Psychoneurological Symptoms and Biomarkers of Stress and Inflammation in Newly Diagnosed Head and Neck Cancer Patients: A Network Analysis

• Published in: Current oncology (Toronto) Vol. 29; no. 10; pp. 7109 - 7121
• Main Authors: Santoso, Angelina M M, Jansen, Femke, Peeters, Carel F W, Baatenburg de Jong, Robert J, Brakenhoff, Ruud H, Langendijk, Johannes A, Leemans, C René, Takes, Robert P, Terhaard, Chris H J, van Straten, Annemieke, Verdonck-de Leeuw, Irma M
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 28.09.2022; MDPI
• Subjects: Analysis; anxiety; Biological markers; biomarker; Biomarkers; Body mass index; C-reactive protein; C-Reactive Protein - analysis; C-Reactive Protein - metabolism; Cancer patients; Care and treatment; Corticosteroids; depression; Depression, Mental; Fatigue; Fatigue - etiology; Head and neck cancer; Head and Neck Neoplasms - complications; Humans; Hydrocortisone; Inflammation; Interleukin-10; Interleukin-6; Interleukins; Medical research; Medicine, Experimental; pain; Sleep; Sleep Initiation and Maintenance Disorders; sleep quality; Tumor necrosis factor; Tumor Necrosis Factor-alpha; Netherlands; anxiety; cortisol; fatigue; pain; head and neck cancer; inflammation; network analysis; depression; biomarker; sleep quality
• ISSN: 1718-7729; 1198-0052; 1718-7729
• DOI: 10.3390/curroncol29100559

Psychoneurological symptoms are commonly reported by newly diagnosed head and neck cancer (HNC) patients, yet there is limited research on the associations of these symptoms with biomarkers of stress and inflammation. In this article, pre-treatment data of a multi-center cohort of HNC patients were analyzed using a network analysis to examine connections between symptoms (poor sleep quality, anxiety, depression, fatigue, and oral pain), biomarkers of stress (diurnal cortisol slope), inflammation markers (c-reactive protein [CRP], interleukin [IL]-6, IL-10, and tumor necrosis factor alpha [TNF-α]), and covariates (age and body mass index [BMI]). Three centrality indices were calculated: degree (number of connections), closeness (proximity of a variable to other variables), and betweenness (based on the number of times a variable is located on the shortest path between any pair of other variables). In a sample of 264 patients, poor sleep quality and fatigue had the highest degree index; fatigue and CRP had the highest closeness index; and IL-6 had the highest betweenness index. The model yielded two clusters: a symptoms-cortisol slope-CRP cluster and a IL-6-IL-10-TNF-α-age-BMI cluster. Both clusters were connected most prominently via IL-6. Our findings provide evidence that poor sleep quality, fatigue, CRP, and IL-6 play an important role in the interconnections between psychoneurological symptoms and biomarkers of stress and inflammation in newly diagnosed HNC patients.