Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer.

Andrew H. Miller, Sonia Ancoli-Israel, Julienne E. Bower, Lucile Capuron, Michael R. Irwin
JCO. 2008-02-20; 26(6): 971-982
DOI: 10.1200/JCO.2007.10.7805

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1. J Clin Oncol. 2008 Feb 20;26(6):971-82. doi: 10.1200/JCO.2007.10.7805.

Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with

Miller AH(1), Ancoli-Israel S, Bower JE, Capuron L, Irwin MR.

Author information:
(1)Department of Psychiatry and Behavioral Sciences, Emory University School of
Medicine, Winship Cancer Institute, 1365-C Clifton Rd, 5th Floor, Atlanta, GA
30322, USA.

Patients with cancer experience a host of behavioral alterations that include
depression, fatigue, sleep disturbances, and cognitive dysfunction. These
behavioral comorbidities are apparent throughout the process of diagnosis and
treatment for cancer and can persist well into the survivorship period. There is
a rich literature describing potential consequences of behavioral comorbidities
in patients with cancer including impaired quality of life, reduced treatment
adherence, and increased disease-related morbidity and mortality. Medical
complications of cancer and its treatment such as anemia, thyroid dysfunction,
and the neurotoxicity of cancer chemotherapeutic agents account in part for these
behavioral changes. Nevertheless, recent advances in the neurosciences and
immunology/oncology have revealed novel insights into additional pathophysiologic
mechanisms that may significantly contribute to the development of cancer-related
behavioral changes. Special attention has been focused on immunologic processes,
specifically activation of innate immune inflammatory responses and their
regulation by neuroendocrine pathways, which, in turn, influence CNS functions
including neurotransmitter metabolism, neuropeptide function, sleep-wake cycles,
regional brain activity, and, ultimately, behavior. Further understanding of
these immunologic influences on the brain provides a novel conceptual framework
for integrating the wide spectrum of behavioral alterations that occur in cancer
patients and may reveal a more focused array of translational targets for
therapeutic interventions and future research. Such developments warrant
complementary advances in identification of cancer patients at risk as well as
those currently suffering, including an increased emphasis on the status of
behavior as a “sixth vital sign” to be assessed in all cancer patients throughout
their disease encounter.

DOI: 10.1200/JCO.2007.10.7805
PMCID: PMC2770012
PMID: 18281672 [Indexed for MEDLINE]

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