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The Impact of Cancer-Specific Stress on Psychological, Physical, and Immunological Responses in Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia

Goyal, Neha Godiwala
http://rave.ohiolink.edu/etdc/view?acc_num=osu1437104095

Abstract Details

2015, Doctor of Philosophy, Ohio State University, Psychology.
Chronic lymphocytic leukemia (CLL) is the most prevalent form of adult leukemia and is considered incurable. While survival of patients has improved with newer therapies, all patients eventually relapse and continue to have poor outcomes with additional therapies. Ibrutinib is a new, targeted therapy for CLL that has demonstrated dramatic efficacy with little toxicity for those with relapsed/refractory CLL. Patients with CLL are understudied and little is known about their psychological and physical functioning, especially among those with relapsed/refractory disease. Furthermore, little is known about the impact of psychological factors on immunological factors that influence disease progression in hematologic malignancies. Research indicates that cytokine-driven processes of inflammation and angiogenesis influence disease progression. In particular, interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), and vascular endothelial growth factor (VEGF) are of interest. Understanding what factors may influence trajectories of psychological, physical, and immunological responses as patients undergo treatment for relapsed/refractory cancer is of utmost importance. According to the biobehavioral model of cancer, stress may be an individual difference variable that influences quality of life and immunity as patients undergo treatment. However, the relationship between stress and outcomes in patients with relapsed/refractory cancer is unclear. The current study examines the role of pre-treatment, cancer-specific stress on trajectories of psychological functioning, physical functioning, and selected cytokines as patients with relapsed/refractory CLL undergo treatment with ibrutinib. One-hundred fifty-one patients were recruited for a phase II drug trial of ibrutinib. Patients completed self-report measures 4 times over the first 5 months of therapy. IL-6, TNF-alpha, and VEGF were analyzed at 3 time points over the first 2 months of therapy in a subset of patients (n=48). Regressions examined the concurrent relationship between cancer-specific stress and outcomes at baseline and hierarchical linear modeling examined the impact of baseline cancer-specific stress on psychological functioning, physical functioning, and cytokines over time. Improvements were noted in all psychological and physical outcomes, excepting mental health quality of life. Cancer-specific stress was related to depressive symptoms, mood disturbance, mental health quality of life, sleep disturbance, and fatigue interference at baseline. Furthermore, cancer-specific stress was related to trajectories of depressive symptoms, mood disturbance, mental health quality of life, sleep disturbance, and fatigue interference. Decreases in TNF-alpha, increases in VEGF, and no change in IL-6 were found. Cancer-specific stress was a predictor of baseline values of TNF-alpha and was predictive of trajectories of IL-6. Overall, these findings provide initial data to support improvements in quality of life and physical functioning in patients with relapsed/refractory CLL taking ibrutinib. Furthermore, cancer-specific stress is a predictor of psychological, physical, and immunological responses over time. Clinical implications and future directions are described.
Barbara Andersen, Ph.D. (Advisor)
Robert Cudeck, Ph.D. (Committee Member)
Julian Thayer, Ph.D. (Committee Member)
Baldwin Way, Ph.D. (Committee Member)
148 p.
Psychology
chronic lymphocytic leukemia; cancer-specific stress; stress; psychological functioning; cytokines; physical functioning

Recommended Citations

Citations

  • Goyal, N. G. (2015). The Impact of Cancer-Specific Stress on Psychological, Physical, and Immunological Responses in Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1437104095

    APA Style (7th edition)

  • Goyal, Neha. The Impact of Cancer-Specific Stress on Psychological, Physical, and Immunological Responses in Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia. 2015. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1437104095.

    MLA Style (8th edition)

  • Goyal, Neha. "The Impact of Cancer-Specific Stress on Psychological, Physical, and Immunological Responses in Patients with Relapsed/Refractory Chronic Lymphocytic Leukemia." Doctoral dissertation, Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1437104095

    Chicago Manual of Style (17th edition)

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© 2015, all rights reserved.
This open access ETD is published by The Ohio State University and OhioLINK.