Supplemental Material for Improvements in Emotion Regulation Following Mindfulness Meditation: Effects on Depressive Symptoms and Perceived Stress in Younger Breast Cancer Survivors

PURPOSE Younger women are at risk for depression and related symptoms following breast cancer. The Pathways to Wellness study, a randomized, multi-institution, three-arm trial, tested the efficacy of two behavioral interventions for younger breast cancer survivors with elevated depressive symptoms: mindful awareness practices (MAPs) and survivorship education (SE) (Clincaltrials.gov identifier: NCT03025139 ). METHODS Women diagnosed with breast cancer at or before 50 years of age who had completed treatment and had elevated depressive symptoms were randomly assigned to 6 weeks of MAPs, SE, or wait-list control (WLC). Assessments were conducted preintervention and postintervention and at 3-month and 6-month postintervention follow-ups. Analyses compared each intervention to WLC using linear mixed models. The primary outcome was change in depressive symptoms from preintervention to postintervention on the Center for Epidemiologic Studies-Depression Scale; secondary outcomes included change in fatigue, insomnia, and vasomotor symptoms. RESULTS Two hundred forty-seven women (median age = 46 years) were randomly assigned to MAPs (n = 85), SE (n = 81), or WLC (n = 81). MAPs and SE led to significant decreases in depressive symptoms from preintervention to postintervention relative to WLC (mean change relative to WLC [95% CI]: MAPs, –4.7 [–7.5 to –1.9]; SE, –4.0 [–6.9 to –1.1]), which persisted at 6-month follow-up for MAPs (mean change relative to WLC [95% CI]: MAPs, –3.7 [–6.6 to –0.8]; SE, –2.8 [–5.9 to 0.2]). MAPs, but not SE, also had beneficial effects on fatigue, insomnia, and vasomotor symptoms that persisted at 6-month follow-up ( P < .05). CONCLUSION Mindfulness meditation and SE reduced depressive symptoms in younger breast cancer survivors. These interventions can be widely disseminated over virtual platforms and have significant potential benefit for quality of life and overall survivorship in this vulnerable group.

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Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors

Journal of Behavioral Medicine ◽

10.1007/s10865-016-9751-9 ◽

2016 ◽

Vol 39 (5) ◽

pp. 832-844 ◽

Cited By ~ 26

Author(s):

Brett Marroquín ◽

Johanna Czamanski-Cohen ◽

Karen L. Weihs ◽

Annette L. Stanton

Keyword(s):

Breast Cancer ◽

Emotion Regulation ◽

Depressive Symptoms ◽

Cancer Survivors ◽

Breast Cancer Survivors

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Association of cognitive impairment and breast cancer survivorship on quality of life in younger breast cancer survivors

Journal of Cancer Survivorship ◽

10.1007/s11764-021-01075-x ◽

2021 ◽

Author(s):

Diane Von Ah ◽

Adele D. Crouch ◽

Patrick O. Monahan ◽

Timothy E. Stump ◽

Frederick W. Unverzagt ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Cancer Survivors ◽

Perceived Stress ◽

Personal Growth ◽

Breast Cancer Survivors ◽

Well Being

Abstract Purpose Younger breast cancer survivors (BCS) often report cognitive impairment and poor quality of life (QoL), which could be interrelated. The purpose of this study was to examine the association of cognitive impairment and breast cancer status (BCS versus healthy control (HC)), with QoL, which included psychological (depressive symptoms, well-being, perceived stress, and personal growth) and physical well-being (physical functioning and fatigue). Methods Four hundred ninety-eight BCS (≤45 years at diagnosis) who were 3 to 8 years post-chemotherapy treatment and 394 HC completed subjective questionnaires and a one-time neuropsychological assessment, including tests of attention, memory, processing speed, and verbal fluency. For each test, cognitive impairment was defined as scoring 1.5 and 2.0 standard deviations below the mean of the HC group. Separate linear regression models for each outcome were ran controlling for known covariates. Results BCS reported significantly more memory problems than HC (p < 0.0001), with up to 23% having significant impairment. Cognitive performance did not differ significantly between BCS and HCs. BCS vs. HCs had greater depression and fatigue, yet more personal growth. Objective and subjective cognitive impairment were significantly related to greater depressive symptoms and perceived stress and lower well-being and physical functioning; whereas, objective impairment was related to less personal growth and subjective impairment was related to greater fatigue. Conclusions Younger BCS report significant cognitive impairment years after treatment which may relate to greater decrements in QoL. Implications to Cancer Survivors Assessment and interventions to address cognitive concerns may also influence QoL outcomes in younger BCS.

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Depressive symptoms and inflammation are independent risk factors of fatigue in breast cancer survivors

Psychological Medicine ◽

10.1017/s0033291717000150 ◽

2017 ◽

Vol 47 (10) ◽

pp. 1733-1743 ◽

Cited By ~ 17

Author(s):

C. Xiao ◽

A. H. Miller ◽

J. Felger ◽

D. Mister ◽

T. Liu ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Depressive Symptoms ◽

Cancer Survivors ◽

Perceived Stress ◽

Inflammatory Markers ◽

Breast Cancer Survivors ◽

Endocrine Treatment ◽

Cancer Related Fatigue ◽

Independent Risk Factors

BackgroundPsychosocial and inflammatory factors have been associated with fatigue in breast cancer survivors. Nevertheless, the relative contribution and/or interaction of these factors with cancer-related fatigue have not been well documented.MethodThis cross-sectional study enrolled 111 stage 0–III breast cancer patients treated with breast surgery followed by whole breast radiotherapy. Fatigue was measured by the total score of the Multidimensional Fatigue Inventory-20. Potential risk factors included inflammatory markers (plasma cytokines and their receptors and C-reactive protein; CRP), depressive symptoms (as assessed by the Inventory of Depressive Symptomatology–Self Reported), sleep (as assessed by the Pittsburgh Sleep Quality Index) and perceived stress (as assessed by the Perceived Stress Scale) as well as age, race, marital status, smoking history, menopause status, endocrine treatment, chemotherapy and cancer stage. Linear regression modeling was employed to examine risk factors of fatigue. Only risk factors with a significance level <0.10 were included in the initial regression model. A post-hoc mediation model using PROCESS SPSS was conducted to examine the association among depressive symptoms, sleep problems, stress, inflammation and fatigue.ResultsAt 1 year post-radiotherapy, depressive symptoms (p<0.0001) and inflammatory markers (CRP: p = 0.015; interleukin-1 receptor antagonist: p = 0.014; soluble tumor necrosis factor receptor-2: p = 0.009 in separate models) were independent risk factors of fatigue. Mediation analysis showed that depressive symptoms also mediated the associations of fatigue with sleep and stress.ConclusionsDepressive symptoms and inflammation were independent risk factors for cancer-related fatigue at 1 year post-radiotherapy, and thus represent independent treatment targets for this debilitating symptom.

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Moderators of inflammation-related depression: a prospective study of breast cancer survivors

Translational Psychiatry ◽

10.1038/s41398-021-01744-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Andrew W. Manigault ◽

Patricia A. Ganz ◽

Michael R. Irwin ◽

Steve W. Cole ◽

Kate R. Kuhlman ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Depressive Symptoms ◽

Negative Affect ◽

Cancer Survivors ◽

Perceived Stress ◽

State Anxiety ◽

Inflammatory Markers ◽

Breast Cancer Survivors ◽

Childhood Adversity

AbstractInflammation has been shown to predict depression, but sensitivity to inflammation varies across individuals. Experimental studies administering potent pro-inflammatory agents have begun to characterize this sensitivity. However, risk factors for inflammation-associated depression in naturalistic contexts have not been determined. The present study examined key psychological and behavioral risk factors (state anxiety, perceived stress, negative affect, disturbed sleep, and childhood adversity) as potential moderators of the relationship between inflammation and depressive symptoms in a prospective longitudinal study of breast cancer survivors. Women with early stage breast cancer were recruited after completing primary cancer treatment (nfinal = 161). Depressive symptoms, inflammatory markers (CRP, IL-6, and sTNF-RII), and key risk factors were assessed post treatment (T1), at 6 and 12-month follow-ups (T2 and T3), and during a final follow-up (TF) 3−6 years after T1; childhood adversity was measured only at T3. Inflammatory markers were combined into a single inflammatory index prior to analyses. Women who reported higher levels of state anxiety, perceived stress, negative affect, and/or sleep disturbance at T1 (post-treatment) exhibited higher depressive symptoms at times when inflammation was higher than typical (interaction βs ranged from .06 to .08; all ps < .014). Results demonstrate the relevance of these risk factors for understanding inflammation-associated depression in a clinical context and could inform targeted strategies for prevention and treatment among at-risk populations.

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