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Weiss Masters Thesis Final.pdf (1.16 MB)

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Cancer-Specific Stress and Absolute Lymphocyte Count Trajectories in Patients with Chronic Lymphocytic Leukemia

Weiss, David M
http://rave.ohiolink.edu/etdc/view?acc_num=osu147765209495775

Abstract Details

2016, Master of Arts, Ohio State University, Psychology.
Chronic stress has been commonly observed in cancer patients and is associated with immune system down regulation. The effect of stress on immunity in hematologic cancers such as chronic lymphocytic leukemia (CLL) has not been studied despite the role of immune system dysfunction in CLL’s pathogenesis. In a phase II clinical trial, 154 patients with relapsed/refractory CLL received ibrutinib, provided blood samples, and completed a self-report measure of psychological stress specific to cancer over an 18-month treatment period (nine assessments).Targeted treatments like ibrutinib have been effective in reducing disease progression in CLL, despite the occurrence of lymphocytosis, which is an increase in absolute lymphocyte counts (ALC) and marker of progressive disease. Controlling for demographic, health status, number of prior treatments, and CLL genetic risk (del17p) factors, random changepoint models were estimated to evaluate the impact of stress on ALC trajectories. Stress was associated with pretreatment ALC (ß_0 = 0.13; 95% CI = 0.02, 0.25) but did not impact the timing of lymphocytosis (fx1= 0.03, CI = -0.15, 0.22), or the treatment response before (ß_x1= -0.11, CI = -0.23, 0.01) and after (dx1=0.10, -0.01, 0.22) lymphocytosis. Stress affects pre-treatment ALC but has little impact on ALC trajectories after beginning drug therapy. Additional analysis showed that lymphocytosis occurs later in the treatment trajectory for individuals classified as drug non-responders by 18-months compared to those regarded as drug responders (fx2 = -0.95; CI= -1.50, -0.41), though it is unclear whether clinical or demographic risk factors can predict these groups. Results suggest patients exhibit similar ALC trajectories after ibrutinib initiation. Distress screening and management should be initiated prior to cancer treatments.
Barbara Andersen, PhD (Advisor)
Julian Thayer, PhD (Committee Member)
Baldwin Way, PhD (Committee Member)
63 p.
Psychology
Chronic Lymphocytic Leukemia, Stress, Immunity, Cancer Treatment, Trajectories, Psychological Distress, Ibrutinib

Recommended Citations

Citations

  • Weiss, D. M. (2016). Cancer-Specific Stress and Absolute Lymphocyte Count Trajectories in Patients with Chronic Lymphocytic Leukemia [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu147765209495775

    APA Style (7th edition)

  • Weiss, David. Cancer-Specific Stress and Absolute Lymphocyte Count Trajectories in Patients with Chronic Lymphocytic Leukemia . 2016. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu147765209495775.

    MLA Style (8th edition)

  • Weiss, David. "Cancer-Specific Stress and Absolute Lymphocyte Count Trajectories in Patients with Chronic Lymphocytic Leukemia ." Master's thesis, Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu147765209495775

    Chicago Manual of Style (17th edition)

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