The relationship of cancer symptom clusters to depressive affect in the initial phase of palliative radiation.
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.
Francoeur
Richard Benoit
RB
Columbia University School of Social Work, New York, NY 10027, USA.
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
Psychooncology. 2001 Mar-Apr;10(2):156-65
11268142
Psychiatry Res. 1981 Oct;5(2):171-81
6945612
Am J Nurs. 1988 Jan;88(1):99-100
3337154
Cancer. 1998 Feb 15;82(4):760-5
9477110
Endocrinology. 1999 Sep;140(9):4359-66
10465310
J Clin Oncol. 2000 Feb;18(4):743-53
10673515
Ann N Y Acad Sci. 1998 Sep 29;856:132-138
9917873
Endocr Rev. 1996 Feb;17(1):64-102
8641224
Psychooncology. 2001 Jan-Feb;10(1):19-28
11180574
J Pain Symptom Manage. 2001 Apr;21(4):323-9
11312047
J Clin Oncol. 2000 May;18(10):2143-51
10811680
Arch Intern Med. 2003 May 12;163(9):1115; author reply 1115-6
12742818
J Gerontol. 1989 May;44(3):S110-20
2715592
Cancer. 2002 Jan 15;94(2):528-38
11900238
Cancer Control. 1997 Oct;4(5):419-428
10763050
J Exp Biol. 1999 Mar;202(Pt 5):623-30
9929463
J Clin Oncol. 2003 Nov 1;21(21):4066-7; author reply 4067-8
14581432
Med Hypotheses. 2000 Jan;54(1):126-30
10790737
J Clin Oncol. 2003 Apr 1;21(7):1373-8
12663729
Radiother Oncol. 1999 Aug;52(2):101-9
10577695
Support Care Cancer. 1995 Mar;3(2):135-8
7539701
Palliat Med. 2002 Nov;16(6):488-94
12465695
Radiother Oncol. 1999 Aug;52(2):111-21
10577696
J Psychosom Res. 1999 May;46(5):437-43
10404478
Cancer. 1999 May 15;85(10):2273-7
10326708
Child Adolesc Psychiatr Clin N Am. 2000 Jul;9(3):605-46, viii
10944659
Br Med Bull. 1996 Jul;52(3):597-617
8949260
Cancer. 1982 Sep 1;50(5):893-9
6178497
J Immunol. 1988 Sep 1;141(5):1522-8
2842396
Brain Res. 1996 Mar 4;711(1-2):163-74
8680860
Psychiatry Res. 1996 Oct 16;64(3):161-7
8944394
N Engl J Med. 1993 May 6;328(18):1323-32
8469254
Psychosomatics. 1999 Nov-Dec;40(6):510-2
10581980
J Pain Symptom Manage. 1988 Spring;3(2):81-5
3356918
Semin Clin Neuropsychiatry. 1996 Oct;1(4):304-314
10320433
J Palliat Med. 2002 Apr;5(2):301-4
12006233
Gerontologist. 2002 Oct;42 Spec No 3:99-103
12415139
Radiother Oncol. 1998 Jun;47(3):233-40
9681885
J Pain Symptom Manage. 1999 May;17(5):320-32
10355211
J Pain Symptom Manage. 2004 Jan;27(1):1-3
14711462
Trends Neurosci. 2001 Aug;24(8):450-5
11476884
Br J Cancer. 1992 Jul;66(1):198-203
1379060
Brain Behav Immun. 2003 Feb;17 Suppl 1:S112-8
12615196
Neuroimmunomodulation. 1995 Jul-Aug;2(4):203-15
8963749
Med Hypotheses. 1999 Feb;52(2):155-62
10340296
N Engl J Med. 1981 Dec 31;305(27):1651
7312015
Arch Surg. 1988 Aug;123(8):992-9
3293552
Am J Physiol Regul Integr Comp Physiol. 2001 Apr;280(4):R929-34
11247812
Acta Anaesthesiol Scand. 1999 Oct;43(9):939-47
10522741
Medicine (Baltimore). 1995 Mar;74(2):74-82
7891545
Neuroendocrinology. 1995 Jul;62(1):13-8
7566433
Psychooncology. 2002 Jan-Feb;11(1):12-22
11835589
J Pain Symptom Manage. 1997 Apr;13(4):220-32
9136233
Brain Behav Immun. 2003 Feb;17 Suppl 1:S132-4
12615199
Brain Behav Immun. 2003 Feb;17 Suppl 1:S41-7
12615185
Trends Pharmacol Sci. 1992 Jan;13(1):24-8
1542935
Cancer. 2003 Jul 1;98(1):198-203
12833472
Cancer. 1994 Nov 1;74(9):2570-8
7923013
Cancer. 2001 Sep 15;92(6 Suppl):1678-83
11598886
J Immunol. 1986 Aug 1;137(3):858-62
3487590
Pain. 1997 Jun;71(2):149-56
9211476
J Pain Symptom Manage. 1999 Apr;17(4):248-55
10203877
Am J Psychiatry. 2000 May;157(5):683-94
10784457
Clin Infect Dis. 1997 Jul;25(1):119-38
9243046
J Palliat Med. 2003 Jun;6(3):351-4
14509480
J Pain Symptom Manage. 2002 Jun;23(6):490-500
12067773
Cancer Control. 2002 Nov-Dec;9(6):480-9
12514566
Hypertension. 2002 Nov;40(5):604-8; discussion 601-3
12411450
Arch Intern Med. 1998 Feb 23;158(4):397-404
9487237
Pain. 2001 Dec;94(3):231-244
11731060
N Engl J Med. 1999 Sep 16;341(12):893-900
10486422
Cancer Invest. 2003;21(4):526-35
14533442
J Pain Symptom Manage. 1994 Nov;9(8):515-9
7531736
Neurosci Biobehav Rev. 1988 Summer;12(2):123-37
3050629
Cancer. 2001 Sep 15;92(6 Suppl):1699-707
11598890
J Clin Oncol. 2000 Feb;18(4):893-903
10673533
Auton Neurosci. 2000 Dec 20;85(1-3):127-32
11189019
Psychother Psychosom. 1996;65(4):171-82
8843497
J Neurosci. 2001 Apr 15;21(8):2808-19
11306633
Cancer. 1990 Sep 15;66(6):1279-82
2205358
Cancer. 2001 Sep 15;92(6 Suppl):1684-8
11598887
Arch Intern Med. 2002 Oct 28;162(19):2204-8
12390063
Cancer Res. 1999 Sep 15;59(18):4493-501
10493494
N Engl J Med. 1999 Jul 29;341(5):362-3
10423472
J Pain Symptom Manage. 2001 Jun;21(6):456-66
11397603
Int J Immunopharmacol. 1995 Aug;17(8):677-83
8847162
Ann Oncol. 1998 Mar;9(3):297-306
9602264
Brain Behav Immun. 2003 Feb;17 Suppl 1:S125-31
12615198
Neuroimmunomodulation. 1995 Nov-Dec;2(6):319-28
8840334
Neuropsychopharmacology. 2002 May;26(5):643-52
11927189
Br J Cancer. 1996 Jan;73(2):241-5
8546913
Clin Pharmacol Ther. 1985 Jul;38(1):16-23
3891192
J Pain Symptom Manage. 1996 Jun;11(6):370-7
8935141
Cancer Invest. 2003 Jun;21(3):363-73
12901282
J Pain Symptom Manage. 2001 Nov;22(5):931-7
11728796
Circ Res. 2000 Apr 28;86(8):906-14
10785514