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The Psychological Symptom Cluster Among Women with Breast Cancer Before and During Adjuvant Therapy

Li, Hongjin (2019) The Psychological Symptom Cluster Among Women with Breast Cancer Before and During Adjuvant Therapy. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Women with breast cancer commonly experience multiple psychological symptoms (i.e., fatigue, depressive symptom, anxiety) that cluster together throughout their cancer diagnosis and treatment trajectory. Individuals differ substantially in their experience and trajectory of psychological symptoms. A number of factors may contribute to these differences in symptom experience, including demographic and clinical characteristics. In addition, given the contribution of the hypothalamic-pituitary-adrenal (HPA) axis to these contemporaneous symptoms, individual differences in genes that regulate the HPA activity may play a role. This dissertation study aimed to (1) characterize the clustering of psychological symptoms over time among postmenopausal women with early stage breast cancer during the first 18 months of adjuvant therapy, (2) identify distinct subgroups of women with breast cancer based on their experience of a cluster of psychological symptoms , and (3) assess whether distinct demographic and clinical characteristics and variation in genes regulating the HPA axis predict symptom trajectory subgroup membership. This study used symptom and genetic data from postmenopausal women with early stage breast cancer followed from baseline (pre-adjuvant therapy) to 18 months post-initiation of adjuvant therapy. Results showed that most symptom clusters (i.e., psychological, neurocognitive, weight, musculoskeletal, vasomotor, urinary, and sexual) existed before adjuvant therapy and were relatively stable through the first 18 months of adjuvant therapy. The gastrointestinal symptom cluster only appeared at 6 months. Fatigue and symptoms of depression and anxiety clustered together as a psychological symptom cluster over the 18-month period. Two distinct symptom subgroups (“all low” and “all high”) were identified based on the trajectories of fatigue, depressive symptom and anxiety. The “all low” subgroup had stable low severity of fatigue and depressive symptom and a linear decreasing pattern for anxiety over time. The “all high” subgroup had stable high severity of fatigue and depressive symptom and a quadratic pattern for anxiety over time. Women who were younger in age, had less education, and who received chemotherapy had greater likelihood of being in the “all high” symptom subgroup. Variation in genes regulating the HPA axis (i.e., FKBP5 rs9394309, NR3C2 rs5525, CRHR1 rs12944712) were associated with membership in the “all high” symptom subgroup. The results of this study may help to identify women with breast cancer who are at increased risk for psychological symptoms, facilitating the development of individualized and preemptive interventions to better manage their symptoms during adjuvant therapy.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Li, Hongjinhol48@pitt.eduhol48
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBender, Catherinecbe100@pitt.educbe100
Committee MemberYvette, Conleyyconley@pitt.eduyconley
Anna, Marslandmarsland@pitt.edumarsland
Susan, Sereikassereika@pitt.edussereika
Date: 14 August 2019
Date Type: Publication
Defense Date: 10 July 2019
Approval Date: 14 August 2019
Submission Date: 13 August 2019
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 159
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: psychological, symptom, symptom cluster, breast cancer
Date Deposited: 14 Aug 2019 14:52
Last Modified: 14 Aug 2019 14:52
URI: http://d-scholarship.pitt.edu/id/eprint/37368

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