Fay Wright

Abstract

Context: Cognitive and physical fatigue are common symptoms experienced by oncology patients. Exposure to stressful life events (SLE), cancer-related stressors, coping styles, and levels of resilience may influence the severity of both dimensions of fatigue. Objectives: Evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and coping in oncology patients (n=1332) with distinct cognitive fatigue AND evening physical fatigue profiles. Methods: Latent profile analysis, which combined the two symptom scores, identified three subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles (i.e., Low, Moderate, High). Patients completed measures of global, cancer-specific, and cumulative life stress as well measures of resilience and coping. Differences among the latent classes in the various measures were evaluated using parametric and nonparametric tests. Results: Compared to Low class, the other two classes reported higher global and cancer-specific stress. In addition, they reported higher occurrence rates for sexual harassment and being forced to touch prior to 16 years of age. Compared to the other two classes, High class reported lower resilience scores and higher use of denial, substance use, and behavioral disengagement. Conclusion: To decrease both cognitive and evening physical fatigue, clinicians need to assess for relevant stressors and initiate interventions to increase resilience and the use of engagement coping strategies. Additional research is warranted on the relative contribution of various social determinants of health to both cognitive and physical fatigue in oncology patients receiving chemotherapy.

Abstract

Background Depression is a growing global problem with significant individual and societal costs. Despite their consequences, depressive symptoms are poorly recognized and undertreated because wide variation in symptom presentation limits clinical identification - particularly among African American (AA) women - an understudied population at an increased risk of health inequity. Objectives The aims of this study were to explore depressive symptom phenotypes among AA women and examine associations with epigenetic, cardiometabolic, and psychosocial factors. Methods This cross-sectional, retrospective analysis included self-reported Black/AA mothers from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study (data collected in 2015-2020). Clinical phenotypes were identified using latent class analysis. Bivariate logistic regression examined epigenetic age, cardiometabolic traits (i.e., body mass index ≥ 30 kg/m2, hypertension, or diabetes), and psychosocial variables as predictors of class membership. Results All participants were Black/AA and predominantly non-Hispanic. Over half of the sample had one or more cardiometabolic traits. Two latent classes were identified (low vs. moderate depressive symptoms). Somatic and self-critical symptoms characterized the moderate symptom class. Higher stress overload scores significantly predicted moderate-symptom class membership. Discussion In this sample of AA women with increased cardiometabolic burden, increased stress was associated with depressive symptoms that standard screening tools may not capture. Research examining the effect of specific stressors and the efficacy of tools to identify at-risk AA women are urgently needed to address disparities and mental health burdens.

Abstract

Background: Moderate to severe fatigue occurs in up to 94% of patients with cancer. Recent evidence suggests that morning and evening fatigue are distinct dimensions of physical fatigue. The purposes of this study were to evaluate the transcriptome for common and distinct perturbed inflammatory pathways in patients receiving chemotherapy who reported low versus high levels of morning or low versus high levels of evening cancer-related fatigue. Methods: Patients completed questionnaires during the week prior to their chemotherapy treatment. Severity of morning and evening fatigue was evaluated using the Lee Fatigue Scale. Gene expression and pathway impact analyses (PIA) were performed in two independent samples using RNA-sequencing (n = 357) and microarray (n = 360). Patterns of interactions between and among these perturbed pathways were evaluated using a knowledge network (KN). Results: Across the PIA, nine perturbed pathways (FDR < 0.025) were common to both morning and evening fatigue, six were distinct for morning fatigue, and four were distinct for evening fatigue. KN (19 nodes, 39 edges) identified the phosphatidylinositol 3-kinase (PI3K)-Akt pathway node (perturbed in evening fatigue) with the highest betweenness (0.255) and closeness (0.255) centrality indices. The next highest betweenness centrality indices were seen in pathways perturbed in evening fatigue (i.e., nuclear factor kappa B: 0.200, natural killer cell-mediated cytotoxicity: 0.178, mitogen-activated protein kinase: 0.175). Conclusions: This study describes perturbations in common and distinct inflammatory pathways associated with morning and/or evening fatigue. PI3K-Akt was identified as a bottleneck pathway. The analysis identified potential targets for therapeutic interventions for this common and devastating clinical problem.

Abstract

Background Improving the recruitment and retention of underrepresented groups in all research areas is essential for health equity. However, achieving and retaining diverse samples is challenging. Barriers to recruitment and retention of diverse participants include socioeconomic and cultural factors and practical challenges (e.g., time and travel commitments). Objectives The purpose of this article is to describe the successful recruitment and retention strategies used by two related studies within a P20 center funded by the National Institute of Nursing Research focused on precision health research in diverse populations with multiple chronic conditions, including metabolic syndrome. Methods To address the complexity, biodiversity, and effect of metabolic syndrome and multiple chronic conditions, we developed culturally appropriate, multipronged recruitment and retention strategies for a pilot intervention study and a longitudinal observational pilot study within our P20 center. The following are the underlying principles that guided the recruitment and retention strategies: (a) flexibility, (b) active listening and bidirectional conversations, and (c) innovative problem solving. Results The intervention study (Pilot 1) enrolled 49 participants. The longitudinal observational study (Pilot 2) enrolled 45 participants. Women and racial/ethnic minorities were significantly represented in both. In Pilot 1, most of the participants completed the intervention and all phases of data collection. In Pilot 2, most participants completed all phases of data collection and chose to provide biorepository specimens. Discussion We developed a recruitment and retention plan building on standard strategies for a general medical population. Our real-world experiences informed the adaption of these strategies to facilitate the participation of individuals who often do not participate in research - specifically, women and racial/ethnic populations. Our experience across two pilot studies suggests that recruiting diverse populations should build flexibility in the research plan at the outset.

Abstract

Background: African American women (AAW) have a high risk of both cardiometabolic (CM) illness and depressive symptoms. Depressive symptoms co-occur in individuals with CM illness at higher rates than the general population, and accelerated aging may explain this. In this secondary analysis, we examined associations between age acceleration; depressive symptoms; and CM traits (hypertension, diabetes mellitus [DM], and obesity) in a cohort of AAW. Methods: Genomic and clinical data from the InterGEN cohort (n = 227) were used. Age acceleration was based on the Horvath method of DNA methylation (DNAm) age estimation. Accordingly, DNAm age acceleration (DNAm AA) was defined as the residuals from a linear regression of DNAm age on chronological age. Spearman’s correlations, linear and logistic regression examined associations between DNAm AA, depressive symptoms, and CM traits. Results: DNAm AA did not associate with total depressive symptom scores. DNAm AA correlated with specific symptoms including self-disgust/self-hate (−0.13, 95% CI −0.26, −0.01); difficulty with making decisions (−0.15, 95% CI −0.28, −0.02); and worry over physical health (0.15, 95% CI 0.02, 0.28), but were not statistically significant after multiple comparison correction. DNAm AA associated with obesity (0.08, 95% CI 1.02, 1.16), hypertension (0.08, 95% CI 1.01, 1.17), and DM (0.20, 95% CI 1.09, 1.40), after adjustment for potential confounders. Conclusions: Associations between age acceleration and depressive symptoms may be highly nuanced and dependent on study design contexts. Factors other than age acceleration may explain the connection between depressive symptoms and CM traits. AAW with CM traits may be at increased risk of accelerated aging.

Abstract

Purpose: Oncology patients receiving chemotherapy can experience both cancer and non-cancer pain. In addition, oncology patients face numerous stressors and their responses are highly variable. Stress and pain are intricately linked. The purpose of this study was to evaluate for differences in pain characteristics and mood disturbance among oncology patients with distinct stress profiles. Methods: From a sample of 957 patients with and without pain, latent profile analysis identified three groups of patients with distinct stress profiles (i.e., Stressed, Normative, Resilient). In the subset of 671 patients with pain, receiving chemotherapy for breast, lung, gastrointestinal, or gynecologic cancer, we evaluated for differences among the stress profiles in terms of pain characteristics (e.g., intensity, qualities, interference) and mood disturbance (anxiety, depressive symptoms). Results: Compared to Normative patients (n = 333; 49.6%), Stressed patients (n = 305; 45.5%) reported higher levels of pain intensity, pain interference, anxiety, and depressive symptoms and more commonly described pain as throbbing, shooting, burning, exhausting, tiring, penetrating, nagging, miserable, and unbearable. Compared to Resilient patients (n = 33; 4.9%), Stressed patients reported significantly higher mood-related pain interference scores and more severe anxiety and depressive symptoms. Conclusions: A high stress profile is common (45.5%) and is associated with more severe pain and associated symptoms. Efforts to identify and target this group for interventions may improve patient outcomes.

Abstract

Context: Pain, fatigue, sleep disturbance, and depression often co-occur in oncology patients and negatively impact quality of life (QOL). Objectives: Study purposes were to identify subgroups of patients with distinct symptom profiles based on their experiences with a pre-specified symptom cluster (i.e., pain, fatigue, depression, sleep disturbance) and to identify demographic, clinical, and symptom characteristics and QOL outcomes associated with each distinct profile. Methods: Patients with breast, lung, gastrointestinal, and gynecologic cancers (n = 1340) were recruited from outpatient clinics during their first or second cycle of chemotherapy. They completed valid and reliable measures of pain, fatigue, sleep disturbance. depression, and QOL prior to their next dose of chemotherapy. Latent class profile analysis was used to identify the patient subgroups. Differences among the profiles were evaluated using parametric and non-parametric tests. Results: Three distinct profiles were identified (i.e., Low (44.0%), Moderate (45.1%), High (10.8%). Compared to Low class, Moderate and High classes were younger and more likely to be female. Compared to the other two classes, High class was less likely to be married/partnered and employed, more likely to have a lower income and childcare responsibilities, had lower functional status, a higher body mass index, and exercised less. For both QOL scales, differences in subscale and total scores followed the same pattern (Low>Moderate>High). Conclusions: Over 55% of patients undergoing chemotherapy had a moderate to high symptom burden associated with these four common co-occurring symptoms. Multimodal interventions are needed to decrease symptom burden and improve QOL outcomes in these patients.

Abstract

Purpose: Pain and fatigue are common symptoms in oncology patients. In a sample of oncology outpatients receiving chemotherapy (n = 1342), the study purposes were to identify subgroups of patients with distinct worst pain and morning fatigue profiles and evaluate for differences among the subgroups in demographic and clinical characteristics, as well as the severity of common symptoms and quality of life (QOL) outcomes. Methods: Oncology outpatients receiving chemotherapy (n = 1342) completed self-report questionnaires to assess pain and morning fatigue, a total of six times over two cycles of chemotherapy. Joint latent profile analysis was used to identify subgroups of patients with distinct pain and morning fatigue profiles. Differences among the classes were evaluated using parametric and non-parametric tests. Results: Five distinct profiles were identified (no pain and low morning fatigue (27.6%), moderate pain and low morning fatigue (28.2%), moderate pain and morning fatigue (28.0%), moderate pain and increasing and decreasing morning fatigue (6.9%), severe pain and very high morning fatigue (9.3%)). Patients with the three worst profiles had clinically meaningful levels of depression and sleep disturbance and decrements in QOL. Conclusions: Over 44% of the sample had moderate to high levels of both pain and morning fatigue. Unrelieved pain may contribute to disturbed sleep which results in higher levels of morning fatigue. Clinicians need to assess for pain and fatigue, as well as sleep disturbance during chemotherapy.