title: Postsurgical Depressive Symptoms and Proinflammatory Cytokine Elevations in Women Undergoing Primary Treatment for Breast Cancer.
abstract: OBJECTIVE
  Depression and inflammation may independently promote breast cancer (BCa) disease progression and poorer clinical outcomes. Depression has been associated with increased levels of inflammatory markers in medically healthy individuals and patients with cancer. However, inconsistencies in study time frames complicate interpretation of results within specific cancer types. This study examined relationships between depressive symptoms and inflammation in women with early-stage BCa before beginning adjuvant treatment.
  
  
  METHODS
  Women with Stage 0-III BCa were recruited approximately 4 to 8 weeks after surgery. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression, and blood samples were collected to quantify circulating levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α) by enzyme-linked immunosorbent assay. Analyses of covariance were used to test for group differences (elevated versus low depressive symptoms) in levels of cytokines. Multiple regression analyses were used to examine relationships between continuous severity of depressive symptoms and levels of cytokines adjusting for relevant biobehavioral covariates.
  
  
  RESULTS
  Thirty-six (40%) of 89 patients showed elevated levels of depressive symptoms and, in adjusted models, had marginally higher levels of IL-1β (mean [M] = 14.49 [95% confidence interval {CI} = 6.11-32.65] versus M = 4.68 [95% CI = 1.96-9.86] and IL-6 [M = 88.74 {95% CI = 33.28-233.96} versus M = 61.52 {95% CI = 27.44-136.40}]) significantly higher levels of TNF-α (M = 17.07 [95% CI = 8.27-34.32] versus M = 6.94 [95% CI = 3.58-12.80]) than did women with low depressive symptoms. Across the spectrum of depressive symptoms, greater magnitude of depressive symptoms was related to greater levels of IL-1β (β = 0.06, p = .006, R = 0.25) and TNF-α (β = 0.06, p = .003, R = 0.27).
  
  
  CONCLUSIONS
  Postsurgery and preadjuvant treatment for early-stage BCa, depressive symptoms covary with elevated levels of multiple proinflammatory cytokines. Findings have implications for psychosocial and biological interventions concurrently focusing on depression and inflammation.
  
  
  BACKGROUND
  NCT01422551.
authors.affiliation: From the Department of Psychology, University of Miami (Bouchard, Antoni, Gudenkauf, Jutagir, Carver), Miami, Florida; Departments of Psychiatry Behavioral Sciences (Antoni, Lechner) and Microbiology Immunology (Blomberg, Diaz), Sylvester Comprehensive Cancer Center (Antoni, Lechner, Carver, Blomberg, Diaz), University of Miami Miller School of Medicine, Miami, Florida; Department of Psychiatry, Massachusetts General Hospital (Stagl), Boston, Massachusetts; Global Medical Affairs, Celgene Corporation (Glück), Summit, New Jersey; and Baptist Health Breast Center (Derhagopian), Miami, Florida.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Bouchard
authors.forename: Michael H
authors.initials: MH
authors.lastname: Antoni
authors.forename: Bonnie B
authors.initials: BB
authors.lastname: Blomberg
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Stagl
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Gudenkauf
authors.forename: Devika R
authors.initials: DR
authors.lastname: Jutagir
authors.forename: Alain
authors.initials: A
authors.lastname: Diaz
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lechner
authors.forename: Stefan
authors.initials: S
authors.lastname: Glück
authors.forename: Robert P
authors.initials: RP
authors.lastname: Derhagopian
authors.forename: Charles S
authors.initials: CS
authors.lastname: Carver
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000097:blood / Q000208:ethnology / Q000523:psychology* / Q000601:surgery; D015897:Comorbidity; D003863:Depression / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D005006:Ethnicity; D005221:Fatigue / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D018655:Lymphocyte Count; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D012959:Socioeconomic Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: C508600:IL6 protein, human; D053583:Interleukin-1beta; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha