Dyadic Study of Depression and Inflammation in Cancer Patients and Caregivers

 描述(申请人提供)：癌症患者及其家庭照顾者都比未患癌症的人更早和更频繁地面临患慢性病的风险。1、2随着癌症幸存者人数的增加，这一人群的健康下降成为受影响家庭和社会的重大关切。22、24、28-33因此，识别癌症患者和照顾者炎症升高的风险因素将为评估和干预提供目标，以改善癌症患者和照顾者的长期健康，降低他们过早虚弱和死亡的风险。在癌症患者36、37和健康人中，抑郁症都是致炎标志物的已知预测指标。38-40然而，结直肠癌患者和照顾者之间的抑郁症状和炎症之间的联系还有待研究。结直肠癌是男性和女性的第三大常见癌症。此外，众所周知，患者和照顾者相互影响对方的健康结果，但一个人的抑郁症状对其他人炎症的二元影响还有待研究。这项拟议的研究将调查抑郁症状作为前炎症标志物IL-6和C-反应蛋白(CRP)升高的心理危险因素之间的关系。这些关系将仅在结直肠癌患者中进行研究，仅在他们的家庭照顾者中进行研究， 以及病人和照顾者在一起。抑郁症状将在诊断后两个月使用CES-D进行评估；促炎细胞因子将在诊断后11个月进行测量。参与者-合作伙伴相互依赖建模将用于分析来自一个正在进行的资助项目的100个患者-护理者对偶子集的数据。拟议的培训计划以实现研究目标，包括通过赞助商的近距离说教培训、补充课程、接触国家行为医学会议、手稿准备和演讲，获得与二元研究有关的理论和分析策略的全面知识。这项培训将促进申请者的职业目标，即独立的临床研究，专门识别可改变的心理风险因素 癌症患者和照顾者的健康状况下降。由于抑郁症状可以通过低成本、简单的筛查方法检测到，并可以得到有效的治疗，如果这项研究的数据显示，患者和照顾者抑郁症状在诊断时都有希望对他们自己和他们的伴侣产生直接的、长期的免疫后果，这一发现将提供一个新的、成本效益高的初级和三级慢性病预防目标。

 DESCRIPTION (provided by applicant): Both cancer patients and their family caregivers are at risk for developing chronic diseases earlier and more frequently than those who have not been affected by cancer.1, 2 With the numbers of cancer survivors rising, health decline in this population becomes a substantial concern to both affected families and to society. Elevated inflammation is one potent marker of chronic disease development in both cancer survivors and their family caregivers.22,24,28-33 Thus, identifying risk factors for elevated inflammation in cancer patients and caregivers will provide targets for assessment and intervention to improve cancer patient and caregiver long- term health and reduce their risk for premature frailty and mortality. Depression is a known predictor of proinflammatory markers in both cancer patients36,37 and healthy persons.38- 40 However, the association between depressive symptoms and inflammation has yet to be studied in patients and caregivers of colorectal cancer, the third most common cancer in both men and women. Additionally, it is known patients and caregivers mutually influence each other's health outcomes, but the dyadic impacts of one's depressive symptoms on the others' inflammation have yet to be studied. This proposed study will investigate the relations between depressive symptoms as a psychological risk factor for elevated proinflammatory markers interleukin (IL)-6 and C-reactive protein (CRP). These relations will be studied in colorectal cancer patients alone, their family caregivers alone, and the patients and caregivers together. Depressive symptoms will be assessed using the CES-D at two months post-diagnosis; pro- inflammatory cytokines will be measured at 11 months post-diagnosis. Actor-partner interdependence modeling will be used to analyze data from a subset of 100 patient-caregiver dyads from an ongoing funded project. Proposed training plans to achieve the study aims include gaining comprehensive knowledge in theories and analytic strategies involved in dyadic research through close didadic training by the sponsor, supplemental coursework, exposure to national behavioral medicine conferences, manuscript preparation, and presentations. This training will facilitate the applicant's career goal of independent clinical research specializing in identifying modifiable psychological risk factors for health decline in cancer patients and caregivers. As depressive symptoms can be detected through low-cost, brief screening methods and can be effectively treated, if the data from this study show promise that both patient and caregiver depressive symptoms at diagnosis have direct, long-term immunological consequences for themselves and their partners, findings would offer a novel, cost-efficient primary and tertiary chronic disease prevention target.