Depression, fatigue and sleep disturbance are common among cancer patients. Some estimates suggest that over 40% of breast cancer patients experience significant distress — both depressive and/or anxious symptoms — shortly after and due to their diagnosis. Up to 80% of cancer patients suffer unusual levels of fatigue, during and following treatment. Moreover, 30-50% of cancer patients complain of difficulty sleeping compared to 15% in the general population. These symptoms can undermine quality of life for breast cancer patients, raising questions of probable causes of these problems, and, importantly, effective relief measures.
What might be answers?
Inflammation can contribute to these 3 disturbing conditions. While inflammation is a necessary part of the healing process in an acute injury, if chronic, certain inflammatory cytokines — interleukin-6 (IL-6), interleukin-1-beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha), for example — can run amok and wreak havoc in the body. (Knowing the importance of these factors, we therefore measure every patient’s level of inflammation using a unique panel of blood tests that enables us to tailor each person’s plan of care.)
In a University of Miami study, researchers assessed depression among 89 women who were recently diagnosed with breast cancer before starting chemotherapy. 40% of the women in this group had indications of depression. And they had higher-than-average levels of IL-6 and IL-1beta, plus significantly higher levels of TNF-alpha. Because similarly elevated levels of inflammatory cytokines have been found in other depressed populations, the researchers suspected that the cytokines played a role in worsening depression in these women. However, this situation is more complicated than just a one-way effect: Although inflammation may contribute to depression, depression definitely can promote inflammation.
Earlier research at the University of California at San Diego examined the relationship of inflammation to sleep quality and fatigue in breast cancer patients, just prior to their 1st chemotherapy and through their 4th treatment. Sleep quality was poor, plus fatigue levels of these patients started out high, and became even more problematic as they went through chemo cycles – not an unusual pattern to many with breast cancer. These researchers discovered that the high IL-6 levels they had measured predicted higher levels of fatigue. Plus, patients who had elevated levels of CRP (another inflammatory marker) were found more likely to wake in the middle of the night and have difficulty falling back to sleep. Other studies of these two markers suggest the inflammatory state may help produce the sleep problems and fatigue.
But are breast cancer patients doomed to suffer from these problems due possibly to high levels of inflammation? At the Block Center, we don’t think so. To help avert this problem, we routinely test all of our patients for IL-6 and CRP as part of our terrain labs, and when we find that patients have elevated inflammatory molecules, our dietitians tailor an individualized regimen to include or increase particular anti-inflammatory foods in their diets: Omega-3 fish, walnuts, flax seeds, omega-3 enriched eggs, olive oil, tart cherries, turmeric and ginger. Specific biobehavioral practices, as explained by Dr. P. Block, actually lower the activity of genes that promote inflammation in the body. Moreover, our professional dietitians, under the direction of Dr. K. Block, recommend anti-inflammatory supplements, chiefly fish oil, curcumin and boswellia. (One example: fish oil in particular has been shown to drop IL-6 levels in middle-aged adults who were not cancer patients.) Using these integrative strategies, we find we can easily help normalize IL-6 and CRP levels in our patients.
And we think it pays off: We will shortly present data on a group of advanced cancer patients treated at our Center who were found to have entirely normal sleep quality and levels of fatigue that were remarkably less than non-cancer patients. We hope you’ll stay tuned over the next months as we report details of these exciting findings!