Reis Joaquim C, Antoni Michael H, Travado Luzia
Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal.
Department of Psychology, University of Miami, Coral Gables, Florida, USA.
CNS Spectr. 2020 Feb;25(1):79-100. doi: 10.1017/S1092852918001621.
Despite emerging evidence that distress and adversity can contribute to negative health outcomes in cancer, little is known about the brain networks, regions, or circuits that can contribute to individual differences in affect/distress states and health outcomes in treated cancer patients. To understand the state-of-the-science in this regard, we reviewed neuroimaging studies with cancer patients that examined the associations between negative affect (distress) and changes in the metabolism or structure of brain regions. Cancer patients showed changes in function and/or structure of key brain regions such as the prefrontal cortex, thalamus, amygdala, hippocampus, cingulate cortex (mainly subgenual area), hypothalamus, basal ganglia (striatum and caudate), and insula, which are associated with greater anxiety, depression, posttraumatic stress disorder (PTSD) symptoms, and distress. These results provide insights for understanding the effects of these psychological and emotional factors on peripheral stress-related biobehavioral pathways known to contribute to cancer progression and long-term health outcomes. This line of work provides leads for understanding the brain-mediated mechanisms that may explain the health effects of psychosocial interventions in cancer patients and survivors. A multilevel and integrated model for distress management intervention effects on psychological adaptation, biobehavioral processes, cancer pathogenesis, and clinical outcomes is proposed for future research.
尽管越来越多的证据表明，痛苦和逆境会导致癌症患者出现负面健康结果，但对于哪些脑网络、区域或神经回路会导致接受治疗的癌症患者在情感/痛苦状态和健康结果方面存在个体差异，我们却知之甚少。为了了解这方面的科学现状，我们回顾了针对癌症患者的神经影像学研究，这些研究考察了负面影响（痛苦）与脑区代谢或结构变化之间的关联。癌症患者的关键脑区，如前额叶皮质、丘脑、杏仁核、海马体、扣带回皮质（主要是膝下区域）、下丘脑、基底神经节（纹状体和尾状核）和脑岛，其功能和/或结构发生了变化，这些变化与更高的焦虑、抑郁、创伤后应激障碍（PTSD）症状和痛苦有关。这些结果为理解这些心理和情感因素对已知会促进癌症进展和长期健康结果的外周应激相关生物行为途径的影响提供了见解。这一系列工作为理解可能解释心理社会干预对癌症患者和幸存者健康影响的脑介导机制提供了线索。本文提出了一个多层次综合模型，用于未来研究痛苦管理干预对心理适应、生物行为过程、癌症发病机制和临床结果的影响。
