Association of childhood trauma with fatigue, depression, stress, and inflammation in breast cancer patients undergoing radiotherapy

Abstract

Background: This pilot study examined whether breast cancer patients with childhood trauma exhibit increased fatigue, depression, and stress in association with inflammation as a result of whole breast radiotherapy (RT).

Methods: Twenty breast cancer patients were enrolled in a prospective, longitudinal study of fatigue, depression, and perceived stress prior to RT, week 6 of RT, and 6 weeks post-RT. Six weeks after RT, subjects completed the childhood trauma questionnaire (CTQ). Patients were also administered the multidimensional fatigue inventory, inventory of depressive symptomatology-self-reported, and perceived stress scale at all three time-points and underwent blood sampling prior to RT for gene expression and inflammatory markers previously associated with childhood trauma and behavioral symptoms in breast cancer patients.

Results: Eight subjects (40%) had past childhood trauma (CTQ+). Compared to CTQ- patients, CTQ+ patients had significantly higher fatigue, depression, and stress scores before, during, and after RT (p < 0.05); however, RT did not increase these symptoms in either group. CTQ+ patients also exhibited increased baseline expression of gene transcripts related to inflammatory signaling, and baseline inflammatory markers including c-reactive protein, interleukin (IL)-6, and IL-1 receptor antagonist were positively correlated with depression, fatigue, and stress scores in CTQ+ but not CTQ- patients.

Conclusions: Childhood trauma was prevalent and was associated with increased symptoms of fatigue, depression, and stress irrespective of RT. Increased symptoms in CTQ+ patients were also associated with baseline inflammatory markers. Treatments targeting childhood trauma and related inflammation may improve symptoms in breast cancer patients.

Conflict of interest statement

Conflicts of Interest: NONE

Copyright © 2015 John Wiley & Sons, Ltd.

Figures

Figure 1. Symptom scores in breast cancer patients with and without childhood trauma

Women with (CTQ+) and without childhood trauma (CTQ−) completed the Multidimensional Fatigue Inventory (MFI; A), Inventory of Depressive Symptomatology-Self Reported (IDS-SR; B) and Perceived Stress Scale (PSS; C) at baseline, during radiotherapy (RT) and 6 weeks post-RT. There was a significant main effect of childhood trauma on MFI, IDS-SR and PSS scores, with CTQ+ patients exhibiting higher symptom scores across all time points (A–C)(all p<0.05). RT did not significantly increase these symptoms to a greater extent in CTQ+ versus CTQ− patients. Data are presented as mean +/− standard error. *-p<0.05 (Student-Newman-Keuls post-hoc test)