Sleep, Inflamation, and Depression Occurrence in Breast Cancer Survivors

描述（由申请人提供）：2006年，美国有超过1140万癌症幸存者。然而，对于许多癌症患者来说，改善生存率是复杂的长期行为影响，包括抑郁症。事实上，乳腺癌幸存者的抑郁症患病率几乎是普通人群的三到五倍。然而，独特的临床，行为和生物学因素，前瞻性地有助于增加抑郁症的风险在乳腺癌幸存者是未知的。在老年人中，我们发现睡眠障碍独立地导致抑郁症的发生，这种预期风险是特定于那些有抑郁症病史的人。乳腺癌状态可能会增加这种风险，因为我们 研究人员发现，患有失眠症的乳腺癌幸存者的抑郁史患病率几乎是患有失眠症的老年女性的两倍;然而，先前风险模型中的其他因素并不能推广到乳腺癌幸存者。目前还没有发表的前瞻性数据来研究睡眠障碍对乳腺癌幸存者抑郁发生的独立影响。越来越多的证据也表明睡眠障碍与炎症信号的激活有关，炎症信号是导致抑郁症的生物学机制。因此，在这项SEER附属的基于肿瘤登记的研究中，我们将评估300名早期、老年（>55岁）乳腺癌幸存者和300名年龄匹配的对照女性，按抑郁症史分层。所有参与者都将是凯撒永久南加州（KPSC）的社区成员，这是一个大型非营利健康计划，为300多万成员提供服务。在一项前瞻性队列研究中，将在基线时评价按抑郁史分层的老年乳腺癌幸存者与对照组（即，乳腺癌存活者的初次治疗后1年）和6、12、18和24个月时，目的如下：1）确定睡眠障碍和抑郁症发生之间的前瞻性关联; 2）评估睡眠障碍和炎症的细胞和基因组标记物之间的前瞻性关联;以及3）检查睡眠障碍、炎症的细胞和基因组标记物与抑郁症发生之间的前瞻性关系。了解癌症特异性的临床，行为和生物学因素，前瞻性地有助于抑郁症的风险在乳腺癌幸存者与比较老年妇女将大大改变临床管理，导致抑郁症预防的有针对性的干预措施的发展，具体为乳腺癌幸存者。

DESCRIPTION (provided by applicant): In 2006, there were over 11.4 million cancer survivors in the US. However for many individuals with cancer, improved survival is complicated by long-term behavioral effects including depression. Indeed, the prevalence of depression in breast cancer survivors is nearly three to five times greater than the general population. Yet, the unique clinical, behavioral, and biological factors that prospectively contribute to increased depression risk in breast cancer survivors is not known. In older adults, we have found that sleep disturbance independently contributes to depression occurrence, and this prospective risk is specific to those with a history of depression. Breast cancer status may add to that risk, as we have found that breast cancer survivors with insomnia have a prevalence of depression history that is nearly twice that in older women with insomnia; yet, other factors in the prior risk model do not generalize to breast cancer survivors. There are no published prospective data that have examined the independent contribution of sleep disturbance on depression occurrence in breast cancer survivors. Increasing evidence also implicates sleep disturbance in the activation of inflammatory signaling, which serves as a biological mechanism that contributes to depression. Hence, in this SEER-affiliated tumor registry-based study, we will evaluate 300 early stage-, older adult (>55 years) breast cancer survivors and 300 age-matched comparison women, stratified by a history of major depression. All participants will be community members of Kaiser Permanente Southern California (KPSC), a large nonprofit health plan that serves over 3 million members. In a prospective cohort study, older adult breast cancer survivors vs. comparisons, stratified by depression history will be evaluated at baseline (i.e., 1 year post- primary treatmen for breast cancer survivors) and at 6, 12, 18, and 24 months with the following aims: 1) to determine the prospective association between sleep disturbance and depression occurrence; 2) to evaluate the prospective association between sleep disturbance and cellular and genomic markers of inflammation; and 3) to examine the prospective relationships between sleep disturbance, cellular and genomic markers of inflammation, and depression occurrence. Understanding the cancer-specific clinical, behavioral, and biological factors that prospectively contribute to depression risk in breast cancer survivors vs. comparison older women will substantially alter clinical management by leading to the development of a targeted intervention for depression prevention, specific for breast cancer survivors.