Abstract A50: An exploratory study examining the acute phase impact of resection on biological and psychological markers of stress among early stage non-small cell lung cancer patients
Authors: Jefferson Melanie , Ford Marvella , Bonilha Heather , Garrett-Mayer Elizabeth , Hughes-Halbert Chanita 
Published: March 2017

Abstract
INTRODUCTION: Surgical resection, though the most optimal treatment for lung cancer induces immunosuppression that can lead to unfavorable outcomes such as tumor recurrence. High psychological stress and sociodemographic factors can further exacerbate outcomes. Chronic stress and sociodemographic factors are significant contributors to dysregulated psycho-immune outcomes. A paucity of literature evaluating the relationship between psychological stress and inflammation exists prospectively among lung cancer patients undergoing surgical resection and personal-level factors that are associated with these outcomes.
OBJECTIVE: To examine the relationship between levels of inflammation and psychological stress and the association between sociodemographic factors and psychological stress and inflammation before and after surgical resection for lung cancer.
METHODS: We used a prospective pre- and post-test design to study clinically recruited early stage I and II non-small cell lung cancer patients. Inflammation and psychological stress were evaluated preoperatively and 2-weeks postoperatively. Inflammatory markers interlukin-6 and C-reactive protein were assessed via venipuncture and laboratory assay testing. Psychological stress was evaluated through self-report using the 15-item Impact Events Scale to evaluate traumatic stress. A score of 30 or greater is indicative of high traumatic stress. Correlation and bivariate analyses were used to examine the association between levels of psychological stress, inflammation and sociodemographic factors.
RESULTS: Of the 21 patients who participated, the majority were smokers (87%), white (93%), married (60%), had a college education or greater (60%), and an annual household income of less than $50,000 (53%). Mean levels of psychological stress decreased and levels of inflammation increased following resection; however, overall levels of psychological stress and inflammation were low preoperatively (M=27.40) and postoperatively (M=24.13). The mean changes in stress and inflammation from pre- to postoperatively were not significant. Effect size analyses revealed a small effect between mean differences in pre- and postoperative stress and inflammation. No relationship between psychological stress and inflammation was found pre- or postoperatively. When we examined associations between levels of traumatic stress and depressive symptoms, we found that those with high stress also had high depressive symptoms. When we examined sociodemographic factors, a lower income level was significantly associated with higher baseline inflammation levels preoperatively (P=0.02).
CONCLUSIONS: This exploratory study was a necessary initial step for establishing preliminary estimates and feasibility data for a novel area of research. A more longitudinal examination among a larger diverse sample of patients is needed in order to further assess the nature and course of psychological stress and inflammation and its long-term impact on quality of life and survival. Due to the perceived self-inflicted and internal causal nature of the diagnosis of lung cancer, patients may perceive less stress and have better coping because of their smoking behavior. Future studies will include both a biological marker of stress (such as cortisol) along with self-report data to evaluate psychological stress more expansively in order to better screen for psychological and inflammatory deficits.
Citation Format: Melanie Jefferson, Marvella Ford, Heather Bonilha, Elizabeth Garrett-Mayer, Chanita Hughes-Halbert. An exploratory study examining the acute phase impact of resection on biological and psychological markers of stress among early stage non-small cell lung cancer patients. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A50.