Stephanie Gilbertson-White, PhD, APRN-BC, Assistant Professor 

Donor: Barbara and Richard Csomay Faculty Research Award

Project: Older Adults' Cancer Symptom Experience: Inflammation and Appraisals

Funding Year: 2014

Project Description: This projected evaluated the feasibility of conducting longitudinal study of symptoms, cognitive appraisals, inflammation, and coping in patients newly diagnoses with advanced solid tumor cancers compared to normal controls with the goal of identifying patients at increased risk of developing distressing symptoms.

Background: Increasingly, advanced cancer is recognized as a chronic disease that requires management of symptoms associated with both the disease and the complex sequelae of intensive therapies and is often associated with increased health care utilization. The majority of patients diagnosed with advanced cancer are older adults who also often manage symptoms of other chronic health conditions such as heart disease and chronic obstructive pulmonary disease. A wide range of interventions have been developed to improve cancer related symptoms (CRS), psychological and physical health, and quality of life (QOL) with some success. However, a hallmark of this literature is the high variability in patient response to these interventions. A biobehavioral approach to studying CRS is vital to understand the complex inter-relationships of cognitive appraisals and inflammatory responses which can lead to ultimately identify older adults at risk for poor outcomes. Understanding the cognitive appraisals that older adults ascribe to symptoms and the contribution that these appraisals make to their inflammatory response may shed light on these processes in older adults resistant to current symptom management interventions.

Objectives: The purpose of this feasibiliy study is to describe how cognitive appraisals of CRS relate to the inflammatory response over 24-weeks in a sample of older adults with advanced cancer. The specific aims are to:

  1. Describe cancer related stressors (i.e., cancer type, stage, and treatments, perceived stress), inflammatory response (i.e., peripheral interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrossing factor-α (TNF-α) ), six common CRS (i.e., pain, fatigue, sleep disturbance, loss of appetite, depressed mood, cognitive dysfunction), and cognitive appraisals of CRS (i.e., threatening, irrelevant, managable), at baseline and over 24 weeks since diagnosis in persons with advanced cancer.
  2. Describe the relationship between cognitive appraisals of CRS (i.e., threatening, irrelevant, manageable) and inflammatory response (i.e., peripheral IL-1, IL-6, TNF-α) in persons with advanced cancer, after controlling for demographics, cancer related stressors, treatment, symptom severity and psychological mediators (e.g. optimism).
  3. Describe the relationships between CRS severity and cognitive appraisals (i.e., threatening, irrelevant, managable) in persons with advanced cancer, after controlling demographics, cancer related stressors, treatment, and psychological mediators (e.g. optimism).

Population: Older adults (i.e. age >55 years) receiving treatment for advanced cancer

Approach: Longitudinal, descriptive cohort design with surveys and blood samples collected at 6 times (diagnosis and every 3-4 weeks with treatment for up to 24 weeks)

Outcomes: Inflammatory response (i.e., peripheral interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrossing factor-α (TNF-α) ), six common CRS (i.e., pain, fatigue, sleep disturbance, loss of appetite, depressed mood, cognitive dysfunction), and cognitive appraisals of CRS (i.e., threatening, irrelevant, managable).

Publications:
Gilbertson-White, S., Perkhounkova, Y., Saeidzadeh, S., Hein, M., Dahl, R., & Burnett, A. A biobehavioral approach to understanding symptom burden in advanced colorectal, pancreatic, and lung cancer patients living in rural areas: a feasibility study. Oncology Nursing Forum. Accepted/In-press.
Gilbertson-White, S., Shahnazi, A., & Cherwin, C. Are perceived stress and cytokine genotypes clinically feasible as predictors of psychoneuroimmune symptoms in advanced cancer? The Permanente Journal. Accepted/In Press.

For more information, contact Dr. Gilbertson-White.