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Early Childhood Adversity in Adult Patients with Metastatic Lung Cancer: cross-sectional analysis of symptom burden and inflammation
Brain, Behavior, and Immunity ( IF 15.1 ) Pub Date : 2020-11-01 , DOI: 10.1016/j.bbi.2020.08.006 Daniel C McFarland 1 , Christian Nelson 1 , Andrew H Miller 2
Brain, Behavior, and Immunity ( IF 15.1 ) Pub Date : 2020-11-01 , DOI: 10.1016/j.bbi.2020.08.006 Daniel C McFarland 1 , Christian Nelson 1 , Andrew H Miller 2
Affiliation
OBJECTIVE
Psychological and physical symptoms commonly occur in patients with metastatic lung cancer and are associated with reduced quality of life and decreased survival. Previous work has associated these symptoms with inflammation. The experience of Early Childhood Adversity (ECA) is linked to chronic inflammation and may identify adult cancer patients who are at-risk for psychological and physical symptoms. We thus hypothesized that ECA in lung cancer patients would be associated with increased psychological symptoms (distress, anxiety, and depression) and physical symptoms and that this relationship would be explained by inflammation. METHODS
Patients with metastatic lung cancer (n=92) were evaluated for ECA using the Risky Families Questionnaire. Concomitant assessments were made of distress (Distress Thermometer and Problem List [DT&PL]), anxiety (Generalized Anxiety Disorder-7), depression (Patient Hospital Questionniare-9), physical symptoms (DT&PL), and inflammation (C-reactive protein [CRP]). Multivariate models were created to explain associations of ECA with depression, anxiety, distress, number of physical problems, and inflammation. RESULTS
ECA was associated with distress (r=.24, p=.03), anxiety (r=.30, p=.004), depression (r=.35, p=.001), greater physical problems (r=.25, p=.03), younger age (r=-.29, p=.006), and elevated CRP (r=.22, p=.04). Multivariate analyses of outcomes found that depression severity was independently explained by both ECA and inflammation (β=.37, p=.001) but not distress or anxiety, while controlling for age and sex. Number of physical problems were also associated with ECA (β=.35, p=.004) but not inflammation. The association between ECA and physical problems was not significant after controlling for depression. CONCLUSION
ECA is associated with increased depression and physical symptoms independent of inflammation. Moreover, depression appears to mediate the impact of ECA on physical symptoms. ECA may identify patients at risk for psychological and physical symptoms.
中文翻译:
成人转移性肺癌患者的儿童早期逆境:症状负担和炎症的横断面分析
目的 转移性肺癌患者通常会出现心理和身体症状,并且与生活质量下降和生存率下降有关。以前的工作将这些症状与炎症联系起来。儿童早期逆境 (ECA) 的经历与慢性炎症有关,可能会识别出有心理和身体症状风险的成年癌症患者。因此,我们假设肺癌患者的 ECA 与心理症状(痛苦、焦虑和抑郁)和身体症状的增加有关,并且这种关系可以用炎症来解释。方法 使用风险家庭问卷对转移性肺癌患者 (n=92) 进行 ECA 评估。伴随的评估是对遇险(遇险温度计和问题清单 [DT& PL])、焦虑(广泛性焦虑症-7)、抑郁(患者医院问卷-9)、身体症状(DT&PL)和炎症(C 反应蛋白 [CRP])。创建了多变量模型来解释 ECA 与抑郁、焦虑、痛苦、身体问题的数量和炎症之间的关联。结果 ECA 与痛苦 (r=.24, p=.03)、焦虑 (r=.30, p=.004)、抑郁 (r=.35, p=.001)、更严重的身体问题 (r= .25, p=.03)、年轻 (r=-.29, p=.006) 和升高的 CRP (r=.22, p=.04)。对结果的多变量分析发现,抑郁症的严重程度由 ECA 和炎症独立解释(β=.37,p=0.001),而不是痛苦或焦虑,同时控制了年龄和性别。身体问题的数量也与 ECA 相关(β=.35,p=.004),但与炎症无关。控制抑郁后,ECA 与身体问题之间的关联不显着。结论 ECA 与抑郁和身体症状的增加有关,而与炎症无关。此外,抑郁症似乎介导了 ECA 对身体症状的影响。ECA 可以识别有心理和身体症状风险的患者。
更新日期:2020-11-01
中文翻译:
成人转移性肺癌患者的儿童早期逆境:症状负担和炎症的横断面分析
目的 转移性肺癌患者通常会出现心理和身体症状,并且与生活质量下降和生存率下降有关。以前的工作将这些症状与炎症联系起来。儿童早期逆境 (ECA) 的经历与慢性炎症有关,可能会识别出有心理和身体症状风险的成年癌症患者。因此,我们假设肺癌患者的 ECA 与心理症状(痛苦、焦虑和抑郁)和身体症状的增加有关,并且这种关系可以用炎症来解释。方法 使用风险家庭问卷对转移性肺癌患者 (n=92) 进行 ECA 评估。伴随的评估是对遇险(遇险温度计和问题清单 [DT& PL])、焦虑(广泛性焦虑症-7)、抑郁(患者医院问卷-9)、身体症状(DT&PL)和炎症(C 反应蛋白 [CRP])。创建了多变量模型来解释 ECA 与抑郁、焦虑、痛苦、身体问题的数量和炎症之间的关联。结果 ECA 与痛苦 (r=.24, p=.03)、焦虑 (r=.30, p=.004)、抑郁 (r=.35, p=.001)、更严重的身体问题 (r= .25, p=.03)、年轻 (r=-.29, p=.006) 和升高的 CRP (r=.22, p=.04)。对结果的多变量分析发现,抑郁症的严重程度由 ECA 和炎症独立解释(β=.37,p=0.001),而不是痛苦或焦虑,同时控制了年龄和性别。身体问题的数量也与 ECA 相关(β=.35,p=.004),但与炎症无关。控制抑郁后,ECA 与身体问题之间的关联不显着。结论 ECA 与抑郁和身体症状的增加有关,而与炎症无关。此外,抑郁症似乎介导了 ECA 对身体症状的影响。ECA 可以识别有心理和身体症状风险的患者。