Sickness Behaviors in Gynecologic Cancer Patients Treated with Chemotherapy

描述（由申请人提供）：研究强调了化疗期间疲劳、抑郁、睡眠和身体活动中断（即疾病行为）的普遍性和破坏性。然而，继发于化疗的疾病行为的生物学机制尚不清楚。疾病行为的一个潜在生物学机制是促炎细胞因子的增加。横断面观察性研究表明，在治疗后经历慢性癌症相关疲劳的乳腺癌幸存者中，循环的促炎细胞因子更高。尽管有这些数据，但没有研究对化疗期间和化疗后的疾病行为和促炎细胞因子之间的关系进行纵向调查。因此，与疾病行为相关的促炎细胞因子的轨迹和时间是未知的。此外，行为干预对细胞因子和疾病行为产生有益影响的成分尚不清楚；一种可能是通过增加放松的情绪。拟议的项目将通过自我报告、活动记录仪和静脉穿刺对150名接受铂和紫杉烷化疗的妇科癌症患者的疲劳、抑郁、睡眠、活动和循环促炎细胞因子进行评估。铂和紫杉烷是癌症最艰巨的治疗方案之一。患者将在第一次、第三次和第六次化疗输注的前一周和后一周，以及化疗结束后的6个月和12个月接受评估。这项研究设计将捕捉疾病行为和细胞因子在治疗期间以及早期生存期的变化。在为期12个月的评估中报告临床显著疲劳或抑郁的患者参与者将参加放松情绪的实验诱导，以测试放松对细胞因子和疾病行为的短期影响。由于未患癌症的女性也会感到疲劳、抑郁、睡眠不足和体力活动减少，并且由于关于循环中的促炎细胞因子的正常波动的数据很少，因此该研究还将评估150名未患癌症的女性样本在相当时期内的疾病行为和促炎细胞因子，这些样本根据年龄和邮政编码与患者进行了单独匹配。这项研究将提供有价值的信息，了解接受化疗的癌症患者的疾病行为和循环促炎细胞因子的自然过程，包括变化率、时间相互关系、与未患癌症的女性相比的变化。此外，它将确定诱导放松是否是减少疾病行为的行为干预的有效组成部分。这些数据将为未来研究疾病行为的生物行为机制和改善它们的干预措施奠定基础。

DESCRIPTION (provided by applicant): Research has highlighted the prevalence and disruptiveness of fatigue, depression, and disruptions in sleep and physical activity (i.e., sickness behaviors) during chemotherapy. Biological mechanisms of sickness behaviors secondary to chemotherapy remain unknown, however. One potential biological mechanism of sickness behaviors is increased pro-inflammatory cytokines. Cross-sectional observational studies suggest that circulating pro-inflammatory cytokines are higher in post-treatment breast cancer survivors who experience chronic cancer-related fatigue. Despite these data, no studies have longitudinally examined the relationship between sickness behaviors and pro-inflammatory cytokines during and after chemotherapy. The trajectory and timing of pro-inflammatory cytokines relative to sickness behaviors is therefore unknown. Moreover, the components through which behavioral interventions exert beneficial effects on cytokines and sickness behaviors is unclear; one possibility is by increasing relaxed mood. The proposed project will assess fatigue, depression, sleep, activity, and circulating pro-inflammatory cytokines via self-report, actigraphy, and venipuncture in 150 gynecologic cancer patients receiving platinum- and taxane-based chemotherapy, one of the most arduous treatment regimens for cancer. Patients will be assessed the week before and the week after their first, third, and sixth chemotherapy infusions, as well as six and twelve months after chemotherapy ends. This study design will capture changes in sickness behaviors and cytokines on-treatment as well as in the early survivorship period. Patient participants who report clinically significant fatigue or depression a the twelve month assessment will participate in an experimental induction of relaxed mood to test the short-term effects of relaxation on cytokines and sickness behaviors. Because women without cancer also experience fatigue, depression, poor sleep, and reduced physical activity, and because data are sparse regarding normal fluctuations in circulating pro-inflammatory cytokines, the study will also assess sickness behaviors, and pro-inflammatory cytokines over a comparable time period in a sample of 150 women without cancer matched individually to patients based on age and zip code. The study will provide valuable information regarding the natural course of sickness behaviors and circulating pro-inflammatory cytokines in cancer patients treated with chemotherapy, including rates of change, temporal interrelationships, variation compared to women without cancer. In addition, it will determine whether induction of relaxation is an effective component of behavioral interventions to reduce sickness behaviors. These data will form the basis for future studies examining biobehavioral mechanisms of sickness behaviors and interventions to ameliorate them.