title: The relationship of cancer symptom clusters to depressive affect in the initial phase of palliative radiation.
abstract: Research on comorbidity across cancer symptoms, including pain, fatigue, and depression, could suggest if crossover effects from symptom-specific interventions are plausible. Secondary analyses were conducted on a survey of 268 cancer patients with recurrent disease from a northeastern U.S. city who were initiating palliative radiation for bone pain. Moderator regression analyses predicted variation in depressive affect that could be attributed to symptom clusters. Patients self-reported difficulty controlling each physical symptom over the past month on a Likert scale and depressive symptoms on a validated depression measure (Center for Epidemiologic Studies-Depression [CES-D]) over the past week on a four-category scale. An index of depressive affect was based on items of negative and positive affect from the CES-D. In predicting depressive affect, synergistic interactions of pain with fever, fatigue, and weight loss suggest separate pathways involving pain. A similar interaction with fever occurs when nausea was tested in place of pain. Further, the interaction between pain and fatigue is similar in form to the interaction between difficulty breathing and fatigue (when sleep is not a problem). Follow-up to the latter interaction reveals: 1) additional moderation by hypertension and palliative radiation to the hip/pelvis; and 2) a similar cluster not involving hypertension when appetite problems and weight loss were tested in place of fatigue. The significance and form of these interactions are remarkably consistent. Similar sickness mechanisms could be generating: 1) pain and nausea during fever; 2) pain and fatigue during weight loss; and 3) pain and breathing difficulty when fatigue is pronounced. Crossover effects from symptom-specific interventions appear promising.
authors.affiliation: Columbia University School of Social Work, New York, NY 10027, USA.
authors.forename: Richard Benoit
authors.initials: RB
authors.lastname: Francoeur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy* / Q000556:secondary; D015897:Comorbidity; D003625:Data Collection; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000517:prevention & control*; D010166:Palliative Care / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology
references.citation: Psychooncology. 2001 Mar-Apr;10(2):156-65
references.pmid: 11268142
references.citation: Psychiatry Res. 1981 Oct;5(2):171-81
references.pmid: 6945612
references.citation: Am J Nurs. 1988 Jan;88(1):99-100
references.pmid: 3337154
references.citation: Cancer. 1998 Feb 15;82(4):760-5
references.pmid: 9477110
references.citation: Endocrinology. 1999 Sep;140(9):4359-66
references.pmid: 10465310
references.citation: J Clin Oncol. 2000 Feb;18(4):743-53
references.pmid: 10673515
references.citation: Ann N Y Acad Sci. 1998 Sep 29;856:132-138
references.pmid: 9917873
references.citation: Endocr Rev. 1996 Feb;17(1):64-102
references.pmid: 8641224
references.citation: Psychooncology. 2001 Jan-Feb;10(1):19-28
references.pmid: 11180574
references.citation: J Pain Symptom Manage. 2001 Apr;21(4):323-9
references.pmid: 11312047
references.citation: J Clin Oncol. 2000 May;18(10):2143-51
references.pmid: 10811680
references.citation: Arch Intern Med. 2003 May 12;163(9):1115; author reply 1115-6
references.pmid: 12742818
references.citation: J Gerontol. 1989 May;44(3):S110-20
references.pmid: 2715592
references.citation: Cancer. 2002 Jan 15;94(2):528-38
references.pmid: 11900238
references.citation: Cancer Control. 1997 Oct;4(5):419-428
references.pmid: 10763050
references.citation: J Exp Biol. 1999 Mar;202(Pt 5):623-30
references.pmid: 9929463
references.citation: J Clin Oncol. 2003 Nov 1;21(21):4066-7; author reply 4067-8
references.pmid: 14581432
references.citation: Med Hypotheses. 2000 Jan;54(1):126-30
references.pmid: 10790737
references.citation: J Clin Oncol. 2003 Apr 1;21(7):1373-8
references.pmid: 12663729
references.citation: Radiother Oncol. 1999 Aug;52(2):101-9
references.pmid: 10577695
references.citation: Support Care Cancer. 1995 Mar;3(2):135-8
references.pmid: 7539701
references.citation: Palliat Med. 2002 Nov;16(6):488-94
references.pmid: 12465695
references.citation: Radiother Oncol. 1999 Aug;52(2):111-21
references.pmid: 10577696
references.citation: J Psychosom Res. 1999 May;46(5):437-43
references.pmid: 10404478
references.citation: Cancer. 1999 May 15;85(10):2273-7
references.pmid: 10326708
references.citation: Child Adolesc Psychiatr Clin N Am. 2000 Jul;9(3):605-46, viii
references.pmid: 10944659
references.citation: Br Med Bull. 1996 Jul;52(3):597-617
references.pmid: 8949260
references.citation: Cancer. 1982 Sep 1;50(5):893-9
references.pmid: 6178497
references.citation: J Immunol. 1988 Sep 1;141(5):1522-8
references.pmid: 2842396
references.citation: Brain Res. 1996 Mar 4;711(1-2):163-74
references.pmid: 8680860
references.citation: Psychiatry Res. 1996 Oct 16;64(3):161-7
references.pmid: 8944394
references.citation: N Engl J Med. 1993 May 6;328(18):1323-32
references.pmid: 8469254
references.citation: Psychosomatics. 1999 Nov-Dec;40(6):510-2
references.pmid: 10581980
references.citation: J Pain Symptom Manage. 1988 Spring;3(2):81-5
references.pmid: 3356918
references.citation: Semin Clin Neuropsychiatry. 1996 Oct;1(4):304-314
references.pmid: 10320433
references.citation: J Palliat Med. 2002 Apr;5(2):301-4
references.pmid: 12006233
references.citation: Gerontologist. 2002 Oct;42 Spec No 3:99-103
references.pmid: 12415139
references.citation: Radiother Oncol. 1998 Jun;47(3):233-40
references.pmid: 9681885
references.citation: J Pain Symptom Manage. 1999 May;17(5):320-32
references.pmid: 10355211
references.citation: J Pain Symptom Manage. 2004 Jan;27(1):1-3
references.pmid: 14711462
references.citation: Trends Neurosci. 2001 Aug;24(8):450-5
references.pmid: 11476884
references.citation: Br J Cancer. 1992 Jul;66(1):198-203
references.pmid: 1379060
references.citation: Brain Behav Immun. 2003 Feb;17 Suppl 1:S112-8
references.pmid: 12615196
references.citation: Neuroimmunomodulation. 1995 Jul-Aug;2(4):203-15
references.pmid: 8963749
references.citation: Med Hypotheses. 1999 Feb;52(2):155-62
references.pmid: 10340296
references.citation: N Engl J Med. 1981 Dec 31;305(27):1651
references.pmid: 7312015
references.citation: Arch Surg. 1988 Aug;123(8):992-9
references.pmid: 3293552
references.citation: Am J Physiol Regul Integr Comp Physiol. 2001 Apr;280(4):R929-34
references.pmid: 11247812
references.citation: Acta Anaesthesiol Scand. 1999 Oct;43(9):939-47
references.pmid: 10522741
references.citation: Medicine (Baltimore). 1995 Mar;74(2):74-82
references.pmid: 7891545
references.citation: Neuroendocrinology. 1995 Jul;62(1):13-8
references.pmid: 7566433
references.citation: Psychooncology. 2002 Jan-Feb;11(1):12-22
references.pmid: 11835589
references.citation: J Pain Symptom Manage. 1997 Apr;13(4):220-32
references.pmid: 9136233
references.citation: Brain Behav Immun. 2003 Feb;17 Suppl 1:S132-4
references.pmid: 12615199
references.citation: Brain Behav Immun. 2003 Feb;17 Suppl 1:S41-7
references.pmid: 12615185
references.citation: Trends Pharmacol Sci. 1992 Jan;13(1):24-8
references.pmid: 1542935
references.citation: Cancer. 2003 Jul 1;98(1):198-203
references.pmid: 12833472
references.citation: Cancer. 1994 Nov 1;74(9):2570-8
references.pmid: 7923013
references.citation: Cancer. 2001 Sep 15;92(6 Suppl):1678-83
references.pmid: 11598886
references.citation: J Immunol. 1986 Aug 1;137(3):858-62
references.pmid: 3487590
references.citation: Pain. 1997 Jun;71(2):149-56
references.pmid: 9211476
references.citation: J Pain Symptom Manage. 1999 Apr;17(4):248-55
references.pmid: 10203877
references.citation: Am J Psychiatry. 2000 May;157(5):683-94
references.pmid: 10784457
references.citation: Clin Infect Dis. 1997 Jul;25(1):119-38
references.pmid: 9243046
references.citation: J Palliat Med. 2003 Jun;6(3):351-4
references.pmid: 14509480
references.citation: J Pain Symptom Manage. 2002 Jun;23(6):490-500
references.pmid: 12067773
references.citation: Cancer Control. 2002 Nov-Dec;9(6):480-9
references.pmid: 12514566
references.citation: Hypertension. 2002 Nov;40(5):604-8; discussion 601-3
references.pmid: 12411450
references.citation: Arch Intern Med. 1998 Feb 23;158(4):397-404
references.pmid: 9487237
references.citation: Pain. 2001 Dec;94(3):231-244
references.pmid: 11731060
references.citation: N Engl J Med. 1999 Sep 16;341(12):893-900
references.pmid: 10486422
references.citation: Cancer Invest. 2003;21(4):526-35
references.pmid: 14533442
references.citation: J Pain Symptom Manage. 1994 Nov;9(8):515-9
references.pmid: 7531736
references.citation: Neurosci Biobehav Rev. 1988 Summer;12(2):123-37
references.pmid: 3050629
references.citation: Cancer. 2001 Sep 15;92(6 Suppl):1699-707
references.pmid: 11598890
references.citation: J Clin Oncol. 2000 Feb;18(4):893-903
references.pmid: 10673533
references.citation: Auton Neurosci. 2000 Dec 20;85(1-3):127-32
references.pmid: 11189019
references.citation: Psychother Psychosom. 1996;65(4):171-82
references.pmid: 8843497
references.citation: J Neurosci. 2001 Apr 15;21(8):2808-19
references.pmid: 11306633
references.citation: Cancer. 1990 Sep 15;66(6):1279-82
references.pmid: 2205358
references.citation: Cancer. 2001 Sep 15;92(6 Suppl):1684-8
references.pmid: 11598887
references.citation: Arch Intern Med. 2002 Oct 28;162(19):2204-8
references.pmid: 12390063
references.citation: Cancer Res. 1999 Sep 15;59(18):4493-501
references.pmid: 10493494
references.citation: N Engl J Med. 1999 Jul 29;341(5):362-3
references.pmid: 10423472
references.citation: J Pain Symptom Manage. 2001 Jun;21(6):456-66
references.pmid: 11397603
references.citation: Int J Immunopharmacol. 1995 Aug;17(8):677-83
references.pmid: 8847162
references.citation: Ann Oncol. 1998 Mar;9(3):297-306
references.pmid: 9602264
references.citation: Brain Behav Immun. 2003 Feb;17 Suppl 1:S125-31
references.pmid: 12615198
references.citation: Neuroimmunomodulation. 1995 Nov-Dec;2(6):319-28
references.pmid: 8840334
references.citation: Neuropsychopharmacology. 2002 May;26(5):643-52
references.pmid: 11927189
references.citation: Br J Cancer. 1996 Jan;73(2):241-5
references.pmid: 8546913
references.citation: Clin Pharmacol Ther. 1985 Jul;38(1):16-23
references.pmid: 3891192
references.citation: J Pain Symptom Manage. 1996 Jun;11(6):370-7
references.pmid: 8935141
references.citation: Cancer Invest. 2003 Jun;21(3):363-73
references.pmid: 12901282
references.citation: J Pain Symptom Manage. 2001 Nov;22(5):931-7
references.pmid: 11728796
references.citation: Circ Res. 2000 Apr 28;86(8):906-14
references.pmid: 10785514