Digest Commentator: Josée Savard, Ph.D., School of Psychology, Université Laval, CHU de Québec-Université Laval Research Center, and Université Laval Cancer Research Center

Edited by: Jennifer Brunet, School of Human Kinetics, University of Ottawa

Childhood trauma is far too common as some research indicates that 45% of primary care patients have experienced some form of abuse during their childhood. In people diagnosed with cancer, childhood adversity has previously been found to be associated with higher levels of symptoms such as fatigue, psychological distress, and stress. This article reports on a pilot longitudinal study aiming to explore associations of childhood trauma with fatigue, depression, and stress in women undergoing radiotherapy for breast cancer. Another goal, more groundbreaking, was to investigate the possible role of inflammation.

Twenty women with 0-IIIA breast cancer about to receive whole-breast radiotherapy were enrolled in this study. They were evaluated 1 week before radiation (T1), week 6 of radiation (T2) and 6 weeks after radiation (T3). At each time point, participants completed the Multidimensional Fatigue Inventory, the Inventory of Depression Symptomatology and the Perceived Stress Scale (PSS). Peripheral blood draws were taken at T1 to measure various markers of inflammation. At T3, participants filled out the Childhood Trauma Questionnaire (CTQ), a 28-item questionnaire that assesses a history of childhood physical, sexual, and emotional abuse, and physical and emotional neglect.

Eight participants (40%) reported a history of childhood trauma (CTQ+). CTQ+ women obtained significantly higher fatigue, depression, and stress scores across all time points than women who did not report childhood abuse and neglect (CTQ-), although post hoc analyses indicated that differences between both groups of women were significant at T1 only. In addition, after controlling for some potential confounding variables (e.g., age, education, marital status), the differences in levels of cancer-related symptoms between CTQ+ and CTQ- women generally diminished, except for PSS scores. Analyses also indicated that radiotherapy did not significantly exacerbate any of the symptoms differentially in CTQ+ women as compared to CTQ- women. More severe symptoms of fatigue, depression and stress were associated with higher baseline levels of several inflammatory markers, namely c-reactive protein, interleukin (IL)-6 and IL-1 receptor agonist, but only in CTQ+ women. Overall, although replication with a larger sample is warranted, this study suggests that childhood trauma is a significant risk factor for cancer-related psychological distress and that inflammation could constitute a mechanism through which early negative experiences may have such a detrimental effect.

Why I liked this article: While this is a small-scale pilot study and mediation could not really be tested, I liked that it was a first attempt to identify inflammation as a possible underlying biological mechanism linking childhood trauma with cancer-related psychological symptoms. In terms of clinical implications, this literature generally suggests that patients with a history of childhood adversity constitute a high-risk group for psychological distress before and after cancer treatment that could be specifically targeted in a screening and prevention program. Moreover, if the role of inflammatory processes is confirmed in future research, it could inspire the development of new pharmacological and non-pharmacological treatment avenues directly targeting inflammation.

Article. Han, T. J., Felger, J. C., Lee, A., Mister, D., Miller, A. H., & Torres, M. A. (2015). Association of childhood trauma with fatigue, depression, stress, and inflammation in breast cancer patients undergoing radiotherapy. Psycho-Oncology. doi:10.1002/pon.3831

Journal website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

Author website: http://radiationoncology.emory.edu/people/physicians/torres-mylin.html