌症治疗的恢复和反应。在本研究中，我们旨在检验对接受小丑干预的化疗住院小儿骨肉瘤患者进行应激和疲劳心理生理参数纵向测试的可行性；并调查小丑干预后这些患者生物标志物水平的变化是否与心理应激和疲劳水平相关。
在巴西一家综合癌症护理中心的儿科肿瘤住院部进行了一项前后测准实验性试点研究，纳入因化疗住院的骨肉瘤儿童和青少年。收集了8份唾液样本，包括基线时（干预前）4份和小丑干预后4份（醒来后+1、+4、+9和+13小时）。使用高灵敏度酶联免疫吸附测定（ELISA）试剂盒测定唾液皮质醇、α-淀粉酶（sAA）、细胞因子和基质金属蛋白酶-9（MMP-9）水平。应激和疲劳分别通过儿童应激量表-ESI和儿童生活质量多维疲劳量表进行测量。使用非参数统计方法研究应激和疲劳评分与生物标志物水平之间的双变量关联分析。计算每个结果变量的效应量。
纳入6例小儿骨肉瘤患者，无缺失数据。心理生理结果未观察到显著效应量。效应量范围从0.54（皮质醇）到0（白细胞介素-1β[IL-1β]）。随着时间推移，所有6例小儿骨肉瘤患者的皮质醇水平均呈现总体下降趋势。此外，所有6例患者的肿瘤坏死因子-α（TNF-α）水平随时间呈现相似模式。转移性骨肉瘤患者在小丑干预后1至9小时MMP-9水平呈线性下降趋势，13小时后恢复至基础水平。
这项试点研究结果表明，对化疗住院的小儿骨肉瘤患者进行心理生理结果的纵向测量是可行的。小丑干预作为减轻应激和疲劳的一种方式值得进一步研究，因为根据我们的工作，应激和细胞因子测量是可行的。
