Faculty

John Merriman headshot

John Merriman

PhD RN

Assistant Professor

1 212 998 5375

433 First Avenue
Room 426
New York, NY 10010
United States

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Professional overview

Dr. Merriman’s research is focused on changes in cognitive function after a diagnosis of cancer.  He is particularly interested in biobehavioral predictors of these cognitive changes, including functional and structural brain markers, genomic markers, and mood.  Prior to his faculty appointment, he was a postdoctoral associate at the University of Pittsburgh School of Nursing and a doctoral student at the University of California, San Francisco School of Nursing.

Education

University of California, San Francisco PhD, Nursing
University of California, San Francisco MS, Nursing
Mississippi College BS, Communication

Honors and awards

University of Pittsburgh Postdoctoral Association Postdoctoral Alumni Award (2016)
Sigma Theta Tau International inductee (2006)
Mortar Board inductee (1993)

Professional membership

Oncology Nursing Society
Sigma Theta Tau International
International Society of Nurses in Genetics

Publications

Publications

Associations between catecholaminergic, GABAergic, and serotonergic genes and self-reported attentional function in oncology patients and their family caregivers

Merriman, J. D., Aouizerat, B. E., Cataldo, J. K., Dunn, L. B., Kober, K., Langford, D. J., West, C., Cooper, B. A., Paul, S. M., & Miaskowski, C. (2015). European Journal of Oncology Nursing, 19(3), 251-259. 10.1016/j.ejon.2014.11.004
Abstract
Purpose of the research: Evaluate for associations between variations in genes involved in catecholaminergic, gamma-aminobutyric acid (GABA)-ergic, and serotonergic mechanisms of neurotransmission and attentional function latent classes. Patients and methods: This descriptive, longitudinal study was conducted at two radiation therapy departments. The sample included three latent classes of individuals with distinct trajectories of self-reported attentional function during radiation therapy, who were previously identified using growth mixture modeling among 167 oncology patients and 85 of their family caregivers. Multivariable models were used to evaluate for genotypic associations of neurotransmission genes with attentional function latent class membership, after controlling for covariates. Results: Variations in catecholaminergic (i.e., ADRA1D rs4815675, SLC6A3 rs37022), GABAergic (i.e., SLC6A1 rs2697138), and serotonergic (i.e., HTR2A rs2296972, rs9534496) neurotransmission genes were significant predictors of latent class membership in multivariable models. Conclusions: Findings suggest that variations in genes that encode for three distinct but related neurotransmission systems are involved in alterations in attentional function. Knowledge of both phenotypic and genetic markers associated with alterations in attentional function can be used by clinicians to identify patients and family caregivers who are at higher risk for this symptom. Increased understanding of the genetic markers associated with alterations in attentional function may provide insights into the underlying mechanisms for this significant clinical problem.

Associations Between Cytokine Genes and a Symptom Cluster of Pain, Fatigue, Sleep Disturbance, and Depression in Patients Prior to Breast Cancer Surgery

Doong, S. H., Dhruva, A., Dunn, L. B., West, C., Paul, S. M., Cooper, B. A., Elboim, C., Abrams, G., Merriman, J. D., Langford, D. J., Leutwyler, H., Baggott, C., Kober, K., Aouizerat, B. E., & Miaskowski, C. (2015). Biological Research for Nursing, 17(3), 237-247. 10.1177/1099800414550394
Abstract
Pain, fatigue, sleep disturbance, and depression are common and frequently co-occurring symptoms in oncology patients. This symptom cluster is often attributed to the release of proinflammatory cytokines. The purposes of this study were to determine whether distinct latent classes of patients with breast cancer (n = 398) could be identified based on their experience with this symptom cluster, whether patients in these latent classes differed on demographic and clinical characteristics and whether variations in cytokine genes were associated with latent class membership. Three distinct latent classes were identified: “all low” (61.0%), “low pain and high fatigue” (31.6%), “all high” (7.1%). Compared to patients in the all low class, patients in the all high class were significantly younger, had less education, were more likely to be non-White, had a lower annual income, were more likely to live alone, had a lower functional status, had a higher comorbidity score, and had more advanced disease. Significant associations were found between interleukin 6 (IL6) rs2069845, IL13 rs1295686, and tumor necrosis factor alpha rs18800610 and latent class membership. Findings suggest that variations in pro- and anti-inflammatory cytokine genes are associated with this symptom cluster in breast cancer patients.

Cytokine Gene Associations With Self-Report Ratings of Morning and Evening Fatigue in Oncology Patients and Their Family Caregivers

Dhruva, A., Aouizerat, B. E., Cooper, B., Paul, S. M., Dodd, M., West, C., Wara, W., Lee, K., Dunn, L. B., Langford, D. J., Merriman, J. D., Baggott, C., Cataldo, J., Ritchie, C., Kober, K. M., Leutwyler, H., & Miaskowski, C. (2015). Biological Research for Nursing, 17(2), 175-184. 10.1177/1099800414534313
Abstract
The purpose of this study was to evaluate for differences in variations in pro- and anti-inflammatory cytokine genes between participants who were classified as having low and high levels of morning and evening fatigue and to evaluate for differences in phenotypic characteristics between these two groups. In a sample of 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 of their family caregivers, growth mixture modeling was used to identify latent classes of individuals based on ratings of morning and evening fatigue obtained prior to, during, and for 4 months following completion of radiation therapy. Differences in single nucleotide polymorphisms and haplotypes in 15 cytokine genes were evaluated between the latent classes. Multiple logistic regression was used to assess the effect of phenotypic and genotypic characteristics on morning and evening fatigue class membership. Associations were found between morning fatigue and number of comorbidities as well as variations in tumor necrosis factor alpha (TNFA) rs1800629 and rs3093662. Evening fatigue was associated with caring for children at home and variations in interleukin 4 (IL4) rs2243248 and TNFA rs2229094. Younger age and lower performance status were associated with both morning and evening fatigue. These findings suggest that inflammatory mediators are associated with the development of morning and evening fatigue. However, because different phenotypic characteristics and genomic markers are associated with diurnal variations in fatigue, morning and evening fatigue may be distinct but related symptoms.

Cytokine gene variations associated with trait and state anxiety in oncology patients and their family caregivers

Miaskowski, C., Cataldo, J. K., Baggott, C. R., West, C., Dunn, L. B., Dhruva, A., Merriman, J. D., Langford, D. J., Kober, K. M., Paul, S. M., Cooper, B. A., & Aouizerat, B. E. (2015). Supportive Care in Cancer, 23(4), 953-965. 10.1007/s00520-014-2443-5
Abstract
Purpose: Anxiety is common among cancer patients and their family caregivers (FCs) and is associated with poorer outcomes. Recently, associations between inflammation and anxiety were identified. However, the relationship between variations in cytokine genes and anxiety warrants investigation. Therefore, phenotypic and genotypic characteristics associated with trait and state anxiety were evaluated in a sample of 167 oncology patients with breast, prostate, lung, or brain cancer and 85 of their FCs. Methods: Using multiple regression analyses, the associations between participants’ demographic and clinical characteristics as well as variations in cytokine genes and trait and state anxiety were evaluated. Results: In the bivariate analyses, a number of phenotypic characteristics were associated with both trait and state anxiety (e.g., age, functional status). However, some associations were specific only to trait anxiety (e.g., number of comorbid conditions) or state anxiety (e.g., participation with a FC). Variations in three cytokine genes (i.e., interleukin (IL) 1 beta, IL1 receptor 2 (IL1R2), nuclear factor kappa beta 2 (NFKB2)) were associated with trait anxiety, and variations in two genes (i.e., IL1R2, tumor necrosis factor alpha (TNFA)) were associated with state anxiety. Conclusions: These findings suggest that both trait and state anxiety need to be assessed in oncology patients and their FCs. Furthermore, variations in cytokine genes may contribute to higher levels of anxiety in oncology patients and their FCs.

Association between an interleukin 1 receptor, type I promoter polymorphism and self-reported attentional function in women with breast cancer

Merriman, J. D., Aouizerat, B. E., Cataldo, J. K., Dunn, L., Cooper, B. A., West, C., Paul, S. M., Baggott, C. R., Dhruva, A., Kober, K., Langford, D. J., Leutwyler, H., Ritchie, C. S., Abrams, G., Dodd, M., Elboim, C., Hamolsky, D., Melisko, M., & Miaskowski, C. (2014). Cytokine, 65(2), 192-201. 10.1016/j.cyto.2013.11.003
Abstract
Subgroups of patients with breast cancer may be at greater risk for cytokine-induced changes in cognitive function after diagnosis and during treatment. The purposes of this study were to identify subgroups of patients with distinct trajectories of attentional function and evaluate for phenotypic and genotypic (i.e., cytokine gene polymorphisms) predictors of subgroup membership. Self-reported attentional function was evaluated in 397 patients with breast cancer using the Attentional Function Index before surgery and for six months after surgery (i.e., seven time points). Using growth mixture modeling, three attentional function latent classes were identified: High (41.6%), Moderate (25.4%), and Low-moderate (33.0%). Patients in the Low-moderate class were significantly younger than those in the High class, with more comorbidities and lower functional status than the other two classes. No differences were found among the classes in years of education, race/ethnicity, or other clinical characteristics. DNA was recovered from 302 patients' samples. Eighty-two single nucleotide polymorphisms among 15 candidate genes were included in the genetic association analyses. After controlling for age, comorbidities, functional status, and population stratification due to race/ethnicity, IL1R1 rs949963 remained a significant genotypic predictor of class membership in the multivariable model. Carrying the rare "A" allele (i.e., GA. +. AA) was associated with a twofold increase in the odds of belonging to a lower attentional function class (OR: 1.98; 95% CI: 1.18, 3.30; p=.009). Findings provide evidence of subgroups of women with breast cancer who report distinct trajectories of attentional function and of a genetic association between subgroup membership and an IL1R1 promoter polymorphism.

Associations between cytokine gene variations and self-reported sleep disturbance in women following breast cancer surgery

Alfaro, E., Dhruva, A., Langford, D. J., Koetters, T., Merriman, J. D., West, C., Dunn, L. B., Paul, S. M., Cooper, B., Cataldo, J., Hamolsky, D., Elboim, C., Kober, K., Aouizerat, B. E., & Miaskowski, C. (2014). European Journal of Oncology Nursing, 18(1), 85-93. 10.1016/j.ejon.2013.08.004
Abstract
Purpose of the research: To attempt to replicate the associations found in our previous study of patients and family caregivers between interleukin 6 (IL6) and nuclear factor kappa beta 2 (NFKB2) and sleep disturbance and to identify additional genetic associations in a larger sample of patients with breast cancer. Methods and sample: Patients with breast cancer (n=398) were recruited prior to surgery and followed for six months. Patients completed a self-report measure of sleep disturbance and provided a blood sample for genomic analyses. Growth mixture modeling was used to identify distinct latent classes of patients with higher and lower levels of sleep disturbance. Key results: Patients who were younger and who had higher comorbidity and lower functional status were more likely to be in the high sustained sleep disturbance class. Variations in three cytokine genes (i.e., IL1 receptor 2 (IL1R2), IL13, NFKB2) predicted latent class membership. Conclusions: Polymorphisms in cytokine genes may partially explain inter-individual variability in sleep disturbance. Determination of high risk phenotypes and associated molecular markers may allow for earlier identification of patients at higher risk for developing sleep disturbance and lead to the development of more targeted clinical interventions.

Associations between cytokine gene variations and severe persistent breast pain in women following breast cancer surgery

Stephens, K., Cooper, B. A., West, C., Paul, S. M., Baggott, C. R., Merriman, J. D., Dhruva, A., Kober, K. M., Langford, D. J., Leutwyler, H., Luce, J. A., Schmidt, B. L., Abrams, G. M., Elboim, C., Hamolsky, D., Levine, J. D., Miaskowski, C., & Aouizerat, B. E. (2014). Journal of Pain, 15(2), 169-180. 10.1016/j.jpain.2013.09.015
Abstract
Persistent pain following breast cancer surgery is a significant clinical problem. Although immune mechanisms may play a role in the development and maintenance of persistent pain, few studies have evaluated for associations between persistent breast pain following breast cancer surgery and variations in cytokine genes. In this study, associations between previously identified extreme persistent breast pain phenotypes (ie, no pain vs severe pain) and single nucleotide polymorphisms (SNPs) spanning 15 cytokine genes were evaluated. In unadjusted analyses, the frequency of 13 SNPs and 3 haplotypes in 7 genes differed significantly between the no pain and severe pain classes. After adjustment for preoperative breast pain and the severity of average postoperative pain, 1 SNP (ie, interleukin [IL] 1 receptor 2 rs11674595) and 1 haplotype (ie, IL10 haplotype A8) were associated with pain group membership. These findings suggest a role for cytokine gene polymorphisms in the development of persistent breast pain following breast cancer surgery. Perspective This study evaluated for associations between cytokine gene variations and the severity of persistent breast pain in women following breast cancer surgery. Variations in 2 cytokine genes were associated with severe breast pain. The results suggest that cytokines play a role in the development of persistent postsurgical pain.

Cytokine candidate genes predict the development of secondary lymphedema following breast cancer surgery

Leung, G., Baggott, C., West, C., Elboim, C., Paul, S. M., Cooper, B. A., Abrams, G., Dhruva, A., Schmidt, B. L., Kober, K., Merriman, J. D., Leutwyler, H., Neuhaus, J., Langford, D., Smoot, B. J., Aouizerat, B. E., & Miaskowski, C. (2014). Lymphatic Research and Biology, 12(1), 10-22. 10.1089/lrb.2013.0024
Abstract
Background: Lymphedema (LE) is a frequent complication following breast cancer treatment. While progress is being made in the identification of phenotypic risk factors for the development of LE, little information is available on the molecular characterization of LE. The purpose of this study was to determine if variations in pro-and anti-inflammatory cytokine genes were associated with LE following breast cancer treatment. Methods and Results: Breast cancer patients completed a number of self-report questionnaires. LE was evaluated using bioimpedance spectroscopy. Genotyping was done using a custom genotyping array. No differences were found between patients with (n=155) and without LE (n=387) for the majority of the demographic and clinical characteristics. Patients with LE had a significantly higher body mass index, more advanced disease, and a higher number of lymph nodes removed. Genetic associations were identified for three genes (i.e., interleukin (IL4) 4 (rs2227284), IL 10 (rs1518111), and nuclear kappa factor beta 2 (NFKB2 (rs1056890)) associated with inflammatory responses. Conclusions: These genetic associations suggest a role for a number of pro-and anti-inflammatory genes in the development of LE following breast cancer treatment.

Cytokine gene variations associated with subsyndromal depressive symptoms in patients with breast cancer

Saad, S., Dunn, L. B., Koetters, T., Dhruva, A., Langford, D. J., Merriman, J. D., West, C., Paul, S. M., Cooper, B., Cataldo, J., Hamolsky, D., Elboim, C., Aouizerat, B. E., & Miaskowski, C. (2014). European Journal of Oncology Nursing, 18(4), 397-404. 10.1016/j.ejon.2014.03.009
Abstract
Purpose: This study explored the relationships between variations in cytokines genes and depressive symptoms in a sample of patients who were assessed prior to and for six months following breast cancer surgery. Phenotypic differences between Resilient (n = 155) and Subsyndromal (n = 180) depressive symptom classes, as well as variations in cytokine genes were evaluated. Method: Patients were recruited prior to surgery and followed for six months. Growth mixture modeling was used to identify distinct latent classes based on Center for Epidemiological Studies Depression (CES-D) Scale scores. Eighty-two single nucleotide polymorphisms and 35 haplotypes among 15 candidate cytokine genes were evaluated. Results: Patients in the Subsyndromal class were significantly younger, more likely to be married or partnered, and reported a significantly lower functional status. Variation in three cytokine genes (i.e., interferon gamma receptor 1 (IFNGR1 rs9376268), interleukin 6 (IL6 rs2069840), tumor necrosis factor alpha (TNFA rs1799964)), as well as age and functional status predicted membership in the Subsyndromal versus the Resilient class. Conclusions: A variation in TNFA that was associated with Subsyndromal depressive symptoms in a sample of patients and their family caregivers was confirmed in this sample. Variations in cytokine genes may place these patients at higher risk for the development of Subsyndromal levels of depressive symptoms.

Differences in the symptom experience of older oncology outpatients

Ritchie, C., Dunn, L. B., Paul, S. M., Cooper, B. A., Skerman, H., Merriman, J. D., Aouizerat, B., Alexander, K., Yates, P., Cataldo, J., & Miaskowski, C. (2014). Journal of Pain and Symptom Management, 47(4), 697-709. 10.1016/j.jpainsymman.2013.05.017
Abstract
Context The relatively low number of older patients in cancer trials limits knowledge of how older adults experience symptoms associated with cancer and its treatment. Objectives This study evaluated for differences in the symptom experience across four older age groups (60-64, 65-69, 70-74, 75 years). Methods Demographic, clinical, and symptom data from 330 patients aged >60 years who participated in one Australian and two U.S. studies were evaluated. The Memorial Symptom Assessment Scale was used to evaluate the occurrence, severity, frequency, and distress of 32 symptoms commonly associated with cancer and its treatment. Results On average, regardless of the age group, patients reported 10 concurrent symptoms. The most prevalent symptoms were physical in nature. Worrying was the most common psychological symptom. For 28 (87.5%) of the 32 Memorial Symptom Assessment Scale symptoms, no age-related differences were found in symptom occurrence rates. For symptom severity ratings, an age-related trend was found for difficulty swallowing. As age increased, severity of difficulty swallowing decreased. For symptom frequency, age-related trends were found for feeling irritable and diarrhea, with both decreasing in frequency as age increased. For symptom distress, age-related trends were found for lack of energy, shortness of breath, feeling bloated, and difficulty swallowing. As age increased, these symptoms received lower average distress ratings. Conclusion Additional research is warranted to examine how age differences in symptom experience are influenced by treatment differences, aging-related changes in biological or psychological processes, or age-related response shift.

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