Abstract
PurposeDespite the fact that the prevalence of anxiety and depression in breast cancer survivors is higher than in the general female population, the psychobiological substrate of this phenomenon has yet to be elucidated. We aimed to examine the predictive role of peripheral dopamine (DA), noradrenaline (NA), serotonin (5-HT) and kynurenine (KYN) in anxiety and depression among breast cancer survivors.MethodWe evaluated 107 women using the Hospital Anxiety and Depression Scale, and monoamine levels were analyzed via high-performance liquid chromatography.ResultsHigh KYN levels predicted both disorders, while low NA and DA predicted anxiety and depressive symptoms, respectively. A negative conditional effect of 5-HT was found for anxiety and depression among younger women only, while being both middle-aged and younger influenced the negative conditional effect of DA on depression.ConclusionMonoamine variations may render breast cancer survivors more vulnerable to anxiety and depression, with young women being especially vulnerable to the detrimental effect of low DA and 5-HT. Assessing subclinical psychobiological markers allows mental health nurses to identify vulnerable survivors prior to the onset of anxiety and depression, and to adjust nursing interventions accordingly.
Highlights
With survival rates of over 85% at 5 years from diagnosis (Allemani et al, 2015), therapeutic efforts related to breast cancer are currently aimed at overcoming the disease, and at preventing its burden during survivorship
The psychobiological approach proposed here constitutes a comprehensive view which takes into account the holistic functioning of the individual, analyzing whether interactions between biological var iables and age are associated with anxiety and depression
The monoamine hypothesis and kynurenine pathway framework have received growing attention in the field of major depressive disorder, our data are consistent with emerging evidence indicating that kynurenine pathway imbalance induces serotonin defi ciency in anxiety disorders (Kim and Jeon, 2018)
Summary
With survival rates of over 85% at 5 years from diagnosis (Allemani et al, 2015), therapeutic efforts related to breast cancer are currently aimed at overcoming the disease, and at preventing its burden during survivorship. Life changes derived from the disease, such as those in the personal, family and professional fields, may condition survivors’ (in)adaptation to their new situation after medical discharge, leading to anxiety and depression, stress-related disorders that often co-occur and precede each other, especially in women (Rodgers et al, 2016). The prevalence of anxiety and depression is higher among breast cancer survivors than among women with no prior history of cancer (Carreira et al, 2018), and depression has been associated with a higher risk of cancer recurrence (Mallet et al, 2018; Smith, 2015). As defined in the conceptual model developed by Callista Roy, adaptation is a positive response to internal or external stimuli, in which the individual switches on psychosocial and physiological mechanisms in order to promote personal integrity (Roy, 2009). This cumulative ef fect may contribute to disease and senescence (Stewart, 2006)
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