Exploring Inflammation and Stress as Biological Correlates of Symptoms in Children With Advanced Cancer: A Longitudinal Feasibility Study

Author:

Montgomery Kathleen E.1ORCID,Basha Mays1,Nyholm Leah1,Smith Corey2,Ananiev Gene3,Fedorov Alexander3,Kapoor Amita4,Brown Roger1,Capitini Christian35ORCID,Kwekkeboom Kristine1

Affiliation:

1. School of Nursing, University of Wisconsin–Madison, Madison, WI, USA

2. Department of Medicine – Pulmonary/Critical Care, UW Health, Madison, WI, USA

3. Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

4. Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI, USA

5. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

Abstract

Background: Few studies have examined biomarkers of stress and inflammation as underlying mechanisms of symptoms in adolescents and young adults with cancer. This study determined the feasibility of collecting blood and saliva samples across time, described the range and distribution of biomarkers, and explored the association of biomarkers with symptom adverse events (AEs). Method: This longitudinal, prospective repeated-measures single-site feasibility study recruited N  =  10 children ( M = 12.5 years) receiving treatment for advanced cancer. Symptom AE data and inflammation (cytokines and C-reactive protein) and physiologic response to stress (salivary cortisol and salivary alpha-amylase) biomarker levels were collected at three time points. Descriptive statistics were used to examine feasibility and acceptability and to summarize symptom AE, stress, and inflammatory biomarker data. A linear regression model was used to determine cortisol diurnal slopes. The relationship between symptom and inflammatory biomarker data was explored and Hedges’s g statistic was used to determine its effect size. Results: Participants provided 83% of saliva samples ( n  =  199/240) and 185 samples were sufficient to be analyzed. Nurses collected 97% ( n  =  29/30) of blood samples. Participants reported the saliva collection instructions, kits, and reminders were clear and helpful. Insomnia, pain, fatigue, and anxiety demonstrated the most medium and large negative effects with inflammatory markers. Symptom AEs demonstrated the highest number of medium and large negative effects with interleukin-8 and tumor necrosis factor-alpha (−0.53 to −2.00). Discussion: The results indicate longitudinal concurrent collection of symptom and biomarker data is feasible and inflammatory and stress biomarkers merit consideration for inclusion in future studies.

Funder

Department of Nursing, University of Wisconsin-Madison

National Institutes of Health and University of Wisconsin Carbone Cancer Center Cancer

National Institutes of Health

Publisher

SAGE Publications

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