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Article ; Online: Depression is associated with higher body image concerns in cancer patients with either visible or non-visible tumors: Findings from a psychiatric oncology clinic.

Chopra, Deepti / Lacourt, Tamara

2021 Volume 71, Page(s) 130–131

MeSH term(s)	Anxiety ; Body Image ; Depression/epidemiology ; Humans ; Neoplasms ; Stress, Psychological
Language	English
Publishing date	2021-03-06
Publishing country	United States
Document type	Letter
ZDB-ID	392299-6
ISSN	1873-7714 ; 0163-8343
ISSN (online)	1873-7714
ISSN	0163-8343
DOI	10.1016/j.genhosppsych.2021.03.003
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Article ; Online: Associations between fatigue and cellular metabolism in breast cancer patients: A longitudinal study.

Lacourt, Tamara E / Kavelaars, Annemieke / Tripathy, Debu / Heijnen, Cobi J

Psychoneuroendocrinology

2022 Volume 144, Page(s) 105866

Abstract: Purpose: Fatigue is frequently experienced during treatment for cancer and persists for months to years after treatment completion in a subset of patients. The underlying mechanisms remain poorly understood. We postulated that reduced cellular energy ... ...

Abstract	Purpose: Fatigue is frequently experienced during treatment for cancer and persists for months to years after treatment completion in a subset of patients. The underlying mechanisms remain poorly understood. We postulated that reduced cellular energy metabolism may underlie fatigue in cancer patients and survivors and tested this hypothesis in a sample of patients newly diagnosed with early-stage breast cancer (n = 49) followed for approximately 1 year from before the start of neoadjuvant chemotherapy (NACT) till after treatment completion. Methods: Patient-reported fatigue was assessed with the Checklist Individual Strength, and blood samples were obtained before, during, and shortly after NACT. A final assessment was completed after surgery and radiation therapy, 4-6 months after NACT. At each study time point, mitochondrial oxygen consumption and glycolytic activity were measured in peripheral blood mononuclear cells (PBMC). Associations of these measures of PBMC energy metabolism with fatigue were assessed in multilevel models. Results: Before NACT, higher mitochondrial oxygen consumption and glycolytic activity were associated with higher fatigue, whereas after completion of all primary treatment, these assessments were associated with lower fatigue. Conclusion: These findings suggest that lower cellular energy metabolism after treatment may be a novel target for interventions aimed at preventing or reducing persistent fatigue. Earlier studies investigated the use of supplements for maintaining mitochondrial health during treatment, with mixed results; when proven to be safe, such interventions may be more effective after treatment and in individuals with reduced mitochondrial oxygen consumption rates.
MeSH term(s)	Breast Neoplasms/drug therapy ; Fatigue/complications ; Female ; Humans ; Leukocytes, Mononuclear ; Longitudinal Studies ; Survivors
Language	English
Publishing date	2022-07-11
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	197636-9
ISSN	1873-3360 ; 0306-4530
ISSN (online)	1873-3360
ISSN	0306-4530
DOI	10.1016/j.psyneuen.2022.105866
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Article ; Online: A detailed description of the distress trajectory from pre- to post-treatment in breast cancer patients receiving neoadjuvant chemotherapy.

Lacourt, Tamara E / Koncz, Zsuzsa / Tullos, Emily A / Tripathy, Debu

Breast cancer research and treatment

2022 Volume 197, Issue 2, Page(s) 299–305

Abstract: Purpose: To characterize the distress trajectory in patients with newly diagnosed, non-metastatic breast cancer from pre-neoadjuvant chemotherapy until 12 months after onset of treatment and to identify demographic and clinical predictors of distress in ...

Abstract	Purpose: To characterize the distress trajectory in patients with newly diagnosed, non-metastatic breast cancer from pre-neoadjuvant chemotherapy until 12 months after onset of treatment and to identify demographic and clinical predictors of distress in these patients. Methods: In a retrospective, longitudinal study, chart review data were abstracted for 252 eligible patients treated at a comprehensive cancer care center. The center screens for distress at least monthly with the distress thermometer; the highest distress score per month was included in the analyses. The growth trajectory was established using mixed modeling and predictors were added to the initial growth model in subsequent models. Results: Distress showed a cubic growth trajectory with highest distress prior to treatment onset followed by a steep decline in the first three months of treatment. A slight increase in distress was apparent over months 6-10. Being Hispanic was associated with a stronger increase in distress in the second half of the year (p = 0.012). NACT was associated with lower distress and surgery with higher distress (both: p < 0.001). Conclusion: Distress is at its peak prior to treatment onset and rapidly decreases once treatment has started. Oncologist should be aware that both completion of NACT and undergoing surgery are associated with increases in distress and Hispanic patients may be more at risk for an increase in distress at these times; this suggests that careful monitoring of distress during the treatment trajectory and in Hispanic patients in particular in order to provide timely support.
MeSH term(s)	Humans ; Female ; Breast Neoplasms/pathology ; Longitudinal Studies ; Retrospective Studies ; Neoadjuvant Therapy ; Chemotherapy, Adjuvant
Language	English
Publishing date	2022-11-16
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	604563-7
ISSN	1573-7217 ; 0167-6806
ISSN (online)	1573-7217
ISSN	0167-6806
DOI	10.1007/s10549-022-06805-y
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Article: Mechanisms of Neurotoxic Symptoms as a Result of Breast Cancer and Its Treatment: Considerations on the Contribution of Stress, Inflammation, and Cellular Bioenergetics.

Lacourt, Tamara E / Heijnen, Cobi J

Current breast cancer reports

2017 Volume 9, Issue 2, Page(s) 70–81

Abstract: Purpose of review: Breast cancer and its treatment are associated with a range of neurotoxic symptoms, such as fatigue, cognitive impairment, and pain. Although these symptoms generally subside after treatment completion, they become chronic in a ... ...

Abstract	Purpose of review: Breast cancer and its treatment are associated with a range of neurotoxic symptoms, such as fatigue, cognitive impairment, and pain. Although these symptoms generally subside after treatment completion, they become chronic in a significant subset of patients. We here summarize recent findings on neuroinflammation, stress, and mitochondrial dysfunction as mechanistic pathways leading to neurotoxic symptom experience in breast cancer patients and survivors. Recent findings: Neuroinflammation related to stress or cancer treatment and stress resulting from diagnosis, treatment, or (cancer-related) worrying are important predictors of a neurotoxic symptom experience, both during and after treatment for breast cancer. Both inflammation and stress hormones, as well as cancer treatment, can induce mitochondrial dysfunction resulting in reduced cellular energy. Summary: We propose reduced cellular energy (mitochondrial dysfunction) induced by inflammation, oxygen radical production, and stress as a result of cancer and/or cancer treatment as a final mechanism underlying neurotoxic symptoms.
Language	English
Publishing date	2017-04-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2493862-2
ISSN	1943-4596 ; 1943-4588
ISSN (online)	1943-4596
ISSN	1943-4588
DOI	10.1007/s12609-017-0245-8
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Article ; Online: A central role for apathy in the effectiveness of interventions for cancer-related fatigue.

Lacourt, Tamara E / Heijnen, Cobi J / Manzullo, Ellen F / Escalante, Carmen

Psycho-oncology

2020 Volume 29, Issue 10, Page(s) 1613–1619

Abstract: Objective: Cancer-related fatigue (CRF) affects a substantial number of cancer patients and survivors. Recommendations for CRF treatments are largely based on results of randomized controlled trials. The interpretability of such results is limited to ... ...

Abstract	Objective: Cancer-related fatigue (CRF) affects a substantial number of cancer patients and survivors. Recommendations for CRF treatments are largely based on results of randomized controlled trials. The interpretability of such results is limited to patients eligible and willing to participate in these trials. We aimed to address this limitation in a retrospective study of patients seen at a CRF clinic in a comprehensive cancer center. The objectives were to (a) determine the effectiveness of clinician-initiated interventions for CRF and identify their mediators and (b) describe the frequency and effectiveness of patient-initiated physical activity (PA) behavior for alleviating CRF and identify determinants of this PA. Methods: Data (patient-reported somatic and mood symptoms; clinical data; clinician-documented changes in medication and behavior) from n = 213 patients collected as part of the clinic's standard of care at initial clinical consult and follow-up 4 to 11 weeks later were included. Effects of clinician-initiated interventions and patient-initiated PA on change in fatigue were analyzed using linear models. Results: Of all clinician-initiated interventions, only psychostimulant start was recorded frequent enough for further investigation and was associated with reduced fatigue; this association was mediated by a reduction in apathy. PA was also associated with reduced fatigue severity. PA initiation/increase after consult was associated with lower apathy at consult. Conclusions: These results demonstrate a major role for patient apathy in the effectiveness and initiation of CRF-targeting interventions. Behavioral therapies focusing on reduction in apathy should be considered as initial treatment of CRF in those with substantial apathy.
MeSH term(s)	Adult ; Aged ; Apathy ; Behavior Therapy ; Cancer Survivors/psychology ; Central Nervous System Stimulants/therapeutic use ; Exercise ; Fatigue/etiology ; Fatigue/therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasms/complications ; Neoplasms/psychology ; Neoplasms/therapy ; Patient Reported Outcome Measures ; Quality of Life/psychology ; Retrospective Studies ; Treatment Outcome
Chemical Substances	Central Nervous System Stimulants
Language	English
Publishing date	2020-08-13
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1118536-3
ISSN	1099-1611 ; 1057-9249
ISSN (online)	1099-1611
ISSN	1057-9249
DOI	10.1002/pon.5476
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Zs.A 3550: Show issues

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Article ; Online: Clinical relevance of a Body Image Scale cut point of 10 as an indicator of psychological distress in cancer patients: results from a psychiatric oncology clinic.

Chopra, Deepti / De La Garza, Richard / Lacourt, Tamara E

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

2020 Volume 29, Issue 1, Page(s) 231–237

Abstract: Purpose: Adequate adjustment to bodily changes during various phases of cancer treatment is important to patients' emotional well-being. The Body Image Scale (BIS) is a widely used tool for assessment of body image concerns in different cancer types. ... ...

Abstract	Purpose: Adequate adjustment to bodily changes during various phases of cancer treatment is important to patients' emotional well-being. The Body Image Scale (BIS) is a widely used tool for assessment of body image concerns in different cancer types. However, a cut point score indicative of clinically relevant body image concerns has not been established. The purpose of our study was to evaluate whether the previously suggested, but not validated, BIS cut point score of ≥ 10 is an adequate indicator of psychological distress. Methods: In a prospective cross-sectional study, 590 adult patients were recruited from a psychiatric oncology clinic (November 2017-March 2018). Patient-reported body image concerns, depression, anxiety, and emotional distress were assessed with the BIS, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, and National Comprehensive Cancer Network Distress Thermometer, respectively. Results: Almost half of the patients had a BIS score ≥ 10; these were more likely to be younger, female, Hispanic, and to have breast cancer than patients with a score < 10. BIS scores were positively associated with depression, anxiety, and distress scores. A BIS score ≥ 10 was a significant predictor of moderate depression and anxiety (odds ratios = 3.555 [95% CI 2.478-5.102] and 3.655 [2.493-5.358]; p < 0.001 for both). Conclusion: To our knowledge, this is the first study to have assessed the validity of the previously suggested clinically relevant BIS cut point score of ≥ 10 as an indicator of psychological distress. Our results suggest that a BIS score of ≥ 10 or higher should lead to follow-up on body image concerns and/or appropriate referral.
MeSH term(s)	Adult ; Aged ; Ambulatory Care Facilities ; Anxiety/psychology ; Body Image/psychology ; Breast Neoplasms/psychology ; Cross-Sectional Studies ; Depression/psychology ; Female ; Humans ; Middle Aged ; Physical Appearance, Body/physiology ; Prospective Studies ; Psychological Distress ; Stress, Psychological/psychology ; Surveys and Questionnaires
Language	English
Publishing date	2020-04-27
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1134446-5
ISSN	1433-7339 ; 0941-4355
ISSN (online)	1433-7339
ISSN	0941-4355
DOI	10.1007/s00520-020-05491-0
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Article ; Online: Frequency of anxiety and depression and screening performance of the Edmonton Symptom Assessment Scale in a psycho-oncology clinic.

Valentine, Alan / Brown, Jessica / Lacourt, Tamara / Chen, Minxing / De La Garza, Richard / Bruera, Eduardo

Psycho-oncology

2021 Volume 31, Issue 2, Page(s) 290–297

Abstract: Objective: The primary objective of this study was to determine the frequency of screening instrument-detected depression and anxiety in outpatients on initial presentation to a consultation psychiatric oncology clinic. The secondary objectives were to ... ...

Abstract	Objective: The primary objective of this study was to determine the frequency of screening instrument-detected depression and anxiety in outpatients on initial presentation to a consultation psychiatric oncology clinic. The secondary objectives were to identify characteristics associated with depression and anxiety among these patients, and to determine the optimal cut-off score for the ESAS-Anxiety (ESAS-A) and ESAS-Depression (ESAS-D) items, using the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder Scale (GAD-7) as a gold standard in cancer patients. Methods: A retrospective chart review was conducted for 1221 consecutive cancer patients seen in the Psychiatric Oncology Center as an initial consult between June 1, 2014 and January 31, 2017. Results: When the cutoff was 10 for the PHQ-9 and the GAD-7, 60% of patients self-reported depression and 51% self-reported anxiety. When the cutoff was 15 (severe symptom) for the PHQ-9 and GAD-7, approximately 30% and 27% of the patients had severe depression or anxiety, respectively. Age and gender were found to be associated with anxiety. An ESAS cutoff value of ≥3 for depression and ≥5 for anxiety resulted in sensitivity of 0.84 and 0.85 when using PHQ 9 ≥ 10 for depression and GAD 7 ≥ 10 for anxiety, respectively. Conclusions: Self-reported depression and anxiety are frequent symptoms among patients at a psychiatric oncology center for an initial visit. ESAS-A and ESAS-D have good sensitivity for anxiety and depression screening of cancer patients.
MeSH term(s)	Anxiety/complications ; Anxiety/diagnosis ; Anxiety/epidemiology ; Anxiety Disorders/diagnosis ; Anxiety Disorders/epidemiology ; Depression/complications ; Depression/diagnosis ; Depression/epidemiology ; Humans ; Neoplasms/psychology ; Psycho-Oncology ; Retrospective Studies ; Surveys and Questionnaires ; Symptom Assessment
Language	English
Publishing date	2021-09-22
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1118536-3
ISSN	1099-1611 ; 1057-9249
ISSN (online)	1099-1611
ISSN	1057-9249
DOI	10.1002/pon.5813
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Article: A Qualitative Study of Knowledge of Metabolic Syndrome, Attitudes about Lifestyle Modifications, and Preferences for Lifestyle Interventions among Patients with Cancer and Metabolic Syndrome.

Martinez Leal, Isabel / Pillai, Ashwathy B / Foreman, Jessica T / Siu, Kimberly W / Heredia, Natalia I / Escalante, Carmen / Manzullo, Ellen F / Christie, Aimee J / Lacourt, Tamara E / Razouki, Zayd A / Hwang, Jessica P

Research square

2023

Abstract: Background: Nearly 60% of patients with cancer have metabolic syndrome, which increases the risk of mortality, but there is no clear guidance for oncology providers about its management. Here, we report on the qualitative component of a larger mixed ... ...

Abstract	Background: Nearly 60% of patients with cancer have metabolic syndrome, which increases the risk of mortality, but there is no clear guidance for oncology providers about its management. Here, we report on the qualitative component of a larger mixed methods study that aimed to understand cancer patients' knowledge, attitudes, and preferences regarding metabolic syndrome. Methods: Adult cancer patients with metabolic syndrome were recruited during 2022-2023 in the MD Anderson General Internal Medicine clinic and participated in semistructured interviews focused on metabolic syndrome and lifestyle interventions. Interviews were audio-recorded and transcribed verbatim. Participants' demographic information was collected. Interviews were analyzed using hybrid thematic analysis and constant comparison involving deductive and inductive coding. Researcher triangulation and debriefing were used to ensure rigor. Results: There were 19 participants, 12 female and 12 White. Eighteen had solid tumors, including gynecologic (n = 5), genitourinary (n = 4), colorectal (n = 3), and breast (n = 2). Analysis yielded 5 major themes: 1) patients' understanding of metabolic syndrome; 2) attitudes about and approaches to managing metabolic syndrome; 3) capacity and limitations regarding managing metabolic syndrome; 4) patient-led care; and 5) tailored intervention plans. Participants had limited knowledge of metabolic syndrome and its cancer-related consequences; most desired additional education. Many participants reported that their cancer or diabetes diagnosis motivated them to prioritize lifestyle Modifications. Participants expressed strong interest in personalized care plans focused on healthy lifestyle rather than simply weight loss. As part of their tailored intervention plans, participants desired clear communication with their medical team, coordination of care among team members, and collaboration with providers about treatment decisions. Conclusion: Cancer patients with metabolic syndrome want collaborative, patient-centered care. Shared decision-making based on respect for patients' distinctive needs and preferences is an essential component of the development of such collaborative care. Tailored interventions, practical implementation strategies, and personalized care plans are needed for cancer patients with metabolic syndrome. The study findings contribute to filling the gap in knowledge regarding clear guidance for oncology providers on managing metabolic syndrome and will inform the development of future lifestyle interventions for patients diagnosed with metabolic syndrome.
Language	English
Publishing date	2023-09-04
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-3232672/v1
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Article ; Online: Can cancer-related cognitive impairment be considered in isolation from other cancer-related symptoms?

Lacourt, Tamara E / De La Garza, Richard / Dantzer, Robert

Psycho-oncology

2018 Volume 27, Issue 10, Page(s) 2511–2512

MeSH term(s)	Cognition ; Cognitive Dysfunction ; Humans ; Neoplasms ; Psycho-Oncology
Language	English
Publishing date	2018-07-18
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1118536-3
ISSN	1099-1611 ; 1057-9249
ISSN (online)	1099-1611
ISSN	1057-9249
DOI	10.1002/pon.4826
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Article: The High Costs of Low-Grade Inflammation: Persistent Fatigue as a Consequence of Reduced Cellular-Energy Availability and Non-adaptive Energy Expenditure.

Lacourt, Tamara E / Vichaya, Elisabeth G / Chiu, Gabriel S / Dantzer, Robert / Heijnen, Cobi J

Frontiers in behavioral neuroscience

2018 Volume 12, Page(s) 78

Abstract: Chronic or persistent fatigue is a common, debilitating symptom of several diseases. Persistent fatigue has been associated with low-grade inflammation in several models of fatigue, including cancer-related fatigue and chronic fatigue syndrome. However, ... ...

Abstract	Chronic or persistent fatigue is a common, debilitating symptom of several diseases. Persistent fatigue has been associated with low-grade inflammation in several models of fatigue, including cancer-related fatigue and chronic fatigue syndrome. However, it is unclear how low-grade inflammation leads to the experience of fatigue. We here propose a model of an imbalance in energy availability and energy expenditure as a consequence of low-grade inflammation. In this narrative review, we discuss how chronic low-grade inflammation can lead to reduced cellular-energy availability. Low-grade inflammation induces a metabolic switch from energy-efficient oxidative phosphorylation to fast-acting, but less efficient, aerobic glycolytic energy production; increases reactive oxygen species; and reduces insulin sensitivity. These effects result in reduced glucose availability and, thereby, reduced cellular energy. In addition, emerging evidence suggests that chronic low-grade inflammation is associated with increased willingness to exert effort under specific circumstances. Circadian-rhythm changes and sleep disturbances might mediate the effects of inflammation on cellular-energy availability and non-adaptive energy expenditure. In the second part of the review, we present evidence for these metabolic pathways in models of persistent fatigue, focusing on chronic fatigue syndrome and cancer-related fatigue. Most evidence for reduced cellular-energy availability in relation to fatigue comes from studies on chronic fatigue syndrome. While the mechanistic evidence from the cancer-related fatigue literature is still limited, the sparse results point to reduced cellular-energy availability as well. There is also mounting evidence that behavioral-energy expenditure exceeds the reduced cellular-energy availability in patients with persistent fatigue. This suggests that an inability to adjust energy expenditure to available resources might be one mechanism underlying persistent fatigue.
Language	English
Publishing date	2018-04-26
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2452960-6
ISSN	1662-5153
ISSN	1662-5153
DOI	10.3389/fnbeh.2018.00078
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