title: Association of childhood trauma with fatigue, depression, stress, and inflammation in breast cancer patients undergoing radiotherapy.
abstract: BACKGROUND
  This pilot study examined whether breast cancer patients with childhood trauma exhibit increased fatigue, depression, and stress in association with inflammation as a result of whole breast radiotherapy (RT).
  
  
  METHODS
  Twenty breast cancer patients were enrolled in a prospective, longitudinal study of fatigue, depression, and perceived stress prior to RT, week 6 of RT, and 6 weeks post-RT. Six weeks after RT, subjects completed the childhood trauma questionnaire (CTQ). Patients were also administered the multidimensional fatigue inventory, inventory of depressive symptomatology-self-reported, and perceived stress scale at all three time-points and underwent blood sampling prior to RT for gene expression and inflammatory markers previously associated with childhood trauma and behavioral symptoms in breast cancer patients.
  
  
  RESULTS
  Eight subjects (40%) had past childhood trauma (CTQ+). Compared to CTQ- patients, CTQ+ patients had significantly higher fatigue, depression, and stress scores before, during, and after RT (p < 0.05); however, RT did not increase these symptoms in either group. CTQ+ patients also exhibited increased baseline expression of gene transcripts related to inflammatory signaling, and baseline inflammatory markers including c-reactive protein, interleukin (IL)-6, and IL-1 receptor antagonist were positively correlated with depression, fatigue, and stress scores in CTQ+ but not CTQ- patients.
  
  
  CONCLUSIONS
  Childhood trauma was prevalent and was associated with increased symptoms of fatigue, depression, and stress irrespective of RT. Increased symptoms in CTQ+ patients were also associated with baseline inflammatory markers. Treatments targeting childhood trauma and related inflammation may improve symptoms in breast cancer patients.
authors.affiliation: Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Tatiana J
authors.initials: TJ
authors.lastname: Han
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.|Winship Cancer Institute, Atlanta, GA, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Felger
authors.affiliation: Medical Center of Central Georgia, Mercer University School of Medicine, Macon, GA, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Mister
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.|Winship Cancer Institute, Atlanta, GA, USA.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Miller
authors.affiliation: Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA.|Winship Cancer Institute, Atlanta, GA, USA.
authors.forename: Mylin A
authors.initials: MA
authors.lastname: Torres
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology* / Q000532:radiotherapy; D003863:Depression / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D005221:Fatigue / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis* / Q000523:psychology; D008137:Longitudinal Studies; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D057566:Self Report; D013315:Stress, Psychological / Q000097:blood / Q000175:diagnosis / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers