title: Eudaimonic well-being and tumor norepinephrine in patients with epithelial ovarian cancer.
abstract: BACKGROUND
  The impact of psychological well-being on the physiologic processes involved in cancer progression remains unclear. Prior research has implicated adrenergic signaling in tumor growth and metastasis. Given that adrenergic signaling is influenced by both positive and negative factors, the authors examined how 2 different aspects of well-being (eudaimonic and positive affect) and psychological distress were associated with tumor norepinephrine (NE) in patients with ovarian cancer.
  
  
  METHODS
  A total of 365 women with suspected ovarian cancer completed psychosocial assessments before surgery and clinical information was obtained from medical records. Study inclusion was confirmed after histological diagnosis. Tumor NE was measured in frozen tissue samples using high-performance liquid chromatography with electrochemical detection. Confirmatory factor analysis was used to model eudaimonic well-being, positive affect, and psychological distress, and structural equation modeling was used to examine associations between these factors and tumor NE.
  
  
  RESULTS
  Eudaimonic well-being, positive affect, and psychological distress, modeled as distinct but correlated constructs, best fit the data (ie, compared with unitary or 2-factor models) (root mean square error of approximation, 0.048; comparative fit index, 0.982; and standardized root-mean-squared residual, 0.035). Structural equation modeling analysis that included physical well-being, stage of disease, histology, psychological treatment history, beta-blocker use, and caffeine use as covariates was found to have good model fit (root mean square error of approximation, 0.052; comparative fit index, 0.955; and standardized root-mean-squared residual, 0.036) and demonstrated that eudaimonic well-being was related to lower tumor NE (β = -.24 [P = .045]). In contrast, no effects were found for positive affect or psychological distress.
  
  
  CONCLUSIONS
  Eudaimonic well-being was found to be associated with lower tumor NE, independent of positive affect and psychological distress. Because adrenergic signaling is implicated in tumor progression, increasing eudaimonic well-being may improve both psychological and physiologic resilience in patients with ovarian cancer.
authors.affiliation: Department of Psychology, University of Iowa, Iowa City, Iowa.
authors.forename: Lauren Z
authors.initials: LZ
authors.lastname: Davis
authors.affiliation: Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California.
authors.forename: George M
authors.initials: GM
authors.lastname: Slavich
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Premal H
authors.initials: PH
authors.lastname: Thaker
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goodheart
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.
authors.forename: David P
authors.initials: DP
authors.lastname: Bender
authors.affiliation: Department of Pathology, University of Iowa, Iowa City, Iowa.
authors.forename: Laila
authors.initials: L
authors.lastname: Dahmoush
authors.affiliation: College of Pharmacy, University of Iowa, Iowa City, Iowa.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Farley
authors.affiliation: Department of Psychology, University of Iowa, Iowa City, Iowa.
authors.forename: Kristian E
authors.initials: KE
authors.lastname: Markon
authors.affiliation: Department of Medical and Social Sciences, Northwestern University, Evanston, Illinois.|Department of Psychology, Northwestern University, Evanston, Illinois.|Department of Psychiatry and Behavioral Sciences, Northwestern University, Evanston, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Penedo
authors.affiliation: Department of Urology, University of Iowa, Iowa City, Iowa.|Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.|Department of Microbiology, University of Iowa, Iowa City, Iowa.
authors.forename: David M
authors.initials: DM
authors.lastname: Lubaroff
authors.affiliation: Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California.|Division of Hematology/Oncology, Jonsson Comprehensive Cancer Center, University of California at Los Angeles School of Medicine, Los Angeles, California.|University of California at Los Angeles Molecular Biology Institute, Los Angeles, California.
authors.forename: Steve W
authors.initials: SW
authors.lastname: Cole
authors.affiliation: Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sood
authors.affiliation: Department of Psychology, University of Iowa, Iowa City, Iowa.|Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.|Department of Urology, University of Iowa, Iowa City, Iowa.|Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Lutgendorf
mesh_terms: D015415:Biomarkers / Q000737:chemistry*; D000077216:Carcinoma, Ovarian Epithelial; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000523:psychology*; D009638:Norepinephrine / Q000009:adverse effects*; D010051:Ovarian Neoplasms / Q000523:psychology*; D012944:Social Support; D013315:Stress, Psychological / Q000150:complications*; D059016:Tumor Microenvironment
chemical_list: D015415:Biomarkers; D009638:Norepinephrine
keywords: biological markers; norepinephrine; ovarian neoplasms; psychological; resilience; tumor microenvironment