title: Trajectories of Stress, Depressive Symptoms, and Immunity in Cancer Survivors: Diagnosis to 5 Years.
abstract: OBJECTIVE
  Five-year disease endpoint trajectories are available for every cancer site. In contrast, there are few longitudinal, biobehavioral studies of survivors extending beyond the first or second year following diagnosis. This gap is addressed with stress, depressive symptom, and immunity data from breast cancer patients followed continuously for 5 years.
  
  
  METHODS
  Women (N = 113) diagnosed and surgically treated for breast cancer and awaiting adjuvant therapy completed self-report measures of stress and depressive symptoms and provided blood for immune assays [natural killer cell cytotoxicity (NKCC) and T-cell blastogenesis]. Assessments (N = 12) were repeated every 4 to 6 months for 5 years.
  
  
  RESULTS
  Multiphase linear mixed models show phases of change and identified specific time points of change. Cancer stress shows two distinct phases of decline, with the change point being 12 months. In contrast, a steep decline in depressive symptoms occurs by 7 months, with stable, low levels thereafter. NKCC shows a steady upward trajectory through 18 months and upper limit stability thereafter, whereas there was no reliable trajectory for T-cell blastogenesis.
  
  
  CONCLUSIONS
  For the first time, trajectories and specific time points of change in biobehavioral data for breast cancer survivors are provided, traced through 5 years. Following diagnosis, the breast survivor experience is one of a co-occurrence of change (recovery) in psychologic and innate immunity markers from diagnosis to18 months, and a pattern of stability (depression, NKCC) or continued improvement (stress) through year 5. These data provide new directions for survivorship care and detail of the biobehavioral trajectory. Clin Cancer Res; 23(1); 52-61. ©2016 AACR.
authors.affiliation: The Ohio State University, Columbus, Ohio. Andersen.1@osu.edu.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Andersen
authors.affiliation: Veteran's Affairs Palo Alto Health Care System Palo Alto, California.
authors.forename: Neha Godiwala
authors.initials: NG
authors.lastname: Goyal
authors.affiliation: The Ohio State University, Columbus, Ohio.
authors.forename: Travis D
authors.initials: TD
authors.lastname: Westbrook
authors.affiliation: The Ohio State University, Columbus, Ohio.
authors.forename: Brenden
authors.initials: B
authors.lastname: Bishop
authors.affiliation: The Ohio State University, Columbus, Ohio.
authors.forename: William E
authors.initials: WE
authors.lastname: Carson
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000276:immunology* / Q000523:psychology* / Q000628:therapy; D000073116:Cancer Survivors / Q000523:psychology*; D003131:Combined Modality Therapy; D003602:Cytotoxicity, Immunologic; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008213:Lymphocyte Activation / Q000276:immunology; D016131:Lymphocyte Subsets / Q000276:immunology; D008875:Middle Aged; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D013315:Stress, Psychological; D063189:Symptom Assessment